That article you wrote for the Portland paper you've linked here is a great article, and I want to encourage readers to take the time to read it.

I have to wonder if the relative ineffectiveness of anti-depressants has led to the growth of polypharmacy. When an antidepressant doesn't work it seems like the natural inclination of prescribers is to toss in another psychotropic. Are antidepressants as largely failed medications now the justification for more adjunctive prescribing, i.e. an antidepressant and an antipsychotic?

As one who had taken a host of antidepressants and maintained the requisite expensive medication compliance, I feel betrayed to now find that they offered so little benefit despite long standing representations to the contrary.

The odd thing is that the vast majority of people I know who take ssri's (I don't know about imipramine) take it for mild or moderate depression and these are the folks that swear by it. One friend, insulted by the argument that her depression might not be a chemical disease, explained that people who suggest she try other things like herb tea or yoga, didn't get that she had a medical disease when to me ssri's are just a much stronger drug than herb tea.

And of course saying that the fact that a drug makes you feel better proves you have a chemical imbalance only works for legal drugs and is obviously a bogus argument or do crack heads now get to win when they argue that crack corrects a chemical imbalance?

Not that ssri's are crack, but they're just drugs that seem to make some people, often highly suggestible folk, feel better. You have to wonder who these drugs work for when most people with severe depression end up on the major tranquilizers.

Still most people get ssri's because they want them I think, probably partially because the commercials for these drugs are so appealing and I would imagine a study like this will make the drug companies decide that they have to make the ads even more enticing. Still maybe a few doctors will prescribe them less and a few people won't want a pill to make the hurt go away.

That is an excellent article!

One thing I can't help thinking about is how unfair it is to the clinical study participants when the drug companies selectively decide not to publish the results of a trial. People sign up for these studies at some risk to their health, and experience some inconvenience, and then the drug companies just throw the results away when they aren't what they want to see?

That seems awfully disrespectful to the ordinary people who are enrolling as patients, presumably hoping to help advance science or medicine. These study participants are being sold a bill of goods!

The funny thing is, this finding has been hiding in plain sight and to some degree is admitted by the pharma companies.

Think of the Abilify ad that notes, "Two out of three people taking an antidepressant still stuffer symptoms." Of course, the pitch is to "add Abilify!" but it also says something pretty damning about ADs.

The thing that strikes me again and again is how, unlike other types of medication, psych drugs affect people so differently from individual to individual -- and even differently in the same individual at different times. If nothing else, all prescribing physicians should be required to fully inform their patients of this fact.

I can't believe how cavalier psychiatrists can be about prescribing new meds and then denying that your symptoms or withdrawal nightmare could be drug-related.

I started on Lexapro and although I did feel better, I gained 30# in a year. I tapered myself off of Lexapro, at what I thought was a slow rate, but ended up with a weird dizzy feeling that stopped only when I lay down.

I switched doctors and the new one believed me when I related my symptoms. He switched me to Prozac which, because of its longer half life, is supposed to be easier to discontinue. I ended up staying on 10 mg of Prozac as it balances out the Wellbutrin I've been on for 8 years. Wellbutrin has been great for me although it is not for everyone. My big concern is staying on it forever. I would love not to have my well-being dependent on a drug. But I've been told that because of my history, it would be too dangerous not to be on meds.

Thank you for your website, which I've just discovered. It's hard being alone in all this.

Posted by: Jayme at February 10, 2008 06:35 PM

This is a comment from the post January 17, 2008 "Pharma Companies Hid Anti-Depressant Data"

I'm sure that there will be some "thank you for your website... It's hard to be alone in all this." along 2010.
This is sad.

Thinking about this issue is making my brain explode. If antidepressants are consistently found to be most helpful for severe depressions, then they should not be prescribed primarily by primary care doctors, as is currently the case. Because severe illness is generally best managed by a specialist, right? But then, i would be wary of sending anyone to a psychiatrist i had not personally vetted. Remove the cynical, hopeless, jerky shrinks, and you're left with even more severe a shortage of resources for patients in need of help... So, where does that leave us?

