The medications that change who we are

Zaria Gorvett
BBC.com
Originally published 8 Jan 20

Here are two excerpts:

According to Golomb, this is typical – in her experience, most patients struggle to recognise their own behavioural changes, let alone connect them to their medication. In some instances, the realisation comes too late: the researcher was contacted by the families of a number of people, including an internationally renowned scientist and a former editor of a legal publication, who took their own lives.

We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent. From paracetamol (known as acetaminophen in the US) to antihistamines, statins, asthma medications and antidepressants, there’s emerging evidence that they can make us impulsive, angry, or restless, diminish our empathy for strangers, and even manipulate fundamental aspects of our personalities, such as how neurotic we are.

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Research into these effects couldn’t come at a better time. The world is in the midst of a crisis of over-medication, with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person – and the average American consuming $1,200 worth of prescription medications over the same period. And as the global population ages, our drug-lust is set to spiral even further out of control; in the UK, one in 10 people over the age of 65 already takes eight medications every week.

How are all these medications affecting our brains? And should there be warnings on packets?

The info is here.

Many People Taking Antidepressants Discover They Cannot Quit

Benedict Carey & Robert Gebeloff
The New York Times
Originally posted April 7, 2018

Here is an excerpt:

Dr. Peter Kramer, a psychiatrist and author of several books about antidepressants, said that while he generally works to wean patients with mild-to-moderate depression off medication, some report that they do better on it.

“There is a cultural question here, which is how much depression should people have to live with when we have these treatments that give so many a better quality of life,” Dr. Kramer said. “I don’t think that’s a question that should be decided in advance.”

Antidepressants are not harmless; they commonly cause emotional numbing, sexual problems like a lack of desire or erectile dysfunction and weight gain. Long-term users report in interviews a creeping unease that is hard to measure: Daily pill-popping leaves them doubting their own resilience, they say.

“We’ve come to a place, at least in the West, where it seems every other person is depressed and on medication,” said Edward Shorter, a historian of psychiatry at the University of Toronto. “You do have to wonder what that says about our culture.”

Patients who try to stop taking the drugs often say they cannot. In a recent survey of 250 long-term users of psychiatric drugs — most commonly antidepressants — about half who wound down their prescriptions rated the withdrawal as severe. Nearly half who tried to quit could not do so because of these symptoms.

In another study of 180 longtime antidepressant users, withdrawal symptoms were reported by more than 130. Almost half said they felt addicted to antidepressants.

The information is here.

Antidepressants Make it Harder to Empathize, Harder to Climax, and Harder to Cry

Big Think
Published on Apr 7, 2015

Dr. Julie Holland argues that women are designed by nature to be dynamic and sensitive – women are moody and that is a good thing. Yet millions of women are medicating away their emotions because we are out of sync with our own bodies and we are told that moodiness is a problem to be fixed. One in four women takes a psychiatric drug. If you add sleeping pills to the mix the statistics become higher. Overprescribed medications can have far-reaching consequences for women in many areas of our lives: sex, relationships, sleep, eating, focus, balance, and aging. Dr. Holland's newest book is titled Moody Bitches: The Truth About the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy.

The increasing lifestyle use of modafinil by healthy people: safety and ethical issues

By Sebastian Porsdam-Mann & Barbara J Sahakian
Current Opinion in Behavioral Sciences
Volume 4, August 2015, Pages 136–141

Pharmacological cognitive enhancers (PCEs) are used in the treatment of a variety of disorders, including targeting cognitive impairment and sleep abnormalities. Evidence suggests that PCEs also enhance cognition in healthy individuals. PCEs have attracted considerable interest recently, particularly from students, academics and the military. Proponents of PCE use in healthy people argue that these substances may be used to reduce fatigue-related and work-related accidents and improve learning outcomes.

In this article, safety concerns as well as ethical issues of fairness and coercion are considered. Discussion amongst experts in the field, government officials and members of society on the topic of the increasing lifestyle use of PCEs in healthy people is urgently needed.

The entire article is here.

Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia

Maust DT, Kim H, Seyfried LS, et al.
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm.
JAMA Psychiatry. Published online March 18, 2015.
doi:10.1001/jamapsychiatry.2014.3018.


