Just for some clarification:

What exactly are the implications of Dr. Goodwin's lapse in ethical judgement?

That all the information that he discussed on his radio problem is false? That some of it is false? Other than probably overstating the case against suicidality and homicidality in antidepressants, what else is there? Is there enough to compromise his entire 10 year history on the radio program?

That all his research is suspect, and his status as a leading authority on bipolar disorder is shattered beyond repair? What research studies of his and textbook sections are suddenly falsified by his ethical lapse?

I guess my point is that unethical behaviour does not automatically falsify the unethical person's entire body of work. Rather, it places it UNDER SUSPICION and invites closer scrutiny, because one ethical lapse can lead to others, including falsifying data and committing fraud, but that is a SEPARATE ISSUE that must be demonstrated on its own terms.

Or am I wrong?

Thanks!

These two sordid affairs of Goodwin's are about par for the course for psychiatrists. I hate to be so pessimistic about shrinks but there are so few good shrinks in this world.

I don't know if this is because people go into psychiatry to try and figure out what is wrong with them or if, once they go into psychiatry, they don't really know what to do with their patients.

Psychiatrists are so deeply influenced by the new prescription drug culture. They are influenced, too, by Pharma and they also have to stay in line with their peers.

But we have to remember that it was psychiatrists who so readily grabbed on to the idea of eugenics [resulting in sterilizations] back in the 1920's and then lobotomies in the 1930's, and insulin shock in the 1940's, so there seems no end in sight.

I imagine the next 10 to 20 years will produce new drugs and new medical devices like brain implants [which is already happening] and the beat will go on.

Goodwin is just one in a long string of psychiatrists who are involved in sordid affairs. Now we have the Net and we have a place to air our grievances and we have wonderful Websites to turn to for information but will shirnks clean up their act. I don't know if that is possible.

Goodwin may have been thinking of inner city youth as another marketing opportunity for Pharma. Pretty sickening.

Dear Philip:

A racist and a drug pimp! This Goodwin should feel so proud of his illustrious accomplishments! When will psychiatry wake up and smell the coffee? Only when they are forced too, I'm afraid is the sad answer to this question!

Yours Truly,
Stan

On the McMan site someone called the Goodwin issue a "character assassination".

No, this is keeping the KOL's honest, and with high moral integrity in an industry that is about human health and safety. Did Goodwin take an Oath with that money?

"That all the information that he discussed on his radio problem is false? That some of it is false? Other than probably overstating the case against suicidality and homicidality in antidepressants, what else is there? Is there enough to compromise his entire 10 year history on the radio program?"

dguller,

Yes!

The radio show also perpetrated the myth that rebound (withdrawal and dependency effects) were actually relapse of a mood disorder. I can't tell you how many young women I am helping right now taper off antidepressants after being told by professionals that they would need to be "medicated for life" for the most ridiculous reasons. It makes my blood boil. They would be put on the drugs, feel better, circumstances would change and they would stop (with no good advice on how to do so) and go berserk. They'd go into the doctor and be told that this means they need to be "medicated for life." Something like this was going on on the radio show too. I remember screaming to myself as I was listening to it. This simply has to stop. It is crazy. People think their "serotonin levels are messed up" and that taking antidepressants is like taking vitamins that will somehow "correct" it. This is widespread and pervasive among antidepressant takers and it is not based on any evidence whatsoever. And Goodwin and his ilk perpetrate this all the time. They probably even believe it. It's outrageous.

Just the idea of a radio show on such a serious subject as mental health is something that is beyond my comprehension.
I'm deeply concerned with all of this.
It seems to me that in the last 20 years things got much more confused.
Diagnoses has been changed in such a confusing way that you can be diagnosed three different diseases if you consult three physicians and the use off-label of psych-drugs shows how things are far from being clear. The use of "drug cocktails" with many drugs has become the rule.
Numerous side effects are still concealed.
I'm also very pessimistic and I dare to say that if in the next 5 years there's not a real change too many people will be harmed by drugs that are highly powerful.
Of course nothing will happen in the next 5 years although it's enough time to make another generation suffer iatrogenic diseases; long-term damage and so on.
If no lesson is learned from what is happening now, if psychiatrists are not confused and start to rethink their practice, listen to their patients, ask their patients - this is highly important because serious drug-induce side effects are not reported by patients because they are also confused... blah blah blah
Oh Lord!
What a mess.
HELP!
SAVE THE CHILDREN!
Please, at least, the children.

Jane:

So, everything on the show in the past 10 years is now suspect? Fine. In May '08, he had a show on how mindfulness meditation can change the neural architecture of the brain through neuroplasticity. I guess that idea has to go, because he did one show that didn't disclose his drug ties!

In December '07, he did a show on peace that "explored the art and science of resolving interpersonal conflicts peacefully, examine some common obstacles to peace, sit in on a mediation session between a landlord and his angry tenant, and probe the role of interfaith dialogue in promoting peace". What a monster! How dare he support "interfaith dialogue"!

Or rather than condemn the totality, we should take his show's points on a case by case basis? You know, like rational people?

Take care.

DGuller,

I wonder if you would be defending an alternative health practitioner who was in a similar situation to Fred Goodwin. Just wondering.

And in case you want to know, I complained to the owner of an alternative health site for running what seemed like an unbiased study only to find that it was sponsored by the company of the product that was used.

Regarding Goodwin, I am not the most objective since I became suicidal on Prozac. But how would you feel if someone minimized something that had hurt you, only to find out that person had a financial conflict.

What if you went to a surgeon who had done a great job for you in the past? This time, he recommends a procedure with a device that causes you great harm such as a hearing loss and you could no longer be a psychiatrist. You later find out that he owned stock in the company of that product. Would you still be saying that his situation should be taken on a case by case basis?

Same concept with Goodwin except obviously, he wasn't my doctor. I lived to tell my story but many people didn't

AA:

I would condemn the alternative practitioner for failing to disclose his financial conflicts of interest, just as I have condemned Dr. Goodwin. However, I would not automatically conclude that all the evidence in support of the treatment recommended by the practitioner was fraudulent and fake. I would have to see the evidence for myself and then make my assessment.

I suppose that I make a distinction between failing to disclose financial conflicts of interest in a treatment that

(a) has a reasonable evidence base to support it;
(b) has an evidence base that is built on falsification of data and outright fraud and manipulation.

I look upon (a) as an ethical lapse that should be criticized, and upon (b) as an ethical horror that should be totally condemned with full outrage. When this website has uncovered evidence that drug companies have engaged in (b), I have always agreed with everyone's disgust with that behavior, but I cannot confuse (a) and (b), and I truly believe that with what has been presented so far, Dr. Goodwin is guilty of (a).

Regarding Dr. Goodwin, there are meta-analyses and studies that can make the case that there is little increased suicidality with antidepressants, except with those under the age of 25, and even then, that they are rare (see Eur Arch Psychiatry Clin Neurosci. 2008 Aug;258 Suppl 3:3-23). It is not as if he and his guests simply invented evidence out of thin air, and it is a mistake to conclude so.

I understand that this position is highly unpopular here, but that is what the randomized studies have shown, and that is likely what he and his guests were trying to communicate. However, that does not excuse his failure to disclose his financial ties to the drug industry on the program.

I also understand that there are many anecdotal lines of evidence in support of increased suicidality with antidepressants. The problem with anecdotes is that they are highly susceptible to confounding biases, which makes it difficult to uncover what agent was causally responsible for the change. That is why RCT's are the gold standard, because they filter out many of those biases.

Until there are clear RCT's that demonstrate increased suicidality with antidepressants, the case reports will be taken as hypotheses that require confirmation rather than genuine facts.

There are many mothers that swear that vaccines cause autism, and there are hundreds and hundreds of case reports in support of that position. However, every large study that has been done to examine that link has turned out negative. Could that be a conspiracy by the vaccine companies to hide the truth in the face of valiant mothers? Maybe. It is also possible that the timing of the vaccines and onset of autism was a chance occurrence without a causal link.

Perhaps a similar situation exists with antidepressants and suicidality? Perhaps there are some individuals that become vulnerable while on them due to mixed states or akathasia as side effects that make them suicidal? Rather than throw out all those medications, it would be better to figure out who benefits and who doesn't in order to maximize efficacy and minimize harm.

Thank you for your time.

dguller,

Ok, lets see, lets be rational about this... This fucker has lied and lied and lied about anti-depressants and sucide, and when people were catching on that there really might be a link between the two, he lied and lied and lied some more.

You think it is rational to reason that because this fucker has some good treatment options that don't invovle medications he can't be all bad? Let's just throw out the fact these non-pharma treatment options are to keep people in the treatment because you need to be "in treatment" to be treated, which means medication.

Everything Goodwin has had his hand in is nothing but lying for profit. Have you seen drugwonks? This guy would just assume patients die on medications and him make a buck than actually get well without medications. There is no money in getting your patients well.

