Goodwin: Pharma Ties Have ‘Never Been A Secret’
44 CommentsBy Ed Silverman // December 1st, 2008 // 4:15 pm
Former National Public Radio host Fred Goodwin is the subject of a great deal of talk these days. Earlier this year, an episode of his program, “The Infinite Mind,” which was heard on 300 NPR stations, featured three experts who discussed the controversial link between antidepressants and suicide. All of them, plus Goodwin, declared that worries about the drugs have been overblown.
Yet the trio’s ties to pharma were never disclosed. Then, 10 days ago, Chuck Grassley, the ranking Republican on the US Senate Finance Committee, revealed that Goodwin, a former director of the National Institute of Mental Health, also has substantial ties to several drugmakers. Since 2000, Glaxo, for instance, paid him more than $1.2 million in speaking fees and over $100,000 in expenses.
The story, which was first reported here on Pharmalot (look here) and shortly afterwards by The New York Times, received tremendous attention as an example of what industry critics say are undisclosed conflicts of interest and unchecked pharma influence. NPR, itself, covered the story late last week after yanking the show (listen here). Meanwhile, the show’s independent producer, Bill Lichenstein, maintains Goodwin never disclosed the full extent of his pharma ties (look here).
A few days ago, Goodwin, who co-founded a consulting firm that Grassley is also now investigating, circulated a cheeky reply to the controvery and the Times article, in particular. His response, some of which doesn’t quite match some info given by Glaxo to Grassley, made its way to the chat room at the American Psychiatric Association. Here it is…
The Times “article is filled with misstatements of fact and nasty innuendo, the latter achieved by the clever sequencing of unrelated facts. Let me first note that I spent nearly an hour on the phone with (Times reporter Gardiner) Harris, and I followed this up with a detailed email; providing easily verifiable factual information. While he did quote a few things I said, all of the important information I provided was left out of the story. Why? It’s clear now that when we talked he already knew what he was going to write and the information I provided simply didn’t fit his narrative. Had he included all of the relevant facts he would not have had a story that would have gotten by any competent editor.
“Some of his misstatements of fact about The Infinite Mind have been covered in other media reports (NPR, 11-26-08.) I’ll focus on his most egregious misstatements and omissions. His story implied that I am and was always the host of The Infinite Mind. In fact from April ‘05 through January ‘08 the producer replaced me with another psychiatrist with no ties to drug companies, while I served as guest host for shows unrelated to pharmacological treatment issues.
“His story also implied that I had been a speaker for GlaxoSmithKline since 2000. My speaking for GSK started in January ‘04 with talks dealing with lithium. Incidentally I saw this as an opportunity to remind psychiatrists about this forgotten drug; forgotten because it’s been generic for decades and doesn’t make enough money to justify it’s promotion by drug companies. I referred him to Manic Depressive Illness 2nd edition, where my views on the dismaying fact that many young psychiatr ists don’t use lithium are clearly expressed. Later, as Lamictal joined lithium as the only other FDA approved mood stabilizer, my talks included the FDA indications for both.
“More egregious is Harris’ Paxil narrative. The story line was that the March ’08 Infinite Mind show that I hosted criticized the FDA warning about suicidality and SSRI’s (such as Paxil) because I was carrying water for GSK which makes Paxil. In fact, had he listened to the show (or had searched the topic on the web) it would have been clear that my real concern, along with many of my colleagues, was the vagueness of the concept of ’suicidality,’ a term never properly defined or validated.
“I was concerned that such language implied that ’suicidality’ was a predictor of actual suicide, an association which is tenuous at best. (Suicidality encompasses everything from suicide attempts to suicidal thoughts, to any ’self harm,’ much of which has no relationship whatsoever to suicide). My concern was straightforward: this black box warning might scare many doctors away from using these drugs, for fear of being sued (suicide being the number one reason why psychiatrists are sued).
