Ron Pies ad hominem du jour: Antidepressant critics want others to suffer

[Altostrata]

The editor-in-chief of Psychiatric Times tries another ad hominem attack to explain criticism of pharmapsychiatry and antidepressants. This time, critics are people who just want others to suffer.

 

Are the Puritans Behind the War on Antidepressants?

Ronald Pies, M.D. Psych Central September 13th, 2011

 

....

These are not good times for Prozac and its progeny. In the popular media, the use of antidepressants has been likened to swallowing “expensive Tic-Tacs”, while in professional journals, the effectiveness of these medications has been challenged, if not discounted. And even a casual Google search under the terms, “Antidepressants damage” turns up thousands of websites and articles claiming that these drugs cause brain damage, induce suicide, or lead to “addiction.” Yikes!

 

Most of these claims and concerns are either groundless or simplistic, based on the best available studies. The “Tic-tac” claim, made in a prominent national magazine, was based on a misunderstanding of recent “meta-analyses”—studies that combine data from many other studies in order to reach a conclusion. What these studies show is that the milder the person’s depression, the less difference there is between an antidepressant and a placebo—famously but inaccurately defined as a “sugar pill.” But this is not a novel discovery: it reflects a well-known phenomenon known as the “floor effect.” Antidepressants were never intended to treat normal sadness, grief, or very mild cases of depression. The farther we move away from the “target” condition—serious, clinical depression—the closer we move to the “floor” of normality, and the less likely we are to see a big difference between drug and placebo. Most of the recent meta-analyses show that in the most severe cases of major depression, antidepressants are more effective than the “placebo condition.”

 

This last term is important, too. When patients enter a large, placebo-controlled study of antidepressants, and are placed in the “placebo group”, they receive much more than a “sugar pill.” They get many hours of attentive listening and evaluation by caring professionals—probably more than many depressed patients get from their primary care doctors! So the comparison is not between medication and a sugar pill, but between medication and a kind of supportive therapy. Furthermore, there is good evidence that when major depression has features we call “melancholic”—such as severe weight loss and a total inability to experience pleasure—the placebo condition is far less effective than medication.

 

There is also no convincing evidence that antidepressants cause “brain damage” or “addiction” among those who take them. In fact, the most recent evidence on how these medications work suggests that they actually enhance the growth of connections between brain cells—perhaps leading to more adaptive brain functioning. They don’t just “rev up” brain chemicals like serotonin. And, there is no evidence that people get “hooked” on antidepressants in the way we understand addiction to sedatives, opiates and related drugs. (That said, suddenly stopping a long-term antidepressant can lead to uncomfortable withdrawal symptoms, and there may be a small percentage of patients who develop delayed “resistance” to antidepressants, with a return of depressive symptoms).

 

So why is there so much hostility directed at these medications? (The same question could be raised with respect to psychiatry and psychiatrists, but that’s another story). I believe that a good deal of the animus arises from our Puritan heritage, and its attitude toward suffering, sin, and expiation. For the Puritans of New England, disease was essentially a divine punishment for Man’s original disobedience to God.....

 

Now, when psychiatrists see patients with severe major depression, these unfortunate souls often express the view that their illness is a “punishment” of some sort. Some believe that God is punishing them for their sins. But this attitude, in a less extreme form, pervades our society’s views about depression—that it is, in some sense, the “fault” of the depressed individual. Some clinicians who argue that depression has an “adaptive” value often begin with the premise that depression represents the person’s “failure to resolve their social dilemmas”—a clinical euphemism for blaming the sufferer. The logical extension of this line of reasoning is that the depressed individual must somehow “repent of his ways”—for example, by ruminating on his problem until it is solved, or by “pulling himself up by his bootstraps.”

 

In this view of depression, taking a “drug”—the term “medication” is almost never used by those opposed to antidepressants—represents a weak-willed dodge. Antidepressants are seen as merely “covering up the real problem” or as “a crutch.” This attitude is extraordinarily unhelpful for those struggling with a potentially lethal illness. Although I prefer to begin with psychotherapy in most mild-to-moderate cases of depression, the more severe bouts usually require medication. Often, the combination of medication and therapy works better than either one alone. And I use a non-Puritanical metaphor in framing the issue for my patients. I say, “Medication isn’t a crutch, it’s a bridge between feeling awful and feeling better. You still have to move your legs to get across the bridge, and that’s the work of therapy.”