Thats the problem with Psychiatry, you make far too many rationalizations for your treatments. You are too willing to overlook and buy into lies, just so you can say you have "treatment options". Its good enough for you to hear patients say "such and such treatment saved my life" as you sit their and watch that very same patient go in and out of hospitals for one sucide attempt after another. You all rationalize it's the disease causing the patient to want to kill themselve.

Don't tell me to be rational when it is Psychiatry that needs to be rational. How such and intelligent group of doctors can be so stupid is beyond me. You are the ones who are buying into the lies and then making excuses as to why your treatments don't work. You're the ones that allow criminals to dictate treatment options and then blame innocent patients when they fail. You can take your rationalizations and shove them where the sun don't shine. Goodwin is nothing more than a murderer. Stop trying to rationalize his work so you can go back to work tomorrow with a "treatment option".

dguller,
If you have any interest in seeing just how flawed RCT are I highly suggest you read Grace Jackson's "Rethinking Psychiatric Drugs: A Guide for Informed Consent."

You seem to take for granted that they are the gold standard when there is much evidence that researchers routinely sabotage the studies and they are "random" in name only by the time they are carried out.

This book goes into great detail about all the flaws in RCTs. And does so with much documentation...

Grace is a astute physician, psychiatrist and serious scientist...please, if you want the whole picture read her book.

Yes, in being rational I have to come to the conclusion that antidepressants don't cause suicidality - that the clinical trials which showed a 2 to 3 times increase in suicidality on antidepressant versus placebo were actually anecdotal stories. There is no way to prove that these are actually statistics.

It is the same with smoking. Smoking does not cause lung cancer. Scientists tried for years to get rats, dogs, etc., to develope lung cancer by forcing smoke down their throats forever - but nothing. Not one of these critters ever developed lung cancer.

Thus, the 175,000 approximate cases of lung cancer that were recorded in the U.S. in 2005 have nothing to do with smoking. These were just all anecdotal stories: the 80 to 85% of these people who smoked cigarettes.

It is the same with the over 200,000 people a year who are going into hospitals with antidepressants induced mania/psychosis. See: Journal of Clinical Psychiatry 2001: 62: 30-33 titled: Antidepressant-Associated Mania and Psychosis Resulting in Psychiatric Admissions by Adrian Preda, M.D.; Rebecca W. MacLean, M.D.; Carolyn M. Mazure, Ph.D.; and Malcolm B. Bowers, Jr., M.D.
These are actually all anecdotal stories. The fact that these people had begun taking an antidepressant and then went insane was just coincidental.

So there we have it. A perfectly rational explanation. I am sure this is why Goodwin denied any link between antidepressants & suicidality on the Infinite Mind show. He was just being rational.

Interesting how people defend Goodwin here. A crime against humanity, a racist, pocketing money?

Wait, just another politician, er... psychiatrist.

Gianna:

Thank you very much for the reference. I will certainly look into it. :)

Just a quick question: Does she conclude that all RCT's in psychiatry are flawed, or that some are?

Unless you are saying that all RCT's are flawed and should be put aside for case reports, then we are back where I started from; namely, each study should be evaluated on its merits, and if a study is found to be methodologically, statistically or otherwise flawed, then it should be rejected as unsound.

I would certainly welcome any individuals on this website to evaluate Dr. Goodwin's research trials in terms of their flaws and offer their critiques. However, I still believe that they should be evaluated on a trial by trial basis, and not rejected completely out of hand, because of an ethical lapse on his part.

Ethical reprimands simply cast doubt upon one's findings. They do not refute them.

Thanks!

Rosie:

I read the 2001 article that you cited, and it has some interesting comments. The authors write: "it is difficult to ensure that the emergence of psychotic or manic symptoms was due to the initiation of antidepressant treatment and not intrinsic to the disease course" (p. 32), but that a strong case can be made if the symptoms resolved once the antidepressant was discontinued without other treatment (p. 32). However, many of the subjects were treated with neuroleptics, as well as decreasing the antidepressants (p. 31), and so that clouded the results somewhat.

Furthermore, they stated that "this is not a study of incidence or prevalence" (p. 32). So, I don't think your 200,000 patients a year figure is correct if you used the 8.1% figure in the study, because the authors clearly state that that number is not to be used to calculate incidence or prevalence.

Funny what happens when you actually read a study rather than the abstract, eh?

Regardless, it has been well known since the 1960's that antidepressants can induce psychotic or manic symptoms in vulnerable individuals (but that this is not as common as you think). That is why the guidelines recommend close monitoring of patients during the few weeks following a change in drug dose.

Regarding antidepressants and suicide, I would read the recent review article at Eur Arch Psychiatry Clin Neurosci. 2008 Aug;258 Suppl 3:3-23. It goes over all the reviews and meta-analyses of the various data sets available, and concludes that there is moderately increased risk of suicidality -- with no completed suicides -- for subjects under 25 years old, and with a decreased risk as subjects got older.

Again, this means that in those individuals who are severely depressed and require medications who are under 25 should be closely monitored for various adverse effects, as per the guidelines.

I hope this helps to clarify a few things.

Take care!

Jane:

I can see that you have very strong feelings against Dr. Goodwin and my field of psychiatry. I am sure you have your reasons.

However, I would like you to specifically cite the innumerable instances where Dr. Goodwin has lied about his findings, distorted his studies, and defrauded the public.

If your only citation is a racist remark in 1994 and a failure to disclose his financial ties in 2008 while discussing the legitimate position that the risk of suicidality with antidepressants has been exaggerated, then I think that perhaps you are rationalizing your underlying hatred of psychiatry rather than being reasonable.

Take care.

Excerpts from askapatient.com:
"my wife Sharon Coalson committed suicide by self inflicted gunshot on 12/12/06 as a result of an adverse reaction between cymbalta and lunesta" (she was 61).

"My husband's suicide note read, "sue Cymbalta, seritonin syndrome."

"My 24 year old neice committed suicide while taking Cymbalta".

Oh wait... I'm sorry dguller; These are just meaningless "anectdotes". That's what you doctor's call them, right? In clinical terms, I'd call it; "Raw Data".
In human terms; horrific tragedies that leave me in tears. I can't imagine living with that pain.
Save your rationilizations, please.
Actually, listen to your patients and you could probably collect some raw data on side effects and withdrawal, etc. that would contradict all the articles and studies you've read.

dguller, you are way too stuck on scientific studies for which the raw data is not available and the conclusions of which in journal write-ups are therefore virtually meaningless to say nothing of the fact that RCTs should never have been made the gold standard for clinical research anyway. What kind of hurdle is it just to be marginally better than placebo? Furthermore all the truth about patients who are included in trials in terms of other meds they may be on or meds from which they have recently been withdrawn is never made available in a complete way. What is the meaning of "placebo" in the context of all these confounding factors anyway? The evidence from trials would only really mean something if you had a complete history for each and every person in it. You need to get out into the real world and away from medical school and pay close attention to what's going on in clinical practice and to listen to patients and not only listen because many of them are too terrified to talk but also empower them to tell you what's really going on. And then get back and design some studies that might really mean something.

And don't kid yourself that you can closely monitor someone who is having an adverse reaction to antidepressants. Some of these people cannot be left alone for one minute. The impulse to self harm and the drive to act on it can come over a victim in seconds with next to no prior warning. How can it be recognized for the suicidal impulse it is if the victim has never been suicidal before? Hundreds of people have died this way leaving a trail of untold suffering and loss in their wake.

Becky:

People are cognitively biased to prioritize personal stories over statistical evidence, even though the latter is far more objectively sound. For example, if studies showed that the Hyundai Sonata is a reliable car that is very rarely returned to the dealership due to flaws and you meet a friend who complained about their Sonata, then you would instinctively trust your friend over the statistic. However, your friend could have been one of the minority of individuals who happened to have bought a lemon.

It is understandable that you would prefer to prioritize personal anecdotes over statistics -- I have the same temptation, too! -- because this is a common human bias, but you should understand the place of case reports in the scientific literature. Anecdotes are absolutely essential to scientific progress, because they are the starting points of inquiry. They provide hypotheses that can be more adequately tested by controlled studies. If the studies confirm the anecdotes, then that is great, but if the studies disconfirm them, then the studies take priority.

For example, if I am suffering from pain and I take a herbal remedy and feel better, then did the herbal remedy alleviate my pain? How can I determine if it was the remedy, the natural course of pain, a regression to the mean, the Hawthorne effect, something else I took, and/or the placebo effect? The best way is to gather a group of people and keep certain factors constant, but give one group the remedy and another group a placebo, and see if there is a statistical difference between the remedy and the placebo. If there is no difference, then the remedy could not have caused the reduction in pain, even though in my personal experience, the pain was reduced after I took the remedy.

That is one of the main reasons that controlled trials take precedence over case reports, i.e. all the confounding factors and biases are better controlled for and we can determine whether the agent under investigation is the cause of the change or not. However, this assumes that the studies are done properly and without fraud and falsification, which does not always happen, as has been well documented by this website.

