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Ronald Pies: Public against psychiatry are "true believers" in denial


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The editor-in-chief of Psychiatric Times again attempts to come to grips with patients opposed to psychiatric drugging, claiming, incredibly, that it's not bad drugs but bad doctors that harm patients. Duh!

 

Antidepressants and the Sound of One Hand Clapping

By Ronald W. Pies, MD | October 10, 2011

 

....First, there is the issue of confidence, both with respect to the efficacy of antidepressants (ADs) in acute treatment studies, and in studies of long-term prophylaxis. (“Efficacy” usually refers to benefit under controlled, clinical conditions; “effectiveness,” to naturalistic settings). It turns out that the reported efficacy of ADs in acute treatment studies is, to a large degree, in the eye of the beholder—or of the statistical analyst....

 

The other dimension in this crisis of faith involves the more religious connotation I alluded to earlier—and here, we must depart the realm of “pure science.” It is clear to me that, among the general public, there is a vociferous and sometimes vitriolic group who fervently and inflexibly believe that antidepressants are worse than useless—indeed, who see these medications as quite toxic and dangerous. My sense is that many of these individuals fit the description of the “true believer,” as described by philosopher Eric Hoffer:

 

“It is the true believer’s ability to “shut his eyes and stop his ears” to facts that do not deserve to be either seen or heard which is the source of his unequaled fortitude and constancy.” (p. 76).

 

(Of course, characteristically, these opponents of antidepressants view psychiatrists as having precisely the same blinkered obstinacy). Hoffer goes on to say that

 

“Mass movements can rise and spread without belief in a God, but never without belief in a devil. Usually the strength of a mass movement is proportionate to the vividness and tangibility of its devil.” (p. 86).

 

Indeed, this loosely-knit community of naysayers sees psychiatry and psychiatrists in nearly satanic terms. For them, however, the “devil” is a Chimera-like creature, with the head of a fraudulent researcher; the body of a drug sales rep; and the tail of a psychiatrist. I do not intend to publicize the websites of these individuals, but you can read some of their comments by linking to the blog sites below.*13,14

 

Now, it is tempting to write these individuals off as fear-mongering cranks, possessed of only the faintest scientific knowledge. A handful certainly fit that description—the ones, for example, who insist that antidepressants are destroying the brains of millions; causing thousands of suicides; and turning scores of once-placid accountants into knife-wielding, psychotic killers. Oh, yes—and causing permanent sexual dysfunction in thousands of patients. (The actual prevalence of this last phenomenon is not known, though, to my knowledge, there are fewer than 30 such cases in the published literature—see refs 15,16). These individuals will probably never be persuaded, no matter the evidence, that antidepressants are usually effective and well-tolerated, when properly prescribed and monitored.

 

And yet, dismissing all critics of psychiatric treatment as querulous crackpots would be a serious mistake. Some of those who wrote to me were both knowledgeable about psychiatric medications, and sophisticated in their grasp of medical research. Some spoke from painful personal experience with psychiatric medications—whether antidepressants, antipsychotics, or mood stabilizers. They spoke, for example, of becoming agitated or manic while taking antidepressants, and feeling depressed or “doped up” while taking mood stabilizers. They spoke of painful “withdrawal symptoms” lasting many months, after their antidepressant was stopped. They spoke of lethargy, blunted creativity, or impaired cognition, while taking antidepressants or mood stabilizers. Perhaps most disheartening, they spoke of how little they felt understood, “listened to,” or respected by their physicians.

 

It is of small consolation to these sincere critics when I reply, as I usually do, along the following lines. “Well, yes: when antidepressants are prescribed by the wrong doctor to the wrong patient, and for the wrong reason, serious problems can occur. Patients with bipolar disorder may indeed become irritable, aggressive, or manic, and in general, should rarely be treated with antidepressants.17 And, yes: when patients are not carefully monitored, they can become excessively sedated, just as they may experience prolonged sexual dysfunction that is not detected by the prescribing physician—who is very likely not a psychiatrist. And, it is true that when a physician discontinues an antidepressant too rapidly, the patient may experience a very uncomfortable, flu-like syndrome that may last for days or weeks—rarely longer—which can nearly always be avoided by using a very slow tapering schedule, over several months. These are problems mainly related to poor medical practice, and only partly related to the properties of the medications themselves. These are problems that arise, in part, from inequities in our health care system, and the lack of affordable and accessible psychiatric care in this country.”

 

I don’t blame disgruntled patients for finding this apologia unconvincing, if not downright insensitive. When you have been made miserable by an inappropriate or poorly-monitored medication, you are not likely to be mollified by the explanations of those prescribing—and not ingesting!—the drug in question. Ironically, given the complaints of these critics, the growing popularity of antidepressants in the United States18 does not suggest that physicians are getting a strong “Cease and desist!” signal from the vast majority of patients. On the contrary: the evidence suggests that most patients are generally satisfied with their antidepressant treatment. For example, a recent study by pharmacists found that among monitored patients taking antidepressants,

 

“Fifty-seven percent of patients reported feeling better a lot of the time, and an additional 30% reported feeling better some of the time. Nearly 75% reported that the antidepressant did not bother them or only bothered them a little of the time. Being very satisfied was reported by 47% of patients, and an additional 28% were satisfied with the antidepressant.”19

 

There is also encouraging news on the level of molecular biology. Antidepressants do not merely rev up levels of neurotransmitters, along the lines of the now outdated “chemical imbalance” hypothesis.14 Rather, ADs may work at the level of the gene, by promoting production of various neurotrophic peptides, such as BDNF. These factors, in turn, may enhance neuronal growth and survival, and appear to underlie the mechanism of several antidepressants.20

 

Rather than damaging the brain, ADs may actually work to enhance “neuroplasticity,” improve stress-tolerance and facilitate learning.21 That said, there are some concerns that, in a small subset of patients chronically treated with ADs, a syndrome of “tardive dysphoria” may develop. Such a delayed, “pro-depressant” effect might reflect some as yet poorly understood “rebound” phenomenon in the brain.22 Clearly, we need more research on this troubling possibility.