 

 

http://psychcentral.com/blog/archives/2011/09/13/are-the-puritans-behind-the-war-on-antidepressants/

[Altostrata]

In case my comment gets deleted:

 

Aside from yet another ad hominem attack on imagined enemies (not only are they Puritans but they *always” use the term “drugs” instead of “medication”), Dr. Pies's article completely disregards the many documented side effects of antidepressants.

 

With so many people taking these, ahem, medications, many inappropriately for less-than-severe depression, many people have had the opportunity to experience side effects that may be severe and long-lasting.

 

Everyone knows someone who’s been injured by these, ahem, medications.

 

It’s bad word of mouth that’s killing antidepressants, Dr. Pies. All of your rationalizations, all of your excuses, all of the drug company advertising, the corrupted research — all of it — cannot stand in the way of bad word of mouth. You simply can’t control it. The more people are exposed to these, ahem, medications, the more people are complaining.

 

Nothing kills a bad product like good advertising. It’s the over-reaching that’s tarnished your profession, Dr. Pies, not psychiatry’s critics. Your search for a conspiracy is making you look, ahem, more like one of those Southern hemisphere psychiatrists.

[Fid]

It appears that the responses to his previous article have gone to his head...he actually thinks he is popular. They didn't publish my last comment so I won't bother commenting on their new article, sufficed to say that, once again, it has no scientific support and is based purely on opinion. Pies is obviously pro-drugging, despite the overwhelming evidence that suggests these drugs are dangerous. No point in debating with someone who puts his fingers in his ears and closes his eyes to the truth.

[compsports]

It appears that the responses to his previous article have gone to his head...he actually thinks he is popular. They didn't publish my last comment so I won't bother commenting on their new article, sufficed to say that, once again, it has no scientific support and is based purely on opinion. Pies is obviously pro-drugging, despite the overwhelming evidence that suggests these drugs are dangerous. No point in debating with someone who puts his fingers in his ears and closes his eyes to the truth.

 

Fid,

 

I respect your decision but as an FYI, I greatly enjoyed a previous exchange you had with him. I felt you really put him in his place.

 

Even if he is closed to the truth, at least other people will learn from reading your posts.

 

If it doesn't get posted, email John Grohol as he has always posted my comments when I felt they were being censored.

 

I realize I could say something also but brain fog has hit me big time this morning so I am having trouble reading long posts like that one.

 

Anyway, I hope I am not coming across as pressuring you as I totally understand your reasoning. I am just being selfish as I love your posts.

 

CS

[Fid]

Do you have John Grohol's email address?

[compsports]

Do you have John Grohol's email address?

 

Hi Fid,

 

It is grohol@psychcentral.com

 

CS

[Fid]

Done :-)

[Fid]

My response has been published now

[compsports]

Hi Fid,

 

I don't see it.

 

Can you provide a link?

 

Thanks!

[Altostrata]

I don't believe anything is going to discourage Ron Pies as an apologist for psychiatry until he is forcibly retired from his perch at Psychiatric Times (and maybe even not then).

 

The advantage is that with every one of this wacky posts, he discredits himself further. Perhaps negative feedback will push him to ever-greater heights of exaggeration and ad hominems.

 

The negative comments seem to hurt his feelings.

[cinephile]

Well, I'm officially done with this guy. I tried to give him the benefit of the doubt before, but now he's revealed his true colors with this new batch of tortured logic. Enough already with this ass clown.

 

I made a post on his site which will be the last correspondence I have with him, as he's clearly hopeless. At this rate, our best hope is that when the old guard boomer generation of psychiatrists retire, the new generation listens to the patients and conducts the kind of research we want on psych meds and changes their prescribing habits accordingly.

 

Anyway, you know the drill: my post is below in case it gets deleted. PS: I posted under the name "Robert Planter" -- it's a pseudonym.

 

Wow, we're really at the end of the road, aren't we Mr. Pies? I can see your overly academic and tortured logic at work to try to explain away your cognitive dissonance about how the psych meds you and psychiatrists everywhere prescribe may actually be harming some patients in the long run.

