Mad in America

This is speculation, but one variable I didn't see referred to in this article was the role of psychotherapy in reducing depression. That is not surprising in our era of treatment mainly being thought of as drug treatment. But, before the SSRI era, almost all depressed patients received some form of psychotherapy. Once Prozac came on the scene, it was increasingly prescribed by general practitioners with no referral's for therapy given, But more, the nature of the effect of SSRI's is that people so often feel indifferent to situations they otherwise would have had the strong affective input of discomfort about. So, isn't it possible that after 10 or 20 years of being numb to one's emotional truth that has been medicated away about a bad marraige or job, that a person could find themselves still depressed if they got off SSRI's? In the past,therapy uncovered and resolved allot of the underlying causes of depression. Without therapy people will remain with underlying depression that can be buried for decades via SSRI's.

I forgot to mention that taxpayer funded county public mental health systems like I worked in for 30 years almost completely eliminated psychotherapy as an option for folks with depression in the late 1980s. Since then, a 15 minute Psychiatrist visit once every 2 or 3 months to monitor medication and 'case management' are the only treatment options that have been offered. In the 70's and 80's, almost all depressed Medicaid insured consumers received psychotherapy. Only about half of them were on tri-cyclic anti-depressants too. Now I'd estimate about 10% of consumers across the country who are depressed are receiving psychotherapy. So, if the underlying causes of depression haven't been treated for over 20 years, it makes sense folks are still depressed underneath the- 'Nothing bothers me when I take my Prozac' effect of SSRIs.

I tend to find an analogy from the area of physical health quite helpful:
Patient suffers from indigestion and it is recommended they take Gaviscon (or similar product).
Product eases the symptoms and patient makes a note of its effectiveness, and in the end, resorts to frequent use.
Antacid neutralises the excess acidity in the stomach.
Stomach thinks: "Wait a minute, something wrong here. Environment far too alkaline. Must produce more acid. Patient becomes addicted to Gaviscon. Result for the pharmaceutical company!

This analogy is merely to suggest that exactly the same process is going on with drugs designed to mess around with seratonin levels or similar in the brain. Surely, making up for the presumed lack of any element in the body is bound to generate a compensatory reaction from the body. Withdraw the drug, and the effect is totally predictable: the patient will be placed in a worse situation than he/she was prior to the intervention.

The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, agitation, etc. These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.

Go to www.SSRIstories.com where there are over 4,500 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [65 of these] and murder-suicides - all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using but sometimes the media article just says "antidepressant" or "medication for depression".

On December 15, 2010, PLoS Medicine released a study which showed that, in regard to prescription medications and violence, the FDA had received the most reports of violence from the SSRI & SNRI antidepressants (except for Chantix, the smoking cessation drug.) The evidence of an association with violence was weaker and mixed for antipsychotic drugs and absent for all but one of the mood stabilizers. Yet, the antipsychotics and mood stabilizers, given for the most serious mental illnesses, bipolar disorder and schizophrenia, would be the most likely culprit involved in violence but, instead, it was the antidepressants which had the most reports of violence. They were given to patients that traditionally were the least likely to commit violence, the depressed and the anxious. See:
http://www.ssristories.com/show.php?item=4701

Dr. Michael Cornwall and others --

Please consider this: In exactly zero of any of these studies, including all of those those reviewed by Dr. Fava or Dr. Irving Kirsch, has a single incidence of withdrawal syndrome been identified, although collectively thousands of people were exposed for various lengths of time to antidepressants and then rapidly "discontinued."

It is likely that although the literature on withdrawal syndrome has found an incidence upwards of 20%, many cases of withdrawal were counted as "relapse" even in these studies discussed above, as withdrawal syndrome is almost universally misdiagnosed even by the most prominent researchers.

On one hand, this is hopeful in that it indicates the brain damage or "tardive dysphoria" is not permanent, although there are cases where it takes many years for patients to recover from antidepressant withdrawal syndrome (see http://survivingantidepressants.org).

On the other hand, the factor of antidepressant withdrawal syndrome confounds the ENTIRE body of evidence for antidepressant efficacy, as cases of withdrawal syndrome were counted as "relapse" and antithetically included in statistics as support for efficacy.

It is certainly a sobering realization that for 20 years, patients have been exposed to the brain-damaging risks of long-term new-generation antidepressant use on the basis of no valid evidence at all -- but for tremendous profit by drug companies and psychiatry itself -- and iatrogenic brain damage itself has used as the justification for continuing drug treatment.

It seems to me the 'party line' was well established before the arrival of the depressing antidepressants...Psychiatry has not based a single drug prescribing practice on clinical research--ever. The reality is for over fifty years psychiatry has victimized those who had no appreciable treatment benefit from being given neuroleptics; yet family members and legislators were told it is because they lack insight and just don't know the drugs are "helping" them?! If a psychiatrist wants trust and respect it wo trust, he/she would have to be honest and respectful they need to earn it like anyone else. If psychiatry wants to be trusted they need to be trustworthy-- Case in point: the neuroleptics, called "antipsychotics," also have a rebound effect upon withdrawal!!! Abrupt withdrawal is not only likely to cause rebound psychosis---yet people are not told that it is because the neuroleptics alter the parasympathetic nervous system---How "medical professionals" can defend even "recommending" SSRIs, neuroleptics or pharmaceutical speed as "safe and effective treatment" for children this is not validated by the research!" Psychiatrists developed treatment protocols and "practice parameters" based on what exactly? What about seriously negative outcomes in clinical research RECOMMENDS widespread use of the drugs trialed? Prescribing of psychiatric drugs is not a practice derived from clinical drug trials, therefore it is not evidence-based; and without Informed Consent, it is not ethical. From my perspective, it seems more criminal than medical...