I hope this helps. :)

Take care.

dguller wrote:

"People are cognitively biased to prioritize personal stories over statistical evidence, even though the latter is far more objectively sound."

except when those trials are cooked by pharma companies and their suckass psych doc minions who are interested in money not people. happens with damn near every trial i am aware of.

Sara:

First, if RCT's aren't the gold standard, then what should be?

Second, according to my understanding, subjects admitted into a research study are throughly screened beforehand to see if they meet the admission criteria. You are correct that often these criteria make the subject group quite artificial, e.g. antidepressant trials specifically excluding subjects who are suicidal.

Third, being marginally better than placebo can be helpful for some people who truly suffer, but only after a frank discussion of the risks involved compared to the benefits. Ultimately, it is the patient's decision once the information has been provided by a clinician.

Fourth, with adequate warning to patients and their family members, I believe that surveillance is certainly possible to a great extent. Obviously, no-one can be watched 24/7 and thus there is always the risk of a sudden onset of agitation or suicidality when someone is alone, but one can say that about every medication available. If you go through the CPS, you will find sudden onset of psychosis, mania and agitation to be rare side effects of almost any medication. Those warnings are there because scientists take anecdotal data very seriously.

Fifth, I do empower my patients to report any changes in their mental or physical status when I start them on medications. Do not assume that I am a pill-pusher who hides adverse effects from my patients. I do recommend them in patients who I believe will benefit from them, given the scientific evidence. I do not believe that they are a panacea that will cure all mental illness, but also do not believe that they should never be used in anyone, because there have been some serious adverse effects in some individuals.

Like most things, a balance can be struck between extremes. If I have a depressed patient who is completely unmotivated, lacks energy, and is exhausted from lack of sleep to do any therapeutic work, then yes, I will recommend an activating antidepressant in order to change his mental status to the point that we can do some therapy. I do not believe that medications are the real agents of change, but that they facilitate a change in people's lives to get them out of depression.

Do not lump me with clinicians who do nothing but manage medications, because I certainly do not practice that way.

Take care.

Jones:

Exactly. That principle that you cited only holds if the statistical evidence is sound. Naturally, if the trial is compromised by fraud or falsification, then it must be rejected altogether.

I would disagree that every trial is tainted by fraudulent data and analysis. If your main source of information is anti-psychiatry websites, then naturally every trial that you are aware of would be the ones that were fraudulent. However, that is a biased sample, and generalizing from that limited data set would be the same as happening to live in an all-white town and concluding that there are only white people in the world.

Take care.

dguller,

The 2001 Preda & Bowers study said that 8.1% of those on antidepressants alone went insane on the antidepressants. Another 3% were on antidepressants & neuroleptics and the neuroleptic was discontinued and the patient went insane.

When I first read this, I was younger and very naieve. I thought the antipsychotic was keeping them sane while they were taking the antidepressant but, subsequently, have realized that the patient could have been in "supersensitivity psychosis" due to an abrupt withdrawal from an antipsychotic.

Anyway, the total combination of 8% and 3% was 11% and, even though the article said not to extrapolate these stats [is Yale & its patient population more sensitive to antidepressants - ridiculous] so I did do some extrpolation and found that, since approximately 2 million people a years enter psychiatric hospitals, that 11% times 2 million is 220,000 patients a year entering a psychiatric hospital due to antidepressant associated mania and psychosis.

Now, there is the possibility that only 162,000 a year [8.1% X 2 million] are entering a psychiatric hospital due to antidepressant induced mania/psychosis and that 58,000 [fifty-eight] are entering due to a "supersensitivity psychosis" caused by an abrupt withdrawal from an antipsychotic.

Speaking of abrupt withdrawals from antipsychotics, there is a new book out by E. Fuller Torrey titled "The Insanity Offense". In the intro to the book he states that he has saved clippings from newspapers of people who were seriously mentally ill - bipolar, schizophrenia, etc. - who committed a violent act. He says that he has file cabinets full of these cases and that, since the year 2000, he has almost 3000 cases. Although he doesn't state it in the intro, in the rest of the book he implies that these individuals did their dastardly deed because they went off their medication - usually an antipsychotic. Torrey really needs to understand better the "supersensitivity psychosis' induced by withdrawal from antipsychotics. It leaves the person in worse shape than before he/she ever began taking the antipsychotic. Truly a National Tragedy.

Too bad that E.Fuller Torrey is this stupid. He is one of these docs in a high position who is not well read in his field of endeavor.

What an interesting find over at the McMan website, Herb Stein and John McManamy buddying up defending Goodwin.

Rosie:

Thank you for the thoughtful remarks.

I still disagree, though.

I reread the article, and I cannot find your 3% figure that you cited. Can you please cite the page number that you found it in? Thanks!

That leaves the 8.1% prevalence in this study of 533 Yale psychiatric inpatients in 1997.

What is interesting is that 93% of the subjects who developed a psychosis or mania following antidepressant use already had a psychotic or manic disorder of some kind (40 out of 43)! Therefore, it is impossible to know whether the subsequent psychosis or mania were due to the antidepressant or the natural course of their illnesses.

That is why the authors specifically stated that "is difficult to ensure that the emergence of psychotic or manic symptoms was due to the initiation of antidepressant treatment and not intrinsic to the disease course" on p. 32.

If the study had included a control group that did not receive antidepressants and there was a significant difference, then a more firm conclusion can be made. However, without that control group, the study is completely inconclusive, as they recognize in the discussion on p. 32.

Finally, in order to calculate the prevalence, one would require a population size far greater than 533, which is why the authors explicitly stated that you cannot take the 8.1% prevalence in their sample as representative of the inpatient population at large.

So, the conclusions that you draw are clearly rejected by the authors of the paper themselves.

However, if we were to use the 8.1% prevalence rate as representative and exclude the 93% of subjects who already had a psychotic or manic disorder, then that leaves a prevalence rate of 0.56%, and multiplying that figure by 2 million means that 11,200 individuals without a previous psychotic illness became temporarily psychotic following antidepressant use and were hospitalized for it. There were no fatalities or long-term consequences, as far as the study mentioned.

Just to keep things in perspective, about 195,000 patients died in hospital of medical errors annually in the U.S. Now thatis "Truly a National Tragedy", as you put it, and I fully expect you to devote your time to creating a blog that exposes the horrific individuals who perpetuate the mass slaughter of hundreds of thousands of lives!

Take care.

dguller,

You are full of it!

Can't you see where it says 11% and then subtract 8% from this number. 11 minus 8 equals 3.

Also, it did NOT state that 40 out of 43 cases had a previous psychosis or mania. In fact, it stated just the opposite. It said that many patients had no previous psychiatric history and this it was "quite common" for them to have the mania/psychosis with no prior psych history.

Are we reading the same journal article.

And, yes, it would be nice if someone could put up a blog about the 195,000 medical errors but who has the time! Maybe you could do it. In fact, I fully expect you to do it. I doubt that you are even a shrink. What shrink would waste their time arguing on a computer with people when they aren't being PAID for it. I have never heard of a shrink doing any volunteer work. They expect to be PAID for everything. Volunteerism isn't their field.

So who are you, really?

Rosie:

Oh, I see. :)

You are using the 11% that the authors found in a DIFFERENT study from 1998, and are subtracting 8.1% from the CURRENT study in 2001 to get your 3% figure. Unfortunately, that is not an allowable calculation, because the studies actually were looking at different things in the sense that the 2001 study narrowed the admission criteria and expanded the time duration to 14 months.

You are also wrong in claiming that the subjects in the 2001 study had no prior psychiatric history. That is not even one of the inclusion criteria on p. 30. If you look at the information under "Results" on p. 31, then you will find the admission diagnoses of the subjects, and 40 out of 43 of them were already diagnosed with either psychotic or manic illnesses (e.g. bipolar, schizophrenia, schizoaffective disorder, depression with psychosis, etc.), and in the remaining three, one had autism, one had generalized anxiety disorder and one had dementia.

We are looking at the same article, but I don't think that you are reading it correctly.

Now, I think it is interesting that you made such a fuss about the number of patients with antidepressant-induced psychosis as if it was an epidemic of terror that must be stopped at all cost, because of all the lives that are ruined and destroyed. And yet, when I mentioned a far more serious problem, you say that you don't have the time. Hmm. Interesting.

Also, that was a nice ad hominem attack against me that you ended your post with. Just for the record, I am a psychiatry resident who is posting my comments for free, which kind of goes against your universal hatred of members of field as whores of the drug industry that only care about money.

I am doing this, because I think that people here are getting only one side of the story. I agree that unethical behavior in my field should be criticized and that where we have harmed people, we should be accountable, but I think that many people here go to such an extreme that I have to speak up and bring some reason to bear on the issues.

Many people here have been harmed by psychotropic medications, and naturally feel wronged and outraged. Fair enough, but it is far too easy to demonize people and to refuse to listen to the voice of reason.

