{"id":47633,"date":"2014-07-09T13:47:47","date_gmt":"2014-07-09T17:47:47","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=47633"},"modified":"2014-07-09T14:01:07","modified_gmt":"2014-07-09T18:01:07","slug":"antipsychiatry-sentiment","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/07\/09\/antipsychiatry-sentiment\/","title":{"rendered":"antipsychiatry sentiment&#8230;"},"content":{"rendered":"<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/www.theguardian.com\/commentisfree\/2014\/apr\/30\/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines\" target=\"_blank\">Psychiatric drugs are doing us more harm than good<\/a><\/div>\n<div align=\"center\" class=\"middle\">As with benzodiazepines in the 1980s, the UK is prescribing SSRI antidepressants at a staggering rate &ndash; and to no good effect<\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">The Guardian<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Peter G&oslash;tzsche<\/div>\n<div align=\"center\" class=\"middle\">30 April 2014<\/div>\n<p align=\"justify\">We appear to be in the midst of a psychiatric drug epidemic, just as we were when benzodiazepines [tranquilisers] were at their height in the late 1980s. The decline in their use after warnings about addiction led to a big increase in the use of the newer antidepressants, the SSRIs [selective serotonin re-uptake inhibitors]. Figures released by the Council for Evidence-based Psychiatry, which was set up to challenge many of the assumptions commonly made about modern psychiatry, show that more than 53m prescriptions for antidepressants were issued in 2013 in England alone. This is almost the equivalent of one for every man, woman and child and constitutes a 92% increase since 2003.<\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<p align=\"justify\">The problem is that many of these drugs simply do not work as people suppose. The main effect of antidepressants is not the reduction of depressive symptoms. They are no better than placebo for mild depression, only slightly better for moderate depression, and benefit only one out of 10 with severe depression. In around half of all patients, they cause sexual disturbances. The symptoms include decreased libido, delayed orgasm or ejaculation, no orgasm or ejaculation and erectile dysfunction. Studies in both humans and animals suggest that these effects may persist long after the drug has been discontinued. The US Food and Drug Administration has shown that antidepressants increase suicidal behaviour up to the age of 40, and many suicides have been reported even in healthy people who took the drugs for other reasons [for example, for stress or pain]. Another report also said that, among people over 65, antidepressants are believed to kill one out of every 28 people treated for one year, because they lead to falls and hip fractures. Indeed, it is not clear whether antidepressants are safe at any age.<\/p>\n<div align=\"justify\">My studies of the research literature in this whole area lead me to a very uncomfortable conclusion: the way we currently use psychiatric drugs is causing more harm than good. We should therefore use them much less, for shorter periods of time, and always with a plan for tapering off, to prevent people from being medicated for the rest of their lives.<\/div>\n<\/blockquote>\n<blockquote>\n<div align=\"center\" class=\"big\"><a href=\"http:\/\/www.behaviorismandmentalhealth.com\/wp-content\/uploads\/2014\/06\/PIIS2215036614702329.pdf\" target=\"_blank\">Attacks on antidepressants: signs of deep-seated stigma?<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">The Lancet<\/font><\/strong><\/div>\n<div align=\"center\" class=\"small\">by David J Nutt, Guy M Goodwin, Dinesh Bhuqra, Seena Fazel, and Stephen Lawrie<\/div>\n<div align=\"center\" class=\"middle\">May 27, 2014<\/div>\n<div align=\"center\" class=\"middle\">[<a href=\"http:\/\/www.behaviorismandmentalhealth.com\/wp-content\/uploads\/2014\/06\/PIIS2215036614702329.pdf\" target=\"_blank\">full text on-line<\/a>]<\/div>\n<p align=\"justify\">Psychiatry is used to being attacked by external parties with antidiagnosis and antitreatment agendas. However, the recent disclosure that a doctor [Professor Peter Getzsche] had joined a new group, the Council for Evidence-based Psychiatry, whose launch was accompanied by newspaper headlines such as &quot;Antidepressants do more harm than good, research says&quot; and &quot;Psychiatric drugs are doing us more harm than good&quot; in <strong><font color=\"#200020\">The Times<\/font><\/strong> and <a target=\"_blank\" href=\"http:\/\/www.theguardian.com\/commentisfree\/2014\/apr\/30\/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines\">The Guardian<\/a> plumbs a new nadir in irrational polemic. What is especially worrying is that this doctor is a co-founder of the Nordic Cochrane collaboration, an initiative set up to provide the best evidence for clinical practitioners. What is the truth about antidepressant efficacy and adverse effects, and why would Professor Getzsche apparently suspend his training in evidence analysis for popular polemic?