Megalith

Hearts of stone
Through anaesthesia on tap.
Great idea!
Adjust the valves to control the pressure.
A chemical lobotomy
Will keep them docile
Or better still,
Why not bottle it up?

Carbonated water (Li²CO³ - enhanced)
Could be marketed
As a panacea for the people
Appellation controllé, aqua mortis,
After all, they swallowed
The bromine, chlorine and fluorine,
Didn’t they?

... Speaking as someone who is weaning himself off Paxil, I have to say that this article leaves little room for hope.

Not so -- I still say withdrawal syndrome confounds these findings!

The Andrews paper attempts to address the issue:

"....While the results are robust, their implications depend on their interpretation, so we first discuss several potential confounds. Is it possible, for instance, that the results do not reflect the risk of relapse, but rather withdrawal symptoms? The discontinuation of antidepressant medication can cause withdrawal symptoms (also known as discontinuation syndrome) that are unrelated to relapse, but may sometimes be mistaken for relapse (Haddad, 1997). Such mistakes are more likely with untrained physicians (Haddad, 1997), so it should be less of a problem in ADM discontinuation studies where trained psychiatrists are employed to evaluate putative cases of relapse. Regardless, drugs with longer half-lives are less likely to show discontinuation syndrome (Fava, 2006; Michelson et al., 2000). If discontinuation syndrome were being mistaken for relapse, then drugs with longer half-lives should have lower relapse rates. To test this possibility, we added half-life to the best-fitting model and eliminated the perturbational variables....in fact, half-life was a significant positive predictor of relapse rate. This is because drugs with stronger perturbational effects on 5-HT tend to have longer half-lives. We therefore have no evidence that withdrawal symptoms were mislabeled as relapses...."

Bob, how could they make this logical error? Their assumption that researchers would be less likely to mistake withdrawal for relapse was incorrect. This is indicated by the fact that NONE of these studies report incidence of withdrawal. Surely it happened once or twice? Therefore, even in the results regarding long half-life medications, it's just as likely withdrawal was mistaken for relapse. The X factor -- human error was constant.

akz28ebu6i, the reason this is important is that we have evidence people DO recover from withdrawal syndrome.

I find it a bit strange how so much time here is spent discussing neurotransmitters and meta studies or whatever, when for me the glaring elephant in the room for anti-depressants has always been the lack of any evidence that anti-depressants help in the long term.

I've never seen 10 or 15 year long clinical trials mentioned. As far as I'm aware theres no evidence of the benefit or harm of anti-depressants in the long term, one way or the other. Yet for some strange reason everyone ignores this. It's about as scientific as astrology.

I do not understand why all the focus is on timeframes measured in months, it's long term depression that's the problem. I cautiously suggest that anyone that gets better in a few months probably doesn't have a serious problem to begin with.

Robert,

I put a comment up a while ago... It hasn't shown, so forgive me if there is redundancy (should the comment finally post).

Science.
Lack thereof.

Our family recently visited NASA in Houston (on the way to Galveston for vacation).

Talk about science at its best!

I cannot begin to express the obvious difference between what any of us can see as 'true science' versus the kind used to expand drug markets....

"Landing a man on the moon and returning him safely to earth"
Science.

Playing with brain neurotransmission, subjectively, foot-loose and fancy - free to expand drug markets.
Not science.

"Failure is not an option" is NASA's motto.
Failure is an everyday occurance on the part of psychiatry.

Science?

Attempting to drug the brain to health... without any indication whatsoever about what's taking place with the nuerotransmitters is science?

Psychiatry is a sham.
And recogniziing the sham ain't rocket science!

Duane

A reading of books by Grace Jackson, MD and Peter Breggin, MD will also give the science and references related to tardive dementia (as well as dysphoria) which is the result of actual brain damage from psychiatric meds. Naturally when the psychiatric drugs are discontinued and hopefully withdrawal ended, the brain will probably do some magnificent compensations and cover ups eventually, but not completely. Thanks Bob for your continued work.

The sneaky way psychiatry poses as "science" is by pretending that a reduction of symptoms is a valid outcome measure. As long as we look at short-term symptom relief, they'll always be able to spin enough research to get a "positive result" (though the SSRIs seem to struggle even to reach that low hurdle).

But when we start looking at real outcomes - things people really care about, like employment, educational attainment, relationship stability, community involvement, social connectedness - these drugs fail every time, and fail more the longer they are studied. ADHD drugs have been studied close to 50 years. You always hear that "untreated ADHD leads to school failure, delinquency, high school dropout rates, and low self-esteem." But 50 years of research show NO IMPROVEMENTS in any of these outcome areas for kids taking medication! So it's a big sham, based on the short-term "symptom reduction" (the kids are more manageable in the classroom, turn in more homework, don't bother their peers as much) that people WANT to believe leads to better outcomes, but clearly does not.

Same applies to all the psych drugs, as Bob has ably indicated. I think the next big push is to stop allowing clinical trials to focus on symptom reduction as a "success," and instead demand that a drug lead to improved life outcomes. If we set that standard, pretty much every drug on the market would fail.

Thanks, Bob, you've done it again!

----Steve