 

Nonetheless—and contrary to the claims of critics—there is some evidence that patients treated with ADs report improvements in “quality of life” (QOL) and overall satisfaction with their lives. For example, a Belgian study of depressed or anxious patients taking the AD escitalopram(Drug information on escitalopram) found that treatment resulted in a significant improvement in quality of life enjoyment and satisfaction.23 However, we need many more studies examining QOL in patients taking antidepressants. HAM-D scores alone do not tell us whether a depressed patient has moved beyond mere remission to a full and flourishing recovery.

 

And so, overall, what is my verdict on antidepressants? In my estimation, our present medications for depression are only mediocre. For moderate-to-severe, and especially melancholic, cases of major depression, ADs are effective and sometimes life saving, particularly when part of a comprehensive treatment plan that includes psychotherapy. And, there is convincing evidence that ADs prevent relapse during at least the 6 months or so after a bout of major depression. For mild, non-melancholic cases of depression, I generally favor beginning with psychotherapy, given the “costs” of antidepressant side effects. In this regard, we urgently need to find antidepressants that are more effective and better tolerated. Recent research suggests that agents that modulate the NMDA system (eg, ketamine(Drug information on ketamine)) are worth further exploration.24 In sum: I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.

 

So what is next? We need to improve access to psychiatric care, so that patients who need antidepressants are seen by those best trained and most knowledgeable in their use. We need to work more closely with our colleagues in primary care, so that they become more proficient in the diagnosis and treatment of depression. We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment....

 

http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1968125

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Here is the direct link to the article on the psychiatric times website:

 

http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1968125

 

Free registration is required

 

Not much one can say regarding someone who is a hard core apologist for psychiatry come heck or high water.

 

He did mention this study which I hadn't seen referenced previously. He claims that if this is replicated, it would prove that taking ADs over a long period of time reduces suicide attempts.

 

11. Leon AC, Solomon DA, Li C, et al. Antidepressants and risks of suicide and suicide attempts: a 27-year observational study. J Clin Psychiatry. 2011;72:580-586.

 

In one way I can see how that could be true if you're the person in which they don't cause suicidal ideation. They will numb you so badly that you won't give a darn about anything.

 

Anyway, I proudly join the "true believer" in the denial club:)

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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This probably belings in Rants.**

Please advise when I may get to point that these articles do not send my pulse racing.

Are physicians taught how to analyze studies? Of course, that would assume that studies/reports are published. Silly me.

 

Is ANYONE getting funding for and studying the chronic (over 6 month) usage? Better yet, discontinuing when they are 'cured'?! Apparently insurance companies have some actuarial data.

'Only a few cases of PSSD in literature'. To quote Alto...'DUH'! Happens when info is buried.

'In acute settings... monitored patients... generally satisfied... not bothered by ... ...(paraphrasing)

Can anyone else feel the emotional anesthesia in those responses from the patients in ACUTE therapy? Any reports of feeling GOOD? Energetic? Motivated? Or (drumroll, please)... requiring less sleep? Wanting to do things they used to enjoy -- having sex, shopping, chatting w friends...? Oh, no! That would indicate unmasking of bipolar.

 

Sign me....

Lost to follow-up in The Land of Denial

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 4 weeks later...

The worst part in arguing with doctors is that the people you have to argue with are doctors.

 

Nobel laureates and professional athletes got nothing on these guys in the condescension and self-absorption departments.

 

If there's ever been a more intellectually pompous bunch... ? ... only the French New Wave film critics of the 60s come to mind as any sort of match.

 

Luckily, I'm a "true believer" in my own cognitive dysfunction (and other impediments to clearmindedness) and am unable to participate in the public debate. (Hell, I can barely craft coherent sentences.)

 

Go out and win this one, guys.

 

Alex.i

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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In sum: I do not hear loud applause for our current antidepressant armamentarium. I believe I hear the sound of one hand clapping.

 

So what is next? We need to improve access to psychiatric care, so that patients who need antidepressants are seen by those best trained and most knowledgeable in their use. We need to work more closely with our colleagues in primary care, so that they become more proficient in the diagnosis and treatment of depression. We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment....

http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1968125

 

On the bright side, I believe this is as close as we'll ever see to Dr. Pies agreeing with us.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I'm sure he means well.

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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""So what is next? We need to improve access to psychiatric care, so that patients who need antidepressants are seen by those best trained and most knowledgeable in their use. We need to work more closely with our colleagues in primary care, so that they become more proficient in the diagnosis and treatment of depression. We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment....

 

I love how he refers to side effects as very rare. Then again, I think that is the mantra for all physicians regarding meds.

 

I do applaud him for stating that psychiatrists need to listen respectfully when patients say they aren't happy with treatment. Near the end of my withdrawal, I diplomatically told my psychiatrist that I wished I had never set forth in a psychiatrist's office.

 

To soften what I said, I made it clear I had some responsibility in this issue also. Unfortunately, his response was to ask questions which made me believe that he thought I was relapsing. I shut up real fast and at that point, started seeing him less frequently until I was down to yearly visits.

 

Anyway, he did what most psychiatrists do which is to interpret any legitimate complaints from folks like us as a worsening of our condition.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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I believe Dr. Pies softened his stance because of all the comments made by dissatisfied patients on his posts. Good job, folks!

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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