Antidepressant Prescriptions Rose In 2005
53 CommentsBy Ed Silverman // July 24th, 2008 // 10:40 am
The increase amounted to roughly 10 percent, and that occurred in a year in which new and controversial Black Box warnings were added to the labeling on the medications. The data was just released by the Agency for Healthcare Research and Quality, a unit of the US Health and Human Services Department.
Those warnings sparked a debate over whether some doctors and patients were being scared away from useful drugs and, therefore, causing an increase in suicides. This contention then prompted an FDA official to say the warnings may have to be revisited if federal data yields such an increase, although the Centers for Disease Control & Prevention has yet to issue more recent numbers. (Back story).
The AHRQ found that, in 2002, there were 154.1 million antidepressant prescription purchases in the U.S. civilian non-institutionalized population, and by 2005, that rose to 169.9 million. Psycyhiatrists wrote the largest share of prescriptions, but that fell from 33.6 percent in 2002 to 29.3 percent three years later.
The percentages for all other specialties in the top four that prescribed antidepressants remained stable when 2002 was compared with 2005 - general practice, 22.7 percent versus 22.6 percent; family practice, 17.7 percent versus 20.5 percent; and internal medicine 10.8 versus 10.0 percent. Here is the AHRQ report.
Lisa Van S
Ed,
Does this study include patients under the age of 18?
Justice in MI
I haven’t reviewed all the numbers, but this appears to flush the “dangerous overwarning” argument re: SSRIs down the tube.
Nathan
JIM - I disagree. From what I read in Ed’s previous post, the major BBW for suicide happened in late 2004. So 2005 scripts should fall from 2004 levels if the BBS had a major effect. But we don’t know what happened from 2002-2004. They could have shot up 20% in 2002-4, then declined by 10% in 2005 after the BBWs.
Nathan
Lisa - the survey was self-reported by HOUSEHOLD, not by individual patients — so from what I can read, yes, children are covered in these numbers. (although, not institutionalized children)
Justice in MI
Nathan - Of course, you are right about that theoretic possibility. Let’s see if anyone has the data.
Of course, what would be even more informative would be correlations with rates of suicide, but those numbers are inevitably uncertain.
Jack2
I’d hesitate to correlate these numbers (positive or negative) with suicide. A lot of factors affect the suicide rate, and I think it’s too much of a stretch to think antidepressants use alone, just one of MANY variables, significantly affects the national rate.
Nathan
It’s interesting to me that while psychiatrists generally get the “bad rap” on this site, the majority of antidepressant scripts actually came from family/general practitioners.
Sam
My experience in a nationally known private psychiatric hospital about 35 years ago,showed that patients diagnosed as clinically depressed, rarely acted or thought about suicide. It was after we started giving patients initial doses of an antidepressants that they reached a level to act out of doing harm to themselves. It was that point of treatment we had these patients on “eye to eye” contact 24 hours a day. As treatment continued along with psychiatric consults, the threat of suicide greatly diminished.
Treatment of depression should not be based on giving depressed
patients a vial of pills. It was a red flag when patients were too happy
too soon during treatment and that when they were continually
observed. If they cannot be hospitalized, then family and friends must
be made aware of the patient’s behavior.
One suicide is one too many.
harpy
Exactly, Nathan, and when people are put on the medications without proper support and counseling (as many are) then you get situations resembling Sam’s description. Depression is an holistic problem and it takes more than a pill to cope with it.
Justice in MI
Of course, I agree with the points made by Jack2, Harpy, Sam, and others about complexity. I am a clinical psychologist, so - to that extent - I have “been there.”
I (too glibly) was responding to arguments sometimes made that the BBWs have, indeed, led to increased rates of depression as well as suicide. You folks are a lot wiser!
truthman30
Depression is an holistic problem and it takes more than a pill to cope with it.
Absolutely..
truthman30
What we have to examine here, is why are people depressed? ..
The factors causing 99% of diagnosed depressives can’t be sorted out with a pill..
An SSRI won’t bring your job back or your dead sister or your general apathy and disappointment in life…
What it will do though is turn the individual into a zombie so that eventually they don’t really care what the original problem was to begin with.. and then the side effects become the problem and the withdrawals , so all it is is replacing one problem with another like a chemical band aid..
But that only lasts so long..
Once off the meds , the original problem is still there only much bigger and scarier because it was never addressed..