“Doctors should be warned about the distressing symptoms that young patients can sometimes feel on these drugs, but a lot of us feel that a less charged word should have been used. Mr. Harris ignored all of this because it didn’t fit his narrative. Furthermore, when Harris quoted the show’s script as asserting ‘that there is no scientific evidence linking SSRI’s to suicide,’ rather than challenging the accuracy of that statement (which he couldn’t do) he fell back on a nasty inference: that our conclusion reflected bias because of my connection to GSK! That’s about as shoddy as journalism gets.
“Also undermining Harris’ narrative is my long-standing, easily accessible record of being quite critical about the overuse of SSRI’s, especially in young people. I referred him to the treatment of depression chapter in my 2007 book (with KR Jamison) on manic depressive illness and gave him references to two recent journal articles I co-authored, which expressed major reservations about the overuse of SSRI antidepressants. I further pointed out that I had never spoken on behalf of Paxil. All this information was ignored.
“Most egregious was the typical tabloid ‘guilt by association’ ploy in which he implied that I somehow knew that GSK had been accused of suppressing data on Paxil and suicidality when we did the show on SSRI’s and suicidality! Of course he has no evidence whatsoever to back that up; he was simply engaging in a cheap-shot, sleazy, indirect form of libel characteristic of tabloid journalism at its worst.
“Second, his ‘bipolar disorder in kids as a promotion of Lamictal narrative;’ I pointed out to Mr. Harris that Lamictal has not yet been properly studied in that age group. Mr. Harris apparently didn’t listen to the show, which, as I recall, did discuss mood stabilizers that have been studied in kids, especially lithium and divalproex, both now generic drugs and no longer ‘promoted’ by anyone. (Additionally, I also pointed out that Paxil had been generic for some time and was no longer promoted).
“Incidentally, I was surprised to find out that Mr. Harris, as a ’science writer’ for a major newspaper did not seem to know even the simplest background information about drugs that were relevant to a story that he was writing.
“Third, his narrative that my involvement with pharmaceutical companies was ‘undisclosed.’ Again, Mr. Harris simply ignored what I told him (and didn’t bother to do a simple web search) - that there is ample evidence in the public record disclosing my work with drug companies; it’s never been a secret. It’s extensively acknowledged in papers that I have published, in my book, and in all of my continuing medical education (CME) activities. A real reporter would have checked these things out.
“I also told him that The Infinite Mind producers were aware of my connections to pharmaceutical companies although I acknowledge that Mr. Lichtenstein may not have known all of the details. While he did quote me in the ar ticle to this effect, he failed to cite an important, easily verifiable fact: Mr. Lichtenstein recruited another psychiatrist without any ties to industry to be the host starting in 2005, and serving through January 2008. This action was taken to deal with Mr. Lichtenstein’s concern that my industry ties could become a problem for the program. Indeed, it is worth noting that during most of the time I was giving promotional talks for GSK, I was not the host of the program. Again, an interesting fact that would’ve taken some of the ‘juice’ out of Mr. Harris’ breathless narrative.
“With respect to the dispute over whether Mr. Lichtenstein was generally aware of my activities, I have been contacted by a former producer of the program who was very upset with Mr. Harris’ story, especially Mr. Lichtenstein’s apparent denial of knowledge about my pharmaceutical company contacts. She sent me a copy of her letter to the Times and if and when they publish it, it will be clear who’s telling the truth:
“The recent NYT article of 11/21 reports that during the time Dr. Fred Goodwin hosted the public radio program “The Infinite Mind,” he also earned fees from pharmaceutical companies for consulting and speaking engagements in which he promoted their drugs. According to the article, the program’s creator and executive producer Bill Lichtenstein says he was “unaware of Dr. Fred Goodwin’s financial ties to drugmakers.” For over two years, beginning in 2001, I was a staff producer for “The Infinite Mind.” I would be surprised if Bill Lichtenstein was entirely “unaware” of Dr. Goodwin’s work for pharmaceutical companies. When I worked there, the program’s series producer told me about Dr. Goodwin’s consultation and speaking fees on behalf of pharmaceutical companies, and that she, Bill Lichtenstein, and Dr. Goodwin had discussed how to manage and avoid a conflict of interests.”
