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.

Antipsychotics: Taking the Long View

By Thomas Insel
NIMH Director's Blog
Originally published on August 28, 2013

Here is an excerpt:

An article recently posted online in JAMA-Psychiatry tells an interesting story about medications and recovery.1 Wunderink and colleagues from the Netherlands report on a seven-year follow-up of 103 people with schizophrenia and related disorders who had experienced a first episode of psychosis between 2001 and 2002. After six months of symptomatic remission following antipsychotic treatment, patients were randomly assigned to either maintenance antipsychotic treatment or a tapering-off and discontinuation of the drug. As expected, the group that stopped taking their medications experienced twice the relapse rates in the early phase of the follow-up. But these rates evened out after a few years, as some patients in the maintenance group also stopped taking their medication. Most important, by seven years, the discontinuation group had achieved twice the functional recovery rate: 40.4 percent vs. only 17.6 percent among the medication maintenance group. To be clear, this study started with patients in remission and only 17 of the 103 patients—21 percent of the discontinuation group and 11 percent of the maintenance group—were off medication entirely during the last two years of follow-up. An equal number were taking very low doses of medication—meaning that roughly one-third of all study patients were eventually taking little or no medication.

Emphasis added.

The entire blog post is here.

Thanks to Tom Fink for this story.

The Psychiatric Drug Crisis

BY GARY GREENBERG

The New Yorker

Originally posted on September 3, 2013

It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.

Yet the psychiatric-drug industry is in trouble. “We are facing a crisis,” the Cornell psychiatrist and New York Times contributor Richard Friedman warned last week. In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry.

The entire story is here.

Thanks to Tom Fink for this story.

3 Ways To Save Psychotherapy

People have been turning away from psychotherapy in favor of medication for years, despite the evidence that therapy works. Here are a few tips for improving the industry's image.

By Shaunacy Ferro
www.popsi.com
Posted 08.21.2013

The subtle art of lying on a therapist's couch is in rapid decline. Psychotherapy, the traditional one-on-one weekly session with a therapist, has been on the downswing for years, as more and more psychiatrists and even primary care doctors prescribe psychotropic medications instead of therapy. As the graphic above illustrates, between 1998 and 2007, psychotherapy use for people being treated for mental health conditions in the U.S. decreased from almost 16 percent to 10.5 percent, and therapy use in conjunction with medication went from 40 percent to 32 percent. By contrast, usage rates of medication alone shot up from 41 percent to a little more than 57 percent.

The entire story is here.

Anxiety, Depression, Relationships

By Allie Grasgreen
Inside Higher Ed
Originally published April 12, 2013

The findings of this year’s survey of college counseling directors about the state of their students and the centers where they treat them look a whole lot like last year’s (in some ways good, in some ways bad).

The percentage of students seeking help for various problems continues to creep up in many areas, and nearly all respondents to the Association for University and College Counseling Center Directors’ annual survey said the number of students with “significant psychological problems” is a growing concern for them. Also still on the slow but (mostly) steady rise are counseling centers’ budgets and staffing levels.

Four hundred directors -- about half the association’s membership -- completed the survey during the 2011-12 academic year. Together, they account for 319,634 students who sought mental health services during that time. The colleges are about split between public and private, mostly four-year, and vary in size and location.

About two-thirds of directors also said they perceived an increase last year in the number of students coming in with “severe psychological problems” (21 percent of students overall) and already taking psychotropic medications (24 percent of students).


Directors also, as has been the case in the past, are unsure whether those students’ needs are being met. About six in 10 directors have psychological services available on their campuses, but 19 percent say what’s available is inadequate.

The entire story is here.

Wars on Drugs

By Richard Friedman
The New York Times - Opinion
Originally published April 6, 2013

LAST year, more active-duty soldiers committed suicide than died in battle. This fact has been reported so often that it has almost lost its jolting force. Almost.

