Tag: antidepressants

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Antidepressant withdrawal problems antidepressants

Withdrawing from Antidepressants: A Woman’s Personal Experience

Welcome to From Insults to Respect. 

Regular readers to this blog know that I have some serious concerns about dealing with emotional experiences referred to as depression or melancholy with the so called antidepressants. Certainly, people should be free to make their own decision regarding whether or not to take these types of pills, and I recognize very intelligent people decide to take them. That said, because I have been employed as a PhD level psychologist, people from time to time have asked me for advice. This led me to evaluating the research on their effectiveness, risks, and side-effects. Having extensive training in evaluating this type of research, sadly, I’ve been dismayed at what I have, and continue to find.

There is an excellent site titled Mad In America that does an excellent job presenting the relevant science. Here, I’ll just say that the research indicates these drugs are not anywhere as effective as they are promoted to be, side-effects are worse than claimed, withdrawal effects are frequently awful, and there are safer, healthier approaches to handling these types of concerns than taking these pills. More and more troubling findings are regularly being revealed to the public. Just this week, The New York Times ran a story about numerous reports of a loss of sexuality from taking these types of drugs, and even upon stopping the drugs, the problem for many people persists.

Dr. Audrey Bahrick

The Times story provides the example of Dr. Audrey Bahrick, who started taking Prozac in 1993 when she was 37. At that time, she was struggling with a difficult job in a new city. Within one day of taking the pill, her clitoris and vagina felt numb. “It was like there was a glove over them — a very, very muffled sensation,” she recalled.

For a while, she said, the trade-off was worth it. The antidepressant made her feel energized and more resilient. But after two years, she stopped taking it for the sake of her relationship. The sexual symptoms persisted, however, and the relationship ended. “It never occurred to me that this would be something that would in fact, in my life, never resolve,” said Dr. Bahrick, who is now 67.

A major strategy that is used to convince people to start taking these drugs is terribly misleading. Doctors claim that it is crucial for depressed people to take antidepressants because depressed people are at an increased risk of committing suicide. This implies that the antidepressant diminishes the likelihood of committing suicide. The facts are just the opposite. The weight of the research evidence indicates these drugs increase suicidal thoughts, behavior and  likelihood of suicide (see HERE). To use the increase in suicides argument despite the evidence to the contrary has always been a very disturbing sales pitch to me.

Now, when reading about all of the serious concerns regarding this type of treatment, many folks who are already taking these drugs begin to consider chucking them. To help with this decision, and how best to go about doing so if they so choose, it helps to hear from people who have made that decision.

One Woman’s Personal Experience

May Cause Side Effects, by Brooke Siam, is one of the first books on antidepressant withdrawal to make it to the mass market. A wonderful interview with the author can be found HERE. Ms Siam’s work on antidepressant withdrawal has appeared in The Washington Post, the New York Post, Psychology Today, and many more. She is also an award-winning chef and Food Network Chopped Champion.

When asked in her interview how she first got involved in the mental health system, she replied:

“This was in 2001 and the timing is important for context as the world was a little different then. I was 15 years old and my father had suddenly passed away. When I look back now, I don’t see someone who was going down a terrible path. I wasn’t suddenly into drugs or hanging out with the wrong crowd, my grades didn’t tank, but I was different than I was before. I was very stoic. I was a serious ballet dancer, so the mantra of ballet is to smile through pain, and so, my reaction was concerning to the adults around me.”

Siam was then referred to a psychiatrist, and at her first appointment was given a prescription for a psychiatric drug.

“I don’t remember which one. I think we started with Prozac and then moved on likely to Zoloft since those were the two that were approved for use in children and teens at the time. I had obvious physical reactions to both drugs and so, in the end, we ended up on a combination of Effexor XR and Wellbutrin XL, neither of which were approved for kids and teens at the time and still aren’t.” 

This approach of deciding in one psychiatrist visit to start throwing one type of pill after another at her because of a very understandable reaction to the loss of her dad is all too frequent from what I have been able to see during my many years of psychological practice. Often it’s not just the loss of a parent, but other grief experiences as well that leads to perfectly normal reactions that lead to this prescribing practice. Sometimes people are normally built to have periods of melancholy, and this too is pathologized and one pill after another begins to be prescribed.

Eventually, Siam began to believe this drug approach wasn’t doing her any good:

“…the only frame of reference I had as an unmedicated person was as a 14-year-old kid, I was in my 30s and I was on the same cocktail of drugs. I didn’t wear the same clothes I wore in high school, so why in the hell was I still taking the same cocktail of drugs every morning? There was just something about that that just didn’t make any sense to me because I knew I wasn’t the same body. My brain wasn’t the same, so if the science was sound why hadn’t it adjusted over time? That was the question that put me on this path.”

It was at this point that Siam began her journey to wean herself off the drugs. She covers such topics as what problems one might face along this weaning journey and suggestions on overcoming them. Her story is well worth reading.

My Best,
Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

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antidepressants conflict resolution

Antidepressant Treatment: Toxic Flimflam?

Feeling depressed? If so, you may decide to consult with a psychiatrist or other medical doctor. By doing so, chances are your description of your feelings will be translated into a language of symptoms, diagnosis, and mental illness, and you will leave the doctor’s office with a prescription for pills marketed as “antidepressants.” Unfortunately, this medicalization approach is so inconsistent with scientific evidence that many people view it as a remarkably successful flimflam funded by the enormously wealthy pharmaceutical industry.