UPDATE: Here is a note from Bill Lichenstein: “The fact is, Senator Grassley’s charges are about Goodwin personally taking at least $1.3 million to speak on behalf of a company, GSK. And that is something I was unaware of until I got the call from the New York Times reporter on November 20, 2008. I still can’t tell you the details of a single speaking engagement, location, date or time, or venue.” Again, for a comment he posted on the NPR site, see this link.
Jim Wheatley
Ed:
All I read here is a press release from Fred Goodwin that he thinks his producers should have known about his pharmaceutical fees, two self-promotions for his manic depression book (including the updated version) and an unsigned note, with no response.
Honestly, I have seen better on your site.
JW
Ed Silverman
Hi Jim,
I understand your point. The reason I posted this is because it was a chance to hear from Goodwin. I reached out to him a couple of times in the past 10 days, but he never replied. So I thought this was an opportunity to hear what he had to say.
Moreover, his complaints are, well, interesting, whether or not one agrees is another matter. For instance, for all his long-winded criticisms, Goodwin never appears contrite. He takes Harris to task for not bothering to check the Internet for his pharma ties, but Goodwin fails to use his own platform to acknowledge he simply could have disclosed his industry connections. And that failure is on full display here.
In any event, sorry if you feel I let you down, but I had an opportunity to post something that I hadn’t seen elswhere and gambled others would find it interesting, even if it is one man’s ramblings.
Best,
ed
David Cantor
This makes no sense at all. Goodwin says he didn’t do any speaking for GSK until 2004.
But the producer who worked there from 2001 to 2003 said it was discussed in the office.
Don’t you read your own copy?
Ed Silverman
Hi David,
I’m not sure why you’re criticizing. I posted this verbatim. I didn’t write the text. Again, such inconsistencies are interesting. At least, I think so. And that’s why I chose to post this.
I hope this helps,
ed
David Cantor
Regarding my post (above): The inconsistencies in Goodwin’s statement and the anonymous producer’s letter when combined are certainly enlighting with regard to who is telling the truth in this matter. Hint: not them. Public radio is taking a beating over this, and all because another top psychiatrist wanted to put a lot of money in his pocket, and not tell anyone. Harvard, Emory, NPR. It’s too bad.
Jane
This sounds like the same crap you would read on drugwonks. But of course it did come from Goodwin. Goodwin takes no responibility and blames everyone else now that he has been caught.
Ed Silverman
Hi Jane,
Again, I did not defend (nor attack) Goodwin in this post. I simply posted his reply, for the reasons stated in my comments above. As for DrugWonks, the tone or substance may sound familiar to you because Goodwin is a board member of the Center for Medicine in the Public Interest, the organization co-founded by DrugWonk Peter Pitts. You can see that connection right here…
http://www.cmpi.org/about-us/board-of-directors/
All best,
ed
Jane
Oh, I know Ed, I should have made it clear I was talking about what Goodwin’s said. What he said he the same crap that is on drug wonks everytime someone gets busted. He just had to use his own name in this clip!
Atlex
David Cantor,
The “inconsistency” that you cite isn’t necessarily so. Goodwin claims not to have begun speaking on GSK’s behalf until 2004. The anonymous producer discusses nonspecific work on behalf of pharma companies in the 2001-3 time frame. It is entirely possible for both statements to be true.
Atlex
Lisa Van S
Ed,
Dr Goodwin’s statements are quite strange. The good Dr., again appears to be speaking psycho babble. Paxil “does” cause; suicidal ideation and gestures, including self-mutilation. He is correct in his discussion of the word suicidality,this was backed up by Dr. Wayne Goodman, a pediatric psychiatrist, who conducted clinical trials of antidepresants in children. He was also the Co Chairman of the FDA PDAC hearings in 2004.
Maybe Dr. Goodwin should have sat next to NYT Reporter Gardiner Harris during the 2004 FDA and Congressional Hearings on this issue, (He could have even sat with you to have a lovely chat). It appears as though the science reporter was more educated on the the adverse effects of antidepressants in the pediatric population than the good Dr. Then again he is paid a lot of money by the industry to be deaf, blind, and mute!
