June 03, 2008Low Sex Drive, Other Behavioral "Flaws" Targeted By Big PharmaIt's been interesting and sometimes jaw-dropping over the last few years to watch how fully various "behavioral health" medications--by which I mean psych meds--have been repurposed for everything from shyness to low libido to public speaking anxiety. There's a nice rundown in the Independent (UK) on just how far the reach has spanned. Two examples: Topamax used to treat gambling addiction and Luvox, an SSRI, to treat compulsive shopping. And who could forget Seroquel--an antipsychotic, for crying out loud--to treat public speaking anxiety? If anyone can show me where public speaking anxiety is a psychotic disorder, I'll eat my hat. Refreshingly, some in mental health circles in the UK are beginning to criticize this trend. "But critics argue that some of these treatments amount to medicalisation of individual differences and traits. Unlike physiological diseases such as cancer, behaviour disorders are a grey area, with no clear boundary between normality and illness. While there is no doubt that people at the extreme end do need treatment, others who may have symptoms may not." The most interesting critiques pop up when it comes to the press in the mental health world to treat issues around sex drive, especially among women. "One of the major areas for trials of new drugs is sexual problems. Reports have suggested that one in three women have low sex drive--and one drug trial has involved women whose symptoms include failure to achieve orgasm in half of their sexual encounters. I don't even pretend to know what would be considered a "normal" sex drive, and that's what worries me some about all of this: how the hell do researchers know what's normal? I mean, if someone has some issues in this area which they desire to address, then by all means have at it. But to pretend that there's not so much individual human variation in the physical and psychological manifestations of desire that it slaps down any objective standard of normal does strike me as dehumanizing somehow. It's interesting too that women seem to be the major focus of the pharma companies on this front. I'm sure their interest is altruistic. Trials cited by the paper include Wellbutrin for "female orgasmic disorder" and flibanserin, a anti-depressant that's never made it to market, for low sex drive. And on it goes: naltrexone for porn addiction, Lexapro for alleged Internet addiction, Deapkote for intermittent explosive disorder (one of the most BS terms I've ever heard). So let's assume for a minute that the researchers and the pharma companies know exactly what they are doing here: there are behavioral norms for every human impulse and wrinkle of feeling, and psych meds are the answer. Let's assume we all get medicated as a culture to address all of these alleged flaws. Will we be any happier? Will our lives be more full? And, would anyone trust these researchers and pharma companies, given how well their treatments for depression, ADHD, bipolar disorder and social anxiety are working out? Posted by Philip Dawdy at June 3, 2008 09:57 AM
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Just when I thought I couldn't be any more stunned regarding the reckless prescribing of psych meds, I am proven wrong. As one whose mom died last month, this exert on medicine for bereavement has left me speechless: "An eight-week drug treatment for newly bereaved people is about to start a clinical trial. Researchers carrying out the trial hope that at least half of those taking part, all of whom must have lost a first-degree relative, will show improvement after taking the drug, duloxetine. One of the aims is to assess the effect of treatment in patients with bereavement-associated depression. A second is to look at its effects on health status, pain and other symptoms. "We expect substantial reductions in measures of grief and bereavement, with improvements in measures of pain, symptom burden and functional status,'' according to researchers at Cooper Green Mercy Hospital and the Jefferson Clinic in the US." I don't even know what to say except my previous statement of professionals wanting to medicalise human condition under this sun seems accurate. To be honest, I thought perhaps I was overreacting but now, I realize I am not. Can you imagine what will happen to that poor person being medicated for grief who for some reason has to come off of a med and finds they never truly processed it since meds suppress all feelings? That thought is sending shivers up my spine as that is so cruel to do a person. Excuse my inflammatory rhetoric but any professional advocating this should burn in h-ll. AA Posted by: AA at June 3, 2008 11:18 AMI agree with AA that medicating grief is one of the great outrages occurring in our time. It is a travesty -- a clinical trial for bereavement -- that really takes the cake. There's even an expression bandied around the medical profession to justify this called "abnormal grief" -- makes my blood boil -- as if anyone has the right to say what is normal and abnormal in the response to the loss of a loved one. Posted by: Sara at June 3, 2008 01:44 PMWhen my Dad died in a horrific airplane crash in January I was intent on not medicating my real life grief and emotions, and have been