"One friend, insulted by the argument that her depression might not be a chemical disease, explained that people who suggest she try other things like herb tea or yoga, didn't get that she had a medical disease when to me ssri's are just a much stronger drug than herb tea."

This kind of thinking just drives me nuts. Do yoga and herb tea somehow NOT alter physiology? Does thinking not alter physiology?

(My ranting right now is actually directed at a friend of mine, who reminds me of your friend... except i am typing it here, rather then saying it to her, because talking to her about this only results in altering MY physiology in an unfavorable manner.)

"...or do crack heads now get to win when they argue that crack corrects a chemical imbalance?"

Isn't that sort of the idea behind dual diagnosis? That the chemical dependency is caused by a person self-medicating for an underlying mental illness? (Not arguing for or against, just sayin'.)

Balls! Sorry about the triple post. Just wanted to clarify that i am agreeing with Sally, about the thing with the friend thinking that the fact that an SSRI "works" validates the existence of her "chemical imbalance"; my rant was not AT her but rather inspired by her... Ok sorry done!

These are very insightful posts. I spend a lot of time trying to point out the mythology that exists around psychiatry and psych drugs. Most don't want to hear it. I tried to talk an opiod dependent female out of taking Celexa today. There was no hx that it ever helped her or any likelihood that it would.She has not stopped using Heroin for years. (Dual DX is circular descriptive bullshit) She would have nothing to do with my attempt to point out the demonstrated lack of benefit for most on such drugs. She demanded it. I have an impossible task. 2 weeks ago I was watching dopey Dr Oz on Oprah spouting off to an audience full of women that depression is a chemical imbalance just like any other medical problem. Idiot. This recent rash of publishing by the medical establishment now claiming that these drugs don't work well is I fear a subtle back door attempt to just replace a group of drugs going off patent with a new group. (atypicals now good for your new Bipolar depression!!) America has been poisoned by the therapeutic culture promoted by psychiatry/psychology. We have created a population of invalids. Shameful.

Thanks Sarah. I agree with you too.

Absolutely...great post. And the article re Turner was excellent. What's frightening is the atypical antipsychotics may be tomorrow's ssri ssnri. Thank You!

Ah, antipsychotics. Reuters Health has a piece out entitled "Many Antipsychotic Users Not Getting Needed Tests," which begins:

People who take newer drugs for schizophrenia and other psychotic conditions are supposed to have their blood sugar and cholesterol levels
checked regularly but many don't, according to a study released today.

These so-called "second-generation" antipsychotic drugs, which include olanzapine (Zyprexa), risperidone (Risperdal) and aripiprazole
(Abilify), were developed because older antipsychotics have significant
side effects. However, the newer drugs are known to significantly increase blood sugar and cholesterol levels, raising the risk for
diabetes and heart disease.

In a study, researchers found that less than one-third of low-income Medicaid patients who are treated with these drugs have their blood
sugar and cholesterol levels checked.

And perhaps even more concerning, say the researchers, screening rates did not increase following government warnings and recommendations
calling for increased blood sugar and cholesterol monitoring.

The findings are consistent with others from non-Medicaid populations, Dr. Elaine H. Morrato of the University of Colorado, Denver, who was
involved in the study, told Reuters Health.

(I don't have the link.)

So when everyone goes on AA's instead of AD's, we're going to have one sicker-than-ever population.

Dr. John: Your phrase, "a population of invalids", fascinates me. It makes me wonder if people actually view themselves as some sort of medium to be acted upon... by their screwed up neurotransmitters, by germs, by medications prescribed by a doctor. Rather than acknowledging the responsibility, that comes with the fact of being a thinking being, to take one's own physical and emotional health in hand.