Importance

Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.

Objective

To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.

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Conclusions and Relevance

The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.

The research article is here.

Forced chemotherapy in a teen: Exploring the ethics

By Ruth Macklin
Dr. Kevin MD blog
Originally posted January 16, 2015

Here is an excerpt:

Exploring the ethics

The legal barrier to respecting Cassandra’s autonomy remains, but the ethics of the case are murky. If this were a one-shot treatment — perhaps painful or uncomfortable, but over quickly — it would be easy to conclude that forced medical treatment would do more good than harm. But that is not clearly the case when the patient has to endure for as long as six months the discomforts of chemotherapy.

In December Cassandra first underwent surgery to install in her chest a port through which the drugs would be administered. State officials took custody of Cassandra and confined her in the hospital, Connecticut Children’s Medical Center, where she has received the forced treatments. Her cell phone was taken away (for a teen, this may be worse than the nausea and vomiting), and the phone in her hospital room was also removed. Her mother has been allowed to visit her in her hospital room, but only with a child welfare worker present. Mother and daughter are not allowed to have contact by phone.

The entire article is here.

Early Death for Severe Mental Illness?

By Allen Frances
The Huffington Post Blog
Originally published December 30, 2014

People diagnosed with serious mental illness -- schizophrenia, bipolar disorder, or severe depression -- die 20 years early, on average, because of a combination of lousy medical care, smoking, lack of exercise, complications of medication, suicide, and accidents. They are the most discriminated-against and neglected group in the U.S., which has become probably the worst place in the developed world to be mentally ill.

In many previous blog posts I have bemoaned the shameful state of psychiatric care and housing for people with severe mental illness. My conclusion was that the United States has become the worst place, and now the worst time ever, to have a severe mental illness. Hundreds of thousands of the severely ill languish inappropriately in prisons. Additional hundreds of thousands are homeless on the street.

The entire blog post is here.

Doctors shame women more than men about their bodies and behavior

By Rachel Feltman
Quartz
Originally published January 16, 2014

Here is an excerpt:

Both studies found that women were significantly more likely to experience these incidents than men were: In the first cohort, which was made up of university students, 26% of women reported being “shamed” by a physician, while only 15% of the men surveyed said the same. The most common topics of this shaming were sex, dental hygiene, and weight. The second study, which included a much broader age and demographic range, showed similar results: While only 38% of men reported feeling guilt or shame because of something their physician said, 53% of women could recall such behavior.

The entire article is here.

Full Disclosure — Out-of-Pocket Costs as Side Effects

Peter A. Ubel, M.D., Amy P. Abernethy, M.D., Ph.D., and S. Yousuf Zafar, M.D., M.H.S.
N Engl J Med 2013; 369:1484-1486October 17, 2013DOI: 10.1056/NEJMp1306826

Few physicians would prescribe treatments to their patients without first discussing important side effects. When a chemotherapy regimen prolongs survival, for example, but also causes serious side effects such as immunosuppression or hair loss, physicians are typically thorough about informing patients about those effects, allowing them to decide whether the benefits outweigh the risks. Nevertheless, many patients in the United States experience substantial harm from medical interventions whose risks have not been fully discussed. The undisclosed toxicity? High cost, which can cause considerable financial strain.

Since health care providers don't often discuss potential costs before ordering diagnostic tests or making treatment decisions, patients may unknowingly face daunting and potentially avoidable health care bills. Because treatments can be “financially toxic,”1 imposing out-of-pocket costs that may impair patients' well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments' side effects. Health care costs have risen faster than the Consumer Price Index for most of the past 40 years.

The entire article is here.

Psychotherapy’s Image Problem

By BRANDON A. GAUDIANO
The New York Times- Op Ed
Published: September 29, 2013

PSYCHOTHERAPY is in decline. In the United States, from 1998 to 2007, the number of patients in outpatient mental health facilities receiving psychotherapy alone fell by 34 percent, while the number receiving medication alone increased by 23 percent.

This is not necessarily for a lack of interest. A recent analysis of 33 studies found that patients expressed a three-times-greater preference for psychotherapy over medications.