Deb
Just met a neighbor in the local library who had recently gone off Celexa cold turkey (from the sound of his general symptoms, I suspect he has manic depression). Having cold-turkeyed off, with no warning, he came within a hair of suicide. He beat it back to Celexa. This is not about his psychological situation - rather it is about a lethal class of drugs
Nathan
I know that this is going to be trite and insensitive to many of you, but here it goes: The fact that there are >150 MILLION scripts for these antidepressants per year makes the “thousands upon thousands” of side effects seem less significant. This is a HUGE number of people we are talking about on these drugs. Does anyone know if the number of people on antidepressants rivals the number of people on statins? It’s got to be in the same ballpark given the above numbers.
Truthman, while I agree with you somewhat that these drugs probably don’t solve the “root causes” of depression, it’s impossible for me to believe that they are completely ineffective given the huge number of people that continue to use them.
Justice in MI
Depression, like cancer and much else, covers a very wide range of conditions, and an even wider range of etiologies. In the end, it is rarely possible to sort out the root cause, which may no longer be a significant cause once a pt. ends up being seen.
My sense as a clinician is that there are a group of pts who benefit enormously from SSRIs (and the older anti-depressants, both tricyclics and MAO inhibitors). There is another group - probably twice as large - who benefit marginally. And there is a third group who derive no benefit, but who continue to take their meds because they were rx’d and in the hope that some day maybe something will “kick in.”
In the meantime, most of these drugs are also used for a wide range of other conditions both on and off-label. It would be interesting to know what proportion of the anti-depressant rx’s are actually not for depresssion. I would guess it is quite substantial.
Laurie
“And there is a third group who derive no benefit, but who continue to take their meds because they were rx’d and in the hope that some day maybe something will “kick in.””
Or a third group that kept taking them and now can’t get off them,due to the withdrawal associated with them.
Nathan
I’m still just astounded by the sheer size of that number: 150 million in the US in one year. There are only 300 million people living in the US. Granted, many of those scripts were filled multiple times for the same person.
I’ve spent the last 20 minutes trying to dig up some hard numbers for number of units sold per drug — but I can’t find anything like that. Sales are always given in dollar amounts, never given in # of units sold. I wanted to see if the prevalence of antidepressants rivals the prevalence of statins. I’m guessing yes - but I can’t find numbers to back it up.
Laurie
http://www.jointogether.org/news/headlines/inthenews/2007/antidepressants-now-most.html
Antidepressants are the top of the list in numbers prescribed, according to the CDC
truthman30
“Truthman, while I agree with you somewhat that these drugs probably don’t solve the “root causes” of depression, it’s impossible for me to believe that they are completely ineffective given the huge number of people that continue to use them.
It is impossible for you to believe because you have not being on the drugs Nathan…
It’s like someone who has never taken heroin or smoked tobacco trying to comprehend what it feels like to be a junkie or a smoker..
If you haven’t ever experienced an addiction , psychological dependence, physical or otherwise then of course you would have no real insight into it…
Also if you have never felt the desperation of depression then of course it would be difficult for you to grasp..
The withdrawal from SSRI drugs keeps many enslaved to them..
Just like the same as the way the withdrawal from nicotine and the withdrawal from heroin keeps a very large number of people hooked..
Many of the millions of people you talk about on these drugs want to come off them, but they do not want to face life without a chemical crutch or the devastation and brain chemical shock of stopping these drugs…
Y
ou could say that it is also quite amazing the amount of people who take narcotic drugs , but when taken into context , that situation is not unlike the SSRI situation, is Heroin or cocaine effective at numbing the pain for the addicts? yes, it is , are these narcotics mood altering? yes, they are. Do many addicts want to quit but are too terrified at the prospect of a severe withdrawal? yes…
It is the same for the SSRI class of drugs..
The fact that millions of scripts are written does not equate with it being a good thing…
Millions of people eat McDonalds every day, is that a good thing? ..
No, but it happens, and Mcdonalds is very successful and reaps in the profits, because some people choose to eat the crap.. doesn’t mean it is good for them though..
Do millions of people binge drink on a Saturday night? Yes..
But that doesn’t mean it is good for them..
Do millions of people drive cars every day… Yes.. But that it not good for the whole planet..
The problem with SSRI drugs is that they are very seductive, particularly to the “depressed or anxious” mind …
Of course if someone offered you relief and told you this drug would fix you , you would take it.. But I doubt very much if these millions of people on SSRI drugs would actually choose to be addicted and dependent on them.. that’s the problem
Addictions are sneaky things, they creep up on you..
The fact that millions of scripts are written for SSRI drugs means the pharmaceutical companies have been very successful at one thing and one thing only.. Enslaving millions of people on dangerous , inadequately tested, lethal drugs which are causing them more harm then good..