It is each individual's own choice whether or not to exercise that responsibility, and i'm not one to go around telling anyone what to do. (Although i'll admit that in the confines of my own mind, it is very hard sometimes to suspend judgment.) But when so many people will just put blind faith in a pill, that says to me that as a population, we have some really screwed up priorities.

Sarah writes "It makes me wonder if people actually view themselves as some sort of medium to be acted upon... by their screwed up neurotransmitters, by germs, by medications prescribed by a doctor." This is exactly what is happening Sarah. The parallels between psychiatry and religion are disturbing. Both depend upon what is essentially revealed truth and priestcraft.By the psychiatrist/priest. There is no more support for the myths that psychiatrists advance than there is for those that priests do. This does not mean there cannot be a moral code in either or an attempt by the priest/doctor to help the pt but both open themselves up to gross manipulation of human beings who are naive and vulnerable. Like religion many are willing to overlook the obvious cognitive errors that such a belief system requires in the name of faith because it provides them a world view and an explanation that is simple and comforting. This is a deal with the devil for short term comfort but the loss of ones soul in general. Psychiatry like religion is invested in promoting dependence because it is good for both as social entities. Clinical psychology is guilty of the same sins. TX tends to be open ended and endless as long as the pt can pay and wants to come.Everyone needs therapy right? Does Chemo work that way? Who's needs are being meet? I have been in practice as psychiatrist/physician for 20 years and slowly came to this realization as I saw what I was taught not only did not work but harms people often at times. I spend my days trying to deprogram people who are chronic psychiatric pts but I loose most of the time. There is too much to be gained by both in the institutional dependency. I will leave in a few years as soon as my kids are older to teach critical thinking to high school students. I am preparing now to go back to school but until I do will continue to try to help those who cross my path regardless if they want my kind of help which most do not. They do not want their Dr to tell them "I can't tell you ANYTHING for sure." They wish to be deceived.

Wow. Lot of strawman building going on - just so you can burn it down.

Consider - maybe psychiatric patients aren't naive idiots. Maybe if the drugs weren't helping them they'd stop taking them.

And - gasp! - maybe the drugs do work. Sally knows several people on SSRIs for mild to moderate depression to swear by them...

I know people who swear by magnets and have seen those who claim to be helped by exorcism. Shall we assume these are TXs valued as being proven beneficial by science? I did not say pts were idiots. I said they have been taught to believe things that have no support in science or objective reality. It is not their fault, it is the fault of psychiatry. SSRI's may blunt emotion. This does not make them more effective a TX for "depression" than smoking weed or drinking scotch. Swallow as much of whatever you want if you feel it helps you as long as you know the risks. People do not know these risks or the limits of these meds as they have been lied to by organized medicine. You appear to have missed the point of my post.

Blackeneth: I think you may be oversimplifying the issue. This issue is not, Do SSRIs ever help people? The issues, as i see them, are as follows:

1. How do we weigh the risks versus the benefits of SSRIs? (When in the decision phase, of whether or not to prescribe a certain medication to a patient, these are going to be in the form of probabilities only. You can only guess the risks and benefits to any one individual, based on their situation and on the risks and benefits shown for a population. I think. I am not a scientist nor a doctor.) I think many people on this forum would argue that the risks of SSRIs have been minimized, and in some cases, perhaps purposely suppressed.

1a. This also gets us into the issue of informed consent.

2. Are SSRIs overprescribed? (This gets more into a population thing... One-third of patients will be helped by placebo. That is a _well-documented_, _physiological_ effect, by the way. In other words, these people are not making it up. But it is not ethical to prescribe placebo.)

I hope i have made some sense; i am in a hurry, and i don't want to come back to this site again today (I need to study! Bad Sarah!), so i trust that others will add to or argue with my list as they see fit.

On a personal note -- I absolutely have been helped by an SSRI. I am currently weaning myself off of it (about to go see the psychiatrist and probably get a stern talking to!). It worked for the situation i was in and enabled me to do some inner work. So i would not ever say that SSRIs do not work. I also would not ever try to take my situation and try to apply it to everyone who has ever suffered from depression.