The entire story is here

The Drug Made Me Do It: An Examination of the Prozac Defense

By J. Marshall
The Neuroethics Blog
Originally posted September 10, 2013

The plot of a recent Hollywood thriller, Side Effects, revolves around many pressing legal and ethical questions surrounding the use of anti-depressant medications. The movie explores the life of a supposedly depressed woman—Emily Taylor—who seeks treatment from her psychiatrist. Emily’s doctor prescribes her an anti-depressant—Ablixa. Emily then proceeds to murder her husband in cold blood while under the influence of the drug. The movie seeks to explore the culpability of this depressed woman in a legal sense. During the trial, the psychiatrist argues that neither he nor Emily Taylor is responsible; rather, Emily Taylor was simply “a hopeless victim of circumstance and biology.” Is it possible that a drug could be responsible for one’s actions as argued by the psychiatrist in the movie? The answer is not clear. Nonetheless, the possibility that someone could escape criminal punishment due to a certain anti-depressant represents a serious ethical quandary that should be examined.

The entire blog post is here.

A Dry Pipeline for Psychiatric Drugs

By RICHARD A. FRIEDMAN, M.D.
The New York Times
Published: August 19, 2013

Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation.

Sure, we have many antidepressants, antipsychotics, hypnotic medications and the like. But their popularity masks two serious problems.

First, each of these drug classes is filled with “me too” drugs, which are essentially just copies of one another; we have six S.S.R.I. antidepressants that essentially do the same thing, and likewise for the 10 new atypical antipsychotic drugs.

Second, the available drugs leave a lot to be desired: patients with illnesses like schizophrenia, major depression and bipolar disorder often fail to respond adequately to these medications or cannot tolerate their side effects.

The entire story is here.

U.S. Probes Use of Antipsychotic Drugs on Children

By LUCETTE LAGNADO
The Wall Street Journal
Originally published August 12, 2013

Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young.

The inspector general's office at Department of Health and Human Services says it recently began a review of antipsychotic-drug use by Medicaid recipients age 17 and under. And various agencies within HHS are requiring officials in all 50 states to tighten oversight of prescriptions for such drugs to Medicaid-eligible young people.

The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation's No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.

The entire story is here.

Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk

by Tracy Weber, Charles Ornstein and Jennifer LaFleur
ProPublica
Published: May 11, 2013

Ten years ago, a sharply divided Congress decided to pour billions of dollars into subsidizing the purchase of drugs by elderly and disabled Americans.

The initiative, the biggest expansion of Medicare since its creation in 1965, proved wildly popular. It now serves more than 35 million people, delivering critical medicines to patients who might otherwise be unable to afford them. Its price tag is far lower than expected.

But an investigation by ProPublica has found the program, in its drive to get drugs into patients' hands, has failed to properly monitor safety. An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive. Federal officials have done little to detect or deter these hazardous prescribing patterns.

The entire story is here.

Why are we still using electroconvulsive therapy?

By Jim Reed
BBC Newsnight
Originally posted July 24, 2013

Here are some excerpts:

The idea of treating a psychiatric illness by passing a jolt of electricity through the brain was one of the most controversial in 20th Century medicine. So why are we still using a procedure described by its critics as barbaric and ineffective?

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"For the first time we can point to something that ECT does in the brain that makes sense in the context of what we think is wrong in people who are depressed," Prof Reid says. "The change that we see in the brain connections after ECT reflects the change that we see in the symptom profile of patients who generally see a big improvement."

But passing electricity through the most complex organ in the body is not without risk. Many doctors think the side-effects of ECT can be so serious they outweigh any possible benefits.

The entire story is here.

Do Antipsychotics Worsen Long-term Schizophrenia Outcomes?

By Robert Whitaker
Mad in America Blog
Originally published March 26, 2013

Martin Harrow and Thomas Jobe have a new article coming out in Schizophrenia Bulletin that I wish would be read by everyone in our society with an interest in mental health. Harrow and Jobe, who conducted the best study of long-term schizophrenia outcomes that has ever been done, do not present new data in this article, but rather discuss the central question raised by their research: Does long-term treatment of schizophrenia with antipsychotic medications facilitate recovery? Or does it hinder it?

