Friedman's article is a bunch of crap, excuse my language. Why can't these guys just let go of their medication paradigm and realize that maybe no meds at all is the way to go or at least only meds for short term emergencies, not for long term recovery? Or maybe that would put them out of business and that's the problem. Meds do not lead to recovery and certainly not to healing -- just about everyone reading this blog knows that. It's grasping at straws to say, "Well the new meds don't work so maybe we should try the old ones again." Please, the old ones have horrific side effects too and don't work any better (or worse) than the new ones. They're all bad and none of them really "work." Sorry.

Not to mention that lithium can really screw up your kidneys if you don't keep an eye on it.

Having said that, from what I've read it does appear that the rest of the world is much happier to prescribe lithium than America is.

P.S. I love the reference to the "smart young doctor" who prescribed five different antidepressants and then blamed the worsening of the patient's problems on his "treatment resistant depression." This would have me bending over in hysterical laughter if it wasn't so serious and so pervasive. As for the miraculous turn around with the MAOI in six weeks we can be pretty sure that's not going to last. Just blasting one part of the brain after another with each different drug -- I kid you not.

Thanks for an inspiring blog!

But aren't you stretching this one a bit? Quoting Friedman saying "they are no more effective than older antidepressants" you immediately object: "it almost sounds as if ye olde MAOIs and tricyclics are so much more effective than the newer". That's certainly not how it "sounds" to me.

To my mind, Friedmans point is an important one and it seems unfair to ascribe him opinions he didn't express, attacking a strawman.

As for comments like Sara's above, I think such anti-intellectual Tom Cruise-talk is just as distorting as the horrible Abilify-commercials I've seen on YouTube (they're banned here in Europe for good reason).

Just to say I am basing my "anti-intellectual" response to Friedman's column on years of reading his work and seeing the same poorly thought out conclusions reappear over and over again. I'm also basing it on bearing witness to psychopharmacological harm in scores of individuals. I've just had it with Friedman and his ilk which is why my language is a little over the top.

Oddly enough, I found myself making the same argument to my docs with my treatment. They were giving me new and improved stuff - anti-depressants, pain meds, etc. - that wasn't working. Finally, we switched to the old, generic stuff because it's cheap, it works and we know just about every single side effect that could possibly occur. That's the great thing about using older meds - they aren't sexy but they've been around long enough that we know what they do ... unlike, say, the liver damage Cymbalta causes (found out after I had been on 120 mg / day for about a year) when my docs prescribed it off-label when it had only been on the market for a couple of years, or the Celebrex, Bextra and Vioxx that I was prescribed to deal with my back problems back in ... 2002 or so?

Be careful in the attack here. I, a psychiatrist liked the article. By the way there is some evidence that the older antidepressants may be more effective in severe depression, particularly melancholic subtype.

Certainly in my clinical experience, MAOI's which are extremely complicated drugs to prescribe and take, but will work in refractory cases. No one prescribes them as they are so complicated. ( tons of time explaining the diet, drug interactions and such to patients). Patients find the diet very challenging.

I liked the article, he was pointing out that doctors are influenced by marketing and that there is limited data comparing treatments.

Lithium, with all it's side effects and complications is very underutilized in the US and to a degree Canada, as is clozapine.

Puckett is right, all drugs have side effects, with the old ones we have a lot of clinical experience with their risks and benefits.

Finally in response to Sara, anyone who reads the evidence knows that various forms of psychotherapy with medication shows the best outcome for most depressions. Problem is with getting psychotherapy, getting patients funded for psychotherapy or for most psychiatrists having adequate time to do psychotherapy. Face it if you work 40 hours a week, seeing patients once week for psychotherapy , you can only have 40 patients.

minddoc says, "anyone who reads the evidence knows that various forms of psychotherapy with medication shows the best outcome for most depressions." I have read this evidence and believe that it usually applies in short term studies of 8-12 weeks but that in longer term studies psychotherapy alone often shows the best outcome. Personally I believe that good empathic psychotherapy is always better than medication and that it is better to do psychotherapy without medication. I do believe that medication can have a role in true psychic emergencies. But the real healing takes place in telling your story and reframing it in a way that integrates it into your identity in a positive way. And that in the long run this is actually the most cost effective way to restore people to healthful self sufficient lives free of mental health care and medication. Anyway I actually apologize for my scornful language towards Friedman. I know it's not the way to get people to open up to new points of view. Yes, we know more about older medications but I don't really think they are safer or more effective.

"Now it’s true that the newer antidepressants are generally safer and more tolerable than older ones, which is an important advantage, but they are no more effective than older antidepressants."

and you say: "The was this is written it almost sounds as if ye olde MAOIs and tricyclics are so much more effective"....

Uh, no, it doesn't sound that way at all. You just quoted the guy as saying they new and old are generally equally as effective.

One of the challenges in all medical practices, but particularly in the treatment of depression, is using the aggregated data from various studies and trials and then applying that to an individual patient. A treatment regimen that works for a lot of people rarely works for any given individual.

