Jump to content

Ethical issues in psychopharmacology


btdt
 Share

Recommended Posts

 

Marketing depression

No one knows exactly how SSRIs work, if indeed they really do work at all. One plausible explanation is that they mask symptoms of depression in moderate cases that resolve themselves spontaneously. It is also well known that the more a drug is hyped in the mainstream media as a “miracle drug”, the greater is the likelihood of a strong placebo effect. What is, however, fundamentally problematic from an ethical point of view is the over inflation of SSRI effectiveness and safety, questionable marketing strategies, and the megadose prescriptions that can alter brain chemistry and behaviour for the worse.

Pharmaceutical companies in their direct to consumer marketing continue to promote SSRIs in television advertisements with the catchy suggestion: “While the cause of depression is not known, you might be suffering from a chemical imbalance. Ask your physician about [sSRI trade name]”. Website advertisements for certain SSRIs claim their non‐habit‐forming drugs “correct the chemical imbalance believed to cause the disorder” and include diagrams of how this “science” works. In this manner, the companies “grow the market” by increasing consumer awareness of depression and target larger populations for their drugs. Direct to consumer advertising increases the request rates of the drugs and brand choices as well the likelihood that these drugs will be prescribed by physicians and psychiatrists.

The idea of selling us depression, whether we are truly ill or not, has become an immensely lucrative strategy for selling SSRIs, a large part of which succeeds on the basis of the idea of chemical imbalance. The range of prescriptions for SSRIs has included severe, chronic depression (completely non‐functional human beings); moderate cases of depression (precipitated by stress, loss of loved ones, rape, divorce, professional failure), and the completely ludicrous (the angst ridden, ill adjusted child, personality sculpting, and psychotherapeutic fashion). The marketing strategy plays on the public's desire for a quick fix for all the vicissitudes of life and the power of the suggestion contained in the easy to understand model of chemical imbalance. This phenomenon has been dubbed the “medicalisation of society”—a phrase coined to describe the belief that every problem requires medical treatment, which is particularly relevant in the case of antidepressants. A report by the UK House of Commons health committee attributes this to the activities of the pharmaceutical industry.23 However, the strategy also works so well because of the public's ignorance of, and trust in, the institution of science—there will always be those who know these marvellous things beyond the reach of ordinary people and they offer these amazing solutions to problems that just yesterday we did not understand. SSRIs have been abused as lifestyle drugs or performance enhancement drugs in the manner of LSD, Viagra, or anabolic steroids. The pharmaceutical companies have benefited from this trend to the tune of ten billion dollars per year from sales of all SSRIs. The problem begins here. The industry is marketing the condition and then the lifelong commitment to their products.24,25 Although patients might gain a short term solution from SSRI prescriptions, the long term harm is only just starting to come into focus for both individuals and the institution of medicine.

Marketing departments employ a strategy they call “evergreening” by beginning with one indication of a use for an SSRI and then moving on to explore other “green” pastures for potential markets. In order to convince people something is wrong with them that requires SSRI therapy, the marketing departments hire public relations firms to raise awareness of a newly approved indication, sometimes using celebrity spokespersons to pitch the idea. SSRIs were first marketed for depression, then for panic disorder, obsessive compulsive disorder, post traumatic stress disorder, seasonal affective disorder, generalised anxiety disorder, and social anxiety disorder. Other potential indications in the marketing strategy that show up in clinical trials include premature ejaculation and paedophilia (since we know SSRIs cause sexual dysfunction), premenstrual syndrome, writer's block, obesity, alcoholism, cocaine addiction, compulsive shopping, and smoking cessation.

Healy explains how the so called “depression epidemic” developed from psychiatric concerns over unrecognised and untreated depression in the 1960s and 1970s. National depression campaigns were mounted in the United States and the United Kingdom. These involved alerting physicians and third party payers in health care to the huge economic burdens of untreated depression and educational campaigns to shame physicians for failing to detect and treat depression (Healy,8 p 43). The infusion of industry money into psychiatry means influence on the very definitions of psychological disorder that determine how a patient will be diagnosed and treated. In this manner, depression is understood to be a physiological disease that is treated by drugs like SSRIs and thereby gains the imprimatur of organisations like the American Psychiatric Association.

