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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Psychotropic Agents. Show all posts
Showing posts with label Psychotropic Agents. Show all posts

Tuesday, November 15, 2022

Psychiatry wars: the lawsuit that put psychoanalysis on trial

Rachel Aviv
The Guardian
Originally posted 11 OCT 22

Here is an excerpt:

In the lawsuit, the 20th century’s two dominant explanations for mental distress collided. No psychiatric malpractice lawsuit has attracted more prominent expert witnesses than Ray’s, according to Alan Stone, the former president of the APA. The case became “the organising nidus” around which leading biological psychiatrists “pushed their agenda”, he told me.

At a hearing before an arbitration panel, which would determine whether the case could proceed to trial, the Lodge presented Ray’s attempt to medicalise his depression as an abdication of responsibility. In a written report, one of the Lodge’s expert witnesses, Thomas Gutheil, a professor of psychiatry at Harvard, observed that the language of the lawsuit, much of which Ray had drafted himself, exemplified Ray’s struggle with “‘externalisation’ – that is, the tendency to blame one’s problems on others”. Gutheil concluded that Ray’s “insistence on the biological nature of his problem is not only disproportionate but seems to me to be yet another attempt to move the problem away from himself: it is not I, it’s my biology.”

The Lodge’s experts attributed Ray’s recovery at Silver Hill at least in part to his romantic entanglement with a female patient, which gave him a jolt of self-esteem.

“It’s a demeaning comment,” Ray responded when he testified. “And it just speaks to the whole total disbelief in the legitimacy of the symptomatology and the disease.”

The Lodge lawyers tried to chip away at Ray’s description of depression, arguing that he had shown moments of pleasure at the Lodge, such as when he had played piano.

“The sheer mechanical banging of ragtime rhythms on that dilapidated old piano on the ward was almost an act of agitation rather than a creative pleasurable act,” Ray responded. “Just because I played ping-pong, or had a piece of pizza, or smiled, or may have made a joke, or made googly eyes at a good-looking girl, it did not mean that I was capable of truly sustaining pleasurable feelings.” He went on, “I would say to myself: ‘I am living, but I am not alive.’”

Manuel Ross, Ray’s analyst from the Lodge, testified for more than eight hours. He had read a draft of Ray’s memoir and he rejected the possibility that Ray had been cured by antidepressants. He was not a recovered man, because he was still holding on to the past. (“That’s what I call melancholia as used in the 1917 article,” he said, referring to Freud’s essay Mourning and Melancholia.)

Ross said that he had hoped Ray would develop insight at the Lodge. “That’s the true support,” he said, “if one understands what is going on in one’s life.” He wanted Ray to let go of his need to be a star doctor, the richest and most powerful in his field, and to accept a life in which he was one of the “ordinary mortals who labour in the medical vineyard”.

Ray’s lawyer, Philip Hirschkop, one of the most prominent civil rights attorneys in the country, asked Ross: “As an analyst, do you have to sometimes look inside yourself to make sure you’re not reacting to your own feelings about someone?”

“Oh yes,” Ross said. “Oh yes.”

“You who’ve locked yourself into one position for 19 years with no advancement in position other than salary, might you be a little resentful of this man who makes so much more money, and now he’s here as your patient?” Hirschkop asked.

Sunday, July 3, 2022

Mental Illness Is Not in Your Head

Marco Ramos
Boston Review
Originally posted 17 MAY 22

Here are two excerpts:

In Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness, Anne Harrington argues that the current crisis is just the latest in a long line of failures to discover the biology of mental illness over the last two centuries. In this sweeping study, the history of psychiatry undulates like the boom and bust of a speculative market. First a wave builds with enthusiastic promises of revolutionary breakthroughs that will change psychiatry as we know it. Then the wave collapses, as psychiatrists fail to deliver on those bold promises. Crisis ensues, and after the requisite finger-pointing, the next wave of psychiatric revolution begins to build. Rinse and repeat.