tapering meds ever since with my psychiatrist completely onboard with it;acknowledging my grief for what it is. I've grieved on LESS medication and am better off for it, because it is what life is all about. (medicalizing emotions is just not my choice right now). Posted by: Stephany at June 3, 2008 06:20 PMWe have treatments for erectile dysfunction. Viagra et al. are prescribed for and quite effective for erectile dysfunction with psychogenic origin. Why should we be resistant to medication for female anorgasmia? It seems like it negatively affects one's life in a similar way. Similarly, compulsive gambling definitely has a negative impact on people's quality of life. A compulsive gambler can easily squander the family savings, leading to some major issues for all involved. I find it hard to justify that people with incapacitating addictions to harmful behavior shouldn't be allowed to try medication. I agree that Seroquel for anxiety associated with public speaking is a silly idea, but some cases might still call for Ativan, which has relatively minor and predictable side effects. Psychiatric medication exists to improve quality of life. I agree that other options deserve to be tried first, as they would likely be as effective or more effective and less dangerous. However, when someone's life is seriously adversely affected by some condition that these meds can medicate, I don't see any harm in trying. Posted by: Simon at June 3, 2008 09:47 PMinteresting simon. i'm guessing you have either not had a med go south on you, or you are one of those nuero jocks, or you are like 15 years old. which is it? Posted by: Harry Callahan at June 3, 2008 10:17 PMSimon, You're going to getting an earful I imagine. However, there is always great risk when just "trying" any sort of psychotropic. There's no way to predict how you will react to it and they all carry potentially deadly side effects. The risk of dependency is very high, especially with benzos like Ativan. I think medication can be useful for acute episodes as long as their use is tightly controlled and very carefully monitored. This is unlikely to be the case when one is prescribed such drugs, however. Psychotropics should be treated and handled like plutonium, imho. Posted by: Paul at June 4, 2008 08:42 AMI completely agree that these psychiatric disorders and drugs are bogus. There are no actual MEDICAL tests to prove any of these "behavioral disorders". Everyone is different. We all have different ways of acting. Yes, some people can become destructive to their environment and these people do need proper help. But the point is, PROPER help, not a psychiatrist spending 5 - 15 minutes with him or her to just prescribe some drugs, without actually finding out what is wrong with the person and handling that. These medications also have legitimate uses that can give people their lives back. I appreciate the knee jerk outrage these study proposals generate and the comments they prompt, but please don't speak for the rest of us. Posted by: cairn at June 4, 2008 10:33 AMwhen psych medications are approved for use in such a specific way i think two things have gone down. first, the drug is seen as a treatment for one aspect of a person's charachter and not a normalization of an insane person;it is used to make a person normal-er (if you will). second, it significantly blurs the line between prescription and street drugs as both taken to alter moods. Psych drugs purport to improve quality of life, but then so do drugs in general. As this applies to women, psychiatric drugs have a long history of being marketed as cures to treat very specific "women's conditions". Conditions which are used by doctors to label women deviants. and this deviance is profitable too. www.bonkersinstitute.org has a page of vintage psych drug ads that is quite amazing. A salad of drugs being sold: Dexedrine for menstrual dysfunction,Thorazine for menopausal symptoms, Valium for psychoneurotic states, stelazine (an antipsychotic) for nervousness etc. . . knee jerk? cairn, no disrespect to your life, experiences, etc., but there is a whole bunch of us who are tired of people like you speaking for us. sorry, but the evidence is pretty good at this point that these treatments don't work very well and that they carry a host of potential problems for those who take them. yes there's a lucky few who benefit from them dramatically, but don't even pretend to think that approaches commonality in patient experiences. Posted by: Philip Dawdy at June 4, 2008 11:03 AM"yes there's a lucky few who benefit from them dramatically, but don't even pretend to think that approaches commonality in patient experiences." The issue isn't commonality in experiences. And it's by far more than a lucky "few" who benefit from them in absolute numbers. That's what you forget. The medications are being pushed so broadly and ineffectively that the proportion of people helped is driven down, but it's not a small number. I'm not talking about commonality, I'm talking about people's lives being saved. And yes it's knee jerk. Don't speak for us because of personal bitterness on your part. Posted by: cairn at June 4, 2008 12:30 PMoh please cairn, where is your data to establish that it's more than a lucky few? can you show me any data showing an effect size