Comments: Peter Kramer Again Defends Anti-Depressants
Here's my experience I guess.
I was ill for years before I sought help. It took trial and error but anti-depressants eventually worked for me.
I had to struggle so hard against my guilt complex that I wasn't ill, I was just a bad person, to get myself to take them initially.
People close to me also repeated the "you're not ill, just pull yourself together" mantra.
I then, when well, went on to project my anger at the wasted years, and the "pull yourself together" brigade, on to the critics of anti-depressants, as I saw them as invalidating my experience.
It took quite a while to realise the critics were NOT telling me not to take my meds. (Actually, this site had a large role to play in this. Thanks). They were just pointing out the other side of the story - that I was part of the lucky 30%, and that frequently, the other 70% don't get a fair hearing, and that there's a lot more to the debate than I had thought, and that I had also been unintentionally invalidating their experiences.
It's a very emotive topic. Lots of buttons to be pushed. Many participants in the debate are not really arguing with one another, but with various bozos of one type or another in their past. Me included.
Posted by DeeDee Ramona at May 30, 2008 04:29 AM
Antidepressants, especially SSRIs, can cause homicides and that is an unacceptable risk. I believe that a person should be hospitalized if they are going to take Prozac/SSRIs. It is the only way to insure the safety of the community.
On www.SSRIstories.com there are over 2,300 tragic stories of murder, murder-suicides, school shootings, etc., involving these antidepressants.
Once the truth about the homicide risk becomes known by doctors, it should be the same issue as second-hand smoke. People didn't care if other people wanted to kill themselves by smoking but, once it became known that they themselves could be killed by another person smoking, that was the end of the tobacco era. So it is the same with the antidepressants.
I think Peter Kramer's book is a farce. Can you imagine a whole nation going on antidepressants becaue of 7 anecdotal stories? If I were Kramer, I would be ashamed and even terrified that I had encouraged this behavior.
Posted by Rosie C at May 30, 2008 11:23 AM
When I read Kramer's book, it made me want to stop taking antidepressants. My memory is that he pretty much says that for everyone, taking ssris is like being just drunk enough all of the time. Turns out that's being overly optimistic. Of course he either played down the horrible reactions lots of people had to these drugs or didn't know about them at the time. Now he's just another creepy hack.
Posted by Sally at May 30, 2008 05:54 PM
I didn't read his book, but I heard an interview with him on KPFA, about 7 years after his book came out. He stated that one of the less positive things about about anti-depressants was that they were being precribed for longer and longer periods of time. From reading your blog, it seems like he then chose to join the doctors he had criticised. When I started to take them 20 years ago, it was never intimated to me that I would need meds forever. It seems to me that a large shift in opinion took place, placing meds in the category of a permanent replacement for the brain's natural balance. Initially, I think it was more a temporary aid in order to look at the underlying issues which caused the depression in the first place, with emphasis on temporary. Therapists would have to actually be of some sort of help with these issues, have some belief in the patients' own ability to heal, and understand what "enough" is, if they were to avoid drug addiction.
Posted by Sophia at June 1, 2008 01:22 PM
This is also a good article:
www.psikofarmakoloji.org/pdf/12_4_6.pdf
ABSTRACT:
MECHANISM OF ACTIONS OF ANTIDEPRESSANTS:BEYOND THE RECEPTORS
Posted by Ana at June 1, 2008 02:21 PM
As I alluded to in my comment re: the PBS depression special thread, I really don't understand why SSRI-induced mania is considered the unmasking of pre-existing (though silent) bipolar disorder rather than a very toxic side effect of antidepressant treatment. What gives?
We'll never know the stats on this because psychiatry, on the whole, refuses to acknowledge this devastation. How many "bipolars" are actually just drug-damaged depressives? Great for Big Pharma, shits for the patient. So what else is new?
Posted by Francesca Allan at June 1, 2008 03:25 PM
Right. Let me translate the last Kramer quote for you Phil: "We may be losing effective substances, [as opposed to, as people are implying] approving ineffective ones."
How far up your ass is your pointy head, that you think Kramer of all people doesn't know the score about the FDA and the last 15 years of psychiatric medications?
It's one of the great mysteries that you can't get a job in journalism.
Posted by Swick at June 2, 2008 03:26 AM
Francesca,
You're right about SSRI-inducing mania.