 

Puritanism? Really? There's a backlash against psychiatric meds now because the corrupt core of the psych med trials (dating back decades) is coming out, as are the long-term side effects. Meds don't cause brain damage? Maybe not, but they're certainly doing something very bad to a growing number of people. In his latest lecture, Robert Whitaker talks of a growing number of young adults who are seeing seemingly permanent sexual dysfunction from taking SSRIs long-term. Even once they get off the SSRIs, the sexual dysfunction remains. It's called PSSD and it's very real. This is backed up by rat studies. What kind of new brain cells are being grown in this situation? I don't know, but I do know I don't want any of them.

 

There's a video of Whitaker's talk on youtube. At 2:17:21 he speaks about PSSD. End your ignorance at the link below.

 

Now I already know ahead of time what you'll say about long-term sides and PSSD: "Yes, for a distinct minority of patients, long-term sides like PSSD and persistent anhedonia are a worrying issue. We need to do more research on these long-term side effects."

 

But where's the research, Ron? And how small is that minority? Why are people like Whitaker the only ones sounding the alarm bells about the dangers of psych meds and how over-prescribed they are? Could it be that psychiatrists such as yourself can't admit to themselves that they may be at least partially wrong, and perhaps have made some patients worse with these meds? It sure helps explain the logic behind your Puritan analogy.

 

Outside the Scientology lunatic fringe, there is no war on antidepressants; there's a corrective backlash. Patients are furious they were lied to (chemical imbalance anyone? What about the suppressed side effects reports from drug companies? Or the fact there are no long-term safety studies even though almost everyone on psych meds is on them long-term?). It really is that simple.

 

But psychiatry has never been about simple common sense. It would be out of business if it were.

[Altostrata]

cine, mentioning Whitaker will be a red flag to Dr. Pies. Maybe he'll be inspired to write yet another defensively stupid essay. Are you trying to gaslight the poor man?

[compsports]

cine, mentioning Whitaker will be a red flag to Dr. Pies. Maybe he'll be inspired to write yet another defensively stupid essay. Are you trying to gaslight the poor man?

 

Personally, I would love it if Pie wrote another stupid essay. Every time he does, he looks like an idiot in my opinion.

 

Cine, I thought that was a great post. You said everything I would have said, particularly calling out Pies for minimizing side effects. I am so bleeping sick of that little game of his in acting like ADs don't cause any problems whatsoever.

 

It almost like in his mind, if he denies something enough times, it can become fact. Your post doesn't allow that to happen.

 

By the way, it doesn't matter what you say in response to Pies if you're not embracing what he feel is god's gift to person kind which is ADs. So personally, I am glad Whitaker was mentioned.

 

CS

[cinephile]

Dr. Pies just made a new post in which he discusses many things, including PSSD. His reasoning on PSSD is the usual deja puke (it must be uncommon since it's under-reported, Whitaker's evidence isn't evidence because it's anecdotal, etc).

 

But I've officially had it with this moron. The gloves have come off and I made one last post about what he said about my post on PSSD.

 

As usual, below is my comment in case it gets deleted:

 

Mr. Pies:

 

I find it more than a little condescending when you suggest that journalists such as Whitaker are not doing careful evaluations of issues like PSSD just because it's not in a clinical setting. Need I remind you how tainted so much of the clinical research was for psych meds? And why do you think the researchers weren't asking "the right questions" about sexual sides? It's because they wanted to present the most favorable side effect profiles for the drugs!

 

Also, there are far more than 25 people suffering from PSSD. There is currently a forum for sufferers of PSSD (SSRIsex) in which there are over 1,000 members, and their symptomology is quite similar: genital anaesthesia, orgasmic anhedonia, and lack of response to visual stimuli. Nearly all of them state THEY NEVER FELT THIS WAY BEFORE TAKING THE MEDS, EVEN IF THEY WERE DEPRESSED. They all say it is an utterly alien, inhuman feeling.

 

Or, as was stated in a 2008 Journal of Contemporary Psychotherapy article (Bahrick, A. S., & Harris, M. M. (2009). Sexual side effects of antidepressant medications: An informed consent accountability gap. Journal of Contemporary Psychotherapy, 39(2), 135-143.), "Genital anesthesia and pleasureless orgasm are not known in the general population and are unassociated with the conditions for which the medications are prescribed, thus these symptoms provide a clear link to the treatment rather than the condition being treated."