To throw light on this, today’s post briefly summarizes the scientific theory that runs counter to the mainstream psychiatric pathologizing “antidepressant” approach. Then, it addresses the question, Are doctors and the pharmaceutical industry supporting the pathologizing of depression really engaging in deliberate deception?

The Theory That Is Inconsistent With The “Antidepressant” Approach

A few weeks ago I presented a post about a study. Here’s how the authors summarized their findings:

Our work shows that the more people hold beliefs that others expect them not to experience negative emotions, the more frequently and intensely they are likely to experience those negative emotions. Such ironic effects also relate to indicators of well-being, such as satisfaction with life and depression. Moreover, our findings suggest that these relationships are at least partly mediated by negative self-evaluations that people have when they experience undesired emotions. Attempts to promote the value of feeling good over the value of feeling bad by emphasizing social norms for these emotions may therefore have the effect of making people feel bad more often.

While keeping this research in mind, let’s turn to some other ways to look at the nature of depression that runs counter to the pathologizing view.

People Who Get Over Depression Without “Antidepressants” Do Better Than Those Who Had Taken Them

Prior to the availability of modern pills to treat depression, numerous examples exist of people recovering without them. Psychologist William James, back in 1902, in his classic book, The Varieties of Religious Experience, provides us a ton of such examples. Most of them involve a religious conversion experience, but James also provides examples that appear to be a result of “…the eruption into the individual’s life of some new stimulus or passion, such as love, ambition, cupidity, revenge, or patriotic devotion.”

One particularly insightful example is the story of William James’s own recovery. There we learn that three events provided the essential ingredients–a change in his philosophical understanding of the nature of depression, marriage to a very helpful wife, and finding a career that suited him (for a more complete story of his transformation, see HERE).

Since those early days of psychology, a clearer understanding of the nature of depression has emerged from careful scientific study. A recent publication in the journal American Psychologist by Professor Steven Hollon neatly summarizes what I am referring to.

Depression is an inherently temporal phenomenon. Any given episode tends to remit spontaneously even in the absence of treatment but recurrence is common (at least among people seeking treatment). There is reason to believe that depression may be an evolved adaptation (like pain or anxiety) that increases reproductive fitness (the likelihood that one’s gene line will pass on). If so, then any treatment that facilitates the functions that depression evolved to serve is likely to be preferred to one that only anesthetizes the distress.  

After this opening statement, Prof. Hollon provides a more complete description of his theory:

Depression is an adaptation that evolved because it keeps organisms focused on (ruminating about) complex social issues until they can be resolved and that medications work not so much by addressing a nonexistent deficit in neurotransmitters in the synapse as by perturbing underlying regulatory mechanisms to the point that they reassert homeostatic control over those systems. If the latter is true then medications may work to suppress symptoms in a manner that leaves the underlying episode unaddressed and patients at elevated risk of relapse whenever they are taken away. 

Prof. Hollon then begins to review the evidence to support this theory. For example, he describes studies that demonstrate depressed individuals who are treated to remission with cognitive therapy are less than half as likely to relapse following treatment termination as a matched group of depressed folks treated to remission with antidepressant medications. He goes on from here to argue that some people have trouble working through their depression efficiently because they misinterpret life events in a negative fashion and that cognitive therapy helps them examine the accuracy of their beliefs, and by so doing it relieves their distress more quickly. Prof. Hollon goes on to say, “it is likely that cognitive therapy works by making rumination more efficient so as to facilitate the resolution of the complex social issue(s) that brought the episode about.”

Although Prof. Hollon focusses on the benefits of cognitive therapy, other research has found that counseling that focusses on resolving interpersonal problems, and humanistic approaches to therapy that empathetically values what each person is going through, are also often helpful. Such approaches avoid the numerous side effects of “antidepressants” and the awful withdrawal reactions that occur upon ending one’s reliance on drug treatment.

For the links to the actual studies documenting the long term harm of the “antidepressant” approach, see my post “Do Antidepressants Worsen Depression?” and my post “Do Antidepressants Increase the Risk of Adult Suicide?” To get a much better understanding of the nature of depression, see HERE.

Are Doctors Promoting “Antidepressants” Deliberately Engaging In A Flimflam?

Early in my career of providing psychological services, having reviewed the scientific evidence regarding the effectiveness and safety of “antidepressant “drugs, I assumed medical doctors were well aware of this research. The fact that they were prescribing them despite the evidence that they are far more harmful than beneficial in the long run led me to wonder if these doctors were deliberately ignoring the research for financial gains.

While reflecting on this, I was hired by a medical doctor to provide counseling to his son who was struggling with depression. It soon became quite clear to me that this doctor dearly loved his son, and yet, in addition to having me provide counseling, he had arranged for his son to take daily an “antidepressant.” In my mind, there is no way this father would go along with the drug approach for his son merely for money and, therefore, it seems to me he must have come to genuinely believe the drug plus counseling approach was the best way to address his concerns about his son. In an effort to understand this doctor’s reasoning, I decided to ask him a few questions.

