Serotonin Syndrome? It's In The Times

It's taken me a long time to get my brain around the serotonin syndrome business. Not because I didn't believe it was possible, but because I really hadn't had time to look into it journalistically and one of my psych sources told me that the whole thing was a bunch of whoeey. It's whooey no more.

There is a good article on it in today's New York Times, penned by Jane Brody, a longtime health reporter at the paper who has been very kind to SSRIs over the years. I am pleased by the increasing skepticism that I am seeing from da' paper of record on where we stand in terms of the outcomes of the psychopharmacological revolution. I wish the rest of the media would get off its lazy duffs and start doing some reporting on these matters.

Here's a little tale of my own evolution as a journalist on these matters. From about 1999 to 2004, anything I wrote about mental illness, which was little at that point, operated on the journalistic consensus that, gosh darn, meds are always good, people just need to take them for the rest of their lives, so we just need to make systems of care more affordable, people need to get diagnosed, we just need to stick with the evidence base, and "the stigma" must be eliminated. That'll fix everything. I thought this in a professional manner even though my own outcomes as a patient on three different meds was poor (and that should've told me something) because, as someone who wrote for the general public, I worried about scaring people off their meds and didn't want to be perceived as a loon by readers. (You just don't want the angry phone calls from readers and sources telling you that you are way off-base for saying that SSRIs suck.) Speaking a different truth into a full-blown consensus coming from the other direction is a very difficult thing to do as a reporter and it's even harder for editors to let you do so.

But, in 2004 in an article where I wrote about the suicide of Cynthia Doyon, I took a little swing at the prevailing orthodoxy:

"My doctors would prefer that I take some hard-core meds as a preventative measure against future bouts of depression and mania. But I've been down that path before, with mixed results. In 15 years of downing psychotropic meds, they've never held off depression or mania for more than nine months. So what's my incentive to take the most potent of psychiatric medications--the risperdals, zyprexas, and various selective serotonin reuptake inhibitors (SSRIs--Prozac and its progeny) that psychiatrists push? Those pills are like neutron bombs: You're still standing, but your feelings and healthy range of emotional response to the world are dead. No, thank you."

That was it--one little graf in a 5,000-word article. Let's just say I heard from people over it. Later that year, however, I did a lot of reporting on the fates of schizophrenics in the public mental health system around Seattle. I kept running into patient after patient who took high doses of atypicals, but, contrary to the side-effect-free-and-more-efficacious hype, were showing obvious signs of EPS and tardive dyskinesia. This isn't supposed to be going on, I thought, and it made me press some more over the next year. Professionals denied to my face that these effects were present yet they obviously were. When I asked why patients were still seeing "breakthrough" symptoms if the atypicals were so good, I was met with cold stares. And, then, the CATIE study came out, pretty much confirming everything I'd picked up on.

I wish some others in the media would start taking a hard look at where we are these days. They would be surprised.