The article I left the link raises some explanations on neuroplasticity:
www.psikofarmakoloji.org/pdf/12_4_6.pdf
ABSTRACT:
MECHANISM OF ACTIONS OF ANTIDEPRESSANTS: BEYOND THE RECEPTORS
Since the discovery of first antidepressants-monoamine oxidase inhibitors-a half century passed. There are now almost two-dozen antidepressant agents that work by nine distinct pharmacological mechanisms at the receptor evel. However, opposite to the divergence in their pharmacological mechanisms at the receptor level, antidepressant drugs probably stimulate similar pathways in subcellular level. These subcellular events or so called beyond receptor effects are named neuroplasticity, and the mechanism may be called as adaptation. These after-receptor processes, through their effects on synaptic transmission, and gene
expression are indeed capable of altering many molecular events in the brain. In this article, the mechanisms of actions of antidepressants at-and beyond-the receptors are discussed by documenting some of the evidence indicating such long-term alterations. Accordingly, the well-known effects of antidepressants on the receptor level are initiating events of antidepressant drug action, which enhance and prolong the actions of norepinephrine and/or serotonin and/or dopamine. Only if an adequate dose of an antidepressant is taken chronically, the increase in the synaptic norepinephrine and/or serotonin and/or dopamine stresses or perturbs the nervous system and the therapeutic response results from the adaptations that occur as a consequence of these chronic perturbations.
Key words :antidepressants, mechanism of action, neuroplasticity, adaptation
Bull Clin Psychopharmacol 2002;12:194-200
"SSRI-induced akathisia and agitation are hypothetically mediated by stimulating 5-HT2 receptors in the serotonin pathway that projects to the basal ganglia (11).This may be due to in part to the fact that serotonin inhibits dopamine
release there. Thus, increasing serotonin may produce a mild pseudo-dopamine deficiency state and concomitant symptoms of akathisia and agitation.
SSRI-induced anxiety and even occasional panic attacks are hypothetically mediated by stimulating 5-HT2 receptors in the serotonin pathway that projects to the hippocampus and limbic cortex (12)."
"SSRI-induced insomnia is hypothetically mediated by stimulating 5-HT2 receptors in brain stem sleep centers, particularly the serotonergic pathway that projects to the cholinergic neurons in the lateral tegmentum. Stimulation of the 5-HT3 receptors both in CNS pathways such as the brain stem vomiting center and the pathway to hypothalamus, and the gut itself appears to be responsible for various
gastrointestinal side effects of the SSRIs (13) . Disinhibition of the serotonin pathway from brain stem to hypothalamus, which mediates aspects of appetite and eating behaviors, may be responsible for the reduced appetite, nausea, and even weight loss associated with SSRIs."
"The so called synaptic plasticity or neuroplasticity is the adaptive ability of the human brain. If the right neurons are stimulated with adequate intensity within certain time constraints, a long-term change occurs, such as alterations in dendritic function, synaptic remodeling, long-term potentiation, axonal sprouting, neurite extention, synaptogenesis, and even neurogenesis (25-27). This stimulation may result from environmental events or psychotropic drugs including the antidepressants. For a long period of time, much of the biological investigations in psychiatry has focused on synaptic pharmacology, especially on neurotransmitter turnover and neurotransmitter receptors, disregarding this brain-adaptive ability (26,27).
Recently, Hyman and Nestler proposed a framework for understanding psychotropic drug action "initiation and adaptation". This framework capitalizes on recent advances in molecular neurobiology and places acute and chronic drug effects in a functional context (26)."
It's a very good article!
Posted by Ana at June 2, 2008 04:34 AM
Don't know exactly where to put this, but know Sarah would want it:
http://www.nationalpost.com/news/canada/story.html?id=556812
Posted by noni at June 2, 2008 09:53 AM
As a studying physician, I think antidepressants are very over prescribed.
My solution would be to have depression conditions managed by specialists, and at least by psychiatrists. Having a general practitioner dispense SSRIs with no complimentary therapy to address possible underlying issues is the biggest problem with antidepression medication, at least as I see it. I think that the condition and treatment are so nuanced that they require additional training above and beyond what a general practitioner might have.
I know that antidepressant medication is very useful for some people, but has also become a crutch for physicians that want a quick and easy way to deal with psychosocial and emotional issues that have less cut and dry treatment procedures than "prescribe medication XX." I think this is one of the manifestations of the underlying problems in medical practice, but that is another rant. I think it is a false dilemma to say that one must either accept antidepressant treatment as it exists fully or completely cease manufacture of the medication. Some simply support a smarter usage of the medication.
I will close with saying that I think it is awful that patients like my best friend's mother, who after losing her husband of over 20 years to lung cancer, was prescribed antidepressants when she still felt grief about her husband's death -one month later-. Are we such a society that any negative emotion is to immediately be considered pathological?
Posted by Matt at June 3, 2008 07:07 PM
Matt, medical stuff isn't that straightforward either. Many drugs seem to exchange one health problem for another and doctors don't seem to pay enough attention to supplements or sometimes to special diets.
Prozac does create a quasi-drunken state sometimes. Prozac is like LSD or PCP, caffeine, and alcohol all combined in a capsule. There is also an impairment of judgment that makes the drug especially dangerous for females, young people, people with disabilities, elderly people, people in bad neighborhoods. . . I've just mentioned the majority of the population. Stay off that garbage. Prozac can also cause depression, anxiety, and obsessive-compulsive stuff.
Posted by Jennifer at March 10, 2009 06:23 PM