Believe me Nathan, in the future, a few generations from now, the SSRI drugs will be remembered as the barbaric treatment that they are..
Things take time to shift culturally , especially when pharmaceutical companies pumping millions into their propaganda and marketing machines..
People can be sold anything poisonous and toxic if you market it well enough.. Just take a look at Coca Cola, Budweiser , Philip Morris , Burger King , they have all been doing it for years…
History will tell the truth about these horrible SSRI drugs , what damage they have done to people and it won’t be a flattering story …
truthman30
Justice you said “My sense as a clinician is that there are a group of pts who benefit enormously from SSRIs (and the older anti-depressants, both tricyclics and MAO inhibitors). There is another group - probably twice as large - who benefit marginally. And there is a third group who derive no benefit, but who continue to take their meds because they were rx’d and in the hope that some day maybe something will “kick in.”
In the meantime, most of these drugs are also used for a wide range of other conditions both on and off-label. It would be interesting to know what proportion of the anti-depressant rx’s are actually not for depresssion. I would guess it is quite substantial.
What do you mean by “benefit” , do you mean that people who are depressed are given a “mood altering” lift , a “numbing” of their “feelings” from these drugs? A chemical band aid?..Because that is what they do..
Is that beneficial do you think? ..
Is it beneficial to create a brave new world?
Is it beneficial as an example to future generations to think that if they have an emotional problem or cannot cope with life they can just pop a “pep” pill and forget all about it?
Is that the kind of society which should be promoted?..
Or more importantly is that the kind of society which is being exploited?..
All psychiatric drugs exploit the human condition to some degree..
They are not medicinal in nature , they are intolerable to most people who take them …
What kind of medicine has the kind of Side effects listed on SSRI drugs?..
they have one of the worst side effect profile of any drug on the market..
How can you say this is beneficial ?..
Nathan
Thanks for pointing to the CDC Laurie — after digging around the CDC website I came up with this link:
http://www.cdc.gov/nchs/data/ad/ad389.pdf
It’s interesting that statins are actually #5 or #6 in terms of prescribed drugs. #1 are antidepressants, #2 painkillers, #3 NSAIDS…
Anyway, this document has all sorts of interesting health-related statistics for those of you who are like me and enjoy such things.
Justice in MI
Truthman - I have pretty much no hope what I write will “make a dent” in your views, but perhaps it will be relevant to others.
By “benefit enormously,” I mean people who begin in a state which they themselves call emotional hell. Major depression is not profound sadness, or even close. It is pure pain - not very different from the agony one would experience with a very severe injury, except that in the case of major depression that pain is all-encompassing. That pain is the world, the past, the future.
By benefit, I mean relief of that agony. What people say are things like awakening to life after prolonged death, the sun coming out for the first time, being able to get up in the morning, not looking forward to every morning, every next minute, with numness, hopelessess, or dread.
It is precisely the opposite of what you write - not numbing but awakening, not a “pep bill” but the restoration of a modicum of hope - hope, for example, that it might be worthwhile to pursue psychotherapy and think about all that is going on in their lives rather than kill themselves.
That’s why, for that group of patients (a relatively small subset of those actually who take meds), I can say anti-depressant medications are “enormously beneficial.”
AA
Justice in MI,
I was going to make similar comments to Truthman.
As one who developed suicidal ideation from the doubling of Prozac dose and then a cold turkey from it, eventually, these drugs did exactly the beneficial things you described. But then as Truthman says in his posts, continued years on them, caused me to not give a damm about anything. I think that is what Peter Breggin refers to as the spellbinding effect.
I could have sworn at the time they were still effective only to realize as I withdrew, how wrong I was. My psychiatrist would have said the same thing.
I have been asking this question of all mental health clinicians so I will ask you:
How do you distinguish between a drug that is truly effective vs. one that is providing false effectiveness as what happened in my situation and Truthman’s? It just seems like clinicians claim that these meds are beneficial even if patients are in a drug induced stupor.
Anyway, now that I am tapering off of all meds, I am doing better than ever in spite of dealing with my mother’s death. Since I ask you to give example, i will do the same.
I am planning to see a movie with some friends this Sunday. In the past, I would have been to numb from meds to even think about doing that.
That may seem minor for most people but for me, it is a big deal.
Justice in MI
AA - It is, indeed, a big thing.
