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Davis et al. 2024 - Undisclosed financial conflicts of interest in DSM-5-TR: cross sectional analysis


Addax

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British Medical Journal / The BMJ (2024) 

link to full article: https://www.bmj.com/content/bmj/384/bmj-2023-076902.full.pdf

 

ABSTRACT
OBJECTIVE
To assess the extent and types of financial ties to industry of panel and task force members of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR), published in 2022.
DESIGN
Cross sectional analysis.
SETTING
Open Payments database, USA.
PARTICIPANTS
92 physicians based in the US who served as members of either a panel (n=86) or task force (n=6) on the DSM-5-TR with information recorded in the Centers for Medicare and Medicaid Services Open Payments database during 2016-19. This period was chosen to include the year that development of the DSM-5-TR began and the three years preceding, a time consistent with previous research on conflicts of interest and consistent with the American Psychiatric Association’s disclosure requirements for the fifth revision (DSM-5) of the manual.
MAIN OUTCOME MEASURES
Type and amount of compensation the panel and task force members of DSM-5-TR received during 2016-19.
RESULTS
After duplicate names had been removed, 168 individuals were identified who served as either panel or task force members of the DSM-5-TR. 92 met the
inclusion criteria of being a physician who was based in the US and therefore could be included in Open Payments. Of these 92 individuals, 55 (60%) received payments from industry. Collectively, these panel members received a total of $14.2m (£11.2m; €13m). One third (33.3%) of the task force members had payments reported in Open Payments.
CONCLUSIONS
Conflicts of interest among panel members of DSM-5-TR were prevalent. Because of the enormous influence of diagnostic and treatment guidelines, the standards for participation on a guideline development panel should be high. A rebuttable presumption should exist for the Diagnostic and Statistical Manual of Mental Disorders to prohibit conflicts of interest among its panel and task force members. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the panels, but they should not have decision making authority on revisions or the inclusion of new disorders.

1988-2012: Prozac @ 60mg (with a few stops and starts)

Fall 2012: Returned to 40mg after discontinuing and horrid withdrawal 

Fall 2013: 40mg Fluoxetine, added 150mg Wellbutrin to treat fatigue 

Winter 2014: Attempting to taper both (too fast)

April 2014: 9mg Fluoxetine + 37.5 Wellbutrin 

Summer 2014: 8 mg Fluoxetine + 0 Wellbutrin (way too fast a drop)

Late summer/Early Fall 2014: Debilitating Withdrawal symptoms 

Fall 2014 - Wellbutrin successfully kicked to the curb but…

Oct- Dec 2014: Panicked reinstatement of Fluoxetine ->30mg - held for 5yrs

Jan 2021: taper to 20mg Fluoxetine  then tapering by 1mg every 2-3 months

Fall 2022 - held at 10mg->December 2022: 9mg->Feb 2023: 8mg ->March 2023: brassmonkey slide begins: 7.8mg -> 7.6 -> 7.4->2 week hold (April)->7.2->7mg->6.8->2 week hold->6.6-> 1-month hold ->(June)-6.5->4-week hold-> (July)-6.4 (discontinued brassmonkey slide and slowed taper)-> (Aug)-6.2->(Sept)-6.0->(Oct)-5.9->(Nov)-5.8->(Dec)-5.7->wave!->(Jan)-5.8->(Feb)-6mg and holding.

 

My 2014 withdrawal experience: https://rxisk.org/antidepressant-withdrawal-a-prozac-story/

 

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Stunning.  Thank you @Addax

Zoloft: 1995 - 2015

Prozac: 2015 - 2018 (tapered from 40mg x day on July 31 to 30mg on August 31 to 20mg on September 31 to 10mg October 31 to 0mg on  December 15, 2018

Gabapentin: 2016 to 2019  (tapered from 300mg x day to 150mg on August 31, 2019 to 75mg on September 15 to 50mg on September 31 to 25ishmg on October 15 to 0mg on December 1, 2019

Enalapril: 2010 - 2019

Lipitor: 2017 -2017

Metformin: 2000 - 2020

Liothyronine: 2007 - 2019

Levothyroxine: 2000 - 2022

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not surprising

 

2011 Paxil 12.5

2022 Paxil 25

2022 Paxil 12.5mg liquid taper 10% per month

2023 Paxil 5mg taper stopped

2023 Dec. 5mg Prozac for 5 days

2024 Paxil/Prozac stopped

 

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