Let me get this straight: the human race (at least in societies wealthy enough to PAY for medications) has somehow become so weakened (and in a rather short time, too) that we're unable to work our way through the normal losses of the cycle of life on this planet.

Gosh.

We're going to look pretty damned silly 100 years from now.

you might want to read the article in this week's Newsweek magazine that interviews Dr Salzman, who makes a very outrageous statement near the end regarding the risks about being on antidepressants for years.

Some of my colleagues are beyond clueless. You read it and decide for yourselves.

I've read your comments and scanned Pies' article. Thought provoking stuff. I'll comment later in more detail, but initially it seems to me that Bruce Levine's recent Huffington Post piece seems the perfect counter to Pies, and since Levine's piece came out before and he does have enough clout to get the attention of the likes of Pies, perhaps Pies' piece is a response.

Here's the link to Levine's excellent piece:

http://www.huffingtonpost.com/bruce-e-levine/thinking-critically-about_b_125019.html

Maybe that article, which I also noted in the Times, represents a new "line of attack" on behalf of antidepressants....blur the lines but basically keep up the parade for antidepressants.

Sadness and sorrow remind me of the old James Taylor song; a line of which goes "Oh, I've seen sorrow; I've seen pain; I've seen sunny days I thought would never end." Despite ongoing and understandable sadness, I would not take an SSRI if you paid me. In fact I am off almost all drugs. The mere thought of them makes me gag. Supplements, yes.

Who is this man trying to win over? Have sales fallen again? Does he mention homicide and suicide as caused by these drugs? Talk about sorrow and pain....

Among other things, Pies discusses the difference in normal bereavement and clinical depression. He ends the article by stating that "until solid research persuades me otherwise, I will most likely see people like my jilted patient as clinically depressed, not just "normally sad" - and I will provide him with whatever psychiatric treatment he needs to feel better." Pies writes about "normal sadness," his quotes not mine, as if it's a simple, painless experience. This is one place his article goes wrong. Normal humans in the course of our normal human lives generally experience a full range of emotions. Mourning the loss of a loved one, or in the case I quote, the jilting of a fiancé, is horribly painful. Emotional pain is a part of life, a part of growing up if you will. Adolescence is supposed to be painful, not just a little uncomfortable but painful. One issue noted by anyone who knows anything about addiction is that people who begin using drugs in their child or teen years are shielded from the normal painful emotional experiences that cause them to grow into adults. Medicating irritability will not lead to saner adults but instead to giant drug dependent children.
The problem isn’t so much that he’s prescribing a pill for bereavement but that he’s telling the patient he is abnormal and mentally ill for being sad. There are all sorts of normal parts of life that medicine has helped ameliorate. For example, dying in childbirth used to be much more common than it is today, to the point that dying in childbirth was not at all abnormal. Now, at least for those who can afford it, dying in childbirth is rare, but to say that pregnancy is a disease that must be treated as a way to justify prenatal care and anesthesia, etc. in the birthing process to justify these valid medical treatments is absurd and unnecessary. Similarly, severe emotional pain upon the loss of a loved one or any other tragic situation or trauma, are unfortunately normal parts of life. This doesn’t mean we can’t used medical science to reduce suffering but it does mean it is profoundly harmful and dishonest to pretend like we’re treating diseases, to tell the sufferer, “cheer up, you’re too sad about your child’s death. Other people wouldn’t be so sad but there’s something wrong with your brain that makes you so and we’ve got a pill to fix it,” particularly when the prescription pills often don’t work or have side effects that make taking them to solve emotional problems often more dangerous than the suffering they are supposed to prevent.
But what if you don't have time to mourn? In today's society, if you are unhappy and need to take some time away from work, you'll lose your job. Our society has no respect for "normal sadness." I agree with Levine that the problems we are facing are societal not individual, but like all societal problems these are experienced by individuals.
Still, if a person is so heartbroken that he or she can't return to work the day after her or his loved one's funeral, and perhaps it seems might need a month or two off of work, then is it wrong for a doctor to give her or him a pill so that s/he can pop right back up as if nothing ever happened, go back to work, and thus keep up the house payments and keep food on the table?
Not necessarily, but the major problem with this tactic is that pills don't work. When antidepressants do work, which research indicates is slightly less than placebos, it's because they are accompanied by the empathy and support of actual humans, thus the widow whose doctor says to her, "I'm so sorry for your loss. I want to prescribe something that will help you meet all of the obligations you still have in this time of sadness, but you are not crazy, never feel guilty bad or genetically flawed for mourning your spouse," and then goes home to friends who call to express their sympathy and bring casseroles, will get better because she is caring for herself and being cared for by others. It's the support system not the drug that heals.
On the other hand, if someone loses a spouse has no close family or friends, no family doctor that knows the family and genuinely cares, the pills probably won't work because it was never just the pill, but still the pills might "help" because the pills dull emotions and like they interfere with sexual function, interfere with other bodily expressions of feelings, like crying. So the disconnected person, told that the death of a loved one has triggered a genetic brain defect and that "normal" people wouldn't be so unhappy over the loss of a loved one can at least keep her job because the drug will probably interfere with the physical effects of mourning like tearfulness and insomnia, and partly because of the placebo effect, partly because a doctor who prescribes an anti depressant will likely also prescribe a benzo and those do "help with sleep." If the doctor presented the drugs as a cure for normal suffering, I’d be okay with that, provided of course they gave provided the patient with real warnings about the increased risk of suicide, violence against others, permanent brain damage and addiction, but this is never done. If it was, we wouldn’t see so many people taking antidepressants.
Pies writes: “if modern diagnostic criteria were converting mere sadness into clinical depression, we would expect the number of new cases of depression to be skyrocketing compared with rates in a period like the 1950s to the 1970s. But several new studies in the United States and Canada find that the incidence of serious depression has held relatively steady in recent decades.” Here Pies is mistaken. As we all know post - modern diagnostic criteria have created new classifications for what in the 20 year period Pies mentions would previously have been labeled depression. Now a large majority of people that would have previously been labeled depressed are being labeled as bipolar, ocd, adhd, dysthemic, generalized anxiety and social anxiety disordered. So in fact, the fact that in spite of all of this, with the supposed miracle drugs on the market that Pies is defending, the fact that the numbers of people who are labeled has seriously depressed has not significantly decreased is a huge indicator that Pies is dead wrong, though I have no reason to assume his vague reference to numbers is correct. The primary problem with his thesis for me is that he devalues normal grief, labeling it as something that is neither painful nor of any value nor deserving of sympathy or special treatment. We need compassion not psych labels.