As a psychologist, I do not prescribe. But I see a number of people on this or that drug. My usual recommendation, and the psychiatrist’s with whom I work who does the actual rx’ing, is not for very long-term medical tx. It has been worth closely supervised tapering down, and off, and then we see.
Just as I believe these drugs are way over-prescribed, I also believe they are usually used much longer than necessary. That is what my clinical experience suggests. Quite often (but not always) people do well moving to psychotherapy and other useful approaches after a relatively brief course (a few months or even less) on meds.
And, again, keep in mind from the get-go that I am talking about a relatively small proportion of those actually rx’d meds. It would be a yet smaller proportion of those who benefit “for years.” Particularly since I see mostly young adults (college-age), the risk of monitored tapering down and off - and seeing how people do - is much less than assuming a life course of medication.
Vince
A responce to the basic premise in. http://ajp.psychiatryonline.org/cgi/content/full/164/12/1907
“The Black Box Warning: Decreased Prescriptions and Increased Youth Suicide?
JON JUREIDINI, M.B.B.S., F.R.A.N.Z.C.P., Ph.D.
British Columbia, Canada ”
Most relevant section
” “While only a small decrease in the SSRI prescription rate for U.S. children and adolescents occurred from 2003 to 2004, the public health warnings may have left some of the most vulnerable youths untreated” (1, p. 1359). The discussion then continues at length as though a clear association (if not causal relationship) has been established, with alarmist predictions regarding the consequences of decreased prescribing. As it turns out, preliminary figures are now available from the Centers for Disease Control (CDC), which show that fewer people under age 25 committed suicide in 2005 (when prescribing did decrease) than in 2004 (2).
truthman30
Justice “Truthman - I have pretty much no hope what I write will “make a dent” in your views, but perhaps it will be relevant to others.
By “benefit enormously,” I mean people who begin in a state which they themselves call emotional hell. Major depression is not profound sadness, or even close. It is pure pain - not very different from the agony one would experience with a very severe injury, except that in the case of major depression that pain is all-encompassing. That pain is the world, the past, the future”
Justice, I am always open to debate these drugs and I am always open to consider all points of view , I have suffered from Major Depression , I know it is absolute hell, agony and a suffering on a scale often beyond words. I know it well.
I do understand that there is a place for some anti-depressants, and that in very severe cases of depression, where all else has failed, as a last resort drugs can be helpful. I never said I was anti-SSRI, I am not anti-pharma either. But I do realize also that in the vast majority of cases, these drugs are over prescribed , they are prescribed for too long and the patients are not given adequate warnings of side effects and withdrawal which can actually leave them in a worse position than the original illness.
It is very easy for pharmaceutical companies to pass the buck when it comes to SSRI drugs, when problems were first being reported of the side effects and dangers, they played them down to save their profits. Then when they were forced to admit some of the problems in their patient information leaflets they told patients to refer to their doctor.
Since most doctors are still largely ignorant to the signs of and manifestations of SSRI induced suicide ideation and SSRI induced Akathisia etc , I place the blame squarely on the pharma’s and the drug reps who should have gone out of their way to educate doctors prescribing these drugs about the dangers.
There are countless peoples lives who have been blighted, affected, damaged and destroyed because of the promotion of these drugs as “wonder drugs” , safe and effective , non habit forming etc etc…
As a result of these marketing lies and the deceitful and callous behavior of pharmaceutical companies , many people are still hooked on these drugs.
I have a friend who was on Paxil (Seroxat) for 15 years up until about 4 years ago, originally prescribed them for depression due to the break up of his first marriage. He had no idea about the dangers of these drugs until he happened to stumble upon a BBC documentary , the now infamous “Secrets of Seroxat”. (There were 3 more follow up documentaries about seroxat, which is unprecedented for BBC Panorama) The last 8 or so years on Seroxat, he had become increasingly reclusive and withdrawn, his hair had been falling out in clumps, he has no sex drive, he became impotent, he was numb to everything, he basically had no life, his health was failing, and his life was falling to nothing. After the documentary he tried to come off the drugs. It took him two years to completely withdraw. His withdrawal was one of the most horrific I had ever heard about. Absolute torture. He has so much long term damage that it is barely conceivable. He will never have any quality of life and possibly never experience any joy, pleasure or peace. His body and mind were literally ravaged from Seroxat. All because he was a little depressed because his marriage didn’t work out. How can this kind of thing be justified?
What GSK did in regards to Seroxat is appalling beyond belief..
Doctors, psychiatrists and GP’s should have stood by the patients and chastised GSK , their products should have been boycotted. Their pharmaceutical license should have been either suspended or revoked. But because of the huge economic influence GSK has in the UK they got away with nothing more than a slap on the wrist. It is an absolute disgrace..
