without warning…

Posted on Saturday 24 May 2014

During my working years, I never watched much serialized television drama – those things like The West Wing that captivated the interest of so many. I preferred my entertainment as films or stage productions. There was an exception, three years in the 70s in a tiny rural village in England where those things just weren’t available, so I kept up with some of the shows on television – mostly mysteries. Now, in retirement, I’m again in a tiny rural village on this side of the pond, but armed with the wonders of modern technology – DVDs, Netflix, and the like. So over the years, I’ve watched the same things as before – the various British Inspector series [Lewis, Morse, Frost] and branched out into the Swedish Walander, Annika Bengtzon, etc. Right now, I’m watching the Danish Borgen series [it means Castle]. I’ll have to say, it’s a cut above the sophisticated pulp fiction of the cops and robber shows, more in the category of serious theater. The premise is the election of the first female Prime Minister of Denmark, with the goings on in the cabinet, the press, and the world providing the backdrop for the private dramas of the characters.

[spoiler alert] In the last episode I watched, the Prime Minister’s 14 y/o daughter has been put on an antidepressant for an anxiety disorder [developed after her parent’s divorce caused by her mother’s preoccupation with her position]. Was she going to develop akathisia? I wondered. No, but then she begins to "cheek" her meds. In the midst of her mother’s triumph in stopping a war in Africa, the daughter ends up in a heap locked in the bathroom. Diagnosis? Alto? You guessed it – SSRI withdrawal. Ultimately, the Prime Minister takes a leave of absence to be with her daughter and stop the media harassment of her child.

I was impressed that the Danish writers were sophisticated enough to include SSRI withdrawal in their plot line and that the fictional psychiatrist made the diagnosis. But alas, we viewers were around for the initial visits to the psychiatrist and watched him put the teenage girl on an SSRI without warning her or her parents about either akathisia or withdrawal. I guess you can’t have it all…
    May 24, 2014 | 1:29 PM

    There may be more going on there than sophistication. For some reason I think that it is much easier for the Danes to access psychotherapy than it is in the USA. Their psychiatrists also seem more protected and I doubt that they are doing 20 – 10 minute med checks per day. I corresponded with the Danish author of an epidemiological study that looked at antidepressant prescribing and I was informed that psychiatrists tend to be involved in initial diagnoses in younger populations. Like the USA, the bulk of antidepressant prescribing (80%+) was done by primary care MDs.

    Like I always tell people – “This is TV and this is reality.” I have seen too many acute injections into the neck and needles being buried in the antecubital fossa to think otherwise.

    May 24, 2014 | 3:04 PM


    [Every time I see one of those “injections,” I worry about elbow sepsis or thyroid abcesses]. The episode I mentioned was more complex that I reported. When they went for treatment after the SSRI withdrawal, the psychiatrist suggested CBT, but there was a waiting time of 50 weeks in the public system [think VA]. So they opted for a private treatment program, but the Prime Minister was pushing a bill to take away a tax credit given to people with insurance, supporting public care. So that was the bruhaha in the press. As you say, it was only TV, and it all got resolved in a nice box with a bow on it.

    May 24, 2014 | 3:57 PM

    danish psychiatry is probably still quite excellent because dr hans c lou is still alive. i doubt he’d allow his country to wreck the field like america has 🙂

    May 24, 2014 | 6:23 PM

    Wow, inclusion of antidepressant withdrawal syndrome is enlightened.

    There’s also the influence of Peter C. Gøtzsche and the Nordic Cochrane Center, based in Copenhagen. I believe his utterances about antidepressants get a lot of press in Denmark.

    (However, I fear the resolution for this teen will be she is forced to take a drug while getting CBT or whatever because of the superstition that the combined treatments are better than psychotherapy alone and why not screw up an adolescent’s hormones?)

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