Furious Seasons

February 18, 2008

Anti-Depressants, Kids And Society

I had dinner with an old friend of mine last night--and, yes, this little anecdote will have a point. She's a single mom and has a daughter of junior high school age who began acting oddly a little over a year ago--wouldn't go to school, wouldn't do her homework, sleeping in class, putting on the emo makeup and so on--and several officials in Seattle public schools pressed her to get her kid on anti-depressants. We're talking teachers and school counselors here, not MDs. The mom knew something was up with her kid and so did I, since the girl had become combative and all the other things that generally lead to some kind of psych dx. The problems were undeniable. And acutely annoying.

Back then, I told her mom to keep her daughter away from any and all meds, especially the anti-depressants. The mother took her daughter to a naturopath and she didn't diagnose the girl with anything (probably because this was a naturopath and not an MD), but she didn't exactly have any words of wisdom either.

I won't bore you with the whole story, but a year later the girl is fine, going to school, doing fairly well and so on (although with teens it's always provisional) and tonight my friend thanked me for telling her that anti-depressants were dicier drugs than she'd thought. Which was nice to hear.

Now to my point. When I began this site many moons ago, I had no idea that I'd be writing about anti-depressants as much as I have been. In 2005, I figured that the public knew about the problems with these drugs--and knew of their benefits as well--and that there was a treasure trove of information available to them on the Internet and that doctors had backed off of prescribing these drugs as aggressively as they were in the 1990s and that everyone was well aware that the pharma companies had played dirty tricks with the evidence for these drugs. I was wrong, at least based upon what I've been picking up from recent research, readers of this site and various media accounts.

Not only are doctors prescribing anti-depressants at near-record levels, but the public is just not getting the picture that the risks with these drugs are very, very real. What I thought was common knowledge is in fact still known to a relative few. I think a lot of doctors don't know enough either about anti-depressants, especially their use in youths. I think everyone is still making the sweeping cultural assumption that these drugs are as wonderful as they were supposed to be circa-1990. Unfortunately, they are not.

There are, of course, a decent percentage of people who do benefit from anti-depressants, who are literally biochemically snapped out of whatever depression or funk they were in before taking them. That maybe makes up 20 percent of the people who take the drugs, but for some reason they become the proxy for everyone else and their experiences have been carved into our cultural and medical mythology as being what everyone should expect.

I don't know what to do to combat that false picture, but I know that there is a lot of legitimate information about these meds on the Net and that on sites like Paxil Progress people can sort through a very extensive database of experiences good and bad with these drugs. I hope regular people start asking some skeptical questions when faced with the choice of anti-depressant use and find a way to access the information that's online.

That said, I think the media needs to do a better job as well, although they are light years ahead of where they were a decade ago. I say this because various reports of the Northern Illinois University shooter's background indicate that he was on anti-depressants until recently and it's clear that the media has been interviewing sources with direct knowledge of what he was taking. The trouble is no one has yet reported what specific anti-depressant he was taking and after watching CNN's interview with the shooter's ex-girlfriend, I am convinced it's because the reporters aren't asking the right question.

They need to ask what specific drug or drugs he was taking, and what specific diagnosis he had. Not all anti-depressants are created equally and if the shooter did have a diagnosis of bipolar disorder or schizophrenia, as some of my sources suspect, then someone with either of those diagnoses who was simply taking an anti-depressant was playing with fire, regardless of how well he was using the drug or how badly he was misusing it.

I hope we can get further answers.

I suspect, too, that one of these days my friend's daughter will thank me when she gets older because, as it turned out, I happened to be dead right about something. Her problem was her environment. Her environment got straightened out and so, too, did the kid. Abnormal behavior and abnormal feeling of any stripe do happen in a social context--there is no ignoring that.

Which is a long of saying that I want to remind readers in the Seattle area that Charles Barber, a lecturer in psychiatry at Yale and author of Comfortably Numb, will be doing a reading at Elliott Bay Books at 7.30 p.m. this evening. Barber is a firm believer than social context needs to play a much larger role in how we approach, recognize and address mental illness in America. I know he's right and that's why I'll be at the reading.

Besides, Barber has recently been savaged by Peter Kramer and the New York Times' Judith Warner. He must be doing something right.

Posted by Philip Dawdy at February 18, 2008 02:06 AM

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Comments

Philip,

Perhaps the reason the reporters are not asking the right questions is because they are afraid to ask. Back in 1997 it was revealed in a speech that 40% of the reporters at the Washington Post were taking Prozac. Whether this was a true statistic or perhaps a statistic only given in jest has never been discovered but a reporter would be nervous about asking a question concerning a drug which they themselves are taking.