Justice in MI
OK, then we don’t see things very differently. The litany of rhetorical questions with which you first responded to my post had no nuance whatsoever - just pushback, bitterness, and rejection.
Unless some here writes something genuinely outrageous, or is personally guilty of child-murder or the like, I don’t think that’s a tone that helps advance one’s views, let alone discussion of them.
BTW, because of a sleep problem years ago, I personally tried all the first generation SSRIs at low dose. (Had also tried tricylics, including trazodone). Based on my experience, I’m amazed that anyone can tolerate a single dose of any of them. But there we are … different people, different stuff.
All of which has nothing to do with over-marketing, false marketing, fraud, etc.
Lori
Nathan -
Regarding number of prescriptions or number of units sold per drug (different numbers), ask your market research department. They will have this information readily available by individual drug or class of drugs.
truthman30
OK, then we don’t see things very differently. The litany of rhetorical questions with which you first responded to my post had no nuance whatsoever - just pushback, bitterness, and rejection.
I think you are getting me wrong justice ..
The rhetorical questions are questions which need to me asked…
Whether you view them as rejection or bitterness is entirely up to you..
People should be doing lot more questioning than me on the subject of SSRI’s. My stance on the issues are much tamer than a lot of people out there.
“BTW, because of a sleep problem years ago, I personally tried all the first generation SSRIs at low dose. (Had also tried tricylics, including trazodone). Based on my experience, I’m amazed that anyone can tolerate a single dose of any of them. But there we are … different people, different stuff.
All of which has nothing to do with over-marketing, false marketing, fraud, etc.
The over-marketing, false marketing and fraud in relation to these drugs is a major part of a combination of factors which has everything to do with the wider picture of why these drugs are controversial and why these drugs have been in constant media spotlight and have been under regulatory scrutiny for the past 10 years…
If as you say you ” are amazed that anyone can tolerate a single dose of this stuff” then why would you be of the opinion that these drugs are effective , beneficial or useful?
And also, if as you say, you were prescribed an SSRI for having trouble sleeping, surely you would be aware that SSRI’s were not intended as sleep aids? And is this not a perfect example of the over prescription and off-label prescription of these drugs which has been much debated already in this very post…
I am not here to argue Justice, and I a not here to inflame of offend, but sometimes it is necessary to illustrate examples and experiences of the reality of these drugs in order portray it accurately from the patients perspective, and surely that should be the most important factor in all of this? ..
Rhetorical or otherwise, the SSRI debate is one which affects the lives of hundreds of thousands of people ..
Asking questions is the only way that we can progress and evolve though the situation. At the moment the whole thing is nothing short of diabolical and at the end of the day the people who have suffered because of the SSRI’s deserve to know the reality…
Justice in MI
Just this bit:
“If as you say you ” are amazed that anyone can tolerate a single dose of this stuff” then why would you be of the opinion that these drugs are effective , beneficial or useful?”
Because I don’t take my reaction to stand for all people, everywhere. “Amazement” of that kind is a natural, but irrational, response to over-generalize from one’s personal experience.
And because of the good I’ve seen this drugs do for the subset of pts we’ve discussed.
truthman30
I don’t take my reaction to stand for all people everywhere either..
But I would argue that the good these drugs have done as you say is purely illusionary…
But anyhow, that’s another debate..
I’m tired..
Justice in MI
OK. Back to square one.
AA
Justice,
Thanks for your response. It sounds like we agree on alot of the issues.
Like Truthman, I realize in very serious cases, that meds might be the only option. But to sentence someone to life on these meds is just not right.
By the way, I take my share of responsibility for not asking my psychiatrist about coming off the meds.
Anyway, have a great weekend.
Justice in MI
You too, AA.
Your point raises a question for me. Since psychiatrists are writing less than a third of the anti-depressant rx’s (and not knowing how many rx’s are actually for depression or something else), I wonder if other specialties are more - or less - likely to rx “for life.”
My instinct would say _more_ likely because, generally speaking, other docs having less training/experience with other ways to treat depression.
If that hunch is right, the trend toward non-psychiatrists rx’ing may also have something to do with the increase in rx’s overall.
But this is all speculation.
AA
Interesting thought, Justice. I have a hard time though believing less psychiatrists write prescriptions for life than other specialties
Many of them still wrong think it is strictly a chemical imbalance issue. They also falsely think that if a person has had two or more depressive episodes, he/she needs to be on medication for life instead of thinking that the person simply hasn’t learned how to cope with life stresses. Everything is reduced to a brain issue.