The first “revolution” in American psychiatry that Harrington tracks arrived in the nineteenth century. At the time, large lunatic asylums dominated the psychiatric landscape, such as the Blackwell’s Island hospital on what today is called Roosevelt Island in New York City. These institutions were designed to cure patients with mental disorders by placing them in the hospitable environment of the asylum architectural space. However, a series of journalistic exposés revealed that these asylums were overcrowded and underfunded with patients living in deplorable, instead of therapeutic, conditions. For example, in 1887, journalist Elizabeth Seaman, who wrote under the pen name Nellie Bly, went undercover as a patient in Blackwell’s Island Hospital and exposed horrible acts of brutality in her best-seller Ten Days in a Mad-House. Asylum psychiatry faced a crisis of public trust.

As Harrington explains, European neuroanatomists came to the rescue. Unlike asylum physicians, anatomists were pessimistic about the potential for a cure. Building on eugenic theories, they believed that asylum patients were “degenerates” who were biologically unfit to cope with the stresses of modern life. But they also believed that the mentally ill could provide a service to society after their deaths by offering their brains to science. The dissection of their pathological brains, the anatomists hoped, could reveal the biological causes of mental suffering.


But if the pharmaceutical industry has invested so heavily in psychiatry, why have there been no breakthroughs in drug treatment? A major reason is that the industry has spent billions of dollars more on advertising psychiatric medications than on research and development of novel drugs. As psychiatrist David Healy has shown, money earmarked for R&D is often not intended to produce genuine innovation. Almost all of the psychopharmaceuticals produced since 1990 have been “copycats” that mimic older, generic pharmaceuticals, with only minor chemical modifications. These (unfortunately named) “me-too” drugs work no better clinically than the drugs that came before them, but their slight biochemical novelty means that they can be patented, so that pharma can charge insurance companies’ top dollar.

Perhaps the worst news is that Big Pharma, having created and capitalized on psychiatric markets, is now jumping ship. Anthropologist Joe Dumit has shown that most psychiatric drugs will soon go off patent, so companies will be forced to charge less for them. With the market already saturated with pharmaceutical copycats and no significant scientific biological breakthroughs in sight, there is suddenly little room for growth. Almost all of the major pharmaceutical companies have decided to divest from psychiatric drug research and turn to more promising sectors, especially the development of “biologics” and other cancer drugs.

Thursday, March 12, 2020

Business gets ready to trip

Jeffrey O'Brien
Forbes. com
Originally posted 17 Feb 20

Here is an excerpt:

The need for a change in approach is clear. “Mental illness” is an absurdly large grab bag of disorders, but taken as a whole, it exacts an astronomical toll on society. The National Institute of Mental Health says nearly one in five U.S. adults lives with some form of it. According to the World Health Organization, 300 million people worldwide have an anxiety disorder. And there’s a death by suicide every 40 seconds—that includes 20 veterans a day, according to the U.S. Department of Veterans Affairs. Almost 21 million Americans have at least one addiction, per the U.S. Surgeon General, and things are only getting worse. The Lancet Commission—a group of experts in psychiatry, public health, neuroscience, etc.—projects that the cost of mental disorders, currently on the rise in every country, will reach $16 trillion by 2030, including lost productivity. The current standard of care clearly benefits some. Antidepressant medication sales in 2017 surpassed $14 billion. But SSRI drugs—antidepressants that boost the level of serotonin in the brain—can take months to take hold; the first prescription is effective only about 30% of the time. Up to 15% of benzodiazepine users become addicted, and adults on antidepressants are 2.5 times as likely to attempt suicide.

Meanwhile, in various clinical trials, psychedelics are demonstrating both safety and efficacy across the terrain. Scientific papers have been popping up like, well, mushrooms after a good soaking, producing data to blow away conventional methods. Psilocybin, the psychoactive ingredient in magic mushrooms, has been shown to cause a rapid and sustained reduction in anxiety and depression in a group of patients with life-threatening cancer. When paired with counseling, it has improved the ability of some patients suffering from treatment-resistant depression to recognize and process emotion on people’s faces. That correlates to reducing anhedonia, or the inability to feel pleasure. The other psychedelic agent most commonly being studied, MDMA, commonly called ecstasy or molly, has in some scientific studies proved highly effective at treating patients with persistent PTSD. In one Phase II trial of 107 patients who’d had PTSD for an average of over 17 years, 56% no longer showed signs of the affliction after one session of MDMA-assisted therapy. Psychedelics are helping to break addictions, as well. A combination of psilocybin and cognitive therapy enabled 80% of one study’s participants to kick cigarettes for at least six months. Compare that with the 35% for the most effective available smoking-cessation drug, varenicline.