As for Peter Pitts, God only knows what his excuse is
Lisa Van S
Atlex,
GSK told Grassley’s Investigators that Dr. Goodwin has been on their payroll since 2002. It wouldnt be in GSK’s best interest to lie to Senate Investigators.
Lisa Van S
Atlex,..oops made a mistake, I meant to say 2000!!
Salmon
Atlex,
You can verify the dates from the following data table (apparently provided by Glaxo) that Ed published previously.
http://www.pharmalot.com/wp-content/uploads/2008/11/glaxo-to-goodwin.jpg
It’s clear from this table that Goodwin was not only talking for Glaxo as far back as 2000 but also when he was talking about off-label use.
atlex
Lisa and Salmon,
Please read what I wrote not what you think I wrote. I was commenting specifically to David Cantor’s statement that Goodwin’s comment was in conflict with the comment from his producer. I stated that this was not necessarily the case. I did not address inconsistencies between Goodwin and GSK’s report to Congress.
Atlex
Mike
Have any of you attended a lecture given by Dr. Goodwin? Regardless of who may or may not have funded the lectures given, Dr. Goodwin’s lectures have ALWAYS been unbiased and based strictly on research. He has taken many risks, including threats on his life for the sake of ALL medical research. This man deserves respect and and an open mind, not slander and non-evidence based medical Witch Hunts.
Lisa Van S
Mike,
Why should anyone have respect for a man, who “clearly” distorts the facts, and then goes on to attack a reporter who states the true facts.
Maybe the good Dr. should be subjected to a room filled w/ grieving parents. Let him tell these parents that the side effects of antidepressants in children are troublesome.
Lisa Van S
Ed of Pharmalot,
You continue to relay to readers that the increased risk of suicide for antidepressants in the pediatric population is contreversial. Id like to remind you that the FDA PDAC Panel, in 2004, determined there was a “causal” role!
You are also aware that FDA negotiated with Industry, on the wording of the antidepressant labels. The word “causal” was dropped, and “increased risk” was added.
Lisa Van S
Atlex,
I stand corrected!
Salmon
Ibid.
Lisa Van S
Ed,
My question to you was just as important as others.
Mike
Lisa,
The appropriate use of antidepressants has saved countless lives, including those of children. The inappropriate use, conversely, has created harm. The blame needs to be put on the medical practicioners who have not properly screened patients prior to treatment. SSRI’s, when used in a child with BiPolar Disorder for example, can create the suicidal issues you have noted. Which would likely not be the case if the child was properly screened and treated for depression. These are issues which we can not paint with a wide brush for the purpose of oversimplification.
Ed Silverman
Hi Lisa,
Sorry for the belated reply. Scrambling a bit this morning, as usual. Anyway, to answer your question, I wrote that the link between suicide and the drugs has been controversial. To put it another way, in my view, I was simply reiterating that there has been controversy over the years. A more recent example would be the debate about the prescribing rates and whether that has been tied to teenage suicides, something I’ve posted about here a few times.
And of course, I recall the FDA decision. I was at the advisory committee meeting in 2004 where the issue was picked over and wrote about the subsequent label changes. Again, I was using a sweeping phrase to remind readers that the issue has been controversial over the years. That’s all.
Hope this helps,
ed
Gil Ross MD
There seems to be some confusion re: “suicidality” vs. suicide. The former concept caused the FDA to slap “black box” warnings on SSRIs for teens in 2004–followed by a decline in prescriptions–and lo and behold, an unprecedented spike in real actual teen suicides! No teen actually harmed him/herself in those studies which led to the FDA’s ill-advised warning labels.
(See my op-ed on this subject:
http://www.washingtontimes.com/news/2008/sep/14/lethal-fda-warning/)
The key comment above is Mike’s, which points out that, financial irregularities aside (and about which I have no comment–misstatements on financial forms are clearly not excused by scientific veracity), Dr. Goodwin adhered to sound medical research in his lectures.
And the “grieving parents” referred to by Lisa Van S would be hard to find among the parents of those taking antidepressants–especially when confronted with the far greater number of parents of teens who killed themselves when their docs stopped their effective meds.