Another profound challeng is the nature of the illness itself. Each episode seems to have its own pattern. I've been dealing with depression for more than 40 years. Some episodes, even serious ones, have run their course without intervention after a few weeks. Others required meds (including lithium) and therapy.

My current episode has lasted for a couple of years, even with aggressive treatment including a litany of meds, various modes of psychotherapy, hospitalization, and a couple dozen ECT treatments. What's worked best, so far, is a new mode of an MAOI (Emsam) that's given me back my life. (I believe that ECT was beneficial for me, but that's a discussion for another day.)

I'm still not able to return to work, but I am useful to my family, friends, and community. My psychiatrist reports that he's prescribed Emsam for several patients, but I'm the only one for whom it has provided significant relief.

There is a lot of bad psychiatric medicine in practice - lazy clinicians, obstructionist insurance companies, abetted by unsupportive families. We (I) can't afford to dismiss all psychiatric practices, including meds and ECT, as failures any more than we (I) can afford to embrace the breathless enthusiasm of Big Pharma on the latest reformulation of a drug that lets them extend their patent by another few years. Treating depression is hard work for all and successes, particularly permanent successes, are elusive. Nevertheless, some treatments do work for some people and we (I) need to make sure that the news of those successes gets to those in need.

I'm sorry I keep saying this and some people can call me naive but once you start saying your depression continues even with aggressive treatment you lose me completely. Knowing what we do about meds, hospitalization, ECT, how can anyone believe for one minute that this is going to make depression better? This isn't going to cure or heal depression in a million years and what it is going to do is make it worse. Healing depression takes a lot of work and a lot of understanding from the person who's suffering in conjunction with other understanding individuals who honor that person.

"Knowing what we do about meds, hospitalization, ECT, how can anyone believe for one minute that this is going to make depression better? This isn't going to cure or heal depression in a million years and what it is going to do is make it worse."

Sara: That is false, plain and simple. If you could name ANY reliable source for your extreme views on this complex topic, one could start to argue with you. Look at the literature and read it critically, but don't use a couple of personal anecdotes to dismiss it completely. Because there's a lot of people (incl myself) who could tell you anecdotes making just the opposite point, and then what do you do - fight over it? That's what I mean by the antiintellectual approach.

Joar, I don't know why you think I'm just using a couple of personal anecdotes to arrive at my "extreme" position. For one thing you might want to start reading the archives of this blog which refer to numerous scientific and well argued articles about the harmful effects of medications (and ECT) as well as countless patient and survivor stories. I actually am very well read on the issues surrounding the safety of medications. I've been studying it for over seven years. A good starting point is Peter Breggin's Brain-Disabling Treatments in Psychiatry which summarizes a lot of scientific evidence in one place. As for anecdotes it is true I know several people who are seriously physically disabled as a result of being on psychiatric medications for over a decade. And then of course there are all the ones who have actually died too. As for people getting better I know people who claim to be better but the facts of their lives don't always support that and I think they are walking time bombs in terms of when the physical issues are going to hit them. My attitude is pretty cynical which makes it difficult to engage in dialogue at times. My life was seriously disrupted by the harm done by psychiatrists to a loved one.

mind doc,
"Face it if you work 40 hours a week, seeing patients once week for psychotherapy , you can only have 40 patients."
Is there something wrong with this? Being able to focus and work together in a meaningful way with 40 people a week is quite a lot better than giving three times as many the usual 15-minute drug-laden lick and a promise.

Economically, if you charge $100 an hour (low for a psychiatrist, but let's assume genuine altruism here) you'd be taking in $4000 per week. Surely that should be enough for anyone, even after deducting expenses.

Sara, what you're saying has certainly been true for me. When I first began treatment I was skeptical and wary of taking meds. But, after a lot of pressure I did take them. I began to believe that I was better when I was on medication.

My sister who knows me better than anyone is the one who said, "Let's look at this. Before you got 'treatment' you were depressed but you were working, going to school, actually leaving the house, paying your bills, etc. Once you began treatment you stopped working, quit school, you're pretty much bonkers, you've been hospitalized multiple times, gone to the ER with panic attacks, and so on."

Once my sister actually laid it out for me, I slowly began to realize she was right. I became a lot worse when I was receiving treatment. Since leaving treatment AMA I eventually went back to school, got a job & work full time, pay my own bills, etc. If I had listened to my psychiatrist I would probably be receiving ECT, shuffling in and out of hospitals, loaded up on meds, and attending the adult day care that was prescribed for me.

Being non-compliant saved my life.

Lisa,
What you said.

In my case there was the extra added attraction of an undiagnosed thyroid problem. But I improved greatly by getting out of "treatment" about ten years ago. I haven't looked back.

Recently I got back into psychotherapy with a woman I've known for 30 years. I trust her a lot. I'm there to work on PTSD issues and am making progress. The other day I was thinking that I would not be able to do this work if I were on psychotropic drugs. My emotions would be too blunted and unavailable to me. My issues would still be making me miserable but I would be unable to do the work of dealing with them.