Please, just be reasonable and keep the insults to yourself, because they do not move our dialogue forward. And yes, I have made hasty remarks, as well.

I'm only human, too. :)

Take care, Rosie.

dguller,

The 11% was from the same study. I think you must be drinking tonight :-).

Anyway, have a good Thanksgiving and reconsider your decision to be a psychiatrist. With an M.D. degree you could go into another residency program and get out of the field of shrinkdom.

Rosie:

Actually, I don't drink, but thanks for further attempting to insult me by claiming that only drunkard would hold my views. Very classy, and with a smiley face, no less!

Now, could you cite the page number where the 11% figure is located, like I have done for my points? The only 11% that I found in the whole article was in the introduction referring to the authors' 1998 JAMA paper where they found 11% of inpatients over a 6 month period with antidepressant-induced psychosis. There is no other 11% in the article! :S

I also wish you a good Thanksgiving, and I will not reconsider my choice of profession, thank you very much, especially based on the advice of someone who cites a research paper and cannot even understand what it says, and from the standpoint of scientific ignorance condemns an entire field as scientifically invalid.

Take care.

Warning, long post.

DGuller, Since you raised the issue of medical errors, this post will be largely off topic before I get back on track for a bit.

About the medical errors, I feel my elderly mother, who died in April, was the victim of medical malpractice last year. While it didn't kill her, I don't think it helped matters. So believe me, I understand that issue better than most people.

Unfortunately, due to battling withdrawal symptoms from psych med withdrawal, including severe insomnia, which alot of your colleagues falsely attribute as a return of the illness, I have to focus on my heath. I can't get help from my psychiatrist and so far, I haven't found an alternative doc.

Speaking of malpractice, your profession seems to be generally missing in action regarding cases like Esmeren Green, the person in the North Carolina hospital who was ignored for several hours and the situation with Psychiatric Solutions that was posted in the LA Times about patient deaths. The Atlanta Constitution also ran a story about deaths in psychiatric hospitals in Georgia, including a 14 year old girl.

The current or former head of the American Psychiatric Association was pathetic about the Green situation saying poor, poor staff workers for being overwhelmed. As one who worked in special ed with limited staffing, just because you are overwhelmed doesn't mean you let someone die if you see them lying on the floor.

Your profession also is generally nowhere to be found regarding patients being discriminated against when they try to get medical care. I would give you the citation but unfortunately, it is on the computer that crashed and I haven't been able to retrieve the data so far. This is anectotal but it was definitely true in my case.

Also, your colleagues aren't monitoring your patients' needs while on meds that cause dangerous side effects:

http://pn.psychiatryonline.org/cgi/content/full/43/21/2?etoc

It seems DGuller, that before you cast stones on other medical professionals, that you might want to look at your own house first even though your point is well taken about medical errors in general.

Back on topic - You keeping mentioning that so far, clinical trials don't prove that there is an increased risk of suicide in SSRIS. But since clinical trials are based on a hypothesis which means you have to have a certain belief, if generally reports of psychiatric side effects are blown off as the "illness" worsening, how is that ever going to happen?

Also, from what I understand, suicidal ideation from an SSRI might not occur right away. There are other symptoms such as athiskesia.



But again, most psychiatrist don't recognize that as a danger sign. So again, how are these trials going to take place?

Jay Cohen, one of your colleagues discusses this on his site:

http://tinyurl.com/378b9f

Also, if 1 to 10% of adverse side effects are reported the FDA, (someone posted the link on this site which I am too lazy to get right now), again, how do you have objective random clinical trials that truly study this issue?

To my fellow posters on this site - I totally understand your anger as I feel these meds have ruined my life, including severe insomnia as a wonderful side effect withdrawal gift. I also have a hearing loss. It may even minor compared to what you have been through.

However, no matter how angry we rightfully are, being condescending does nothing to advance our cause. You can be angry and hard hitting as I have done that with a psychiatrist who used to post on this blog who I feel is flaming us big time on other blogs. But please leave the condescension out as it does nothing for us.

DGuller, I mean no disrespect but I am convinced you are a psychiatrist:)) I applaud you for posting on this blog when you know what type of response you will get.

Let me end with a few questions I have been dying to ask you Do you ever have situations where you placed a patient on a med and he/she reacts violently no matter what it is,?
Do you continue searching for meds or do you say to the person that it might be better if they sought another option?

My reason for this question is that many of us fairly or unfairly have the perception that psychiatrists medicate come heck or high water and that is one reason for our extreme anger.

The other question is what if a patient with schizophrenia decides they are coping well and wants to go off meds. What do you do?

Thank you and everyone else for reading a long post. Happy Thanksgiving.

There's no doubt in my mind dguller is a Psychiatrist. His attempts to insult me with his suddle comments, his condensing and demeaning attitude, his inability to see the harm medications do, his defending of corrupt researchers, this man is a Psychiatrist. What would be funny if it weren't for that fact he actually sees patients, is that he has absolutely no awareness whatsoever of what I'm talking about. I only write this because others on this board know exactly what I'm talking about and can have a little chuckle. Many of us sat in offices such as his for years allowing his profession to degrade and tear us down believing we were the ones with the problems, because we all thought doctors cared about us. We had no idea about the size of their egos. They go home each night feeling like they are somehow better than their patients. They throw their corrupted research at us to try and prove to us they are gods. What psychiatry hasn't figured out yet, is all their patients are showing up on these blogs at an astounding rate and instead of attempting to clean up and fix their mess, they defend it.

Dguller

The want to be psychiatrist! Now the picture is getting very clear for us all. You are not just a diehard at supporting skewed data, false and corrupt science, the fallacy of the DSM paradigm, and criminal elements within the mental health system; but you also want to be another pill distributing child destroyer and killer in the end also. What a charmed life you must lead!

Let’s hope someday you learn to think for yourself and start questioning why you’re esteemed so called model and theory doesn’t work. That’s objective by the way {laughing}

Are you a card carrying member of the Biederman, Nemeroff, FDA, and Goodwin fan club too? Now we all know why you have your pony in the race, and are making your so called intellectual stands here! Go hug your Goodwin, and McPimp! You’re nothing but a cheap version of a sell out and pharmaceutical whore.

Please become a Psychiatrist! So you can waste all that time, effort, and money to go down the tubes with the rest of the failed establishment, pill toting script writers, and corrupt researchers. That’s right, you and all your so called mentors are sinking to the bottom of the food chain, and you don’t even realize it!

All your arguments are coming from that same old bull s--t propaganda that psychiatry and pharmaceutical are renowned for and have been pushing on the public for decades; so keep on posting and lying here!

The US Congress investigation sure believes there's a lot more to uncover! I guess they a purely subjective also in your mind.

Those people that come here seeking some truth, integrity, honesty, humane health care, and ethical standards; will keep calling you out and attacking you for what you really are (even those that may not agree with me on some of these issues or my personal opinions).

You’re just a sleazy old school medical model pimp, nothing more or less.

Is it personal? You bet it is; you are one of those everything is fine and dandy in my life; now I want the power to destroy others lives too arse!

Are you being attacked? Yes you are!

I believe we call your kind a smooth talking con man that has an agenda and was prompted to come here to support the myth by others (Just maybe that drugged up fantastical Mood Garden aka John McPimp crowd, or maybe Dr. Goodwin is your good Pal and helped you get into this professional track your riding?).

Do you have any fresh ideas of your own to share? You go on and on about balance and civil discourse; yet we all know there is no balance or real discourse with you! Your right and everyone else is wrong and just subjective enough to medicate. I guess that is how your psychaitrist in training patients feel also, you ever ask them?

On one side there are Psychiatrist pimping pills for a buck and payoff (and yes there are a few psychiatrist that actually question the estabishment, practice sound, and ethically care out there; but I haven't seen more than a few "Subjective"), with big Pharmaceutical holding and rubbing the psychiatrist hands as they scoop up billions off the misery of others.

Then on the other side are the patients; those of what your kind consider subhuman, damaged goods, flawed, and since their crazy anywise; why not stuff some poison down their throats to make a buck. We can always blame the patient if things go bad, they are crazy anywise right. Yet if they can show a so called scientific measure of improvement by watching a patient stumbling and clamoring across a nicely polished psych ward floor, we can claim credit for their "wellness". Great scam you have going there!

You cherry pick what you want to believe and call it science, you spout off data, statistics, and studies like they were drilled into your head by a machine; but you don't dare question anything, because that would put your whole false world in jeopardy. Ironic really; sick and twisted definitely.

Objective? Subjective?

Choke on that with your turkey and stuffing, you fraud and witch doctor want-to-be!

not so nice, but I call it as I see it,
Stan

Dguller,
Yes, I knew what this journal article said but, since I come from a long line of physicians and, in fact, have a physician in my immediate family, I didn’t want this one fact to stand out too clearly as it showed the utter ineptitude of all physicians in regard to antidepressants , not just psychiatrists. Any physician who doesn[t know that antidepressants have the potential to cause mania/psychosis, especially in those who have already had an episode, is incompetent.