Gil Ross MD/ACSH
Lisa Van S
Mike,
Medical Practitioners like Dr. Biederman, who by the way has been described as a man with a “short fuse” who loves to be wined and dined by yhose who manufacture antidepressants, or Dr. Keller who touts a negative paxil study as positve. Then you have a Pfizer Exec. who produced voodoo medicine by combining two negative zoloft studies to make one positive.
And as far as children benefiting from antidepressants, please produce that evidence to support your claim of efficacy(Benefit).
Please,. science based evidence only that “prove” antidepressants are not only safe, but efficacious.
joanne
Dr. Goodwin has authorized me to note an inadvertent omission from his statement in response to the recent NY Times story. Since the NY Times piece was about Lamictal promotion, he indicated that he did not start speaking for GSK (meaning Lamictal) until 2004 which is what the Times reporter asked about. Unfortunately neither GSK, Sen. Grassley’s office or the NY Times extended him the courtesy of sharing the data that stimulated all of this so he answered from memory in good faith. Apparently Ed Silverman has been given access to data that has never been provided to Dr. Goodwin. After reading Mr. Silverman’s post I reviewed old records and noted that Dr. Goodwin had spoken on behalf of Wellbutrin beginning in 2001. Although not germane to Mr. Harris’ article, Dr. Goodwin has corrected this inadvertent omission in an updated response to the Times.
Mike
Kudos to Dr. Ross. The FDA should investigate the results of the labeling changes it has created. More harm than good would undoubtedly be found due to the discontinuation of SSRI therapy by those that were scared by the labeling change. Also, thanks Joanne for shedding full light onto Dr. Goodwin’s comments. Why am I not suprised by another slander article by the NY Times and more grandstanding by a politician.
truthman30
Why doesn’t anyone here say it like it is..
All these psychiatrists exposed with lucrative links to drug companies have sold their reputations for financial gain, it is that simple.
Whether they declared it or not is not the issue..
The issue is, they are little more than psychiatric drug pushers, backed by big pharma, their opinions are bought and their reputations are sold.
There is absoultely no regard for patient well being, mental health , ethics or morals here. Just look at the profits that they make from other people’s misery, it is disgusting. They get away with it because up until now, they could.
Any psychiatrist that chooses to go on Big Pharma’s payroll immediately enters the area of “conflict of interest” and “bias”
Their intentions simply cannot be trusted.
Even if they are open about their drug company ties, their reputations are still biased and they deserve no credibility…
The damage from these “medications”, SSRI’s and Anti-psychotics is being played down by the drug companies and the top psychiatrists on their pay roll. They are a disgrace to medicine and a disgrace to humanity.
truthman30
“The appropriate use of antidepressants has saved countless lives, including those of children. The inappropriate use, conversely, has created harm. The blame needs to be put on the medical practicioners who have not properly screened patients prior to treatment. SSRI’s, when used in a child with BiPolar Disorder for example, can create the suicidal issues you have noted. Which would likely not be the case if the child was properly screened and treated for depression. These are issues which we can not paint with a wide brush for the purpose of oversimplification”
Oh and Mike…
You’re talking a mile high pile of horse manure and if you don’t realize that then really you should talk to some SSRI survivors about their experiences on these poison pills… And if you don’t still don’t get it, why don’t you take a load of Lamictal, Zyprexa and Paxil and see how it makes you feel?….
AA
Mike,
Please stop creating the misconception that people become suicidal from SSRIS due to being bipolar. Joseph Glenmullen, a psychiatrist who is not anti meds says that is a false premise and that people who are not bipolar can become suicidal.
David Healy, another psychiatrist showed that perfectly healthy volunteers can become suicidal on SSRIS.
Jay Cohen, also a psychiatrist, talks about it on his medsense website.
Dr. Ross, stopping medications cold turkey or withdrawing people too fast from antidepressants can also lead to suicidal ideation. That has nothing to do with proving whether antidepressants are effectiveness or not.
I know a little bit about this as I became suicidal thanks to being cold turkeyed off of Prozac.