of great than 30 percent in anti-depressant use? i doubt it, except for a few stray studies ginned up by pharma companies. i am not speaking for you or trying to. so don't let your better experience try to overrule my frustration. stop being an elitist. respect diversity. Posted by: Philip Dawdy at June 4, 2008 12:50 PMShow me a person who believes their life has been saved and I'm sorry to say you will be showing me someone who is an accidental addict and doesn't even realize it. Whatever benefit addiction by prescription (and that really is what we're talking about here) has over a certain window of time I can assure you it doesn't last and comes with severe downside problems over time. Posted by: Sara at June 4, 2008 01:32 PMwell i'm speaking for myself here, and meds have done nothing but cause me problems. using them and finding out i felt better off of them. i'm not sure who cairn considers "us", but it isn't me cairn is speaking for! Posted by: Stephany at June 4, 2008 02:34 PMI would say the same, Phil. Call it ten percent of people put on antidepressants that respond well. Make it five, even. And one in ten people take antidepressants. That makes about 1.5 million people in the United States who gain significant relief from an antidepressant. I agree it is a scandal how these medications are being pushed onto so many more people who don't respond or suffer terrible side effects, but that does not make the one or two million people who have a life again because of these medications inconsequent. Untreated bipolar depression alone has a completed suicide rate of between 10 and 20 percent according to Jamison. This is a higher mortality rate than some cancers. And yet no one would deny effective treatment to cancer patients even though the treatment would have unacceptably severe side effects to those without cancer. It's a patient's personal choice, balancing side effects and potential benefits. You're implying the medications are the problem when it is their marketing. Don't blame the medications. They save lives. It's their administration that is the problem. Posted by: cairn at June 5, 2008 05:19 AMPersonally I do not regard Jamison as a person of status to quote here she has no more authority on stats than the medical journals. One person is stating that millions of lives are saved? blame it on the marketing? How about the Paxil babies born with holes in their hearts? Considering the lawsuits involved with these drugs, I dare say millions of lives have been lost/injured or permanently disabled as a result of using these drugs. Regardless of personal choices to use them or not, a broad defense "They save lives" is absurd cairn. Posted by: Stephany at June 5, 2008 10:49 AMRight, Stephany, I wouldn't trust drugged up Jamison on statistics either and 10-20 percent completed suicide in "untreated" bipolar sounds preposterous. For one thing, once someone gets labeled "bipolar" how often do they go "untreated" -- how do you even find "untreated" "bipolar" patients? I wonder if "untreated" really means temporarily untreated, as in withdrawal. Now I can believe suicide rates in withdrawal are high and if that gets labeled "untreated" then it skews those numbers a lot and misrepresents the real situation. Medication on its own and over the long term rarely, if ever, "saves lives." To believe this is to be naive. Posted by: Sara at June 5, 2008 12:13 PMWell, I guess we'll leave it at psychiatric medications help no one and harm everyone. And all psychiatrists, pharmaceutical companies and patients who claim otherwise are lying or wrong. Gee. Everything is so much simpler now. What I fool I've been. Posted by: cairn at June 5, 2008 03:59 PMAnd one in ten people take antidepressants. That makes about 1.5 million people in the United States who gain significant relief from an antidepressant. cairn, It's a patient's personal choice, balancing side effects and potential benefits I totally agree with you. "-If you take ........... you will have the following benefits: ..................... ." Please fill in the blanks for us and give us all the data available so that we can also benefit and make our choices. The National Institute of Mental Health (NIMH) estimates that 18.8 million Americans—12.4 million women and 6.4 million men—suffer from a depressive illness every year cairn, What do you think about the 1 million people worldwide that receive ECT every year? What about mild depression and clinical depression? Please I hope you can give more detail about these 1.5 million. We need this to help people that are depressed and in search for treatment. In all directions of antidepressants there's one side effect that is appalling, ironic, funny or sad according to the personality or mood of every person: -depression LOL Posted by: Ana at June 6, 2008 06:11 AMDon't speak for us because of personal bitterness on your part. cairn, Please, answer my questions for I have others! It's all here: http://www.socialaudit.org.uk/download.htm This is one of inumerous of Charles Medawar work on antidepressants. There's a lot of good data and some of his statements only now are being "revealed". Excerpts (70 pages - .doc version) Fluoxetine was launched in 1988/89. Prozac became a buy-word and the main driving force behind the huge expansion of the