It quickly became apparent that the doctor was familiar with a very few short term studies that appear to support the value of the drugs, but none of the studies that found the opposite results. In his defense, he noted that it was not billable time to go to the library to review the evidence. Moreover, in any given week he was prescribing dozens of other very different types of medications, and new drugs were regularly becoming available. To be up to date on the research for all of them would be just way too much to expect of medical doctors. Instead of reading the research, he relied on the Physicians’ Desk Reference which is a compilation of prescribing information provided by the drug companies. There, you can find, among some other very limited information, if the drug is approved by the Food and Drug Administration (FDA) to treat the patient’s complaint, such as depression. He went on to say, and I am paraphrasing here, for I don’t remember his exact words:

As long as the drug has been approved by the FDA for depression, then I’m willing to give it a try with my patients. In time, I carefully monitor whether or not the drug is being helpful. With the antidepressants most of my patients have done well on them, and several have told me it has saved their life. I also want to add that the leading experts in the field support the use of these antidepressants as first line treatments for depression and argue that it would be malpractice to not prescribe them to depressed patients. Even if I was to agree with your research analysis, I could not risk getting sued for malpractice.

Since my discussion with this medical doctor, I have had other opportunities to discuss this issue with medical doctors. These discussions have led me to conclude that most of them use a similar set of reasoning for why they prescribe “antidepressants.” My impression is that rather than a flimflam, they truly believe they are doing something helpful for their patients.

Is The Pharmaceutical Industry Engaging In A Flimflam?

As far as the pharmaceutical industry engaging in a flimflam, here I have little first hand knowledge to draw any firm conclusions. My knowledge chiefly comes from reading The Truth About the Drug Companies: How They Deceive Us And What To Do About It. It was written by Marcia Angell, M.D., the former editor in chief of the prestigious medical journal The New England Journal of Medicine and she is currently a member of Harvard Medical School’s Department of Social Medicine. I came away from reading her book thinking that the enormous profit motive in the industry does lead to substantial bias in how research is carried out and the information they provide to medical doctors.

The FDA’s approval process, Dr. Angell tells us, relies extensively on information provided by the pharmaceutical industry. This clearly raises concerns about bias.

I do think the FDA does serve a valuable function for evaluating treatments for diseases that have clearly objective criteria for identifying their existence. For example, when patients who have a cancerous tumor, it can be objectively seen by doctors with the use of an imaging device. How large each of the patient’s tumor is can be assessed objectively by measuring its circumference. In a clinical trial that has half of the patients randomly assigned to a group that gets a placebo, and the other half to a new drug, if, after three months, the placebo group’s subjects tend to have tumors that grew larger, while those getting the new drug have shrunk, this shows a clear benefit for the drug treatment.

As another example, let’s say the drug company develops a vaccine for Covid 19. When tested against a placebo, let’s say far more people who took the placebo end up dying than those who took the vaccine. This provides clear objective evidence that the drug is effective at preventing death because we have an objective way to tell if someone is alive or dead.

Unlike these types of objectively identifiable conditions, with depression doctors rely on a subjective indication of effectiveness, that is, a conversation. Moreover, the studies that the FDA looked at to approve the “antidepressants” were done with patients who took the actual drugs for a mere few weeks, even though doctors regularly advocate that their patients take the drug for far longer, often for the rest of their life. It is the long term studies that came out after the FDA approval process that has begun to indicate that these drugs are likely to be worse than non-drug approaches.

There are far more problems with the control studies that had been used by the FDA to approve the various “antidepressants” on the market, and the links I provided earlier in this post describe them. But for now, let’s move on to discussing the wisdom of doctors relying on what their patients say in order to evaluate whether or not their “antidepressant” prescriptions are working.

Relying On The Reports Of Patients Regarding the Effectiveness of “Antidepressants”–Is That Wise?

Recall that doctors often will defend their use of “antidepressant” by saying, “With the antidepressants, most of my patients have done well on them, and several have told me it has saved their life.” The problem with this, as noted earlier in this post, is that people with depression spontaneously recover at a high rate even without treatment. It is this fact that leads to the doctor’s misattribution.

Thus, consider an example. Upon prescribing an “antidepressant” for depressed patient Judy, Dr. Smith hear’s from her after a few weeks that she has recovered. Did she recover as a result of the drug treatment, or because of the natural rate of spontaneous recovery of depressed patients. Because she began to feel better shortly after she began to ingest the drug, she and her doctor are likely to mistakenly attribute her improved mood to the drug’s effectiveness.

Consider another example. Dr. Smith has prescribed an “antidepressant” for depressed patient Marc. Not feeling any better despite taking the drug for several weeks, Dr. Smith tells Mark, “It takes time for the drug to have an effect, so give it a little more time.” A few more weeks go by with no improvement, so Dr. Smith tells Marc, the dose of the drug needs a little adjustment because some folks need a little more than others. When a few more weeks go by with no improvement, Dr. Smith responds by prescribing a different “antidepressant.”

Notice that more and more time is going by, thus further increasing the likelihood that some of the doctor’s patients would recover without the drug approach. If the patient does recover during this process, rather than attributing it to the natural recovery process, the improvement is misattributed to the drug treatment. In this way, doctors fall under the illusion that by assessing their patients responses to their prescribed “antidepressants” they can come to know how effective they are.

Conclusion

I have presented the case that medical doctors typically genuinely believe their prescriptions for”antidepressants” are effective, and therefore are not deliberately seeking to mislead their patients in order to make more money. Their process of coming to their belief about the effectiveness of these types of drugs is indeed deeply flawed, but a quality evaluation appears to be a too arduous process for each doctor to perform. I have heard that in my area doctors in medical practice for a medical company find their company advocates each patient be seen for a mere few minutes. I do think medical doctors must understand that their drug information is coming from people selling the drugs. Although I respect doctors for their life saving efforts, I would respect them more if they would ban together and hire a team of epidemiologists to provide an independent evaluation of the risk and benefits of these treatments.

