{"id":44404,"date":"2014-03-01T15:56:59","date_gmt":"2014-03-01T20:56:59","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=44404"},"modified":"2014-03-01T16:05:26","modified_gmt":"2014-03-01T21:05:26","slug":"musings","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/03\/01\/musings\/","title":{"rendered":"musings&#8230;"},"content":{"rendered":"\n<p align=\"justify\">Wednesday, I was writing about the NZ survey of patients&#8217; experience taking antidepressants [<a href=\"http:\/\/1boringoldman.com\/index.php\/2014\/02\/26\/a-surprising-finding\/\">a surprising finding&hellip;<\/a>] titled <strong><font color=\"#200020\">Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants<\/font><\/strong>. From the title and references, one can assume that the authors were honing in on the more subtle and understudied &quot;<strong><font color=\"#200020\">emotional and interpersonal effects<\/font><\/strong>&quot; of these drugs, so widely prescribed and taken, often for long periods of time. There&#8217;s a paradox in the study. In spite of the heavy side effect burden reported by the&nbsp; respondents, they took them for a long time and reported positively on the results &#8211; at least more positively than many might&#8217;ve expected. Several commenters thought that was a placebo effect of some kind rather than an outcome from the drugs themselves. I&#8217;m not so sure I know the answer to that, but I was intrigued by the results. I emailed the authors,  John Read, Claire Cartwright,  and Kerry Gibson, at the University of Auckland and asked if we could take a look at their questionnaire, and had a pleasant exchange with Dr. Read the same day.<\/p>\n<div align=\"justify\">We all had some question about their cohort &#8211; &quot;who were they?&quot; Here&#8217;s how they were recruited [looks pretty straightforward to me]:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><font color=\"#200020\">Following ethics approval from the University of Auckland, the anonymous questionnaire was placed online. A google webpage advertising the study was established [<a target=\"_blank\" href=\"http:\/\/www.viewsonantidepressants.co.nz\">http:\/\/www.viewsonantidepressants.co.nz]<\/a>. This webpage provided participant information and a link to the online questionnaire. The study was publicized in the New Zealand media via media releases, interviews with the researchers and advertisements.<\/font><\/div>\n<\/ul>\n<div align=\"justify\">I asked Dr. Read if we could take a look at the survey itself, since it&#8217;s no longer on-line. He sent me the section that had to do with this paper [this is an ongoing project]. I formatted it [not very well] from a Word document and posted it <a href=\"http:\/\/1boringoldman.com\/index.php\/nz-survey\/\" target=\"_blank\">here<\/a>. When you look it over, you&#8217;ll see that some of it isn&#8217;t reported in this paper as this article was focused on adverse effects, particularly those often overlooked. I presume we&#8217;ll learn more in later reports.<\/div>\n<p align=\"justify\">But as for the questionnaire itself, again it seemed straightforward. The paper well documents the heavy &quot;emotional and interpersonal&quot; side effect burden of these drugs and made it clear that the way to find out these things is simple &#8211; ask the patients who take them. The survey confirmed the high incidence of suicidal feelings and aggressiveness [attributed to the antidepressants, not the depression itself], and higher incidence of these symptoms in younger patients. But in spite of these negative findings, over half of the respondents had continued taking the medications for over three years, and their general report on the quality of life was surprisingly positive:<\/p>\n<p align=\"center\"><img decoding=\"async\" width=\"500\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/side-effects-3.gif\" \/>&nbsp;<\/p>\n<p align=\"justify\">The chart on the right is in response to this question: <em><font color=\"#200020\">While taking anti-depressants my quality of life was: Greatly improved&hellip; Slightly improved&hellip; Unchanged&hellip; Slightly worse&hellip; A lot worse&hellip;<\/font><font color=\"#200020\"> <\/font><\/em>Those of us who follow this story on the use of antidepressantss in modern psychiatry and the dramatic prescription rate over the last twenty-five years come to the table from a variety of directions. I got here when I left my cloistered practice and discovered how many people were on such bizarre combinations of drugs, and I stayed when I began to look at the psychopharmacology literature and saw how it had been invaded [and corrupted] by industry and complicit KOLs. Others are former patients who suffered unannounced side effects or unacknowledged withdrawal symptoms. Some were offended by the &quot;medicalization&quot; of human mental life and the assumptions about underlying biology. That&#8217;s only a few. But no matter how we got here or where we point our fingers, we share an outrage at the takover by PHARMA with the complicity of many higher-ups in psychiatry, the corruption and commercialization, and the resulting rampant prescription of psychiatric medications in both psychiatry and primary care. So a report like this can be a Rorschach for any of us to project our preconceptions onto &#8211; mine included.<\/p>\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"180\" border=\"0\" height=\"136\" src=\"http:\/\/1boringoldman.com\/images\/rorschach.gif\" \/><\/p>\n<p align=\"justify\">I had several thoughts about the survey. First, I thought it was a great idea. While it lacks the scientific rigor of a randomized, placebo controlled, double-blind clinical trial, it goes straight to the heart of the matter &#8211; <em>What do the patients say?<\/em> It&#8217;s like David Healy&#8217;s <a href=\"https:\/\/www.rxisk.org\/Default.aspx\" target=\"_blank\"><font color=\"#990000\">Rx<\/font><font color=\"#200020\">isk<\/font><\/a> web site which I also like. We ought to be doing this kind of survey on all the medications, over and over. It&#8217;s what both&nbsp; prescribers and patients alike need to know. By listing the side effects explicitly, the authors bias may show, but how else are we going to find out if we don&#8217;t ask? And frankly, their findings with a few exceptions are what I might have predicted having prescribed these medications in my new post-retirement role as a &quot;clinic doc&quot; in a charity clinic staffed by volunteers. But the article speaks to some open questions I have in my own mind working in that setting. These are my speculations, not those of the authors.