 

Now, it is very easy for psychiatrists to sweep such patients under the rug by drawing the conclusion from sparse journal reports that this must be a rare problem. That's where someone like Whitaker comes in, who gives a voice to the voiceless and advocates for these poor souls and gets the psychiatric community -- kicking and screaming -- to acknowledge it and hopefully research it. When research into PSSD begins, we may just find out it's more common than once thought. It's premature on your part to draw the conclusion that it's rare based on reading a few journal articles (I've also read the journal articles you cited, as well as a few more on the subject). After all, just because something is under-reported doesn't mean it's rare. I seem to remember a time in the not-too-distant past when SSRI withdrawal was considered rare.

 

And "anecdotal" evidence is the springboard for scientific inquiry. Both are equally important. Do you honestly think psychiatry is interested in cleaning up its messes (that is, its mistakes)? To do so would be to admit it was wrong and caused egregious harm to more people than previously thought. No, much easier to dismiss those suffering with PSSD or long-term side effects as "anecdotal" and "statistically insignificant" and move along to the next psychiatric hula-hoop, whether it be personalized medicine, genetics, or brain imaging.

 

Remember this, Mr. Pies: us patients have to live with psychiatry's mistakes.

 

If it were not for people like Whitaker, those suffering in silence would CONTINUE to suffer in silence. I, along with many other psych patients, would be taking a dirt nap by the time psychiatry got around to researching PSSD and other long-term symptoms. I have my life to live and can't wait, Mr. Pies.

 

In an era of unprecedented medical corruption, we need all the gadflies like Whitaker we can get.

[compsports]

Great response as always Cine.

 

I tried to respond to Pies but the words just weren't coming out right. You pretty much echoed my points.

 

I don't know why but I continue to be stunned at how arrogant his posts are.

 

Anyway, your post isn't up yet but please, please, please, email John Grohol at the address I gave Fid if it doesn't get posted by Sunday morning.

 

CS

[Altostrata]

Really excellent post, cine. Where is Dr. Pies's post? Is it in comments on the Puritans article?

 

You see, the comments really bother him. Clearly he was stung by your earlier comment.

[Altostrata]

Okay, I couldn't resist, I posted another comment:

 

Dr. Pies, I would like to see you using your quasi-celebrity status to insist on more studies of adverse effects of antidepressants from research psychiatry, rather than being an apologist for what are emerging as clear flaws in biological psychiatry.

 

Pharma has assiduously hidden adverse effects for 30 years, their pro-business lobby crippled the FDA's monitoring of post-marketing adverse drug reactions, but mainstream psychiatry still has not stepped up to the plate to correct the gaps in a truthful risk-benefit analysis of antidepressants.

 

Speaking of prejudices, in your last post you have dismissed reports of PSSD as inconsequentially rare -- with no evidence whatsoever of its rate of incidence.

 

May I point out that the FDA would consider a rate of incidence of only .1% as significant? Given the approximately 30 million in the US on antidepressants, if PSSD affected only 30,000 people, it would be considered a serious drawback to prescribing antidepressants.

 

Without psychiatry doing its duty to protect patients and seriously investigating adverse reactions, all we have to go on is anecdotal reports from patients -- and they are all over the Web. Thousands upon thousands of reports of lasting damage from antidepressants.

 

Another nightmare for you: PSSD is a subset of prolonged antidepressant withdrawal syndrome, which can last years. Dr. Carlotta Belaise, a colleague of Dr. Giovanni Fava, is gathering cases for publication. The details are at http://tinyurl.com/3zuaxo9

 

Dr. Pies, you seem to be trying very hard to come to grips with criticisms of psychiatry, but failing to integrate what's worthy in them with your own unconscious attitudes and prejudices.

 

This cognitive dissonance must be causing you a lot of stress. May I suggest Paxil or Effexor for 18 months? As Peter Kramer says, they can make anyone "better than well" -- surely there's no harm in trying them yourself?

[compsports]

Great post Alto and it is published along with Cine's comments. I greatly thank both for you for commenting and responding to Pies.

 

By the way, in the Antidepressant Survival Program Book, that Dr. Robert Hedaya wrote when he was more pro psych meds than I think he is now, he quoted SSRI sexual dysfunction as occurring 50 to 70% of the time.

 

CS

[Baxter]

Cine and Alto, BRAVO. Great posts.