The fact is that the majority of people who went manic/psychotic on these antidepressants had had a previous manic episode and, to me, this made physicians [and 70% of prescriptions for antidepressants are by physicians other than psychiatrists] look like such complete idiots that I wanted to keep this fact low key. It is like a fireman going out to fight a fire and throwing gasoline on the flames.

Physicians should know that anyone who has had a previous manic/psychotic episode of some kind should not be given an antidepressant. The most tragic case I can use as an example is that of Andrea Yates. She had a postpartum psychosis after the birth of her fourth child and recovered in three months without an antidepressant. After her fifth baby was born, the psychiatrist gave her the antidepressant Effexor. When she became worse on this drug, he added another antidepressant, Remeron. These were the only two drugs she was on at the time of the murders – she was on no other psychotropic drugs.

Now I ask you why this psychiatrist gave her two antidepressants when she had previously had a postpartum psychosis. Because he was an idiot – that is why. In fact, in some theoretical way, he was a murderer.

What shocked me most about Andrea Yates’ two trials was that no physician came forward and said that this is what happened to her. Not one. Physicians all protect one another.

Thanks, dguller, I will now stop trying to protect physicians. They don’t need my help. They help each other. They are behind the 3rd leading cause of death which is prescription drugs with 240,000 deaths a year. I also think the lst two causes of death, heart disease and cancer, probably have a lot of people in there who had these two diseases because of the prescription drugs they were taking.

As for the close to 12,000 people a year who take antidepressants, go insane but have never previously had a psychotic episode, all I can say is that physicians really need to know more about antidepressants. Physicians know practically nothing about medications because they are not given any training to speak of in med school in regard to pharmacology.

So if I appeared stupid about this article when I was actually trying to protect the good name of physicians, then I will admit that this is my weakness. I will try to overcome this fault of mine and accept the fact that all physicians are idiots.

Rosie:

First, thank you for your thoughtful post. I am terribly sorry for the suffering your mother went through due to medical errors, and I am equally sorry for your unfortunate struggles with psychotropic medication withdrawal.

Second, regarding the tragedy of those who die while in hospital for preventable reasons, I wholeheartedly agree with you that it is inexcusable and to be condemned whenever it occurs. That holds true for any specialty, including my own.

Third, I never said that there wasn't a link between increased suicidal ideation and antidepressant use. The latest evidence says that there is a moderate -- 1.5 x -- increase in risk in those who are under 25 years of age, but a decrease in risk as people get older.

There is some question about the reasons for the age disparity, possibly having to do with the immaturity of the brain until around that time. There is also a question of the precise mechanism of the increased suicidality, i.e. due to the dysphoria of akathasia or mixed states, due to the return of normal energy levels before sadness and hopelessness improve, etc.

Fourth, to answer your questions:

1. Do you ever have situations where you placed a patient on a med and he/she reacts violently no matter what it is?

-- Fortunately, I haven't had that experience yet, but according to the statistics, it is only a matter of time that that situation will occur. However, I always caution people, and family members when possible about the possibility of radical personality changes.

2. Do you continue searching for meds or do you say to the person that it might be better if they sought another option?

-- It depends on the clinical situation. I do not recommend medications for everyone, and usually avoid their use. I do recommend them in those who are quite severely ill and require a change in their mental status to be able to change their behavior, which I happen to believe is the primary agent of change.

3. The other question is what if a patient with schizophrenia decides they are coping well and wants to go off meds. What do you do?

-- I would advise them against it, especially if they are doing well and have minimal or no side effects. I would also inform that a reduction in dose could lead to a relapse, and every psychotic episode makes subsequent treatment more difficult. However, if finances or side effects are a problem, then I would recommend a closely monitored gradual reduction in dose.

I hope this helps, and again, thank you for your long and positive post. :)

Take care.

Jane:

First, how was I condescending towards you?

In my first post to you, I wanted to show you that your rejection of EVERYTHING on Dr. Goodwin's radio show was wrong, because there were many things that he discussed that are not only true, but helpful. You then called me stupid and delusional, and told me to shove my rationalizations up my ass.

I then asked you to show me specific examples of Dr. Goodwin's research where he demonstrably committed fraud and manipulated data. You then replied by accusing me of being an egomaniac and believing myself to be a deity.

But I'm the one who's condescending and demeaning towards you.

Again, I do not defend my profession in a dogmatic way, because there is much to criticize. However, I do believe that the criticism should be proportionate to the evidence against the field. Just because there are several high profile examples of fraud does not imply that the entire profession is fraudulent.

As I said elsewhere, that would be like accusing every Catholic priest of being a pedophile and condemning Catholicism in general for the actions of a few disturbed individuals.

AA:

Sorry, the post addressed to Rosie should have been addressed to you. :S

Stan:

All I can say is, wow. WOW. W-O-W.

I wish you nothing but relief from your suffering.

Please, take care.

Appreciated your Thanksgiving blast, Stan. We do have thanks to give for the Internet, and a number of very pure and good sites such as this one.

Thinking about this psyc. resident among us, and his attitude, I know that he is probably desperate to defend his life choice, and has been innoculated to see all of "us" as poor pitiful Pearls. I have to say all the many doctors seen by my family members throughout the years except one have this attitude problem. A few examples - Fuller Torrey's partner, an"expert" in bipolar, gave my daughter Seroquel (this after my son had been killed by Zyprexa. One more failed experiment,and the personality of a Nazi); a guy who gave Lamictal (immediate suicidality as a result which he denied he'd ever seen; personality of a D- student and a member of the Glaxo Lamictal Round Table), the doctor who first diagnosed my son correctly - going through the roof after he died because I had turned into an activist. Called me a Scientologist. A Hopkins grad who almost killed my daughter not recognizing clear symptoms of lithium toxicity got his nose out of joint when I swore at him from the ER where she almost died. And on and on it goes, with men and women making serious and fatal mistakes using dangerous, lethal and fatal drugs and blaming it all on US and our CONDITION. It's not just the drugs that should be banned; it's the doctors. I wonder what the studies say of the character traits of those who pick to go into psychiatry. If grubby Biederman can make up a fake diagnosis, perhaps we can make up a real alternative to psychiatry. I can see it coming.

dguller

WOW W-O-W WOW - Is this in the New DSM-V - finally a true diagnosis for "psychiatrist ego-centric ass-a-tightus" - Geez, I'm sorry your such an ass and in such denial!
Are you taking any meds for that nasty condition affecting you and your patients? I'm sure Big Pharmaceutical will come up with something to help you that are completely puritanical and objective. Of course until that day, I wish you suffer tenfold what your poor patients do!

Now F-Off and go play want-to-be-doctor!

Stan

DGuller, thank you for what you said about my mother and my struggles. Warning, you may not think this follow up post is as positive.

You didn't address my comments about how there can be true clinical trials on suicidal ideation and SSRI if generally, that is blamed on the patient. Again, a trial is based on an hypothesis which comes from a belief which right now, seems to generally be blame the patient.

By the way, I feel you are unintentionally doing that with this statement

"There is also a question of the precise mechanism of the increased suicidality, i.e. due to the dysphoria of akathasia or mixed states, due to the return of normal energy levels before sadness and hopelessness improve, etc."

DGuller, this is why get the responses that you get and why people get so angry. Not that I feel it justifies name calling but I am trying to let you know why people are so angry.

As one who became suicidal on Prozac, this hits my hot button big time as I feel your profession is discounting my experience. I don't wish this on anybody but maybe a few of your colleagues need to have this happen to them so you get what is going on.

By the way, I don't think you would label someone who became suicidal from a drug like accutane or a birth control pill as having normal energy levels before sadness disappeared. It seems that only in your profession is everything attributed to a patient's illness.

""It depends on the clinical situation. I do not recommend medications for everyone, and usually avoid their use. I do recommend them in those who are quite severely ill and require a change in their mental status to be able to change their behavior, which I happen to believe is the primary agent of change.""

But again, what if they have reacted violently to every med? What if the cure is worse than the disease? Are drugs the only thing in your toolbox? I am not asking to be flippant

" The other question is what if a patient with schizophrenia decides they are coping well and wants to go off meds. What do you do?"

"I would advise them against it, especially if they are doing well and have minimal or no side effects. I would also inform that a reduction in dose could lead to a relapse, and every psychotic episode makes subsequent treatment more difficult. However, if finances or side effects are a problem, then I would recommend a closely monitored gradual reduction in dose.""

Again, DGuller, this is one of my hot button issues. This is the same erroneous argument in my opinion that has been used to justify keeping people on antidepressants for life. In my opinion, you are confusing withdrawal symptoms from way too fast tapers with a return of the illness.

Neuroleptics should be tapered at 2 to 5% of current dose every 3 to 6 weeks and I highly doubt that any psychiatrist does that. Again, if they do, please refer me to studies.