As for the pharmaceutical industry, in a recent New York Times, I happened to notice an article indicating drug distributors and the drug company Johnson and Johnson have reached a $26 billion deal to end opioid lawsuits that came about because of the hundreds of thousands of overdoses. The vast majority of those who died began their addiction as a result of prescriptions from doctors that relied on the Physicians’ Desk Reference, which, as I have said, bases the information it supplies to doctors on information provided by the pharmaceutical industry. From what I have read about the opioid crisis and the way research on “antidepressants” has been carried out, my best guess is that there has been some flimflamming going on within that industry.

When I discuss problems with the “antidepressant” approach for dealing with depression, some folks who are currently taking such drugs sometimes decide to stop taking their pills. Suddenly stopping them all at once can be risky because of a variety of distressing withdrawal reactions possibly including waves of suicidal feelings. For help in deciding on the safest way to go about the withdrawal process, I recommend tapping into Mad In America’s “Drug Withdrawal Resources” page (see HERE). The madinamerica.com website is an excellent nonprofit resource for finding out a host of information about psychiatric drugs that seeks to be free of the pharmaceutical industry’s financial influences.

My Best,

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on.  This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence.  To begin at the very first post you can click HERE.

Categories
Antidepressants effectiveness conflict resolution Harmful effects of antidepressants

Do Antidepressants Worsen Depression?

Pills and capsules macro

Welcome to From Insults to Respect. Regular readers know that from time to time I address concerns about the use of antidepressants in our society. Well, as I was thinking about what to write about this week’s post, I learned of a new meta-analysis that was published in the medical journal Lancet that appears to support the claim that antidepressants are effective, at least in short-term studies.

Although well thought out critiques of this analysis soon appeared, the power of the pharmaceutical industry’s media promotion apparatus will lead to the public hearing far more readily a simplified version of the Lancet findings. And so, out of respect for the public’s right to make informed choices, I have decided to provide my readers the link to one of the most thorough and readable critiques (see HERE).

Robert Whitaker

It’s written by Robert Whitaker, a medical writer who started out as a Knight Science Journalism fellow at MIT. Following that, he became director of publications at Harvard Medical School. His most recent book is Anatomy of an Epidemic.

In addition to providing the link to Whitaker’s critique, below I provide a brief summary of his critique’s main objections to the conclusions of the Lancet article. As you will see, there exists substantial evidence that rather than improving outcomes for people dealing with the challenging experiences of depression, antidepressants actually tend to worsen outcomes. The studies I refer to below are fully referenced in Whitaker’s article.

A Brief Summary of Robert Whitaker’s Critique

Whitaker tells us that the Lancet analysis relies on random control trials (RCT) that compared depressed patients taking a placebo with those taking the antidepressants over a mere eight weeks. After eight weeks, symptom reduction, as measured in this study, did favor those in the groups that took the real drug. Should that be the whole story?

Whitaker rightly points out that RCTs are fraught with problems. Most of the studies are industry-funded, thus investigator bias is a worry. The placebo group is composed of patients who have been abruptly withdrawn from antidepressants that they had been taking before the trials got underway, which isn’t a true placebo group at all. Rather, they are a special group of depressed individuals likely to be suffering withdrawal reactions.

Upon looking at the risks versus benefits from this symptom-reduction data, Whitaker tells us that even if we assume that the results are accurate, then:

“12% of patients will benefit from the treatment, while the remaining 88% will suffer the adverse effects of treatment without any additional therapeutic benefit beyond placebo. Those are the odds that a person contemplating taking an antidepressant drug might want to know.”

Whitaker goes on from here to point out that the RCT studies use eligibility criteria to select participants most likely to respond well to the drug. Only about 10% to 30% of real-world depressed patients meet these criteria. Do real world patients respond differently?

In one study that looked at this, only 19% had responded to the treatment at three months, which was one-third the response rate recorded in RCTs. In another study known as the STAR*D trial, this one hailed as the largest antidepressant study, patients who didn’t respond to a first round of treatment could then have a second round with a different antidepressant, and so on through four courses of treatment. The idea was that eventually a treatment would be found that would work. Yet, even with this design, the short-term findings indicated only 38% of the 4041 patients reached meaningful improvement as defined by the researchers.

Whitaker’s conclusion about the effects of antidepressants as determined from the two major short-term studies on real world patients follows:

“Are they better than “natural recovery” rates over the short term? I am not sure there is a good answer to that question in the research literature, but what can be concluded from these two studies is that there is a lack of evidence that antidepressants are effective in the majority of real-world patients, even over the short term. They “work” in only a minority of patients, and it may be that they don’t provide any benefit over natural recovery rates at the end of 6 to 12 weeks.

As interesting as these studies are, it is perhaps even more important to look at the effectiveness of these types of drugs beyond 12 weeks. After all, the goal for people who are depressed is to get well and stay well. In research terms, patients want to experience a “sustained remission.” Whitaker’s critique extensively reviews the studies bearing on this, and the results are troubling.

In one study with real-world patients, 13% were in remission at the end of the year, but only 5% had a “sustained remission” during the year. The outcomes in this study, according to John Rush, the lead researcher in the study, “reveal remarkably low response and remission rates.”

The documented stay-well rate in the STAR*D trial was even worse. At the end of one year, only 108 of the 4041 patients (3%) had remitted and stayed well and in the trial. All of the others had either failed to remit, relapsed, or dropped out of the study.