<\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<p align=\"justify\">Of course, all active drugs have adverse effects, but for the new antidepressants these are rarely severe or life-threatening, even in overdose situations. Indeed, the new antidepressants, especially the selective serotonin reuptake inhibitors, are some of the safest drugs ever made. In our experience, the vast majority of patients who choose to stay on them do so because they improve their mood and well&middot;being rather than because they cannot cope with withdrawal symptoms when they stop. Many of the extreme examples of adverse effects given by the opponents of antidepressants are both rare and sometimes sufficiently bizarre as to warrant the description of an unexplained medical symptom. To attribute extremely unusual or severe experiences to drugs that appear largely innocuous in double-blind clinical trials is to prefer anecdote to evidence. The incentive of litigation might also distort the presentation of some of the claims.<\/p>\n<p align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/p>\n<div align=\"justify\">Whatever the reasons, extreme assertions such as those made by Prof G&oslash;tzsche are insulting to the discipline of psychiatry and at some level express and reinforce stigma against mental illnesses and the people who have them. The medical profession must challenge these poorly thought-out negative claims by one of its own very vigorously.<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">I picked these two articles because at first reading they seem like antipodes &#8211; two diametrically opposed takes on the same thing. Dr. Peter G&oslash;tzsche has become a lightning rod for criticism since writing <a href=\"http:\/\/www.amazon.com\/Deadly-Medicines-Organised-Crime-Healthcare\/dp\/1846198844\/ref=la_B001JSCEI8_1_1?s=books&#038;ie=UTF8&#038;qid=1404086661&#038;sr=1-1\">Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare<\/a>, a book whose very title makes his position clear to all. And yet his conclusion doesn&#8217;t strike me as particularly radical &#8211; more like good advice:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\">&#8230;the way we currently use psychiatric drugs is  causing more harm than good. We should therefore use them much less, for  shorter periods of time, and always with a plan for tapering off, to  prevent people from being medicated for the rest of their lives.<\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">He doesn&#8217;t argue that the drugs shouldn&#8217;t be used. He says that they are overused, and reaffirms that depressions are time limited, so the use of the medication should be time limited. His recommendation for tapering is rooted in clinical observation. Withdrawal symptoms are common and are frequently misinterpreted as returning depression. We regularly see people who have been on antidepressants for years, afraid to stop as if some underlying depressive something-or-another will raise its ugly head. So in spite of Dr. G&oslash;tzsche&#8217;s confrontational style, his actual recommendations seem &quot;evidence-based&quot; to me. <\/div>\n<p align=\"justify\" class=\"small\">Dr. Nutt&#8217;s reply to Dr. G&oslash;tzsche is pretty much standard fare for him &#8211; forever championing the notion that there&#8217;s too much attention paid to adverse effects of the psychopharmacologic drugs. Three years ago, he made a similar speech to the Royal College of Psychiatry, No Psychiatry Without Psychopharmacology, that vilified Dr. David Healy as a &quot;scaremonger&quot; in an opening slide:<\/p>\n<p align=\"center\"><a href=\"http:\/\/www.rcpsych.ac.uk\/pdf\/Nutt%20KN16.pdf#page=1\" target=\"_blank\"><img decoding=\"async\" width=\"400\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/nutt-1.jpg\" \/><\/a><\/p>\n<div align=\"justify\" class=\"small\"> I had decided to skip Dr. Nutt&#8217;s article [<a href=\"http:\/\/www.behaviorismandmentalhealth.com\/wp-content\/uploads\/2014\/06\/PIIS2215036614702329.pdf\" target=\"_blank\">Attacks on antidepressants: signs of deep-seated stigma?<\/a>], but yet I kept it around. I looked at it periodically and was never quite able to close it. So here it is over a month after it was published. These are the phrases that linger:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\">Psychiatry is used to being attacked by external parties with antidiagnosis and antitreatment agendas. However, the recent disclosure  that a doctor [Professor Peter G&oslash;tzsche] had joined a new group, the  Council for Evidence-based Psychiatry, whose launch was accompanied by  newspaper headlines such as &quot;Antidepressants do more harm than good,  research says&quot; and &quot;Psychiatric drugs are doing us more harm than good&quot;  in The Times and <a target=\"_blank\" href=\"http:\/\/www.theguardian.com\/commentisfree\/2014\/apr\/30\/psychiatric-drugs-harm-than-good-ssri-antidepressants-benzodiazepines\">The Guardian<\/a> plumbs a new nadir in irrational polemic..<\/div>\n<p>       <\/p>\n<div align=\"justify\" class=\"small\">&#8230; and at some level express and reinforce  stigma against mental illnesses and the people who have them. The  medical profession must challenge these poorly thought-out negative  claims by one of its own very vigorously.<\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">Several things. I don&#8217;t much mind Peter G&oslash;tzsche&#8217;s style. He goes after mammography with the same passion [see the video in <a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/11\/25\/a-major-force\/\">a major force&hellip;<\/a>]. His conclusions seem right as rain to me, so he can rant all he wants. The antidepressants are unquestionably overused; people are on them too long [and hard to get off]; and I&#8217;ve come to believe that they should always be tapered. Solid points. And as for Dr. Nutt&#8217;s implication that it represents an attack on psychiatry, I didn&#8217;t think of that when I read what G&oslash;tzsche had to say. He says, &quot;the way we currently use psychiatric drugs,&quot; and I take him literally as meaning &quot;we doctors.