This is a paper that needs to be widely known. I wish every psychiatrist in the country would read it, and I wish that it would be widely discussed in the media too.

Now, Harrow’s study produced findings that belied common wisdom. He and Jobe followed schizophrenia patients for 20 years, and those who got off antipsychotics, as a group, had much better outcomes. Over the long term, they were much more likely to be recovered, much more likely to work; they were much less likely to be experiencing psychotic symptoms; and they had better cognitive function and they were much less anxious. So how can you square that finding with research showing that when patients are withdrawn from antipsychotic medications, they relapse at a much higher rate? That is the evidence for long-term use of antipsychotics, and here is what Harrow and Jobe write: “We view the results from these discontinuation studies as involving a paradox.”

Within six to 10 months following discontinuation, they write, 25% to 55% of schizophrenia patients withdrawn from their medications relapse. But, they note, “relapse rates are considerably lower subsequently in discontinued schizophrenia patients who remain stable during these 6-10 months,” and that “patients with schizophrenia not on antipsychotics for a prolonged period do not show this tendency to relapse when they remain unmedicated.”

So the puzzle is this: Why is there such a high relapse rate in the immediate months following withdrawal, compared to the relapse rate when patients “remain unmedicated” after this initial discontinuation period?

The entire blog post is here.

Heart risk link to SSRI antidepressants confirmed

BBC Health News
Originally posted January 30, 2013

Some but not all antidepressant drugs known as SSRIs pose a very small but serious heart risk, say researchers.

Citalopram and escitalopram, which fall into this drug group, can trigger a heart rhythm disturbance, a new study in the British Medical Journal shows.

UK and US regulators have already warned doctors to be extra careful about which patients they prescribe these medicines to.

And they have lowered the maximum recommended dose.

The UK's Medicines and Healthcare products Regulatory Agency (MHRA) says people with pre-existing heart conditions should have a heart trace before going on these drugs, to check for a rhythm disturbance known as long QT interval.

Experts reassure that complications are very rare and that in most cases the benefits for the patient taking the drug will outweigh the risks.

The entire story is here.

Thanks to Tom Fink for this story.

Drowned in a Stream of Prescriptions

By ALAN SCHWARZ
The New York Times
Published: February 2, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

The entire story is here.

J&J Settles Lawsuit Alleging Injury From Antipsychotic

By Peter Loftus

The Wall Street Journal

Originally published September 10, 2012

Johnson and Johnson agreed to a last-minute settlement of a lawsuit claiming that a boy's use of its antipsychotic drug Risperdal caused abnormal breast growth.

The settlement—whose terms were confidential—averted a civil trial scheduled to begin Monday in which plaintiffs' lawyers intended to summon J&J Chief Executive Alex Gorsky as a witness. Mr. Gorsky previously held leadership roles at the J&J division responsible for marketing Risperdal during the period when the boy's alleged injury occurred.

Robert C. Hilliard, an attorney for the plaintiff, told a judge in the Philadelphia Court of Common Pleas Monday "this case has reached a final resolution." He said the settlement amount was confidential.

The entire story is here.

Do Post-Market Drug Trials Need a Higher Dose of Ethics?

Patients who sign up for trials testing more than one already approved intervention do not always know if one is being tested for harmful side effects

By Katherine Harmon
Scientific American
Originally published August 23, 2012

Here is an excerpt:

What you might not know—even after you sign up for the trial and have inked the informed-consent form—is that scattered reports are starting to suggest that the new medication might occasionally cause severe side effects. And the real reason the trial is being conducted with these previously released drugs is to test whether the new medication really is a lot riskier to everyone or just to a subset of patients.

If you found that out, would you still sign up for the trial? The problem is that many patients—and often even the institutional review boards that approve the trials—are never informed of these lingering questions.

This is one of the big ethical holes often left open in post-market trials, says Ruth Faden, director of the Johns Hopkins Berman Institute of Bioethics, who co-authored a new essay on this topic in The New England Journal of Medicine, which was published online August 22. She and a team of co-authors released a formal Institute of Medicine (IOM) report earlier this year recommending that the FDA improve this and other ethical aspects of post-market trials—especially those it requires.

Click here for the entire story.