A Minnesota report on the real-world outcomes of 260,000 patients treated for depression from 2010 to 2013 found similarly low remission rates. At the end of each year, only about 5% of the patients were in remission. Another 10 percent or so were still considered responders to antidepressant treatment.

How does this compare to people who are depressed but don’t take antidepressants? Whitaker describes the following study that seeks to answer this question:

In 2006, Michael Posternak, a psychiatrist at Brown University, studied the one-year remission rate for unmedicated patients. To do his research, he identified 84 patients enrolled in an NIMH study who, after recovering from an initial bout of depression, subsequently relapsed but then did not go back on an antidepressant. He tracked their remission rate over time: 23% percent had recovered by the end of the first month; 67 percent at the end of six months; and 85% at the end of one year.

Posternak summed up his results in this way: “If as many as 85% of depressed individuals who go without somatic treatment spontaneously recover within one year, it would be extremely difficult for any intervention to demonstrate a superior result to this.”

These results are quite startling. In the Minnesota study, only 5% of those taking antidepressants were viewed as recovered at the end of one year while in the Pasternak study 85% of those not taking an antidepressant recovered in the same time period. Although definitive conclusions can not be made from just two such studies, the findings do raise the question, do these types of drugs worsen outcomes for people dealing with depression experiences?

Exploring this issue further, Whitaker takes a close look at the few longer term studies that used real world patients. He tells us:.

  • In a retrospective study of the 10-year outcomes of 222 people who had suffered a first episode of depression, Dutch researchers reported that 76% of those not treated with an antidepressant recovered and never relapsed, versus 50% of those initially prescribed an antidepressant.
  • In a Canadian study that charted outcomes for 9,508 depressed patients for five years, those taking antidepressants were depressed on average 19 weeks per year, versus 11 weeks for those not taking antidepressants.
  • In a World Health Organization study designed to assess the merits of screening for depression, which was conducted in 15 cities around the world, the patients who were diagnosed by their GPs and treated with an antidepressant were twice as likely to be depressed at the end of one year as those who weren’t diagnosed and treated, even though their baseline depression scores were nearly the same.
  • This WHO study also provided some insight into the effectiveness of antidepressants—or their lack of effectiveness—over time. At the end of three months, the patients treated with medications had improved slightly more than the unmedicated group, but after that time they stopped getting better, while the unmedicated group continued to improve throughout the year.
  • In a study of 1,281 people who went on short-term disability in Canada due to depression, 19% of those who took an antidepressant failed to return to work and went on long-term disability, compared to 9% of those who didn’t fill a prescription.
  • An NIMH-funded study assessed the six-year “naturalistic” outcomes of 547 people who suffered a bout of depression, and found that those who were treated for the illness were three times more likely than the untreated group to suffer a “cessation” of their principal social role, and nearly seven times more likely to become incapacitated.
  • The burden of depression in developed countries around the world has dramatically increased since Prozac arrived on the market in 1987.  A 2015 study found that the economic burden from depression in the United States increased from $83 billion in 2000 to $210 billion in 2010.
  • There has been a dramatic increase in the number of people on disability due to mood disorders in developed countries during the Prozac era, with this increase happening in lockstep with the increased prescribing of antidepressants.

Whitaker concludes with these words:

I think it is fair to conclude, based on this data, that antidepressants, as they are used now, can’t be said to “work” for society. Instead, they can be said to cause significant societal harm.

Now, I hasten to point out that for people experiencing depression, their choices are not merely either taking an antidepressant, a placebo, or no treatment at all. Many people report great help from psychotherapy and counseling, although the cost can be unrealistic for many. With regard to learning how to positively deal with the emotional pain that is a central feature of the depression experience, there are several effective approaches that don’t cost any money, such as sensory focus, expressive writing, and meditation. I describe these approaches HERE. Exercise such as walking, yoga, etc, have not only been found in scientific studies to be helpful, but enhance other health outcomes as well.

One of the most frustrating aspects of taking drugs like antidepressants, is that the prescribing doctors often don’t explain how difficult it is for many people, once they begin taking them, to come off them. People can experience severe withdrawal effects that can last for months. Learning how to safely ween off of them can be a challenge. Just stopping them, cold turkey, has the potential to be dangerous for some. There are people, however, who can help you through this challenging experience (see HERE for recommendations).

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Categories
antidepressants antidepressants and suicide in adults conflict resolution

Do Antidepressants Increase Risk of Adult Suicide?

According to the FDA, there has been a long-standing concern that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) classified as having major depressive disorder and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a very slight reduction with antidepressants compared to placebo in adults aged 65 and older.

This may sound somewhat encouraging for those who are thinking of taking antidepressants and are over 24-years old if they are willing to put aside concerns about the many other negative side effects associated with taking this class of drugs. However, interpreting these findings is highly problematic for a number of reasons. For example, these results were based on short-term studies, typically lasting just a few weeks, while many people used the drugs for years. Many drugs that were viewed as relatively safe when the short-term evidence became available later turned out to have serious negative effects when the long-term effects started to come in.