The info is here.

Tuesday, May 7, 2019

Are Placebo-Controlled, Relapse Prevention Trials in Schizophrenia Research Still Necessary or Ethical?

Ryan E. Lawrence, Paul S. Appelbaum, Jeffrey A. Lieberman
JAMA Psychiatry. Published online April 10, 2019.

Randomized, placebo-controlled trials have been the gold standard for evaluating the safety and efficacy of new psychotropic drugs for more than half a century. Although the US Food and Drug Administration (FDA) does not require placebo-controlled trial data to approve new drugs or marketing indications, they have become the industry standard for psychotropic drug development.

Placebos are controversial. The FDA guidelines state “when a new treatment is tested for a condition for which no effective treatment is known, there is usually no ethical problem with a study comparing the new treatment to placebo.”1 However, “in cases where an available treatment is known to prevent serious harm, such as death or irreversible morbidity, it is generally inappropriate to use a placebo control”. When new antipsychotics are developed for schizophrenia, it can be debated which guideline applies.

From the Conclusion:

We believe the time has come to cease the use of placebo in relapse prevention studies and encourage the use of active comparators that would protect patients from relapse and provide information on the comparative effectiveness of the drugs studied. We recommend that pharmaceutical companies not seek maintenance labeling if it would require placebo-controlled, relapse prevention trials. However, for putative antipsychotics with a novel mechanism of action, placebo-controlled, relapse prevention trials may still be justifiable.

The info is here.

Friday, November 2, 2018

Companies Tout Psychiatric Pharmacogenomic Testing, But Is It Ready for a Store Near You?

Jennifer Abbasi
JAMA Network
Originally posted October 3, 2018

Here is an excerpt:

According to Dan Dowd, PharmD, vice president of medical affairs at Genomind, pharmacists in participating stores can inform customers about the Genecept Assay if they notice a history of psychotropic drug switching or drug-related adverse effects. If the test is administered, a physician’s order is required for the company’s laboratory to process it.

“This certainly is a recipe for selling a whole lot more tests,” Potash said of the approach, adding that patients often feel “desperate” to find a successful treatment. “What percentage of the time selling these tests will result in better patient outcomes remains to be seen.”

Biernacka also had reservations about the in-store model. “Generally, it could be helpful for a pharmacist to tell a patient or their provider that perhaps the patient could benefit from pharmacogenetic testing,” she said. “[B]ut until the tests are more thoroughly assessed, the decision to pursue such an option (and with which test) should be left more to the treating clinician and patient.”

Some physicians said they’ve found pharmacogenomic testing to be useful. Aron Fast, MD, a family physician in Hesston, Kansas, uses GeneSight for patients with depression or anxiety who haven’t improved after trying 2 or 3 antidepressants. Each time, he said, his patients were less depressed or anxious after switching to a new drug based on their genotyping results.

Part of their improvements may stem from expecting the test to help, he acknowledged. The testing “raises confidence in the medication to be prescribed,” Müller explained, which might contribute to a placebo effect. However, Müller emphasized that the placebo effect alone is unlikely to explain lasting improvements in patients with moderate to severe depression. In his psychiatric consulting practice, pharmacogenomic-guided drug changes have led to improvements in patients “sometimes even up to the point where they’re completely remitted,” he said.

The info is here.

Tuesday, September 12, 2017

The consent dilemma

Elyn Saks
Politico - The Agenda
Originally published August 9, 2017

Patient consent is an important principle in medicine, but when it comes to mental illness, things get complicated. Other diseases don’t affect a patient’s cognition the way a mental illness can. When the organ with the disease is a patient’s brain, how can it be trusted to make decisions?

That’s one reason that, historically, psychiatric patients were given very little authority to make decisions about their own care. Mental illness and incompetence were considered the same thing. People could be hospitalized and treated against their will if they were considered mentally ill and “in need of treatment.” The presumption was that people with mental illness—essentially by definition—lacked the ability to appreciate their own need for treatment.