Wanted to throw in something that's been bugging me as of late. It's very clear to me that the antidepressant hub-bub over the decades has been a masterful bit of PR work by pharma, etc. No doubt, the real facts show in many cases they aren't a heck of a lot more efficacious than placebo. That said, if one of my blog readers has lulled themselves into a sense of wellness incorporating a placebo effect, what potential harm do I cause by stating the facts?

Sarah, I think you made perfect sense. It's not informed consent if the truth is hidden from people.

I am now at the point where know far more about the actual mechanisms of psych drugs and their biological damages (including target organ toxicity, AKA BRAIN toxicity) than my doctor. I really don't think he was purposely misleading, I think he's a victim of his training. I don't think true informed consent is even possible with psychiatry as it exists today. To quote Dr. John "[Psychiatry] needs to die!" Viva la Revolucion!

Bill, I've had the same concern. The people who like ssri's really think they are life saving. And any attempt to argue with them is about as successful as arguing with any devout religious believer that their religions big promise is not true, usually futile and for the really decent, sincere ones downright cruel.

My theory is that for a lot of people depression involves a loss of hope so especially at first ssri's work because they give hope, sort of like Dumbo's feather. If ssri's really were just sugar pills there'd be no problem but unfortunately if what I understand about the placebo effect is correct, you'd have to lie to people to generate the effect.

I think the best time to gentley point someone towards the lack of evidence for ssri's is when the hope fades, i.e. the placebo effect wears off or a drug tolerance builds up, because, assuming the ssri's haven't caused irreversible side effects like harm to self or others, that time when the "patient" goes back in looking for a new drug because life ain't perfect on prozac anymore is when the diagnosis goes up a notch to bipolar and the patient gets a major tranquillizer which will give him or her real "psychiatric symptoms" and also make it very, very difficult to be allowed by medical folk to stop taking meds. After all when you're depressed you can "just get better." Once you roll over to bipolar feeling better is labeled either hypo manic or denial or I guess both.

Blackeneth,

Haven't seen anyone use the phrase straw man in a comment here in a while. Hope it's the same person back. You're right I do know lots of people who swear by ssri's but then I know lots of people who swear by wine and pot and chamomile tea.

One of my friends who swears by ssri's was having sex outside of marriage. He thinks he cheated on his wife because he had a chemical imbalance in his brain known as depression and that prozac cleared it up. This would seem a classic case of an ssri side effect, the blunting of sex drive, being interpreted as a medical restoration of normal chemical balance. Still for now the drug seems to have saving his marriage. It's not that the drugs don't brighten many folks moods, it's that mood brightening, emotional pain control, is a part of the normal human experience not medical treatment for a disease.

Excuse me if I've written about this before but back in junior high, my church youth group leaders, two idealistic college kids, told the youth group they would let us all have one drink, one Seagrams and Seven, so we all had one drink. We all felt a little bit buzzed and one guy started acting really drunk, or like a he thought a drunk really would act, but he wasn't acting, he really felt drunk. Then the youth group leaders told us they had just rubbed booze around the edge of our glasses so that the would smell strongly of booze but not have any in them. They did this to show us the placebo effect of alcohol. I never forgot this experiment, important to remember, but it doesn't mean alcohol doesn't get one drunk. It also doesn't mean wanting a glass of wine with dinner or a night of whiskey drinks means your body is suffering from a booze deficit (unless of course you've consumed so much alcohol your body has become physically addicted).

Some people are saying, "if patients are happy on meds, then why worry about it?" But, the mental state that Lexapro put me in absolutely made it impossible for me to evaluate my own situation. I was in such a fog that I didn't even know that the drug was the problem until I went off it and the fog suddenly lifted.

Any outside observer should have been able to see that my life was going down the tubes -- my career was in ruins, my behavior was erratic and out of control -- but I couldn't see it because I was in this altered mental state.