Other concerns have to do with the fact that the current available studies are almost always carried out by the drug companies that have a massive interest in proving that the drugs are safe. With the largest lobbyist group in Washington, DC (see HERE), even those working for the FDA may be incentivized to underrepresent the number of suicidal incidents and suicides. Here’s an analysis by  who looked closely at this issue:

“In a meta-analysis of the placebo-controlled trials from 2006, the FDA reported only five suicides in 52,960 patients on SSRIs (one per 10,000 patients)(3), but there were many more suicides in these trials(2). Five years earlier, in 2001, Thomas Laughren, who was responsible for the FDA’s meta-analysis, published a paper using FDA data where he reported 22 suicides in 22,062 patients randomised to antidepressants(4), which is 10 per 10,000, or 10 times as many as he reported in 2006. In Laughren’s 2001 paper, there were four times as many suicides on antidepressants as on placebo, which was statistically significant (P = 0.03, my calculation). However, Laughren did not tell his readers about this but wrote: “There is obviously no suggestion of an excess suicide risk in placebo-treated patients.” No, but there surely was in the drug-treated patients!”

In interpreting the safety of these types of drugs, there are many other types of concerns hidden in the data. For example, there is strong reason to think that the subjects in these published studies are not at all the typical people who take antidepressants. Usually when someone is depressed and is open to taking antidepressants to feel better, they go to a nearby physician and get a prescription for the actual drug. That’s not at all how the subjects in these studies go about it. They have to fill out more forms than usual, and they have to agree to be part of an experiment that has them being randomly assigned to taking either the real drug or a placebo.

Now think about that. If you are depressed and open to taking these types of drugs, why would you agree to not knowing if you are taking the real pill or the fake one? Here’s a possible clue. As it turns out, many, if not all, of the subjects who agree to this are already taking one or more psychiatric drugs, including antidepressants. They have to agree to stop taking the antidepressants that they were taking, which typically leads to very uncomfortable withdrawal reactions.

So, again, why would people who are already depressed agree to undergo such an ordeal. It seems to me that it is very possible that many of these subjects had come to feel that the drugs that they had been taking had not been helping them. Thus, they became willing to try being part of the experiment in the hope that they will be put on another experimental drug they have not tried yet and it might end up providing the relief they were seeking.

Now, add this to the picture. Those who agreed to being subjects were excluded if they had had any suicidal thoughts or attempts. So, keeping this in mind, it turns out that many in this group of subjects are those who were placed in the past on antidepressants and did not have suicidal issues when taking them. This leads one to conjecture that this is a group of people who are particularly less likely to have suicidal issues than most people when they use antidepressants. After all, many people who choose to go on antidepressants in the usual manner (going to a local doctor) do so because they have begun to have suicidal thoughts and feelings, and some may have made an attempt to end their life. These folks would be excluded from participating in the study. Thus, those who participate in these studies are a special group who tend to not have suicidal reactions before taking antidepressants and when taking antidepressants.

Given all of these problems, how can we get some additional relevant information about whether these drugs increase suicidal issues for adults? Well, here’s a recent published study that I think is worthwhile to consider.

Published October, 2016 in the Journal of the Royal Society of Medicine (see HERE), it looked at healthy volunteers with no history of mental illness who agreed to take antidepressants for several weeks. When the study began, none of them were taking any psychiatric drug. Therefore, if these healthy individuals suddenly began to experience suicidal issues when taking the drugs, it is far less likely to be blamed on either their mental illness condition or as a result of being on an antidepressant for some time and suddenly being asked to withdrawal from it just prior to when the study began. Here’s a summary from the study’s discussion section.

Discussion

We found that antidepressants double the risk of suicidality and violence, and it is particularly interesting that the volunteers in the studies we reviewed were healthy adults with no signs of a mental disorder….

While it is now generally accepted that antidepressants increase the risk of suicide and violence in children and adolescents5,12 (although many psychiatrists still deny this10), most people believe that these drugs are not dangerous for adults. This is a potentially lethal misconception.7,10,15,24

As far as we know, our review is the first of the risk of suicide and violence in healthy volunteers….

In one of the two crossover trials we excluded because we did not have data on the first period separately, a healthy volunteer committed suicide, which was mentioned in both published articles.A14,A15 She had received duloxetine in increasing doses for 16 days, tapered off the maximum dose of 400 mg daily very quickly (in just four days according to the design of the study) and killed herself four days later while on placebo. The authors, several of whom were employees of Eli Lilly or owned stock in the company, judged her suicide ‘to be unrelated to study drug treatment’,A15 although it is well known that the suicide risk is high when an antidepressant is stopped abruptly.10,23 There was no more information about the suicide in the articles, and it was not included in the listing of adverse events we acquired from Eli Lilly, which only mentioned a woman who reported suicidal ideation twice while on placebo. As we do not know if this was the same patient, we asked Eli Lilly for access to anonymised data for the volunteer who committed suicide and the detailed person narrative, as we also wanted to know how it could be possible to state that the suicide was not related to duloxetine, but the company refused to give us the data….

Although only two of the 29 clinical study reports were eligible for our meta-analysis, e.g. as the studies needed to be double-blind, two researchers (AØB and PBD) read them all (2224 pages) and extracted data independently, as we wanted to explore possible selective reporting of harms in the published articles. Nineteen clinical study reports reported on the harms we investigated and nine of these were published, but less than half of the harms were reported in the articles (21 of 50 events on antidepressants and two of four events on placebo)….