Worse, according to data not reported on until now, the military evidently responded to stress that afflicts soldiers in Iraq and Afghanistan primarily by drugging soldiers on the front lines. Data that I have obtained directly from Tricare Management Activity, the division of the Department of Defense that manages health care services for the military, shows that there has been a giant, 682 percent increase in the number of psychoactive drugs — antipsychotics, sedatives, stimulants and mood stabilizers — prescribed to our troops between 2005 and 2011. That’s right. A nearly 700 percent increase — despite a steady reduction in combat troop levels since 2008.

The prescribing trends suggest that the military often uses medications in ways that are not approved by the Food and Drug Administration and do not comport with the usual psychiatric standards of practice.

The military tests prospective enlistees with an eye toward screening out those with serious psychiatric disorders. So you would expect that the use of these drugs in the military would be minimal — and certainly less than in the civilian population. But the opposite is true: prescriptions written for antipsychotic drugs for active-duty troops increased 1,083 percent from 2005 to 2011; the number of antipsychotic drug prescriptions in the civilian population increased just 22 percent from 2005 to 2011, according to IMS Health, an independent medical data company.

The entire article 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.

Antipsychotic Use Skyrockets in America's Poorest Children

By Fran Lowry
Medscape Today News
Originally published March 12, 2013

Antipsychotic use among Medicaid-insured children from low- or very-low-income families skyrocketed in just under a decade, new research shows.

Investigators from the University of Maryland in Baltimore found that from 1997 to 2006, use of antipsychotic medications in this population increased 7- to 12-fold, with most of the increased use associated with treatment for behavioral problems.

"Awareness of the expanding use of antipsychotic medications in the emotional and behavioral treatment of children has been noted in several studies of community-based pediatric populations," lead author Julie Magno Zito, PhD, from the University of Maryland, told Medscape Medical News.

"But," she added, "additional information is needed on trends in our neediest youth, namely according to how antipsychotic users differ in terms of their eligibility for Medicaid insurance coverage and the reasons for use. Such information would help to characterize the 'who' and 'why' of expanded antipsychotic use."

The study is published in the March issue of Psychiatric Services.

The entire article is here.

If Medications Don’t Work, Why Do I Prescribe Them Anyway?

By Steve Balt, Psychiatrist
Thought Broadcast Blog
Originally posted January 4, 2013

I have a confession to make.  I don’t think what I do each day makes any sense.

Perhaps I should explain myself.  Six months ago, I started my own private psychiatry practice.  I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions.  I figured that an independent practice would permit me to be a more effective psychiatrist, as I wouldn’t be encumbered by the restrictions and regulations of most of today’s practice settings.

My experience has strengthened my long-held belief that people are far more complicated than diagnoses or “chemical imbalances”—something I’ve written about on this blog and with which most psychiatrists would agree.  But I’ve also made an observation that seems incompatible with one of the central dogmas of psychiatry.  To put it bluntly, I’m not sure that psychiatric medications work.

Before you jump to the conclusion that I’m just another disgruntled, anti-medication psychiatrist who thinks we’ve all been bought and misled by the pharmaceutical industry, please wait.  The issue here is, to me, a deeper one than saying that we drug people who request a pill for every ill.  In fact, it might even be a stretch to say that medications never work.  I’ve seen antidepressants, antipsychotics, mood stabilizers, and even interventions like ECT give results that are actually quite miraculous.

But here’s my concern: For the vast majority of my patients, when a medication “works,” there are numerous other potential explanations, and a simple discussion may reveal multiple other hypotheses for the clinical response.  And when you consider the fact that no two people “benefit” in quite the same way from the same drug, it becomes even harder to say what’s really going on. There’s nothing scientific about this process whatsoever.

And then, of course, there are the patients who just don’t respond at all.  This happens so frequently I sometimes wonder whether I’m practicing psychiatry wrong, or whether my patients are playing a joke on me.  But no, as far as I can tell, I’m doing things right: I prescribe appropriately, I use proper doses, and I wait long enough to see a response.  My training is up-to-date; I’ve even been invited to lecture at national conferences about psychiatric meds.  I can’t be that bad at psychiatry, can I?

The entire blog post is here.