You also should read Bob Whittaker's book as he has several citations on people with schizophrenia in other countries who fared better without meds. He also has citations on a few older studies with people recovering from schizophrenia without meds.

The chances of people having minimal side effects on a drug that causes brain shrinkage is slim and none. A mainstream researcher made this claim by the way about the brain shrinkage.

And if you think I am wrong, please refer me to a study where people have minimal side effects from neuroleptics after 10 years.

DGuller, I will end with this exert from Pat Deegan's webpage about the disconnect between your claims that drugs work vs. our claims that they don't. In case you aren't familiar with her, she is a PhD psychologist who was hospitalized 8 to 9 times for schizophrenia. As far as I know, she is not taking medication.

http://www.patdeegan.com/blog/archives/000017.php

PSYCHIATRIST **** ME

You are getting better ***** Your cure is disabling me

Your symptoms are gone**** My symptoms no longer bother you

You are more in control**** Haloperidol is controlling me

You are stable **** I can't think or feel

You are functioning again **** My life is without meaning or passion

What would you say to someone who made similar comments?

Thanks

Rosie:

I see. You posed as someone totally ignorant of what a research article said in order to protect the reputation of physicians, especially those in your family. You are quite the martyr, assuming the mantle of ignorance in order to protect the fragile profession of medicine.

Or, you actually didn't know what the article said. I think I'll go with this interpretation, because I doubt that you were trying to make physicians appear in the most positive light possible. Anyone reading your previous posts will note your hostility towards psychiatrists. And anyone reading your last post will now note your hosility towards ALL physicians. That's a lot of hate!

Congratulations on admitting that most of the subjects in the study who had a manic or psychotic episode following antidepressant use already were diagnosed with a psychotic or manic illness. Since there was no control group with didn't receive antidepressants, it is impossible to know whether the psychotic or manic episodes post-antidepressant use were due to the medication or just the natural course of their illnesses. Therefore, it is actually a pretty weak study that requires better controlled research to make its point. I'll have a look to see what is out there.

Regarding Andrea Yates, I think your facts are confused. You are right that she was on Effexor at 450 mg daily for the month before she drowned her children, but you failed to mention that she stopped taking her Haldol about two weeks before she killed them. Also, she had been prescribed Effexor on several prior occasions since her first suicide attempt in 1999 without problem. It is more likely that she became destabilized after discontinuing the antipsychotic than due to her taking the antidepressant. In fact, she was still taking the Effexor plus an antipsychotic while in jail while she was stable. If the problem was with the Effexor, then she would still be psychotic, right?

Take care.

Rosie:

One more thing. I don't know why you say that 12,000 people annually become psychotic while taking antidepressants. If you're using the prevalence in the 2001 article, then you a fool, because they explicitly state that you cannot use that number to refer to the general population.

Take care.

Sorrowful:

I do not pity anyone here and I am certainly not desperate to defend my life choice, because I greatly enjoy what I do and my interactions with my patients, spending time getting to know their life stories and giving them suggestions to manage their thoughts and feelings in a more productive fashion. I do not need the approval of people on this website to give my life significance. I am here for educational purposes, including my own. :)

I am not a caricature. I am a real person who does not match with your twisted fantasy of what I must be thinking and feeling by virtue of being in psychiatry. I do not think that you are stupid or blame you for your condition, and please do not assume to know what I believe about you.

Why not just ask me what I think? Or would my human response to your query conflict with your vision of me as a monster? Kind of hard to dehumanize someone when you can relate empathically with them, eh?

DGuller,

Recommended reading.

Interesting how you come back with personal retorts but not answers to directed questions.

IF, in fact you have a vested interest in psychiatry (job, career, education)you most likely would not be here spending so much time in an internet forum.

Victimized? had withdrawals? taken psych meds? advocate for humane treatment of people with mental health labels?

Didn't think so.

I do have to admit that dguller must be a bit disturbed to keep coming back and trying to have the last word with all of us commenters -- on Thankgiving no less unless he's from Canada where they don't celebrate it. I wonder if he's on something himself to be honest. A lot of psychiatrists do take their own medicine. He doesn't want to let go -- a pitbull (but hopefully not with lipstick). I think he might have a narcissistic personality disorder which certainly fits with going into psychiatry I'm sorry to say. From his behavior on this site I would not want to be one of his patients. I am sure that he has not completely wrapped his head around the number of people being harmed by psychiatric treatments and the extent of the harm. We are talking some really seriously life changing effects, not just a temporary setback. And the group here in these comment threads really is just the tip of the iceberg.

But what I truly wish is that he would not accept conclusions of medical journal articles at face value. As I have said before unless the raw data is available and, in fact, unless all the facts are even recorded in the raw data it is impossible to judge whether the conclusions are meaningful at all. And I'm not talking about just ruling out suicidal patients or "placebo responders" in trials. I'm talking about much more serious confounding factors like including patients who are being medicated for co-morbid conditions like ADHD in an antidepressant trial or letting patients continue on benzos or hypnotics while they are in an SSRI trial or having them abruptly stop one antidepressant or some other medication in the "wash-out" phase and then putting half of these "withdrawal" patients in the placebo arm and the other half in the new antidepressant arm. Three guesses which arm does better in that trial? If he doesn't think this sort of thing is going on all the time he doesn't understand what's going on in research nor does he realize how hard it is to find patients to sign up and therefore that's why the clinicians don't insist on drug naive people or take the time to get people off prior treatment properly (they don't understand withdrawal very well anyway). They literally turn a blind eye to these other treatments and pretend it doesn't make a difference. Each and every adverse "placebo" event should have a narrative associated with it to make sure it's not a drug-induced event from prior or concomitant treatment or withdrawal. There are commercial forces at work driving all this. Frontline did a documentary on clinical trials and it was chilling. So the trials are "corrupt" (out of convenience rather than deliberate deceit at least some of time) and then doctors like dguller base their prescribing decisions on the conclusions and then we end up with people like those who have found each other on this site. I wish it wasn't like this but I am darn sure it is. Happy Thanksgiving everyone and God bless this site.

Stephany:

Thank you for the website. I will certainly look at it. :)

Oh, and I am here, because (a) I am interested in the negative experiences that people have had with psychiatry to learn from them and not repeat the mistakes with my patients that have happened to people here, and (b) to bring some balance to the debate here.

That's all. Nothing more sinister, I'm afraid.

Sara:

LOL. So, because I come here and post often, I am taking psychotropic medications and have a narcissistic personality disorder? And you complain about being misdiagnosed?

Other than that initial silliness, you make excellent points about research trials. There are often confounding factors, which is why the charts that describe patient demographics always include comorbid illnesses, other medications, and so on, and attempt to randomize those factors evenly between the different groups to try to ensure that they will NOT be confounders.

You are right that without the raw data, we are simply trusting that the authors of a study are honestly presenting the information. However, the raw data is available, if you would request it. But why stop there? What if the raw data itself is also compromised? Maybe we should fund an agency that shadows all research trials in order to make sure that the data is inputted correctly by monitoring every researcher-subject interaction? That would get a little expensive, but might actually be useful.

As I said earlier, I do take findings in studies at face value, and if the methodology and statistics are sound, then I do trust the results presented. Unless you can show that there is an epidemic of fraud in psychiatric research -- i.e. > 50% of studies are falsified in some way -- then I will continue to believe them, in general. I'm afraid I cannot throw the baby out with the bathwater.

Sara:

I read your post a little more closely, and you make several specific charges. If a study does not evenly distribute subjects who required a washout period due to taking previous medications between the active and placebo arms, then the results will be biased and unreliable. You are absolutely right on this.

How often does this happen, and where is your evidence? I know that there are a few high profile examples of this practice, but there are hundreds and hundreds of trials. Because a few researchers played fast and loose with their trial design does not mean that ALL psychiatric research is fraudulent.

Again, that is simply my point. In any human endeaver in general, and medical specialty, there are going to be people who have not done well. If you gather together everyone who ever had a negative outcome in surgery, and posted their stories, then surgery will look like the most barbaric and horrendous practice ever, but this is a biased sample. There is no doubt that those people have suffered and that should not be minimized, but the conclusions that we draw should be within the bounds of reason, and rejecting the entire specialty of surgery is not a valid logical inference, although it may be the right emotional inference.

I am truly very sorry for everyone here who has suffered from misdiagnosis, mismanagement of medication, adverse effects and invalidating physicians. However, without additional evidence, I cannot join the chorus here to throw psychiatry out the window and replace it with ... what?

I wonder what people here would recommend when encountering someone who is psychotic or manic or so depressed that they cannot even get out of bed? Is there a limited role for medications? Is there no role for medications? Herbal remedies?

DGuller and others, you might want to watch these videos and sit back and wonder what the hell is going on with the drug industry.

To view the rest of the series, a total of 10 videos, go to Stan's blog and Bob Fiddaman's blog.

These videos have former drug reps interviewed, parents of children who are dead from psych meds, KOL's, etc. well worth the time to watch.