There can be little doubt that we underestimated the harms of antidepressants. For 11 of our 13 trials, we only had access to the published article, and it well documented that the drug companies underreport seriously the harms of antidepressants related to suicide and violence, either by simply omitting them from the reports, by calling them something else or by committing scientific misconduct.2–5,7,10,27 In trials of duloxetine and sertraline, for example, only 33 of 45 cases of suicidal ideation, attempt or injury listed in a trial register were also mentioned in the published reports.2

Psychiatrists believe that the suicide risk with antidepressants is only increased till age 24, but this misconception builds on seriously flawed trial data that the FDA has published.12 Several meta-analysts have pointed out just how unreliable the trials are.5,10,28,29 A 2005 meta-analysis conducted by independent researchers of the published trials included 87,650 patients of all ages and found twice as many suicide attempts on drug than on placebo (odds ratio 2.28, 95% CI 1.14 to 4.55).28 They also found out that many suicide attempts must have been missing; some of the investigators responded that there were suicide attempts they had not reported in their trials, while others replied that they did not even look for them. Further, events occurring shortly after active treatment was stopped were not counted. Another 2005 meta-analysis conducted by independent researchers used UK drug regulator data and included 40,826 patients; they found a non-significant doubling in suicides or self-harm events when events occurring later than 24 hours after the randomised phase was over were included (relative risk 2.14, 95% confidence interval 0.96 to 4.75, our calculation).29 These researchers also noted that the companies had underreported the suicide risk in their trials, and they found that non-fatal self-harm and suicidality were seriously underreported compared to the reported suicides.

Even the FDA’s 2006 meta-analysis of 100,000 patients in 372 placebo-controlled trials12,30 is seriously flawed. Based on trials that were included in FDA’s analysis, one of us has estimated that there are likely to have been 15 times more suicides on antidepressant drugs than reported by the FDA.10 Two important reasons for the underreporting of suicides are that the FDA trusted the data the companies sent to them and that they only included events up to 24 hours after the randomised phase was over.10

Well, this is just one study that discusses the issue of suicide risks for adults choosing to take antidepressants. I chose to present it because it is the most recent study on this topic, and it seemed to me to present some additional information not usually available in the US literature.

Until next time, may you find healthy ways to deal with the many challenging experiences life has to offer.

 

Categories
antidepressants conflict resolution Depression panic attacks

Depression As Illness: A Case Study

sadness 1In a past post I asked the question, “Is Depression an Illness?” Many expressed strong feelings on this subject. Some argued that it is indeed an illness; others made the case that it was an experience that most of us go through, some more than others for sure, but classifying it as an illness leads one down a path toward taking unhealthy drugs that in the long run cause more harm than good.

In another post, I described Ms. Laren Stover’s story, who, rather than pathologizing her experiences of deep melancholy, she avoided taking psychiatric drugs to deal with it, and defended her experience as having artistic value.

sadness 3“Whatever happened to experiencing the grace of melancholy, which requires reflection: a sort of mental steeping, like tea?….It visits you like a mist, a vapor, a fog. It is generally uninvited. And as some people are born into royalty, wealth and prestige, others inherit a disposition for sadness.”

Shortly after writing my article, I came upon another one published in the AARP Magazine titled, “The True Story of My Life on Antidepressants.” Today I thought I would summarize this story and then provide my personal comments.

A Summary of Meg Grant’s Story

Meg Grant, tells us that the first 25 years of her life was “pretty darn good.” She had a good marriage, wonderful friends, and both she and her husband had excellent jobs–she a journalist and he a clinical psychologist.

Then, after a major move to another city and taking on a new job, one morning she woke up very disoriented and fearful. She describes this incident as follows:

panic 1“My ears buzzed, my leg muscles spasmed, and my throat closed. What was worse: I did not know where — not even who — I was.”

After about five minutes, she started to become less confused. And then, as she tells us:

I shook my husband awake, paced the living room floor, then finally ran out into the street, where I doubled over, struggling to catch my breath.

“Take me to the hospital!” I demanded. Instead, Greg [her husband] walked me back into the house and calmed me down, telling me I’d probably just had a disorienting dream. “We’re in a new place,” he said, donning his therapist hat. “It’s normal that you might at times feel scared.” He managed to coax me, still shaking, back into bed, where he held me tight. With him at my side, I tossed and turned until dawn.

We then learn that over the course of the next three weeks Ms. Grant was concerned about her hands trembling, lack of sleep and appetite. According to her, she “was in panic mode 24/7.”

Ms Grant as a young reporter.
Ms. Grant as a young reporter.

To help her through these experiences, she conferred with her internist, increased her exercise, and went to counseling. When none of this led to feeling as well as she would have liked, she decided to go to a psychiatrist. He or she explained to Ms. Grant that she was suffering from a serious depression, along with panic disorder, and then convinced her to take one of the drugs that the pharmaceutical industry refers to as “antidepressants.” She felt that this drug tamped down her anxiety enough to allow her to sleep. Nevertheless her problems continued.

ocean tidesFor months my symptoms swept in and out like pernicious tides. One day I’d be able to savor a meal or talk to my sister on the phone without crying; the next, nothing would seem real, including me. I’d be lost in a fog — numb and dull. Travel, meeting new people and unstructured time all made me uneasy, which quickly morphed into a vague feeling of free-falling, then anxiety, then hopelessness about ever feeling normal again. Indeed, merely anticipating what I saw as the next inevitable bout of panic seemed to bring one on.

CONSTIPATIONHer second psychiatrist, a Dr. Verhulst, at one point, upped her “antidepressant” dosage, which gave her dry mouth, constipation, and fatigue but quelled her panic. She felt that to live without all the angst was worth the side effects.

At about the time that she decided to have children, she was feeling well enough to see if she could withdraw from the drug that she was taking. There are some good reasons to consider getting off such drugs before a woman does become pregnant. Research studies suggest that there may be a number of very serious negative effects on the developing fetus and newborns when a mother takes these types of drugs during her pregnancy.