In response to Sally, I agree. I would like to point out that pregnancy is often treated as a disease, at least in as much as there is a franticness on the part of mainstream doctors and midwives to get the baby out of you as quickly as possible, and to do whatever would look good in a court case should something terrible happen, in other words, over-intervening in bodily functions. I saw a silly comedy years ago called "Nine months," and there was a seemingly peripheral point in the movie in which the main actor is hit on the head with a flying frisbee, says "ow," upon which the actor who threw the frisbee tackles the one he hit and proceeds to do all sorts of things to him in order to "help" him, like socking him to "revive" him, attempting to do CPR, etc. He then demands the poor guy's reassurance that he will not sue him because he was responsible enough to do all of those things to him. This metaphor seems to state the point that there are risks in any sort of intervention. I also remembered my CPR class in which they stressed the importance of always making absolutely sure a person's heart has actually stopped before trying to start it manually, because it can kill a person if this mistake is made.

TF,



Thanks for the tip about the Newseek article by Dr. Salzman. For those of you who haven't read the article, this is what TF is referring to:

http://www.newsweek.com/id/158447



What is the toll on the brain of taking psychoactive medications for 15 years or more? Can this contribute to permanent physical brain damage?
When psychiatric medications are taken as directed by a physician, there are no long-lasting harmful effects on the brain. In fact, it is clear that some medications, such as antidepressants, may actually be helpful for the parts of the brain that regulate emotions.

I intend to comment once I am finished with this post as one who suffered the damage that this doctor says I don't have.

Anyway, back on topic - Unfortunately, I became an amateur expert on grief, having lost my mother this year. I fear that being on psych meds is causing an abnormal grief reaction such as not truly mourning the loss. I wonder if once I am completely off of them which won't be for another few years due to my slow tapering if I will have a delayed reaction. I may not but I do wonder.



I think my point is that these meds that Dr. Pies thinks are so wonderful in helping with grief actually hinder the process and in the long run do alot more damage.

Hurricane Ike hit the Gulf Coast on Saturday. It wasn't a day or two later before the local news interviewed a psychiatrist who was busy telling everyone how they're suppose to be feeling & reacting to this crisis. I just wanted wanted to say to this guy, "Go away." This just happened we don't need mental health experts on tv telling people how they're suppose to be coping with this, what's normal and what's not. It's infuriating.

Is it too much to ask that they give us time to sweep up the glass & get the tree off the roof before the psychiatrists appear on tv?

Lots of good comments here. I talked with a friend last night who was having some serious sadness, random crying jags, and anxiety, panic attacks, etc for the first time in his life. He talked to doctors but resisted medication. He went through 7 counselors before he found one that he clicked with and through honesty realized there was some hidden stuff he's been avoiding that took some time to come to the surface. He felt immediate relief from his sadness and anxiety once they touched on the issue. What would have happened if he'd been medicated?