Psychoactive Medication Use Among Children In Foster Care

The Children's Hospital of Philadelphia
"Hope Lives Here"
Originally published April 30, 2012

A few months after the federal Government Accountability Office (GAO) issued a report on the use of psychoactive drugs by children in foster care in five states, a national study from PolicyLab at The Children's Hospital of Philadelphia describes prescription patterns over time in 48 states. The updated findings show the percentage of children in foster care taking antipsychotics - a class of psychoactive drugs associated with serious side effects for children - continued to climb in the last decade. At the same time, a slight decline was seen in the use of other psychoactive medications, including the percentage of children receiving 3 or more classes of these medications at once (polypharmacy).

Psychoactive drugs prescribed at higher rates for foster children

As public scrutiny has increased about the use of psychoactive medication by children over the past decade, children in foster care continue to be prescribed these drugs at exceptionally high rates compared with the general population of U.S. children. According to the PolicyLab study, 1 in 10 school-aged children (aged 6-11) and 1 in 6 adolescents (aged 12-18) in foster care were taking antipsychotics by 2007.

The entire story is here.

Contact: Dana Mortensen, Children's Hospital of Philadelphia, 267-426-6092

Growing up drugged

For the first time ever, millions of today's adults were raised on psychotropic medications. What does that mean?

By Kaitlin Bell Barnett
Salon.com
Originally published April 7, 2012

Here are some exerpts:

For the first time in history, millions of young Americans are in a position not unlike Andrew’s: they have grown up taking psychotropic medications that have shaped their experiences and relationships, their emotions and personalities and, perhaps most fundamentally, their very sense of themselves. In “Listening to Prozac,” psychiatrist Peter Kramer’s best-selling meditation on the drug’s wide-ranging impact on personality, Kramer said that “medication rewrites history.” He was referring to the way people interpret their personal histories once they have begun medication; what they thought was set in stone was now open to reevaluation. What, then, is medication’s effect on young people, for whom there is much less history to rewrite? Kramer published his book in 1993, at a time of feverish — and, I think, somewhat excessive — excitement about Prozac and the other selective serotonin reuptake inhibitor antidepressants, or SSRIs, that quickly followed on its heels and were heralded as revolutionary treatments for a variety of psychiatric problems.

For most people, I suspect, medications are perhaps less like a total rewriting of the past than a palimpsest. They reshape some of one’s interpretations about oneself and one’s life but allow traces of experience and markers of identity to remain. The earlier in life the drugs are begun, the fewer and fainter those traces and markers are likely to be. All told, the psychopharmacological revolution of the last quarter century has had a vast impact on the lives and outlook of my generation — the first generation to grow up taking psychotropic medications. It is therefore vital for us to look at how medication has changed what it feels like to grow up and to become an adult.

The entire story is here.

Thanks to Tom Fink for this information.

Judge says Prozac factor in teen murder

Winnipeg Free Press

Sympatico.ca News

WINNIPEG - A Manitoba judge says a Winnipeg teen was driven to fatally stab another teen due to the adverse effects of an anti-depressant drug.

Provincial court Judge Robert Heinrichs agreed to keep the case in youth court, where the male youth now faces a maximum sentence of just four more years behind bars on the charge of second-degree murder.

Heinrichs said Friday the use of Prozac resulted in “unique circumstances” which he was forced to consider.

He described how the youth, who was 16 at the time of the stabbing in 2009, went from a loving, happy-go-lucky kid to a dark, depressed drug abuser who began to act out violently and even tried to harm himself on several occasions.

Heinrichs said it’s clear the youth's parents did the right thing in bringing their concerns to his various doctors, but they were largely ignored and the drug's dosage was increased.

Since his arrest, the youth is now clean of all drugs, has expressed remorse for his actions and greatly reduced his risk to the public.

“His basic normalcy now further confirms he no longer poses a risk of violence to anyone and that his mental deterioration and resulting violence would not have taken place without exposure to Prozac,” Heinrichs said in a written decision.

The entire story can be read here.