Pharmaceutical companies effectively control many professional conferences and medical journal publications, employ psychiatrists as “key opinion leaders” and pay them handsomely to sign on to publications ghost written by their own staff or medical communication agencies employed by the company. The practice of for profit, industry sponsored ghost writing has become a major concern since scientific journals are meant to be neutral arbiters of merit via the critical peer review process.27,28 Marketing interests have, however, tainted some of the most distinguished journals in medicine, especially psychiatry. The marketing of depression has spread to the very highest levels now that the distinction between promotional materials and scientific objectivity has been blurred. Academics who are expected to be the legitimate authors of journal articles turn out to be little more than ornaments to a business rushing to gain blockbuster status for its drugs or instruments used in the competition between the various companies to dominate the market share.29

 

more at the link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564489/

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

Link to comment
Share on other sites

When I saw this headline, I was reminded of something my prescribing doctor (a psychiatrist) told me at my last visit. He said that in medical school, in pharmacology class, the first thing they were told on the very first day was "drugs are poison." That drugs are something that is not meant to be in the body. They are not food. They should be prescribed with caution. (He graduated from medical school in the 1970s.)

 

For some reason, this completely boggled my mind. What sort of disconnect must there be, what kind of dissociation, to hear this sort of message and then go on to prescribe "poison" to patients? This seems to be where the marketing of pharmaceuticals comes into play, where doctors get swept along on the tide. And some doctors clearly have much to gain from this.

 

I am lucky in that I have an M.D. psych doc who is not drug-oriented--not the original prescriber, but the one who is working with me as I struggle to get off. While he doesn't know much about withdrawal or tapering (he is learning along with me), he believes me, which I find to be far more important. He gets that what I am experiencing is caused by the drug and not the re-emergence of some "underlying disorder."

 

If only more doctors within the system could be enlisted in this way. I have had a better experience with this more-mainstream doctor than with so-called benzo-wise or holistic doctors who have their own agenda that calls for me to rush off the drug faster than my system can handle.

 

Sorry to hijack this thread and take it somewhat off-track. I'm still processing all this and may start a separate thread when I have my thoughts together. What I have been struggling with are questions such as: how do we get the message about withdrawal syndrome to the medical establishment? How can we possibly quantify our experience in a way that will make it believable, in a system that requires proof?

 

Of course I should qualify that statement: the system requires proof from the individual, not the drug manufacturers.

1990 - mid-2000s: on and off several ADs, including Prozac, Effexor, Celexa, and Wellbutrin. Many side-effects and hard withdrawals. 

1990 - mid-2000s: Klonopin 0.5 mg per day prn for sleep & anxiety.

mid-2000s - 2011: switched dosing to Klonopin 0.25 twice-daily for the above plus back pain (!) Never increased dose.

2011 - began taper with missteps; then @ 5% of current dose every 2 wks, using combo of pill and compounded liquid.

2012: yearlong hold at 0.165 bid to undergo specialized PT for pelvic floor syndrome, prob triggered by high muscle tone from taper.

2013: resumed taper @ 5% of current dose per month, from 0.165 down to 0.155 bid.

3/2013 - 6/2014: another year+ hold due to bad foot fracture & family trauma (sudden deaths).

6/2014 - 1/2015: resumed taper at 5% month; from 0.155 down to 0.125 bid (half original dose; or 1/4 of 0.5 tab). Held two months.

3/2015: Started 0.125 compounded tablets pure clonazepam, twice a day.

Supplements: fish oil, probiotics, cranberry, Vit C, Vit D, turmeric, magnesium powder, tablets, oil. Also occasional baby aspirin.

Exquisitely sensitive to meds. Working full time. In my late fifties. My intro thread:

http://survivingantidepressants.org/index.php?/topic/8733-brighids-intro-my-slow-mo-clonazepam-taper-hits-a-speed-bump/?p=145214

Link to comment
Share on other sites

It would be cruel to do an experiment, right? The best hope for data is doctors which seen it happen, such as GPs who'd known a patent for decades and seen a change come over a patient who had started taking them.

