Those 2 posts on the Carlat blog are excellent, I couldn't link to that Dr. Rep article fast enough! Outstanding discussion coming from a psychiatrist.

Where medication compliance is esteemed and medication is the only treatment so many can access, are there truly any antidepressants or antipsychotics prescribed for the short-term? They are tested in the short-term but too often prescribed for the long-term absent alternatives to medication.

Not sure if someone has already posted this article from the 11/18/07 issue of the St. Petersburg Times on the use of atypicals in the elderly:

http://www.sptimes.com/2007/11/18/Worldandnation/Dementia_relief__with.shtml

The article mentions Neurontin as being unhelpful for BP. What's been any one's experience with Neurontin (for any condition)?

I have taken it on several different occassions over the years and it made me very uncoorinated and dizzy to the point I was unable to stand on my own two feet!!!

That is a wonderful, wonderful article. I think it is far too easy to get caught up in believing drug reps are morally bankrupt people. The second you believe people like drug reps are inherently amoral people, you lose sight of the nuances of the situation and you yourself become vulnerable to that kind of blindness.

It is also easy to fall into the conspiracy theorist camp that way, if you believe all drug reps sit around in underground grottos, stroke overfed cats, and scheme ways to ruin people's lives.

I do wish that Dr. Carlat had written about 'Homicidal Ideation" being an adverse reaction to Effexor. This side effect is listed on page 36 of the insert and is also in the PDR.

I think for a prescription drug to cause ideas of homicide is unjustifiable. [Refer to the 93 cases for Effexor listed in the Index at www.ssristories.com.]

I liked the article generally, but I disliked its author who violated one of the three basic principles of medical ethics, that of undivided loyalty to his patients (the other two principles being competence and compassionate). I also visited his website at which he sells his newsletter for $120 a year and read the November 2007 issue in full, in which, among other things, he discusses various augmentation agents to the SSRIs, such as Welbutrin, Remeron, Ritalin, Provigil, among others. His review of the augmentation medicines was shallow, based on my personal experience as a patient and medical researcher. I think that he "whored" (I don't know of a better word describing what he did) for Wyeth's Effexor because he wasn't a good doctor to begin with and had few patients. He said in his article that he made $140,000 a year from his practice (aside from the $30,000 he made from Wyeth). I believe that psychiatrists typically make significantly more than $140,000 a year.

I wish that Phil had used this article as a springboard to discuss the general incompetence, carelessness, and arrogance of psychiatrists who prescribe us atypicals and other bad psychiatric drugs without hesitation, rather than focus, as he does now, on the badness of the pharmaceutical companies in producing atypicals. After all, it's not guns who kill, it's people with guns who kill.

Carlat has a disclaimer on his site that he receives money for his newsletter, and it also says he is a practicing psychiatrist. That's pretty honest, as we know he rx's meds if he is a psychiatrist. Exposing the industry that pays his bills takes guts, and frankly I always wonder what his collegues think of him telling it like it is--I for one appreciate the guts it took to admit he was an Effexor pusher. Also glad he wrote Thase into that piece---google that guy.

The best part of this is the exposure. Who really ever knew about CME or pharma reps teaching doctors about medications to use? He wrote another letter back in June that discusses conflict of interest. I think both letters are what Americans need to see--if we want to be savvy consumers, this is a start.

No, Stephanie, it was he who exposed the industry; there was a prior article about it written by a former drug rep who exposed the industry, "Following the Script: How Drug Reps Make Friends and Influence Doctors" by Adriane Fugh-Berman and Shahram Ahari.

Here's the link:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040150

I was generally speaking regarding "exposure" meaning media exposure for the general public who may not know pharma reps/CME even exist.

I am pleased that Dr. Carlat has finally seen the light, but I think his piece highlights how insular the psychiatry profession was during the last decade. At the time Carlat was making his rounds there was plenty of information out there pointing to the problems with these drugs and to the problematic ethics of the relationship between doctors and the pharm companies. He provides a great example of how gullible and malleable the profession is. It seems that neither he nor his colleagues were exposed to any form of critical thinking about the nature of the profession. It always surprises me when you get into a discussion with psychiatrist and discover how little exposure they have had to the primary literature and to the critics of the literature. About four years ago I was scheduled to give a lecture in a class to medical students on the relationship of the SSRIs to suicide. The course director cancelled the talk and said that the information was "dangerous" - because the students might not write as many prescriptions when they entered practice. The students persisted and I ended up giving the talk as a seminar. At the time, I imagine that the course director would have welcomed Dr. Carlat to come and speak. The silver lining in all this is that the coming generation of doctors is much more aware of these issues and is less likely to be duped.