Not to mention a review of PBS Frontline "The Medicated Child". This issue regarding top KOL's being investigated is not a topic that will go away, this is the tip of the iceberg.

AA:

I will try to address some of the important points that your raised in your post.

First, regarding the impossibility of clinical trials assessing the connection between suicidality and antidepressant use, because clinicians "blame the patient". I actually disagree with you. It is well recognized that there is a moderately increased risk of suicidal ideation in the early phase of antidepressant use in those under the age of 25. Multiple meta-analyses have confirmed this link. So, it is certainly possible to study it, and I do not know anyone who "blames the patient". What exactly did the patient do to deserve blame for increasing suicidal ideation?

Second, how did I "discount" your experience by saying that there are a variety of possible mechanisms that would lead someone to become more suicidal on antidepressants? Some people who had no prior history of suicidal ideation have a severely dysphoric reaction to antidepressants, such as akathasia or a mixed state, and it is so unbearable that they want to kill themselves. Others who were depressed and possibly suicidal, but lacked the motivation or energy to follow through, may have the early return of energy, which makes it possible for them to act on their suicidal impulses. Others develop SIADH and have altered electrolyte levels that dramatically change their mental status in suicidal directions. I'm sure there are other mechanisms involved that I am unaware of, but those are some. The resulting suicidal ideation is certainly real and of concern.

Third, regarding other medications, like OCP, resulting in suicidal ideation, I would not blame it on depression unless they were actually depressed before taking the OCP and already had suicidal thoughts, but lacked the energy to do so. Naturally, if there was no depression, and someone started an OCP and became suicidal, then I would look for another explanation, such as akathasia, a mixed state, a change in blood chemistry, if those are appropriate, given the clinical information. In other words, what I would believe happened would depend on the whole picture, and not just bits and pieces of information.

Fourth, if someone has found no benefit and only disturbing side effects from treatment, then I would have a discussion with them (and their family, if necessary) about the situation. I would say that, at that point, there is little evidence in terms of what to do next, and that we could try another round of medications, or we could discontinue treatment and see where that goes. Assuming that they were not a danger to themselves or others, and they wanted to go off their medications, then that is their right and prerogative. I would support them in whatever they decided, and would discuss less evidence-based possibilities, such as therapy, herbal remedies, etc.

Fifth, you are right that it is important to distinguish relapse from withdrawal symptoms. My typical practice is that if I discontinue a medication in a patient, and they develop psychiatric symptoms within a month, and they include symptoms that they did not have during their psychiatric episode, then I would ascribe them to withdrawal and counsel the patient to be patient, or to slow the taper. If those two conditions aren't met, then I would strongly consider whether they were having a relapse, and would discuss the possibility of increasing their medication, if they agree to it. I recognize the reality of withdrawal symptoms. Do you recognize the reality of relapse? What to do then, if someone has benefited from medication and they suffer a relapse of teh same condition?

Sixth, I actually have never heard of the slow titration schedule for antipsychotics that you mentioned, and so naturally I have no studies to support people using it. Which studies have you read about that taper schedule?

Seventh, can you provide more information -- including the citations -- from Whittaker's book about those individuals who recovered from schizophrenia in other countries without medication? Also, the older studies that showed the same. Just keep in mind that older studies did not share our diagnostic criteria, and may have mislabelled something else as schizophrenia. One of the reasons for the DSM was because of such situations. Also, many psychotic symptoms are due to an underlying medical illness and other medications. Were these ruled out in the individuals who spontaneously recovered?

Eighth, you are right that most patients do have long-term side effects of antipsychotics, including EPS, metabolic syndrome, QT changes, and so on, and there is a substantial loss of life-years associated with their use. I am also aware of Dr. Andreasson's study showing brain shrinkage and look forward to its publication so that I can review its methodology and other factors. That being said, they have been shown to be beneficial to relieve many psychotic symptoms, and thus it is a difficult risk-benefit analysis. Some people would rather have diabetes than hear voices commanding them to kill their family. It is a difficult decision to make and should be taken very seriously.

I also know that many people find no or little relief from their psychosis and are burdened by side effects. And that is extremely heartbreaking, and I wish our treatments were better, and hope they will be better in the future. I would also ask you what you would do with someone who was acutely psychotic and distressed?

Ninth, Dr. Deegan's comments are extremely profound and humbling. Thank you for sharing them.

Take care.

Stan:

I still wish you a relief from your suffering.

Good luck on your life journey. :)

Stephany:

Thank you for linking those videos. They were very informative. There was much that I agreed with and much that I disagreed with, but they certainly presented their case well. Thank you, again.

Take care.

I stick to my egomaniac statement. Interesting you've chosen to post on this site. You really think you need to balance out what is said here? Do you really think people at this site haven't heard your side? You think we can't go to any joe shrink, turn on any news program, read any news paper and not hear your side?

Like I said ealier, stick to your side and wonder why so many people are turning to sites such as this one. while psychiatry benefited and benefited greatly in the past because your side had all the power, all the research, the internet has become the patients power. But you stick to your corrupted reseach for the time being and we will stick to telling your patients the truth.

I agree with Stan, fuck off!

Jane:

I have as much a right to be here as you do. I have as much a right to give my understanding of these issues as you do. I have been patient and courteous with you on this forum. I haven't said a harsh or unkind word to you.

Rather than attack me, attack my ideas and the evidence for them. I think that would serve your cause much better than insults and derogatory remarks.

Dguller; Quote:

"Stan:
I still wish you a relief from your suffering."

To begin with, I believe you are suffering from a condition of pure unadulterated one minded ignorance; far more than I will ever suffer. As you have made that subjective assumption that I am suffering? I actually laughing at you and crying for the suffering of others! That’s a concept you’ll never understand!

I guess this is your diagnosis criteria for your patients also. Understanding that you are only a medical student and probably squeaking by since you have chosen psychiatry as your medical path; you are probably writing your paper right now on the anti psychiatry movement. I would gather you would have no other reason as supposed resident to be here throwing your same old crap out to us day after day when your time studying would be used in a more valued commodity. Of course it could be that you’re just so personally repulsive, and have such a social anxiety disorder that it keeps you from functioning in the real normal world; so psychiatry is a perfect place to create your very own little world. Ego-maniac psychiatrist with the power to treat others with any subjective interpretation of that Myth you call the DSM and medicine.

Reading your indoctrinated bullS--T from the medical establishment shows us you don't or are not capable of thinking for yourself. Which is understandable since this is status quo in psychiatric and medical training.

You won't ever find what you’re looking for here; No converts to be had! Most here have been through your ego centric world and your money mongering whore hell already and survived. Some have lost their children and loved ones to this myth you call psychiatric medicine.

Your suffering has barely began, because you have years of inflicting suffering on others ahead of you! But as always; you in the end will reap what you have sown. Think about that next time you pull out your script pad and write a drug you know is poison, make your excuses for the skewed data and studies you know the drug companies had ghost written to say exactly what they wanted it to. Lets add kudos to the whole mental health profession for creating such a subjective tool to label almost anyone walking through their doors with (Yes, your Bible the DSM). Quite a scam you have going for yourself there; in another time and place you'd be a good snake oil salesman or even a sales rep for lobotomies! You could read the so called subjective false science, and make a case for that too in your line of reasoning; that's if you had no conscience what so ever.

You see you’re the one that needs help, my pitiful puppet; but then you are completely blind to that fact.

Hope your paper turns out well for class and you get the grade you deserve. You have come to a place where you are just wasting my time reading your witch doctor science assumptions. Enough is kind of enough already!

From this point on do want us to play “its trash the psych doctor game”? Ask TherapyFirst how this game is played. He's gone into hiding for some unknown reason. Not just because he was banned from this site, but because he was walking a line he was afraid would come back to bite him on other sites also. Funny how some people create their very own fear in this world, subjectively speaking of course.

So keep it up resident boy! You just went from ignorant commenter to bulls’ eye target. Now I wish you relief from your blind suffering, you never know when you'll be the patient?

Stan

Stan:

I am sorry that I assumed that you were suffering. I thought that your hostility towards my field was because psychiatrists had caused a great deal of problems for you that you are still extremely upset about. Perhaps that was a hasty assumption on my part. However, I am glad to hear that you are doing well, and I truly hope that your life continues in that direction. :)

I want to emphasize that I am NOT meaning to get in the middle of any personal conflicts where people with terrible personal experiences have clashed with dguller's more clinical perspective.

And though dguller does have medical training I of course don't, I find it simply incredible that there would commonly be situations where a patient would have to either take atypical antipsychotics causing diabetes or suffer horrendous schizoaffective symptoms. Except for maybe one or two patients in the entire world, do such "Sophie's Choices" really exist?

Yet and still, I agree with dguller when he says ...

**I wonder what people here would recommend when encountering someone who is psychotic or manic or so depressed that they cannot even get out of bed? Is there a limited role for medications? Is there no role for medications? Herbal remedies?**

At least Sorrowful said the problem is with psychiatrists rather than medications IN AND OF THEMSELVES, which allows dialogue with someone of my mindset.