It also seems that psychiatrists are only comfortable using meds to treat depression. Just my opinion.
But you make some great points about other doctors prescribing meds for life. I think they are all pretty much doing it in equal numbers.
It would be interesting to survey doctors on the RX for life issue and why they do it. You might not get a high participation rate due to the type of question.
Justice in MI
Some of it is generational too. Needless to say, younger psychiatrists (and other docs) were trained during the “Prozac Age.” Older one were more familiar with other approaches.
The psychiatrists with whom I work are keenly sensitive about undue reliance on meds, and for how long. I see no such concern among GPs.
truthman30
Forgive me if I’m wrong here, but are psychiatrists not meant to offer solutions to patients problems and offer some kind of therapy as well as medication? Because from my experience, all they do is prescribe medications with no follow up and the way it works in Ireland, where I’m from, is, you need to see a consultant psychiatrist to get a diagnosis before the GP writes the script. Usually the diagnosis is done in ten minutes and after that the GP gives 3 months prescriptions. There is rarely, if ever and follow up from the psychiatrist and the GP’s do not monitor a patient. It seems to be the same in the UK. It is this kind of irresponsible prescribing habit which results in people being left suffering and trapped on Psychiatric medications for years on end.
Also I have noticed, from my previous experience of doing youth work, there has been a surge in the use of anti-psychotics for young people. This i find quite worrying, and I have seen these kids display the side effects first hand. It seems that the A-typical anti-psychotics are the psychiatrists latest wet dream and the new generation of patients are all but just a part of their experimentation.
Very sad state of affairs..
AA
Justice,
Can you send those psychiatrists to my state? I don’t think based on my conversations with other people on psych meds that these doctors exist. In fact, I was told that I was pretty lucky that my psychiatrist was at least cooperating with my med withdrawal even though initially, he was totally opposed to it.
Truthman, I had follow-up with my psychiatrist on these meds but I wouldn’t call it true follow-up if you catch my drift.
For example, even though I emailed him links showing that the Mosby Consult had listed hearing loss as a side effect of Remeron, he never followed up on that. He, like the ENTs who misdiagnosed me with coclear meneires (must be the boiler plate diagnosis for people who get hearing loss from prescription meds), refused to believe that drugs could cause a hearing loss.
Sorry, I am getting this thread off topic but responding to the points you raised caused me to recall this particular issue. It makes me so angry.
You are so right about antipsychotics being used in young people. I suspect that the reports about there being a huge increase in obesity, diabetes, and cholesterol are due in large part to these meds. Of course, the deny game will be played big time.
Ok, I had really better stop as the more I write, the angrier I am becoming.
Justice in MI
There was a time when psychiatrists _did_ a lot of psychotherapy, as well as offering medical consultation. The latter would not necessarily have to do with drugs. It might be assessing, for example, whether depression or anxiety could reflect an endocrine disorder (hypo- or hyperthyroidism, for example), or a neurological illness, and make the relevant referral. So medical training was used in those ways.
The psychiatrist-mostly-as-pill-prescriber (as opposed to “head shrinker”) is a relatively recent phenomenon, at least in the U.S., but it is certainly the predominant model. Most psychiatrists do relatively brief consults and rx. The best will be sure the right pt. is also in an appropriate therapy. And, yes, will monitor meds for efficacy, AEs, appropriateness, etc.
Some still do the first description above.
The responsibility is certainly that of the profession. But it has also been structured by the ways insurance reimburses, and for _what_ insurance reimburses. And, of course, it has been sponsored by a belief in the efficacy of meds which only sometimes reflects the science.
truthman30
Hello AA
I understand what you mean, It is difficult not to get angry about the psych drug fiasco, particularly when , like myself, you have been prescribed them. There is, I believe, something of a “psych-drug merry-go round” which is perpetrated from when you first get a diagnosis. These drugs are prescribed like candy, and psychiatry itself is guilty of suppressing side effects because they do not want to believe the drugs they push cause harm. I am also aware that most out-patient clinics operate by moving psychiatrists around. So usually the psychiatrist who prescribes the drug will not be the one who follows up. This system works by protecting the psychiatrists and confusing the patient. They know damn well that the people they are dealing with (or drug dealing to) are vulnerable, scared and usually very confused from their condition and then also from the side effects from psych meds. The most vulnerable people in society are the ones which are exploited the easiest and that is exactly the way which psychiatry works. In my opinion psychiatry is a criminal practice.