Also, the reporter might be asking the right question but the editor, fearful of the impact on the advertising renevue, might be refusing to publish the question and the answer.

Posted by: Rosie at February 18, 2008 06:21 AM

The other thing needs to be asked is "Was there a behind the scenes threat from a shrink if you quit taking this I'll involuntary commit you". Was he was being threaten, coerced or any way intimidated into doing something he didn't agree with? The old stand by's "Fear, Fraud and Force" do not leave a person in a "positive" mental state.

IF he was being bullied then he may be in that small group that gets antagonized and provoked until they violently lash out. Add any withdrawals into the mix and you'll start getting dangerous if not deadly outcomes.

People who self harm do it for/only to themselves. Instead of hurting other people. Their actions may hurt people around them emotionally. However Self Injurers burn, cut and physically harm only themselves. They turn more inward than outward. Using that coping technique as indicator for future violence risk is about as accurate as using "they went to a public school".

Lets not forget the shrinks labeled ear piercing and tattoos as self mutilations in the past. God forbid if gave himself a burn with a paper clip to decorate his skin. Any prior so called diagnoses can be just as false as all the so called "expert opinions" readers here have had dumped on them.

The difference of how he acted in group setting tells us nothing than he wasn't happy there because we all know every person running such things are the most wonderfully people in the world and everyone there loves them and is thankful for their greatness. /end sarcasms

There is no issue of the responsible party writing things up negatively because they just didn't like them and/or "teach them a lesson" about how bad they could be.

The reality is the people responsible for examining everything will be shrinks and shrinks don't admit they do harm and cause problems.

One must always remember to hold the white wall against patients and possible lawsuits. Doctors should not testify against doctors.

Posted by: forced name and email address is not real security at February 18, 2008 09:46 AM

Philip - You say, "That maybe makes up 20 percent of the people who take the drugs". Is this anecdotal, or is there a source you can refer me to? I'd love to bring it up w/ my pdoc if it's from a published study.

Posted by: Chloe at February 18, 2008 10:57 AM

chloe:

that figure is based on evidence and some guessing and estimating based upon my own interviews with loads of people who've been on these meds. direct your doc towards the star-d study (just search it on my site) and you'll see that of all the anti-deps the best remission figure they got was about 30 percent and the lowest was about 8 percent. most docs i know--and i mean the smart ones--tell me that anti-deps only work well about 30 percent of the time. the phenomenon i was poking at on that post wasn't just people who achieve remission but ppl who get that glowing, just back from the spa, prozac is so damn awesome look to them and who will talk most passionately about the drug being life saving and life changing. the 20 percent figure is a bit of a guess for that group, and i am just trying to be fair to the notion when i slam anti-deps that there is a significant minority of patients who do very very well on these drugs. but why their glowing experiences have become the standard for what others should expect is beyond me. either way i assume that not all of the 30 percent responders have that over the top reaction to the drugs so i downgraded the totally awesome responders to 20 percent. it's likely not a wholly accurate number but i imagine it's close.

btw, you might also want to mention to your doc that in the step-bd study that placebo beat anti-deps in treating bipolar depression. if your doc is not familiar with either step-bd or star-d, then they are at least one year behind in reading important clinical literature. that should tell you something.

so what of the 70 percent who don't get remission? roughly 20-40 percent get mixed results--sorta half remission with no relief if you know what i mean. i base that figure on an nimh internal planning document of a few years ago which gives one of the best overviews ever of where we are at with treating mood disorders. that number wouldn't be much different from what star-d reports either.

the remaining 30-40 percent simply get no relief from meds and probably not much from psychotherapy either. different terms are used to describe this group. refractory depression. non responders. untreatable depression. and so on.

those are kind of grim numbers given how positively these drugs are viewed in our culture and in particular by doctors. but they also happen to be the truth.

Posted by: Philip Dawdy at February 18, 2008 11:34 AM

Anecdotal story based on real life experience:

I had a horrific experience on and withdrawing Prozac.

My daughter has such adverse reactions to anti depressants[Zoloft,Luvox,Immipramine,Prozac][suicidal thinking/actions],that she wears a red "allergy" band in medical hospitals that says
"NO SSRI'S."

THAT should speak volumes. At least it does to me.

Posted by: Stephany at February 18, 2008 01:10 PM

Thanks for the info. I'm diagnosed bp, so we stay well clear of anti-deppresants of any flavor. I've got a good pdoc in the fact that when I start throwing around #s from what I've read online, she asks me where I get the #s from. She's very well read and is open to talking about what I've read. I appreciate you making the distinction of "totally awesome responders", because I think 20% is most generous in that case.

Posted by: Chloe at February 18, 2008 01:31 PM