In the 1970s, the situation began to change. First, the U.S. Supreme Court ruled that a patient could be hospitalized against his will only if he were dangerous to himself or others, or “gravely disabled,” a decision that led to the de-institutionalization of most mental health care. Second, anti-psychotic medications came into wide use, effectively handing patients the power—on a daily basis—to decide whether to consent to treatment or not, simply by deciding whether or not to take their pills.

The article is here.

Sunday, December 18, 2016

There may be no worse place for mentally ill people to receive treatment than prison

By The Spotlight Team
The Boston Globe
Originally posted November 25, 2016

Here is an excerpt:

Last year, more than 15,000 prisoners walked out of Massachusetts jails and prisons. More than one-third suffer from mental illness; more than half have a history of addiction. Thousands are coping with both kinds of disorders, their risk of problems amplified as they reenter society.

Within three years of being released, 37 percent of inmates who leave state prisons with mental illnesses are locked up again, compared with 30 percent of those who do not have mental health problems, according to a Department of Correction analysis of 2012 releases. Inmates battling addiction fare worse: About half are convicted of a new crime within three years, according to one state study. And inmates with a “dual diagnosis” of addiction and mental illness, like Nick Lynch, do the worst of all, national studies show.

Despite the vast need — and the potential payoff in reduced recidivism — mental health and substance abuse treatment for many Massachusetts inmates is chronically undermined by clinician shortages, shrinking access to medication, and the widespread use of segregation as discipline. The prison environment itself is a major obstacle to treatment: In a culture ruled by aggression and fear, the trust and openness required for therapy are exponentially harder to achieve.

And when their incarcerations end, many mentally ill and drug-addicted prisoners are sent back into the world without basic tools they need to succeed, such as ready access to medication, addiction counseling, or adequate support and oversight. Such omissions can be critical: The Harvard-led Boston Reentry Study found in 2014 that inmates with a mix of mental illness and addiction are significantly less likely than others to find stable housing, work income, and family support in the critical initial period after leaving prison, leaving them insecure, isolated, and at risk of falling into “diminished mental health, drug use and relapse.”

The article is here.

Thursday, November 10, 2016

Has capitalism has turned us into narcissists?

Terry Eagleton
The Guardian
Originally published August 3, 2016

Here is an excerpt:

In our own time, the concept of happiness has moved from the private sphere to the public one. As William Davies reports in this fascinating study, a growing number of corporations employ chief happiness officers, while Google has a “jolly good fellow” to keep the company’s spirits up. Maybe the Bank of England should consider hiring a jester. Specialist happiness consultants advise those who have been forcibly displaced from their homes on how to move on emotionally. Two years ago, British Airways trialled a “happiness blanket”, which turns from red to blue as the passenger becomes more relaxed so that your level of contentment is visible to the flight attendants. A new drug, Wellbutrin, promises to alleviate major depressive symptoms occurring after the loss of a loved one. It is supposed to work so effectively that the American Psychiatric Association has ruled that to be unhappy for more than two weeks after the death of another human being can be considered a mental illness. Bereavement is a risk to one’s psychological wellbeing.

It is no wonder that the notion of happiness has been taken into public ownership, given the remarkable spread of spiritual malaise around the globe. Around a third of American adults and close to half in Britain believe that they are sometimes depressed. Even so, more than half a century after the discovery of antidepressants, nobody really knows how they function.

The article is here.

Wednesday, November 9, 2016

Report: More than half of mentally ill U.S. adults get no treatment

By Amy Ellis Nutt
The Washington Post
Originally published October 19, 2016

Mental Health America just released its annual assessment of Americans with mental illness, the treatment they receive and the resources available to them — and the conclusions are sobering: Twenty percent of adults (43.7 million people) have a mental health condition, and more than half of them do not receive treatment. Among youth, the rates of depression are rising, but 80 percent of children and adolescents get either insufficient treatment or none at all.

“Once again, our report shows that too many Americans are suffering and far too many are not receiving the treatment they need to live healthy and productive lives,” Paul Gionfriddo, president of Mental Health America, said in a statement. “We must improve access to care and treatments, and we need to put a premium on early identification and early intervention for everyone with mental health concerns.”

The article is here.

Tuesday, September 20, 2016

State mental hospitals were closed to give people with mental illness greater freedom

but it increased the risk they’d get no care at all.

By The Spotlight Team
The Boston Globe
Originally posted August 28, 2016

Here is an excerpt:

The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.