&quot; And he&#8217;s right from where I sit. Most of the overuse of antidepressants I see is by primary care physicians [though there aren&#8217;t&nbsp; many psychiatrists around here in rural Georgia]. So I guess I see Dr. G&oslash;tzsche as an acquired taste &#8211; not for everyone. But I don&#8217;t particularly think of him as attacking psychiatry as a medical discipline.       <\/div>\n<p align=\"justify\" class=\"small\">On the other hand, there are some things about this piece by Dr. Nutt that do bother me. In fact, most of what he writes bothers me. I think it dredges up my memories of the conflicts of the late 1970s. Dr. Szazs monotonous definitions of disease requiring some biological marker [the Myth of Mental Illness] and the neoKraepelinians going him even one step further by saying &quot;The focus of psychiatric physicians should be on the biological aspects of illness&quot; and then sliding over the years to Tom Insel&#8217;s &quot;Psychiatry is a Clinical Neuroscience Discipline&quot; version. I guess they all feel like dogmatic pronouncements or injunctions &#8211; but they&#8217;re really just opinions. I was personally comfortable with the more traditional Doctors take care of sick people. That&#8217;s who came to my office, and that&#8217;s what I did. Sickness came long before any biological understanding was around. We started with just &quot;Do no Harm&quot; and that&#8217;s where we&#8217;re still supposed to be. So my complaint is that besides Dr. Nutt&#8217;s pharmaphillia, and his neoKraepelinian bio-dogma, I think he perpetuates what seems to me a false dichotomy, one that goes back into the dawn of our history.<\/p>\n<div align=\"justify\" class=\"small\">But if that were all, I would&#8217;ve probably just sent this article to cyberspace. It&#8217;s this part that kept it around:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\">&#8230; and at some level express and reinforce   stigma against mental illnesses and the people who have them. The   medical profession must challenge these poorly thought-out negative   claims by one of its own very vigorously.<\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">I recalled something similar from Dr. Lieberman [<a target=\"_blank\" href=\"http:\/\/psychnews.psychiatryonline.org\/newsarticle.aspx?articleID=1715655\">Psychiatry: Nothing to Be Defensive About<\/a>]:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\">I recently wrote an article for the Scientific American blog that explores how stigma and antipsychiatry sentiments fuel prejudice against our field and our patients. But I think it&rsquo;s also important to note how the unwillingness of the public and pundits to accept psychiatry as a scientific discipline and full-fledged medical specialty perpetuates the false dualism of the mind and the brain &mdash; attempting to transport psychiatry back to the Cartesian philosophy of the 17th century&#8230;<\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">I don&#8217;t question that there is still a stigma with mental illness, though less than there used to be. And I don&#8217;t question that there are anti-psychiatrists or people who question psychiatry as a medical specialty. But I think that in this case, Dr. Nutt and Dr. Lieberman are misappropriating those things to keep from looking in the mirror. If Peter G&oslash;tzsche is making his complaints as a veiled attack on psychiatry as a medical specialty, I sure can&#8217;t see it. And I read him as a patient advocate. I frequently make the same comments about not overprescribing antidepressants, using antidepressants in a more time limited way, warning about the dangers, and tapering these drugs. And I&#8217;m neither an antipsychiatrist nor prejudiced against mental patients. I&#8217;m saying those things because the antidepressants are used too often, too long, too casually, and stopped too abruptly. I resent him imputing other fantasied motives to people that disagree with him. And his maximizing efficacy and minimizing adverse effects is no different from people who do the opposite. There&#8217;s a rational place in the middle. I would propose that the Dr. Nutts and Dr. Liebermans of the world do no one any favors by making these defensive and externalizing kind of comments. They actually cause a lot of the antipsychiatry sentiment they seem to think they&#8217;re fighting against. That&#8217;s not Peter G&oslash;tzsche&#8217;s doing&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Psychiatric drugs are doing us more harm than good As with benzodiazepines in the 1980s, the UK is prescribing SSRI antidepressants at a staggering rate &ndash; and to no good effect The Guardian by Peter G&oslash;tzsche 30 April 2014 We appear to be in the midst of a psychiatric drug epidemic, just as we were [&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_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-47633","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47633","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=47633"}],"version-history":[{"count":67,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47633\/revisions"}],"predecessor-version":[{"id":48047,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/47633\/revisions\/48047"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=47633"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=47633"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=47633"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}