I only was able to see what happened when I went off the drug and got my critical thinking skills back. Prior to that, I was a zombie.

Immediately after going off the drug, I was thinking clearly and I had so much more energy. I couldn't believe everything that I could get done in a day. And, my external situation when I got off the drug was terrible. I'd lost almost everything that meant anything to me while I was on the drug. So, I should have been depressed and lethargic... but all of a sudden I was energized and productive.

That drug took three years of my life, but I'm relatively lucky I think. At least I didn't have that experience when I was a little kid, and at least it ended eventually.

In my post above, I think that I made the transition from drugs to no drugs sound more rapid than it was. I actually was 90% improved within 2 months after going off the antidepressant, but that first month was sort of rough. I had extreme mood swings and brain zaps that were so bad that they would wake me up in the middle of the night.

The withdrawal symptoms probably solidified my resolve to stop my medication against doctor's orders. I knew something wasn't right with those brain zaps, and that the pill that was causing them couldn't be anything good.

Again, I think I got lucky because my withdrawal didn't take that long. I was stabilized within 2 months, and I've gotten better slowly since then. I may not ever get back to 100% (I'm not sure how I'd know) but things are much much better. Going off Lexapro is the absolute best decision I've made in my entire life.

Dr. John,
Your post about deprogramming chronic psych patients touched me deeply. I have endured 25 years of "treatment" for a misdiagnosis. For 25 years I have been told I was mentally ill, my suggestion that I had a specific physical ailment was nonsense to be patronized, my opinions were invalid, I knew nothing, I needed to be drugged, incarcerated and have my brains fried--and I would always be this way! I came from a horrendously abusive home so this programming actually seemed quite benign compared to the more pervasive programming I grew up with. I mean, these people looked sympathetic, didn't usually laugh openly at my suffering and probably sincerely believed they were wearing white hats to go with their nice, official-looking coats.

So now I'm doing much better, thank you. I've learned over the years how to manage the very real things that happen to my body when my PTSD gets triggered and how to manage the other, really annoying psychological symptoms of that stuff. I'm working two days a week as an office gofer and newsletter editor. As I approach retirement age, I find my life actually just beginning. I really do my best to live in the moment because I refuse to be eaten up with the rage that would over take me if I dwelt upon my wasted adulthood (and yes, like most people I spent some time wanting someone else to "fix" it--the eternal rescue fantasy of the abuse survivor--so I played into all that).

But, I have to tell you, it is extremely difficult to have confidence now in my own judgment, to stand securely over time in my own space, when the high priests/priestesses of my society have for so long undermined what little confidence I had to begin with. I work on issues from the original abuse, but I find myself even more often working on the damage done by your colleagues. At the same time I really do want to take responsibility for my life and behaviour because I know it's the only way to full functioning for me. My greatest difficulty is somehow discerning where to draw the line in my work life as to where to stand my ground versus knowing what's going to be small potatoes down the line--picking my battles.

At any rate, your posting is such a validation of the process I am going through. Thank you.

Sherry, thank you for your story and wonderful post. You have said with power and eloquence what I could not. You have also clarified what is in general completely lacking from psychiatry. Humanity and humility. You and you alone know your emotional experiences. Once the DX is made in psychiatry is usually when people quit listening and somehow believe they know more about what's going on than the person telling the story. I have never understood why someone would believe they could go to an absolute stranger to learn about themselves. You have learned on you own (as we most often must) what psychiatry almost never gives anyone. Resiliency in the face of emotional injury. Oh it pretends it does but telling people they are disordered, dependent and just in need of balanced brain chemistry harms them in terrible ways. You have turned your pain into knowledge and moved forward in your life. Well done. I find almost nothing in life more gratifying than hearing from people who have decided they no longer need psychiatry or what it offers!

Someday we need to have a furious seasons party. I would love to meet you guys. I don't think I've ever encountered so many gutsy, courageous women (and men).

