{"id":42418,"date":"2013-12-18T21:39:39","date_gmt":"2013-12-19T02:39:39","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=42418"},"modified":"2013-12-18T21:43:58","modified_gmt":"2013-12-19T02:43:58","slug":"its-not","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/12\/18\/its-not\/","title":{"rendered":"it’s not…"},"content":{"rendered":"
Yesterday, I worked in the clinic, and I kept thinking about the old saying, "shutting the stable door after the horse has bolted<\/em><\/font><\/strong>" [in East Tennessee it was "closing the barn door after the cows ran off<\/font><\/strong><\/em>" but the spirit’s the same]. In psychiatry, the pipeline’s empty, and we have about all the SSRIs\/SNRIs and Atypical Antipsychotics we need for a very long time. Absent some talk about i.v. ketamine and brain wires, it’s all quiet on the new medication front. We’re all dressed up to Translate, but there’s little psychopharmacology around to advance into the clinical arena just now. <\/div>\n

But the "cows are still loose.<\/font><\/em><\/strong>" These commentaries below that have introduced our journal articles for several decades have filtered into the general water system where they linger long: <\/p>\n\n\n\n\n\n\n
Depression is one of the most prevalent and costly brain diseases. In the last major epidemiology study conducted in the United States, major depression had an overall lifetime prevalence rate of 17.1% (21% in women and 13% in men), and comparable figures have been obtained worldwide. These findings represent an increase of approximately 6% in the 15 years since the previous study…<\/font><\/em><\/sup><\/td>\n<\/tr>\n
Affective disorders account for considerable psychiatric morbidity (pain and suffering), but also significant disability and consequent loss of productivity. Depression has been estimated to be the second leading cause of disability worldwide, surpassed only by ischemic heart disease. Moreover, depression is often associated with comorbid psychiatric disorders, most notably anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive−compulsive disorder and post-traumatic stress disorder). The mean age of onset of depression has markedly decreased from the 40- to 50-year-old range noted several years ago to the 25- to 35-year range, and this phenomenon has been observed worldwide. Depression often goes undetected, especially in children, adolescents and the elderly. Mood disorders are associated with a significant risk for suicide, which remains one of the top ten causes of death in the United States and in many countries throughout the world. Depression is a major independent risk factor for the development of coronary artery disease and stroke, and possibly other major medical disorders.<\/font><\/em><\/sup><\/td>\n<\/tr>\n
Major depression is now recognized as a highly prevalent, chronic, recurrent, and disabling biological disorder with high rates of morbidity and mortality. Indeed, major depression, which is projected to be the second leading cause of disability worldwide by the year 2020, is associated with high rates of mortality secondary to suicide and to the now well-established increased risk of death due to comorbid medical disorders, such as myocardial infarction and stroke. Considerable strides have been made over the past 2 decades in the development of safe and efficacious antidepressants.<\/font><\/em><\/sup><\/td>\n<\/tr>\n
Depression is an illness that frequently starts early in life, tends to run a chronic course, and produces substantial disability. According to the World Health Organization, depression is the leading global cause of years of life lived with disability and the fourth leading cause of disability-adjusted life-years, a measure that takes premature mortality into account. Depression is not only widespread and common, it may be fatal; an estimated 90% of suicides are associated with mental illness, most commonly depression. There were nearly 30 000 suicides in the United States in 1999, almost twice the number of homicides. Suicide has become the third leading cause of death in individuals aged 15 to 24 years.<\/font><\/em><\/sup><\/td>\n<\/tr>\n
Despite efficacious and widely available antidepressants and psychotherapeutic interventions, the psychosocial and medical burden of depression is increasing. In fact, the World Health Organization projects that depression will continue to be prevalent, and by the year 2020, will remain a leading cause of disability, second only to cardiovascular disease. Although we do not know with certainty why rates and disability associated with depression are increasing, it is likely that this mood disorder continues to be remarkably under-recognized and under-treated. Depression frequently occurs in the context of chronic medical illness, and it is only relatively recently that the research community has turned its attention to the relationship between depression and chronic medical conditions. However, there is much work yet to be done.<\/font><\/em><\/sup><\/td>\n<\/tr>\n<\/table>\n

Four of these paragraphs were written by a paid medical writer, Sally Laden, in industry generated articles ghosted for key opinion leader<\/em> guest psychiatrist authors. One, however, was written by Dr. Tom Insel, Director of the National Institute of Mental Health. They sound the same whether they’re written as part of a stealth advertising campaign to sell more drugs or by the person in charge of setting our research agenda. I’ve come to believe that this campaign,  undertaken primarily for non-medical reasons, has been so inculcated into the current cadre of primary care physicians, psychiatrists, and the population at large, that it’s likely to reverberate there for a very long time.<\/p>\n

And from my perspective, I think our patients have become a major independent force in the problem of over·diagnosis and over·medication. They press for the results promised by the roll-down from our own literature, the ads with the beautiful people on television sets, and their doctors quickly responding to reported symptoms with a prescription. It would be naive to think that the massive psycho·pharmaceutical promotions of the drug industry, the third party payers, and psychiatry itself wouldn’t have a profound effect on the general populace, creating a self perpetuating inertia. I think that has already happened to a greater extent than we’d like to admit. <\/p>\n

We can be proud of the progress we’re making in shutting the doors that allowed the corruption and inflated claims of the last quarter century. But the "the horse has bolted<\/font><\/strong><\/em>" and "the cows are out of the barn<\/font><\/strong><\/em>." The pressures for symptomatic medication that chased the pills as they flowed from the pipeline isn’t likely to just abate on its own, and is kept alive by the our current leadership<\/em> who think that their futuristic promises will continue to work with no "deliverables" in sight. And while I expect that we will see advances in the biological treatment of true depressive illnesses, the clamor is coming from people who have been lead to believe that unhappiness itself is a disease with a chemical solution. It’s not. And that’s a notion that psychiatry and industry helped to create… <\/div>\n","protected":false},"excerpt":{"rendered":"

Yesterday, I worked in the clinic, and I kept thinking about the old saying, "shutting the stable door after the horse has bolted" [in East Tennessee it was "closing the barn door after the cows ran off" but the spirit’s the same]. In psychiatry, the pipeline’s empty, and we have about all the SSRIs\/SNRIs and […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-42418","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42418","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=42418"}],"version-history":[{"count":2,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42418\/revisions"}],"predecessor-version":[{"id":42420,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42418\/revisions\/42420"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=42418"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=42418"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=42418"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}