Justice in MI
T’man writes: “In my opinion psychiatry is a criminal practice.”
That’s where I get off the train. In the U.S., at least, psychiatry reflects what has happened in medicine more generally - a system that is more and more costly and less and less useful to pts as indicated by basic outcome measures.
The impact of pharma has _something_ to do with this, but only something. Insurance, managed care, PBMs, politicians who buy (or are bought) into systems like TMAP, and a system that has evolved itself into knots also has much to do with it. To damn the whole practice rather than understand it in the context of such developments is, I think, missing the point.
I know many psychiatrists who fight these developments, and do so for reasons that parallel the principles invoked by many who write here. For an indiviual pt., the work is to find one.
truthman30
“To damn the whole practice rather than understand it in the context of such developments is, I think, missing the point”
Well Justice ..
If you look at the history of psychiatry , it is certainly not a practice which could be considered anything but “criminal” ..
Frontal lobotomy, ECT, barbaric institutional asylums, forced drugging, abuse, nazi era psychiatrists and the birth of modern psychiatry etc etc..
The whole concept of psychiatry is one based on demoralizing people, branding them and dehumanizing them..
Biological psychiatry is a pharmaceutical agenda , it has nothing to do with healing or medicine, it is exploitation ..
AA
Justice,
I understand why you wouldn’t want to condemn the whole profession. But to be honest, I have to agree with alot of what Truthman writes although I am reluctant to call psychiatry a criminal practice. I think no matter how strongly I feel about a profession, I never want to stereotype the whole field as I wouldn’t want someone doing that to me.
But I live in a state where I saw none of the main main mental health groups, including psychiatrists take a stand when our legislature passed very regressive mental health commitment laws. For awhile, I wondered if I was living in the old Soviet Russia who we used to criticize for doing that.
A group of people were complete demonized for the VA Tech tragedy who had nothing to do with the killings and we were left to hang to dry. None of the mental health groups and I mean no one stepped up to the plate.
Also, when Esmin Green tragically died, the head of the American psychiatric association offered what I felt was a very flimsy excuse for what happened. Frankly, it was disgraceful.
Many psych survivors have have been brutalized in psych hospitals weren’t surprised at all this happened. Again, no psychiatrists have spoken out other than the Peter Breggins of the world who gets condemned by mainstream psychiatry.
There was a series in the Atlanta Constitution about patients dying in psych hospitals, including a 14 year old girl due to negligent medical care.
I haven’t seen any psychiatrists speaking out against a situation in our state where a patient is still in seclusion after the Justice Department ruled in 99 that his rights were being violated.
Justice, looking at things in context is fine but meanwhile, as we are having this discussion, people are getting seriously injured or dying.
I know when you’re in a closely related profession that sometimes the truth stings big time. But it is what it is.
truthman30
Well, it is all very fine being politically correct, but sometimes we have to call a spade a spade…
And Psychiatry commits human rights abuses every single day..
That to me is a “criminal organization”..
Some people might say I am basing my judgement only because of my own experiences, but I am not..
I have come to know many people who have been damaged by psychiatry through drugs , ECT, etc etc … I have visited people in psychiatric institutions and I have seen what goes on , these places operate under a policy of “fear” and it is appalling what these psychiatrists get away with..
Some of them are absolute egocentric sadists ..
Justice in MI
Nothing is more “politically correct” than accusing calling other folks’ commentary “politically correct.”
I have no need to defend “my profession,” since I actually have a few - I’m mainly a teacher/writer/researcher. Within psychology, I am known mostly for my criticism.
If you’ve read anything I’ve written here since I “appeared,” you’ll know I do not back down from calling things as I them.
And the “meanwhile people are” perspective is actually where I come from.
Justice in MI
On a more positive note, here is a brief quote from the person who has been my “hero” for about 40 years, the American psychologist / philosopher, William James. I think you guys will appreciate it, and it may even be useful in your own work:
“We should broaden our notion of health instead of narrowing it; we should regard no single element of weakness as fatal - in short, we should _not be afraid of life_.”
[emphasis in original]
William James (1895)
truthman30
Nothing is more “politically correct” than accusing calling other folks’ commentary “politically correct.”
Is that an oxymoron ? or a paradox?
Because to be honest I fail to see the analogy there..