<\/p>\n<p align=\"justify\">I would never qualify as a <strong><font color=\"#2f1401\">bio-bio-bio<\/font><\/strong> psychiatrist. In my natural state, I&#8217;d clearly fit more into the <strong><font color=\"#c6b4a9\">bio&middot;<\/font><font color=\"#2f1401\">psycho&middot;<\/font><font color=\"#8c7461\">social<\/font><\/strong> category. So I&#8217;ve had to retool for the clinic where I work [and, for that matter, for this blog as well]. I&#8217;m able to use more of my <strong><font color=\"#2f1401\">psycho&middot;<\/font><\/strong> skills there than I would&#8217;ve thought, but in an abbreviated and modified way. My <strong><font color=\"#8c7461\">social&middot;<\/font><\/strong> has been flexed beyond my imagination, since much of what I do a lot of is classic social work. And the <strong><font color=\"#c6b4a9\">bio<\/font><\/strong><strong><font color=\"#c6b4a9\"><strong><font color=\"#8c7461\">&middot;<\/font><\/strong><\/font><\/strong> is a major player. I take my comfort in doing it rationally, which isn&#8217;t what my colleagues and the local docs do, and people on meds are definitely bludgeoned with my warnings and instructions. But I have to compromise more than I&#8217;d like, because the patients just go elsewhere and get medicated up to the hilt. But there are some observations from the clinic that relate to this survey.<\/p>\n<p align=\"justify\">There&#8217;s an enormous pressure to medicate coming from the patients. I expected it from the &quot;druggies&quot; that haunt such clinics, but I was surprised to find that it was from almost all comers. As I mentioned, most of my practice before was with treatment failures, people who had already given up on a medicine cure\/treatment. The other thing is that the patients in the clinic come in thinking that all I want to hear about is their symptoms and the intensity thereof. I have to ask, even prod, to hear about their lives. I wasn&#8217;t used to that. And there&#8217;s something else that seemed peculiar to me. There&#8217;s the frequent refrain that the drugs are not working &quot;enough&quot; or have &quot;stopped&quot; working. But suggesting discontinuing altogether is not well received, and best mentioned after you get to know the patient well enough to be trusted. So it&#8217;s not just that they expect medications, they want them &#8211; even the patients dissatisfied with the results. I think that must be why each new drug that comes along has a waiting following. As long as I&#8217;m blathering about odd things, I was taught and actually think of most depressions as time limited, but the patients in the clinic don&#8217;t seem to think that way. Plenty stop them on their own all along the way, but a surprising number see them as an ongoing need. And it&#8217;s certainly not because I push that idea on them. Quite the opposite. <\/p>\n<p align=\"justify\">I can generate psychological and conspiracy theories galore about all of these things &#8211; a symbolic attachment, placebo effects, acknowledgement, etc. and have seen examples of each new theory, but what I really think is that the paradox in this NZ survey is accurate &#8211; many patients are enduring the downside in return for an upside that&#8217;s hard to quantify, one that shows up in the answer to &quot;<em><font color=\"#200020\">my quality of life.<\/font><\/em>&quot; Recently, a friend who was struggling with the task of taking care of a new incapacitating illness in her husband had been put on an antidepressant. She said something I&#8217;ve heard many times, &quot;<em>Yeah, it really helped. Nothing was different, but I just didn&#8217;t care as much.<\/em>&quot; And she was visibly &quot;<em>better.<\/em>&quot; After a couple of months, she stopped it and seems fine. I believe her, and the patients in the clinic, and the results of this survey. There&#8217;s a real reason that many take antidepressants, and keep taking them, in spite of the adverse effect burden. That said, there are many that take them because they&#8217;ll take anything just in the hope of feeling better, even if they don&#8217;t work. And there are too many that take them just because they&#8217;ve been prescribed. <\/p>\n<div align=\"justify\">These are just some musings on a cold gray Saturday afternoon, not what this article was intended for. So back to the article, besides being a Rorschach ink-blot, it is a helpful look at how patients feel on these drugs and a confirmation of their ability to blunt all kind of human experience &#8211; what they do <u>to<\/u> people. I&#8217;m glad to see that written down. But I also often wonder if that&#8217;s what they do <u>for<\/u> people &#8211; dampen life experience. If you heard some of the patients&#8217; life narratives and interpersonal situations I hear in our clinic, you&#8217;d understand why I say that&#8230; <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Wednesday, I was writing about the NZ survey of patients&#8217; experience taking antidepressants [a surprising finding&hellip;] titled Adverse emotional and interpersonal effects reported by 1829 New Zealanders while taking antidepressants. From the title and references, one can assume that the authors were honing in on the more subtle and understudied &quot;emotional and interpersonal effects&quot; of [&hellip;]<\/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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-44404","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/44404","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=44404"}],"version-history":[{"count":49,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/44404\/revisions"}],"predecessor-version":[{"id":44453,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/44404\/revisions\/44453"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=44404"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=44404"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=44404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}