It was never supposed to be this way. President Kennedy and his allies recognized the grim state of America’s mental institutions — which at their peak housed nearly 560,000 people — and promised a robust, humane system of community-based treatment in their place.

The article is here.

Wednesday, July 20, 2016

An NYU Study Gone Wrong, and a Top Researcher Dismissed

By Benedict Carey
The New York Times
Originally posted June 27, 2016

New York University’s medical school has quietly shut down eight studies at its prominent psychiatric research center and parted ways with a top researcher after discovering a series of violations in a study of an experimental, mind-altering drug.

A subsequent federal investigation found lax oversight of study participants, most of whom had serious mental issues. The Food and Drug Administration investigators also found that records had been falsified and researchers had failed to keep accurate case histories.

In one of the shuttered studies, people with a diagnosis of post-traumatic stress caused by childhood abuse took a relatively untested drug intended to mimic the effects of marijuana, to see if it relieved symptoms.

The article is here.

Friday, March 11, 2016

Notes From Psychiatry’s Battle Lines

By George Makari
The New York Times - Opinionator
February 23, 2016

Here is an excerpt:

Consider this: Like most clinicians, I am eager for scientific progress, something new that will yield more clarity and provide my patients with faster or deeper relief. However, as I take stock of a new “neuroenhancer,” or the latest genetic correlation that may point to the cause of an illness, or a suddenly popular diagnosis, the historian in me senses ghosts beginning to stir.

Historians have shown that psychiatry has long suffered from the adoption of scientific-sounding theories and cures that turned out to be dogma. Perhaps the clearest example of such “scientism” was psychiatry’s embrace, in the early 19th century, of Franz Joseph Gall’s phrenology, in which all mental attributes and deficiencies were assigned to specific brain locales, evidence be damned. During much of the 20th century, psychoanalysis proposed far more conclusive answers than it could support, and today, the same could be said for some incautious neurobiological researchers.

The article is here.

Monday, November 2, 2015

Many Antidepressant Studies Found Tainted by Pharma Company Influence

By Roni Jacobson
Scientific American
Originally published October 21, 2015

Here is an excerpt:

Almost 80 percent of meta-analyses in the review had some sort of industry tie, either through sponsorship, which the authors defined as direct industry funding of the study, or conflicts of interest, defined as any situation in which one or more authors were either industry employees or independent researchers receiving any type of industry support (including speaking fees and research grants). Especially troubling, the study showed about 7 percent of researchers had undisclosed conflicts of interest. “There’s a certain pecking order of papers,” says Erick Turner, a professor of psychiatry at Oregon Health & Science University who was not associated with the research. “Meta-analyses are at the top of the evidence pyramid.” Turner was “very concerned” by the results but did not find them surprising. “Industry influence is just massive. What’s really new is the level of attention people are now paying to it.”

The researchers considered all meta-analyses of randomized controlled trials for all approved antidepressants including selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, atypical antidepressants, monoamine oxidase inhibitors and others published between 2007 and March 2014.

The entire article is here.

Monday, April 13, 2015

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.


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.


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.


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.

Wednesday, November 26, 2014

Ethical Responsibilities of Direct-to-Consumer Neuroscience Companies

By Mary Darby
Published on November 5, 2014

As part of the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, President Obama asked the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) to “identify proactively a set of core ethical standards – both to guide neuroscience research and to address some of the ethical dilemmas that may be raised by the application of neuroscience research findings.”

This morning, the Bioethics Commission resumed its consideration of ethical issues related to direct-to-consumer (DTC) neuroscience, including products like dietary supplements, neurofeedback devices, and even memory games.

The entire blog post is here.

Monday, July 28, 2014

Episode 12: Prescriptive Authority Illinois Style

Dr. Beth Rom-Rymer from Illinois speaks with John about  the recent RxP success in Illinois. Psychologists advocated passing a law to permit appropriately trained psychologist to prescribe psychotropic agents.  Beth shares many words of wisdom, including reasons for psychologists obtaining prescriptive authority, keys to advocacy, and the details of the prescriptive authority law in Illinois.  While John laments that Pennsylvania may be in the Precontemplative stage of change, Beth offers numerous suggestions to any state moving in a forward direction on RxP legislation.