A makes an excellent point. The whole issue of informed consent is muddy to begin with when it comes to psych patients. Sometimes the patient's disease distorts their sense of reality, and clinicians have to work with that. But when it's the _treatment_ that affects the patient's judgment and ability to advocate for themself, that's really shameful... and i can't believe clinicians don't make it a priority to prevent that.

Sherry, reading your story makes me so angry. First of all, hypothyroidism should be one of the first things ruled out! And also, i've had a little taste of how it feels to be treated like a crazy person by a doctor, my opinions discounted and my questions dismissed, and it's awful. Not only is it hurtful, but it can harm the patient; how can you diagnose someone without listening to them?

I wonder if it's just very hard for clinicians to accept that there is only so much change they can effect in other people's lives, and that's why they get so heavy-handed with the drugs? I really want to understand _why_ this is happening! They are only people; they're doctors, they must believe that they are doing good... but they're smart; they're doctors, can they really believe you can know a person in ten minutes? Because they're Just That Good?

I have been told by a doctor i was LYING about having never experienced mania (I was very upset, because i am honest and it takes a lot for me to open up to a stranger... Oops, arguing about it got me "borderline traits"). Also been accused of lying about auditory hallucinations (again, never had); been assessed as "paranoid with flat affect" (read: tired and pissed). Some of these guys truly believe they're omniscient!

Some of you guys (SteveBMD, Dr. John, and luckily for me, my own psychiatrist) manage to keep your humility and insight, and you really are a gift to your patients.

Well, i've gotten off topic, but i do think my ramblings retain some inkling of relevance. The original post is about this class of drugs, which so many clinicians prescribed widely and with confidence... and now we have all these doubts about their efficacy. Seems somewhere in there was a giant lapse of judgment.

There is so much i have to say on this subject, but (fortunately for y'all) i really can't think about it for too long at a stretch... If anyone has any suggestions for taking action, i'm all ears.

http://www.nytimes.com/2010/01/12/health/12mind.html?scp=6&sq=paxil&st=cse

Anonymous,

I read Richard Friedman's article that you posted a link to above. I would agree with him that no one should stop anti depressants abruptly but disagree with him when he disingenuously misleads the public with this statement: "there is no question that the safety and efficacy of antidepressants rest on solid scientific evidence."

What he doesn't mention is where any of that solid evidence might be or of course the obvious disclosure of how much research money Weill Cornell where he is employed gets from big pharma. Besides he doesn't say there's any evidence that taking ssri's is helpful to those who are depressed but makes a statement I've not heard before - that ssri's have found to be helpful in preventing "relapse" into depression. I wonder why he might think this is true. He doesn't site any evidence. Wonder who funds him.

Maybe there is real evidence or real studies that imply evidence that ssri's work at preventing relapses of depression if not curing it, but if so why doesn't he mention at least one by name?

Here's a bit about Weill Cornell:

"On March 26, 2008, the New York Times published a front page story revealing that the Liggett Group, a major tobacco company, had supported research at Weill Cornell Medical College showing the benefits of early screening for lung cancer. The article, published by the New England Journal of Medicine in 2006 did not disclose the source of funding. The Journal's editor, Dr. Jeffrey M. Drazen, told the Times, "In the seven years that I've been here, we have never knowingly published anything supported by" a cigarette maker. The authors of the report and officials at Weill Medical College denied any effort to cover up the source of the funding. However, former New England Journal editor Dr. Jerome Kassirer, author of a book about medical conflicts of interest, expressed skepticism about this denial. He told the Times that he believed that Weill Cornell had created the foundation to hide its receipt of money from a cigarette company. "You have to ask yourself the question, 'Why did the tobacco company want to support her research?' They want to show that lung cancer is not so bad as everybody thinks because screening can save people; and that's outrageous." http://corporationsandhealth.org/campus_research.php

Still Friedman is right about this, SSRI's should not be stopped cold turkey. This is one reason it's irresponsible to get people who might not be able to afford them in the future addicted...