depression market. Here is a drug immortalised by Woody Allen (as Valium was before it) and the subject of overwhelming volumes of airtime and webspace, and countless miles of print. Ten popular books with "Prozac" in the title have been referred to in this paper, but there are at least twice that number, in English alone. (Baker & Taylor, 1996) Along with fluoxetine there are now several other SSRIs and related drugs and the value of the world market (1997) is about £3bn a year. The table shows how Prozac and the others have, in the last five years, secured a 50% increase in the England market. (Department of Health, 1991-1995) The SSRIs have yet not significantly eroded prescribing levels for other antidepressants (as they now have in the US); the whole market dramatically expanded once they arrived on the scene. Diagnostic & Statistical Manual let's see what DSM-5 will bring:) The way in which depression is now formally defined has expanded the market also by effectively undermining a major instrument of regulatory control. When drugs are licensed, by law they can be promoted only for quite strictly defined indications - but as antidepressants have typically been indicated "for the treatment of symptoms of depressive disease", DSM-IV provides scope for great over-simplification. This is exemplified in the following, the complete text of a full-page advertisement for the leading SSRI: (Lilly, 1993) "First line ... for all nine symptoms of depression - Depressed mood Drug/Usual dose Cost
It seems to me that there is a drug of some sort to "cure" just about anything. However, the fact that the medical community is a business, just like any other, makes me leery. This is not an altruistic world where companies are producing things just to help people. Drugs are synthesized, then tested to see if there is a marketable aspect to them. Even if you are a single person in the field with genuine motives, the only way to get funding for research is to promise that it will turn up something profitable. Even the doctors prescribing these medications are given incentives by pharmaceutical companies to push their product. So where is the good of mankind in any of that? And how much of the positive effects people report are simply psychosomatic? I also want to know why there is so little research done on natural ways to cure, why my doctor can't prescribe some 5-HTP for my mild depression. Something that isn't going to hurt my Kidneys, Liver or Stomach. I mean, anyone else read the "possible side-effects on some of the medications going out? It seems like most of them do more harm than good. Cases, like my father, in which the patient is on one medication for their heart, another to counter-act the affects of the heart medication on the liver, then another to counteract the affect of the one trying to help the liver while destroying the stomach lining and so on and so forth, until they are taking upwards of 10 medications a day just because the have heart problems. Doesn't that seem absurd? Posted by: Carina at June 12, 2008 11:09 AMI also want to know why there is so little research done on natural ways to cure, why my doctor can't prescribe some 5-HTP for my mild depression. Carina, The the good of mankind is here fighting hard not to let other people be on these drugs. I see a lot of good here. I trust human kind! Posted by: Ana at June 12, 2008 01:53 PMAmazing, reading these comments, I feel that blogs can be such incredible echo chambers, but I also feel compelled to respond, since people like me probably don't. I am one of those people successfully being treated for depression. I have been on medication for it for over 10 years. It did not change my personality, nor does the medication itself make me happy -- all it does is give me a bit of room to gain perspective on how I feel and thus grow as a person. I do think medications are over-prescribed, but at least for someone with severe depression, medication can be a life saver, and its effects are very real. Posted by: laur at June 12, 2008 03:51 PMlaur, Lucky you! laur wrote: That's great, laur. And I like your bit at the end, "all it does is give me a bit of room to gain perspective on how I feel and thus grow as a person." For twenties after coming out of a crash I was pretty much on my own in terms of real support and had little good to say about the talk therapy side of things. Two years ago after a month's stay in the hospital I was discharged and connected with a community clinic for follow up. The therapist I was assigned to turned out to make in involuntary stay worth while. We really connected and our weekly meetings are productive. It changed my whole attitude towards therapy in conjunction with appropriate medication. I hope things remain well for you. It's a long road, isn't it? Posted by: cairn at June 13, 2008 07:15 AMCan someone please tell me if valium 10 mg in men can take away their sex drive and is it common for a man wanting to sleep more nights that not The person I am with is on 10 mg. I don't know if it's per day or not but I know it's been for over 10 years. First the grief when he was 13 years old of his mother .... then coming off of drug abuse 10 years ago.. Help And if so how does one get it back. Post a comment
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