Years ago a friend of mine went into labour. They gave her demerol for the pain. She told me the pain was still there but because the demerol put her to sleep she was unable to use the pain management techniques she'd learned to get on top of it because she would wake up in the middle of a contraction when the pain was overwhelming instead of being able to deal with it from the beginning. Kind of like surfing and being unable to meet the wave, just waking up to find yourself off your board and in the middle of it all.

This is what these so-called medications did for me--didn't change the pain, just made me less able to deal with it. Thanks a heap, doc.

Sherry

Sara, I appreciate you taking the time and energy to discuss this, despite the pain you've felt. In the end, only fundamentalists can do without dialogue, right?

That's why I'd like to reply one more time when you say: "As for people getting better I know people who claim to be better but the facts of their lives don't always support that and I think they are walking time bombs in terms of when the physical issues are going to hit them."

I think this is a slippery slope that leads to believing everyone who doesn't share my view are victims of a delusion. Having looked at only the first chapter of Breggin's book, I'm repulsed by his rhetoric use of the term "medication spellbinding", which can be used to dismiss all the facts from countless clinical trials where people actually has reported improvement from study medication.

I find evidence from clinical trials and metaanalysis more trustworthy than anecdotes or gurus like Breggin when it comes to conclusions on what works and not. Can't you see there's money in the anti-psychiatric camp too? Here in Europe, the scientologists have started expensive treatment centers for addiction with methods that are proven worthless but still attracts some of the desperately ill with propaganda.

Anyhow, life is not a clinical trial and it's always important to hear voices like Lisa and Sherry's, who obviously have suffered from misdiagnosis and unserious follow-up of their treatments.

Well Joar, I wish you well in your psychological and spiritual healing. I'm sorry Breggin repulses you. I find him quite compelling, although he's certainly not my only source and neither he nor myself are Scientologists by any stretch of the imagination, so I guess we'll have to agree to disagree on many issues. I certainly do not hold my point of view because of any financial gain that it might be bringing my way. I do know that treatment works for people in certain windows of time and you must be in one of those right now. Of course, for your sake I hope it continues -- I really do not wish anyone ill, but I've just seen too many sad stories to believe it goes on indefinitely and also believe the science about how medications affect the brain and the immune system etc. etc. Still I'm sure there is a lot that's not known or understood.

(I agree that my language earlier in this thread was aggressive and it's not how I normally express myself. I had just had a disappointing run in with a psychiatrist whom I thought was more open to my point of view about medications -- dependency and withdrawal, in particular -- than he proved to be and I was taking it out on the readers here.)

Lisa and Sherry, I want to thank you so much for sharing your stories and affirming something I do believe from the bottom of my heart -- that we need to tell and understand our stories free of the affects of medication to truly heal and then the chance exists to go on with our lives free of mental health care and psych medication.

"Being non-compliant saved my life."

Me, too, Lisa. And I consider standing up to the psychiatric machine as winning the major battle of my life. I'm glad you had your sister's insight to help set you on the right path.

I visit the hospital regularly (I do art therapy there) and see lots of the people who didn't win the battle or perhaps, sadder still, didn't even fight. Their eyes are glazed over, their faces blank, as they shuffle out to the smoking area. It's really sad.

Joar: "Anyhow, life is not a clinical trial and it's always important to hear voices like Lisa and Sherry's, who obviously have suffered from misdiagnosis and unserious follow-up of their treatments."

Ok, so, everybody who has been harmed by psychiatry has been so because they were misdiagnozed?? - Geez, it seems, psychiatry does really an awful lot of misdiagnozing! - It's about the same kind of "argument", as the one that tries to deny the possibility for full recovery from "severe mental illness", because everybody who has fully recovered initially must have been misdiagnozed...

Joar, you're doing the same, you're accusing Breggin of doing. And, btw, it's not that Breggin has no evidence from clinical trials and meta-analysis on his side. Indeed, he has psychiatry's own evidence from clinical trials and meta-analysis on his side.

"Ok, so, everybody who has been harmed by psychiatry has been so because they were misdiagnozed??"

I never said that, Marian. Excuse me if I didn't express myself clearly, english is not my first language. What I meant to say is that I prefer to look at the studies myself rather than having Breggin or anyone else interpret them for me.

I haven't read much of Breggin but the general picture he's painting seems quite clear: that psychopharmacology never really helps but only disturbs your brain so you might not feel how miserable you are. I find that attitude and the language he's using to be arrogant and disrespectful, since my experience is very different from his. But I understand and respect that many of you have lived and seen other things than I have.

I took lithium for two weeks and HATED it. Got the shuffling walk. Felt all achy and flu-ish. And actually started contemplating suicide for the first time in my life, even though lithium data shows it prevents that in general. After Risperdal, it was my least favorite drug.