 

http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2015;volume=57;issue=2;spage=200;epage=202;aulast=Ummar;type=0

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

Link to comment
Share on other sites

When I saw this headline, I was reminded of something my prescribing doctor (a psychiatrist) told me at my last visit. He said that in medical school, in pharmacology class, the first thing they were told on the very first day was "drugs are poison." That drugs are something that is not meant to be in the body. They are not food. They should be prescribed with caution. (He graduated from medical school in the 1970s.)

 

For some reason, this completely boggled my mind. What sort of disconnect must there be, what kind of dissociation, to hear this sort of message and then go on to prescribe "poison" to patients? This seems to be where the marketing of pharmaceuticals comes into play, where doctors get swept along on the tide. And some doctors clearly have much to gain from this.

 

I am lucky in that I have an M.D. psych doc who is not drug-oriented--not the original prescriber, but the one who is working with me as I struggle to get off. While he doesn't know much about withdrawal or tapering (he is learning along with me), he believes me, which I find to be far more important. He gets that what I am experiencing is caused by the drug and not the re-emergence of some "underlying disorder."

 

If only more doctors within the system could be enlisted in this way. I have had a better experience with this more-mainstream doctor than with so-called benzo-wise or holistic doctors who have their own agenda that calls for me to rush off the drug faster than my system can handle.

 

Sorry to hijack this thread and take it somewhat off-track. I'm still processing all this and may start a separate thread when I have my thoughts together. What I have been struggling with are questions such as: how do we get the message about withdrawal syndrome to the medical establishment? How can we possibly quantify our experience in a way that will make it believable, in a system that requires proof?

 

Of course I should qualify that statement: the system requires proof from the individual, not the drug manufacturers.

Your post seems on topic to me carry on put anything you like here or any of my posts I find a lot of times the most important information comes up as off topic.. peace to you

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

Link to comment
Share on other sites

It would be cruel to do an experiment, right? The best hope for data is doctors which seen it happen, such as GPs who'd known a patent for decades and seen a change come over a patient who had started taking them.

 

http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2015;volume=57;issue=2;spage=200;epage=202;aulast=Ummar;type=0

I am not sure a doctor would always notice sometimes for sure but others are damaged and try to hide it as they don't know it is the drug that has changed them and they try to sort out what seems to be their morality or other issues... people have not clue what these drugs can really do they think changes like that are impossible... I thought changes like I had were impossible for a drug to cause. If what we see here is any example doc just think it is another psych issue  and give more drugs... 

WARNING THIS WILL BE LONG
Had a car accident in 85
Codeine was the pain med when I was release from hosp continuous use till 89
Given PROZAC by a specialist to help with nerve pain in my leg 89-90 not sure which year
Was not told a thing about it being a psych med thought it was a pain killer no info about psych side effects I went nuts had hallucinations. As I had a head injury and was diagnosed with a concussion in 85 I was sent to a head injury clinic in 1990 five years after the accident. I don't think they knew I had been on prozac I did not think it a big deal and never did finish the bottle of pills. I had tests of course lots of them. Was put into a pain clinic and given amitriptyline which stopped the withdrawal but had many side effects. But I could sleep something I had not done in a very long time the pain lessened. My mother got cancer in 94 they switched my meds to Zoloft to help deal with this pressure as I was her main care giver she died in 96. I stopped zoloft in 96 had withdrawal was put on paxil went nutty quit it ct put on resperidol quit it ct had withdrawal was put on Effexor... 2years later celexa was added 20mg then increased to 40mg huge personality change went wild. Did too fast taper off Celexa 05 as I felt unwell for a long time prior... quit Effexor 150mg ct 07 found ****** 8 months into withdrawal learned some things was banned from there in 08 have kept learning since. there is really not enough room here to put my history but I have a lot of opinions about a lot of things especially any of the drugs mentioned above.
One thing I would like to add here is this tidbit ALL OPIATES INCREASE SEROTONIN it is not a huge jump to being in chronic pain to being put on an ssri/snri and opiates will affect your antidepressants and your thinking.

As I do not update much I will put my quit date Nov. 17 2007 I quit Effexor cold turkey. 

http://survivingantidepressants.org/index.php?/topic/1096-introducing-myself-btdt/

There is a crack in everything ..That's how the light gets in :)

Link to comment
Share on other sites

 Share

×
×
  • Create New...

Important Information

Terms of Use Privacy Policy