I didn’t accuse anyone’s commentary as being “politically correct” but I am aware that there is a certain code of conduct in regards to what one “can’t say” as opposed to what one “wants to say” ,this happens particularly in the US but not so much in Europe…
To some , the statement “Psychiatry is a criminal organization” might be politically incorrect” to others it might be softer than saying “psychiatry is a sub-fascist ideology” , either one is valid and both could be viewed as “politically incorrect” …
Anyhow, it all boils down to “universal truth” as far as I am concerned..
truthman30
“We should broaden our notion of health instead of narrowing it; we should regard no single element of weakness as fatal - in short, we should _not be afraid of life_.”
[emphasis in original]
William James (1895)
That is a very good quote Justice, and really it is quite apt ..
If it was applied to the psychiatric ideology a little more then maybe the profession would grow and evolve a bit more instead of it drowning in its own arbitrary dogma and separatist nonsense…
truthman30
On the subject of quotes , here are a few about psychiatry which I believe have more than a few echos of universal truth within them : -
Psychiatry is probably the single most destructive force that has affected the American society within the last fifty years. ~Thomas S. Szasz
Everybody believes in psychiatry; it’s supposed to be for our own good. Let psychiatry prove that anybody has an illness, and I’d concede, but there is no physical proof.
Kate Millett
Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, … Thomas S. Szasz, M.D. Professor of Psychiatry Emeritus
The difference between a neurotic, a psychotic, and a psychiatrist. The neurotic builds castles in the sky, the psychotic lives in them and the psychiatrist collects the rent.
Unknown Source
The way to sell drugs is to sell psychiatric illness.”—-Dr. Carl Elliot, University of Minnesota Bioethicist (The Washington Post, 2001).
We can manufacture enough diagnostic labels of normal variability of mood and thought that we can continually supply medication to you…But when it comes to manufacturing disease, nobody does it like psychiatry.”—Dr. Stefan Kruszewski, psychiatrist, Pennsylvania Medical Society, 2004
We do not have a clear-cut lab test” to diagnose such an imbalance. He later stated, “In order to survive, we (psychiatrists) must go where the money is.”–Steven Sharfstein, Ex-President, American Psychiatric Association
Anyone who goes to a psychiatrist ought to have his head examined.”– Samuel Goldwyn.
“Biological psychology/psychiatry is a total perversion of medicine and science, and a fraud.”— Neurologist Fred Baughman.
“The empire of psychiatric power is more than three hundred years old and grows daily more all-encompassing. But we have not yet begun to acknowledge its existence, much less to understand its role in our society.”– Thomas Szasz.
“Doctors have throughout time made fortunes on killing their patients with their cures. The difference in psychiatry is that it is the death of the soul.” – R.D. Laing, MD.
AA
Justice,
Perhaps, I should have said that people in general don’t want to face the fact that bad things like Esmin Green’s death are happening in our country. Incredulously, on an ER Blog, a doctor blasted the kids for suing. How is that for avoiding the issue?
I realize that dicussing that on this thread is getting off the topic so I won’t take it any further. But when I felt Truthman was getting an unfair rap in being critical of psychiatry, that is why I gave the examples that I did. Not that he needs me to defend him as he does a great job of speaking up. But it struck a nerve in me.
I think I all I am asking is that when people seem too negative to you, there is often very good reasons why they feel the way they do. It isn’t just because they want to stir up trouble.
truthman30
Thanks for the support AA :)
Yes I am critical of psychiatry and yes I am critical of pharmaceutical companies who lie about the side effects and dangers of their medications, but as you said I don’t do this to stir up trouble. I speak out because someone has to.. Psychiatry and pharma have much bigger and louder platforms to air their propaganda anyway so I doubt very much that anything I could say here on Pharmalot would have an impact on their agenda..
Justice in MI
Thanks, AA. It’s probably worth keeping mind that no one here has a monopoly on relevant experience, cause to be righteous (even self-righteous!), concern for what’s happenin’, taking stands, yadayada.
truthman30
Justice “It’s probably worth keeping mind that no one here has a monopoly on relevant experience, cause to be righteous (even self-righteous!), concern for what’s happenin’, taking stands, yadayada.”
I’m not sure if you are including me in that bunch..
But If you are, I should hope that you would respect the opinion of someone like myself who was 4 years on Paxil, three years in withdrawal and 6 years researching psychiatry, the pharmaceutical industry and mental health. I say what I say because it is based on research and experience. I don’t claim to know it all, but I do know a hell of a lot about the topics I choose to participate in. And if that sounds too “righteous” to you then that’s just tough..
If standing up for human rights, justice and truth is being “self righteous” in your book, then yes, I am “self righteous” …
Anyhow, if you were not referring to me, then ignore my comments above…