(Which is, I think medicine has helped me maintain my sanity despite Big Pharma's ills -- a stance one would think is eminently moderate and rational even if one ultimately disagrees. But I guess not.)

Larry:

Unfortunately, those difficult choices occur all the time. Until there are better treatments, that is the best we can do at this time. Ultimately, it is up to the patient to make their own decision, like with the psychosis or the side effects, and for a substantial group, both.

DGuller, In your previous post, you said:


“There is also a question of the precise mechanism of the increased suicidality, i.e. due to the dysphoria of akathasia or mixed states, due to the return of normal energy levels before sadness and hopelessness improve, etc."


While of course, you, DGuller, are not directly blaming the patient, the statement about the return of normal energy levels is subtly doing that. However, you did expand your response in this post to indicate there are many possibilities and not just this one reason, which a lot of your colleagues automatically come up with as the only possibility.


A comparable situation – When patients complain about weight gain from psych meds, initially, it was automatically blamed on their eating habits instead of the strong possibility that these meds themselves cause this issue. Fortunately, that has changed somewhat but not enough.


You said:


“Fifth, you are right that it is important to distinguish relapse from withdrawal symptoms. My typical practice is that if I discontinue a medication in a patient, and they develop psychiatric symptoms within a month, and they include symptoms that they did not have during their psychiatric episode, then I would ascribe them to withdrawal and counsel the patient to be patient, or to slow the taper. If those two conditions aren't met, then I would strongly consider whether they were having a relapse, and would discuss the possibility of increasing their medication, if they agree to it. I recognize the reality of withdrawal symptoms. Do you recognize the reality of relapse? What to do then, if someone has benefited from medication and they suffer a relapse of teh same condition?”


With all due respect, DGuller, I don’t think you do. People who either cold turkeyed or withdrew from a med too quickly are fine for a month and develop symptoms. Also, there are also those folks who about every 6 months to a year develop some withdrawal symptoms.


Someone on an email list I belong to says it is because even though a person is off the meds, segments of it stay stored in fat tissues and at certain periods, release it into the body.


I am not sure what to make of your question about recognizing the reality of a relapse. It takes weeks to develop from what I understand and is a gradual process. A relapse isn’t being fine one day and feeling like killing yourself the next when the person has tapered too quickly from psychiatric meds.


I could also turn that question back at you. Do you and your colleagues understand it?


The reason I ask is I know someone who was taking medication every 4 days had a relaspe. Yes, the person knows not to do it anymore. Anyway, the person’s doctor didn’t recognize that it was withdrawal taking place due to the inconsistent dosing and not a relapse. The person’s dosage was increased.


“I actually have never heard of the slow titration schedule for antipsychotics that you mentioned, and so naturally I have no studies to support people using it. Which studies have you read about that taper schedule? “


I thank you for your honestly but I am speechless. Psych meds drugs makes neurochemical changes in the body and that the brain needs time to adjust to having less of the drug in the body, particularly when they are more powerful like neuroleptics.


You might be able to taper faster at the beginning of the taper. But that is a big fat “if” and must be monitored very carefully.


No, there aren’t any studies because your profession minimizes withdrawal issues and as I keep saying, a belief leads to an hypothesis which leads to trials. So if your profession doesn’t think this is a problem in general, the chances of clinical trials taking place are slim and none.


I don’t mean to sound condescending but why do you need trials to do something like this? Sara alluded to in her previous post that if you taper a neuroleptic too quickly, you run the risk of rebound psychosis and other nasty side effects. It seems like common sense to me that since this isn’t just an issue of lowering the med levels, that you would taper a powerful med very slowly.


Regarding the Whitaker citations, there are really too many to post. But if you go to http://psychrights.org/index.htm, you will see the Whitaker Affidavit right away, which will give you the citations you are looking for. I can’t answer your other questions.


“Eighth, you are right that most patients do have long-term side effects of antipsychotics, including EPS, metabolic syndrome, QT changes, and so on, and there is a substantial loss of life-years associated with their use. I am also aware of Dr. Andreasson's study showing brain shrinkage and look forward to its publication so that I can review its methodology and other factors. That being said, they have been shown to be beneficial to relieve many psychotic symptoms, and thus it is a difficult risk-benefit analysis. Some people would rather have diabetes than hear voices commanding them to kill their family. It is a difficult decision to make and should be taken very seriously. “


I greatly appreciate you saying that about the loss of life as many of your colleagues would blame the patient.


If a person is fully informed of the risks and chooses to take the meds, their decision should be respected. But again, that is not happening in a lot of cases.


Furthermore, thanks to tightening mental health commitment laws that will forcibly commit people who are not a danger to themselves or others, they will be forced on these meds against their will. That is chilling.


“I also know that many people find no or little relief from their psychosis and are burdened by side effects. And that is extremely heartbreaking, and I wish our treatments were better, and hope they will be better in the future. I would also ask you what you would do with someone who was acutely psychotic and distressed?”


Unfortunately, I am not as familiar with natural remedies for schizophrenia as I am with depression. I would go to vitasearch, http://tinyurl.com/5s9wuv and see what studies have been done on schizophrenia in this area. In the name of disclosure, it is run by a vitamin company but nothing is sold on the site and the studies are from mainstream journals


Here is the link for psychosis on the same site: http://tinyurl.com/5th9hq als.


I would also go to http://soteria-alaska.com/ and contact them about their methods.


You also might want to look at this site regarding an alternative perspective regarding hearing voices:


http://en.wikipedia.org/wiki/Hearing_Voices_Movement


Because you asked the same question about depression on another post, I wanted to respond. Here are my suggestions:

1. St Johns Wort – It isn’t completely side effect free but compared to SSRIS, it is a walk in the park. When I stupidly cold turkeyed off of a med, this immediately stopped the depression I experienced as a withdrawal symptom. Worked for about 3 years.


2. Fish Oil Capsules – Must be pharmaceutical grade. If you buy them at your local drugs store, save your money


3. Vitamin D – Many people have very low levels and should get it tested. You should be ordering this in your practice. From what I have read, D3 and not D2 is what you want if you need it.
The general consensus seems to be that 400 IUS are too low and that it should be around 1000.


4. B12 and folic acid


5. Magnesium – Here is the website to a health researcher who claims that magnesium enabled him to get off of Zoloft:

http://george-eby-research.com/html/depression-anxiety.html#story

This one is trickier as a lot of trial and error is involved. But in my situation, I think if I find the right magnesium that doesn’t cause problems, I think I have hit upon a winner. You also have to get the right calcium/magnesium balance.

Finally, thank you for your comments about Dr. Deegan’s remarks on psych meds. I think they should be in every psychiatriatric office, classroom, and hospital.

You might even ask her to speak if you are serious about understanding the patient's perspective.

AA:

Just a few remarks.

First, you wrote: “I am not sure what to make of your question about recognizing the reality of a relapse. It takes weeks to develop from what I understand and is a gradual process. A relapse isn’t being fine one day and feeling like killing yourself the next when the person has tapered too quickly from psychiatric meds.” I actually agree with you, and that is part of my general criteria to differentiate between relapse and withdrawal. If you reread my previous post on the subject, then you will notice that I actually explicitly state what you said.

Second, you made an intriguing suggestion that there could be a delayed withdrawal syndrome due to the deposition of medication in fatty tissues, which could result in a slower release of the medication. Are there any studies that support this? Animal studies? Clinical studies? What is the rate of release into the bloodstream from the fatty tissue? Is it slow enough to count as an automatic taper? If so, then shouldn’t that minimize withdrawal symptoms?

Third, your comments about the need for an extremely slow taper of antipsychotics is also intriguing, and it certainly makes sense. However, if there are no studies to support it, then it remains a hypothesis in need of confirmation. I’ll have a look at any studies that looked at various degrees of taper of medications. You specifically mentioned that “Neuroleptics should be tapered at 2 to 5% of current dose every 3 to 6 weeks”. How did you come up with those numbers? Why not at 1% every 2 weeks? Or 10% every month?

Fourth, if there aren’t enough studies looking at withdrawal effects, then there should be. As I mentioned during our previous discussion several months ago, there were several high profile articles written in reputable psychiatric journals that highlighted this issue. If this understanding is not prevalent thus far, then I hope that it will improve with time.

Fifth, I have read some of the literature on the Soteria program that you referred to. I also found a review article (see Schizophrenia Bulletin. 2008; 34:181-192) that looked at 3 controlled studies involving 223 first- and second-episode schizophrenia patients that concluded that although there was mostly no difference between traditional treatment and the Soteria program, there were significant differences in certain domains, implying that it could be conceptualized as, at least, equivalent to traditional treatment involving medications. That is extremely interesting, and if the results can be replicated in larger, better controlled studies, then that would result in a paradigm shift in psychiatric treatment of schizophrenia. Thank you, again, for bringing this important information to my attention.

Take care.