Some comments here make me think about my own battles with sadness, dreadful thinking and medication and what alternatives there might be to pills which might just be covering up things or just plain sedating the life out of me.

I'm one of the people who would not be here, if not for anti-depressants, anti-psychotics and serious therapy. The problem, as I see it, is that they are too slow to work. If a person in physical pain was told that the pain reliever would take four to six weeks to work, there'd be a public outcry.

In the meantime, I'd like to invite you to a site that over-sees the whole big pharma issue, from drug tests to actual results. I found out about it by sheer chance, because I paint for a brilliant woman who's part of it:

http://www.circare.org/

These people really give a, well, you know. They've shut down clinical trials, or exposed them to the feds, globally. They most certainly deserve our attention, as well as appreciation for their committed mission.

My personal journey with grief the last 8 months started with me tapering down and removing medications when my Dad was killed in January. I did not want to have my emotions stunted, my goal was to allow the grief and the loss to be what it is. Grief. Medicalizing of emotions is not healthy. Short term PRNs for when necessary, but for the long haul, I'd rather feel it and go on w my life than have it come back later as unresolved.

I've done better on less meds, and I've had a lot of "big ticket" life situations happen to me this year, and I'm doing well and glad I didn't take my psychiatrists offer of Lexapro. (I wasn't entertaining the idea at all) But he listened to me carefully when I told him I didn't want to lose my emotions.

Life is full of grief and sadness, and it's how we learn to cope is what counts.

'Dr. Pies has received research funding from various pharmaceutical and related corporate entities; has received ad hoc stipends from Abbott, Janssen, GlaxoSmithKline, and other pharmaceutical or related corporate entities; and is a consultant for Apothecom Associates.'

Source: J Clin Psychiatry 2003;64:1284
http://www.psychiatrist.com/abstracts/abstracts.asp?abstract=200311/110301.htm

Thank you, thank you, thank you. I work with so many clients who have suffered a major loss (a child, a spouse of 20 years, etc.) and are put on antidepressants! They have no previous history of depression and no familial history of depression. They are simply grieving and are not allowed to do so. We seem to have forgotten that grief is a normal, human process. It is not a medical disorder that requires medication. Clients show up in my office concerned that their antidepressants are not working and feeling totally lost as to what to do and why they aren't happy. It's heartbreaking to see perfectly normal, healthy behavior "diagnosed" and "treated" as a disorder.

Thank you for another timely and relevant article.

"It's curious to me that defenders of anti-depressants keep returning to the example of post-stroke depression."
This comment caught my eye. Because of an original research study, a clinical trial, evaluating an antidepressant (surprise, surprise, one that is still under patent) that was recently (May 08) published by (surprise, surprise) JAMA.
Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, Fonzetti P, Hegel
M, Arndt S. Escitalopram and problem-solving therapy for prevention of poststroke depression:
a randomized controlled trial. JAMA. 2008 May 28;299(20):2391-400. PMID: 18505948.
I have started a blog abt the issue of meds vs. therapy for mainly mental health problems, but also other problems> In July, I posted an analysis of this article.
http://medsvstherapy.blogspot.com/2008/07/license-please-or-what-happened-to.html
In brief: three damning findings unreported, and unnoticed by JAMA peer reviewers: 1. the CRISP database notes that Citalopram was originally the drug under eval - why the change? well, escitalopram )a recently patented modification of recently-expired-patent citalopram)had not yet gone to market; 2. meds versus therapy: who were the "therapists"? One "therapist" has a bachelor's degree, and I can detect no further indication of professional qualification, and teh other has a master's degree, although this 2nd "therapist" shows up in no on-line records in Iowa as a licensed anything, although a long evident on-line history as a research coordinator at this university psychiatry research center; 3.
nortriptyline should have been reported as the third arm in this study, per CRISP, yet was not mentioned! Q. Why? A. (Again) Not under patent. I suspect that nortryptyline did about as well as Escitalopram or better, but this was ignored, i.e., unpublished. For a more thorough review, check my post on this article regarding of antidepressants for post-stroke.

We have become a society of people who measure life by how good we feel rather than how good we are doing. Feeling bad is a normal human experience and not a aberation of experience. My wife is bipolar and depression is a huge problem for her. However she is more than bipolar and has the same human experience that others have. One lady in the support group we have said, "Just for once I would like to get mad and people see it happens because I am human and not simply because I am bipolar." The same can be said about the experience of sadness. Many bipolar people I know are profoundly sad or profoundly angry at the bipolar and not because of it. Medicalizing experience tells you that you understand something just because you have a name to call it. It ain't so. The idea of "curing" human experience with medication that has a dazzling array of toxic side effects seems to me to be a naive delusion of someone who is not as smart as they think they are.
Larry Drain
www.hopeworkscommunity.com
www.hopeworksadvocacy.wordpress.com