ProzacMs. Grant’s efforts to get off the drug that she was taking at that time, Prozac, was not easy. She first tried cutting her dose in half. She learned that these types of drugs can lead to a very uncomfortable withdrawal syndrome. She experienced muscle cramps in her thighs, trembling hands, a dry lump in her throat, obsessive thoughts about going crazy and being locked away in a mental hospital.

By tapering off the Prozac in much smaller increments, she found that she was able to wean herself off entirely after six months. Now, med-free, she and Greg welcomed the birth of a baby girl. How did she fare off the drug?

My unmedicated life was kind of a beautiful thing. Yes, I was better. And yes, it felt liberating to no longer rely on a chemical crutch. But most important was my fading sense of alienation. I could now count myself among the normal masses, a healthy woman who, with my husband, had just started a family — something, in the throes of my illness, I feared would be closed off to me.

baby-boyI remember those four years free of antidepressants as a cheerful but busy blur of baby-raising — decorating a nursery, changing diapers, hiring a nanny — while balancing my career. But after the birth of our second child, a strapping son, signs of a relapse appeared.

Ms. Grant quickly scheduled an appointment with a new psychiatrist. Without hesitating, he put her back on Prozac. Three months went by with no relief. She then tried Zoloft, again with no success. Finally, a colleague of Greg’s recommended Effexor. This seemed to help. As Ms. Grant tells it, the “crashing waves of fear and hopelessness began sliding out to sea.” It had taken her two years to regain what she referred to as “a sense of stability.”

Since then, she has decided to stay on her drug for the rest of her life. In making this decision, she conferred with a number of experts. Kenneth Duckworth, M.D., medical director of the National Alliance on Mental Illness, told her that there was not enough research on the long term safety of these types of drugs to offer any assurances that down the line she might have to pay a serious negative health consequence. “Medicines are tested for weeks or months, not years, to get FDA approval,” Dr. Duckworth said. “Once things are on the market, we rely on voluntary reporting for side effects.”

NIMHA researcher at NIMH, a Dr. Rudorfer told her, “It took many years to figure out that the older antipsychotics could cause tardive dyskinesia — a terrible, permanent neurological disorder. There does not seem to be anything that drastic with these antidepressants, but we’re talking about medications we are intentionally getting into the brain — and that should be taken very seriously.”

risksDr. Rudorfer, did offer Ms. Grant some words of encouragement. In his opinion, “The risk of untreated depression is greater than the risk of any adverse effect of antidepressants.” Toward the end of her story, Ms. Grant states that she recognizes there are more ways to treat depression and panic experiences than with the drug that she was taking, but she came to believe that she could never have recovered without it.

My Comments

Jeff Rubin
Jeff Rubin

First of all, I wish Ms. Grant well, and I fully support her right to choose how she wants to deal with her challenging experiences. She has far more expertise in what has been going on in her life than I do. I mean her no disrespect because of my disagreement with her drug approach for dealing with the type of experiences that so troubled her. Moreover, I have met people who chose to take drugs to deal with these kinds of experiences and they struck me as intelligent, decent folks.

That said, I wish to point out that in 30 plus years of providing counseling, I have met many people who struggled with panic experiences that sound very similar to what Ms. Grant described. As Ms. Grant mentioned, there are other ways to deal with panic and depression than drugs, and it just so happens I have experience using one such method. I taught people expressing concerns about their personal panic experiences that they can easily get through them by finding a quiet place, sitting in a comfortable position, and then practicing a type of meditation which involves observing the physical sensations they are experiencing in a nonjudgmental manner, as if they were tasting for the first time, fresh island mountain water. I encourage them to learn to befriend these experiences. I then taught them how to meditate on a regular schedule (twenty minutes in the morning and twenty minutes before the evening meal) even when they were not experiencing a panic episode.

Some found that after a while they stopped having these experiences. The others continued to have panic episodes from time to time after learning these skills, but they became less intense, occurred less frequently and lasted for much shorter periods of time. All my counseling cases got on with their lives without having to deal with the side effects of the drugs and being concerned about their long term health risks. None were ever hospitalized or committed suicide as a result of such experiences.

Besides the panic attacks, how would I handle the other sad and fearful experiences that accompanied Ms. Grant’s concerns? In an earlier post, I discussed three ways to deal with emotional pain that does not cost any money (see HERE). I refer you to that article. For those who find that they can use some additional help getting through these challenging experiences, counseling can be very helpful.

There was one particular part of Ms. Grant’s story that irked me. risk-zoneIt occurred when Dr. Rudorfer told her that in his opinion, “The risk of untreated depression is greater than the risk of any adverse effect of antidepressants.” As someone who has participated in a number of debates on the use of psychiatric drugs, I have heard a number of physicians make the same claim. Whenever I asked these doctors what risks they were referring to regarding untreated depression, the answer has always been an increased risk of suicide. The doctors’ statements about this imply that if treated with “antidepressants” this can decrease the risk of suicide enough so that the depressed patient, by taking the drug, is better off than facing the risk of any adverse effects of the drug. But the doctors don’t know what the long term effects of taking the drugs are. What’s more, the scientific evidence currently available indicates that these drugs do not reduce the risk of suicide; for some, they may actually increase it. So, I did want to clarify this issue a bit.

Okay then, that’s my “From Insults to Respect” post for this week. I hope you have found in it some ideas worth thinking about.

My Best to You All,

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.