The Skype connection was not the best, so apologies in advance for any technical flaws.

In terms of learning objectives, at the end of the podcast, the listener will be able to:

1.      Describe two reasons why psychologists are seeking prescriptive authority;
2.      Explain the educational requirements of becoming a prescribing psychologist in Illinois; and,
3.      Describe two important components to passing legislation on prescriptive authority.

Find this podcast on iTunes

To earn 1-APA approved Continuing Education Credit, click here.

Click to listen directly below


Updated Prescriptive Authority Law Enacted
American Psychological Association

Ethics and Psychology Resources on Prescribing Psychologists/Medical Psychologists

APA Resources on the RxP movement

Thursday, June 5, 2014

Creating a 'morality pill' more a question of ethics than science

By Katie Collins
Originally posted May 16, 2014

Is there any way that we could create a drug that would make us moral? This is the question Molly Crockett, neuroscientist at Oxford University, posed to the crowd at a Brain Boosters event organised as part of the NERRI Project in London this week.

Crockett was tackling the subject of neuro-enhancement -- the idea that we could potentially use science to make our brains in some way better. Much of the discussion at the event revolved around intelligence, but Crockett instead chose to tackle the subject of personality -- and more specifically, morality.

The entire article is here.

Friday, December 20, 2013

Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting

Dedan Opondo, Saied Eslami, Stefan Visscher, Sophia E. de Rooij, Robert Verheij, Joke C. Korevaar, Ameen Abu-Hanna
Published: August 22, 2012DOI: 10.1371/journal.pone.0043617



Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting.


The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting.


We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class.


We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription.


Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support.

The entire article is here.

Tuesday, November 5, 2013

Mental illness: is chemical imbalance theory a myth?

Torstar News Service
Originally published on October 19, 2013

Here is an excerpt:

Now, neuroscience would attribute such things as depression and psychosis to “chemical imbalances” — specifically to disruptions in the neurotransmitters that allow the brain’s billions upon billions of grey matter cells to speak to one another.

And so mental illnesses became normalized and destigmatized.

And so their treatments, to a huge extent, came off of the couch, out of the asylums and onto pharmacy counters.

And so a $70-billion drug market grew to feed tens of millions worldwide with daily doses of magic bullets — pills that could bring their brain chemistry back into balance.

Trouble is, in the minds of many neuroscientists today, that chemical imbalance theory has turned out to be a myth, with little more scientific or medicinal substance than poetry or song.

The entire article is here.

Thanks to Ned Jenny for this information.

Monday, October 14, 2013

National Trends in Psychotropic Medication Use in Young Children: 1994–2009

By Vilawan Chirdkiatgumchai, and others
doi: 10.1542/peds.2013-1546

OBJECTIVE: To examine recent national trends in psychotropic use for very young children at US outpatient medical visits.

METHODS: Data for 2- to 5-year-old children (N = 43 598) from the 1994–2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys were used to estimate the weighted percentage of visits with psychotropic prescriptions. Multivariable logistic regression was used to identify factors associated with psychotropic use. Time effects were examined in 4-year blocks (1994–1997, 1998–2001, 2002–2005, and 2006–2009).

RESULTS: Psychotropic prescription rates were 0.98% from 1994–1997, 0.83% from 1998–2001, 1.45% from 2002–2005, and 1.00% from 2006–2009. The likelihood of preschool psychotropic use was highest in 2002–2005 (1994–1997 adjusted odds ratio [AOR] versus 2002–2005: 0.67; 1998–2001 AOR versus 2002–2005: 0.63; 2006–2009 AOR versus 2002–2005: 0.64), then diminished such that the 2006–2009 probability of use did not differ from 1994–1997 or from 1998–2001. Boys (AOR versus girls: 1.64), white children (AOR versus other race: 1.42), older children (AOR for 4 to 5 vs 2 to 3 year olds: 3.87), and those lacking private insurance (AOR versus privately insured: 2.38) were more likely than children from other groups to receive psychotropic prescriptions.

CONCLUSIONS: Psychotropic prescription was notable for peak usage in 2002–2005 and sociodemographic disparities in use. Further study is needed to discern why psychotropic use in very young children stabilized in 2006–2009, as well as reasons for increased use in boys, white children, and those lacking private health insurance.