AA
Lisa Van S
Gil Ross, MD
“No teen actually harmed him/herself in those studies”….. Not only did children harm themselves in these studies, they also harmed others. Clearly you were not in attendance during the FDA/Congressional hearings in 2004, were evidence through clinical trials, was presented to the Public.
And if my memory serves me correctly, it was 84 parents who attended or testified before FDA that their children were harmed or died, (I know, I was there) compared to one Parent who stated their child had benefited. It should be noted that, that child was heavily medicated and slurred his words.
Your OpED in the Washington Times is not scientifically based, Stupidity doesnt become a Physician. I take it you are one of those insane Docs who believe its ok to medicate babies, because as a Physician you can diagnose depression or Bipolar in this subgroup. Its just voodoo medicine!!!!
atlex
Lisa,
Suffice it to say, despite your admonition to Ed, this remains a controversial subject.
Atlex
Lisa Van S
Atlex,
The bias and vested interest of those proclaiming that the black box is the cause in suicide rates beteween 2003 and 2004. Almost all of the “scientists” speaking out about the black box and its relationship to rising suicide rates have a vested interest (incuding an interest in defending their own actions of promoting the use of the drugs for children and adolescents despite an abscence of efficacy data) and most have pharmaceutical industry ties.
The current trend in suicides for children and adolescents could be the result of the meteoric rise in pediatric prescriptions of atypical antipsychotics, such as Zyprexa and Risperdal:
According to research conducted by Medco Health Solutions, Inc., in which the company reviewed prescription drug claims of some 370,000 youngsters ages 10 to 19, the prevelance of adolescent girls taking antipsychotics has grown 117% in the past five years while it has increased 71% for boys. The suicide rates are even higher in patients taking antipsychotics than those on antidepressants.
Salmon
Mike,
Given what Lisa has said. Be careful what you ask for.
atlex
Lisa,
Despite all that you have said, this is still a controversial issue. We all have read reports and studies, valid or not, that teen suicides have increased since the black box warning was instituted. You can choose to minimize them, criticize them or discount them. But, one way or the other, this is still a controversial topic.
Atlex
Lisa Van S
atlex,
Your comment amounted to nothing.
Lisa Van S
Atlex,
When looking back at my last, it sounds a bit condescending, which was not my intention.
truthman30
“Controversial Topic”
The holocaust is still a controversial topic..
So is World War 2..
As are may things…
By calling the evidence of SSRI induced suicides a “controversial topic” is an attempt at deflection away from the issue..
And the issue is , these drugs are very dangerous and the psychiatrists who pimped them are just as much a danger to public health as the drugs are…
Liz
While it is awful and disheartening that many have suffered from psychiatric medications, have some of you out there, (the ones who seem to have a very negative view of psychiatric medication) stopped to think that for every one of those suffered, thousands have benefited?
I work with mentally ill children (have any of you out there dealt with a bipolar or ADHD child or adolescent???) and they are treated with psychiatric medication. Most, if not all, of their lives, and their families lives, have improved immensely (I could write a novel based on this.) People need to look at the issue from both sides before they accuse people of unethical and immoral behavior. Dr. Goodwin and others accused by Gardiner Harriss have dedicated their lives to the research and development of treatment for these awful and debilitating diseases. Yes, they may be affiliated with drug companies, however both Dr. Goodwin and others have been critical of these companies at the same time. This bit of information is just the tip of the iceburg of information that Gardiner Harris does report.
P.S. Just in case you were wondering, I am not affiliated with any drug companies and do not get paid by them in any sort of way.
Anonymous
Liz,
I am one of those individuals who you refer to as being negative.
I also suffer from severe psychiatric illness as do my children (ADHD, Bipolar, Panic Attacks, GAD, etc, been homeless, been institutionalized), and yes we have both benefited from them.
However I also work in the industry on these meds and I know what’s being hidden as to their safety and it absolutely disgusts and terrifieds me. There is alot of very serious long term toxicity that is yet to be publicly known.
Don’t give me what good Goodwin has done. He and Biederman definitely know that they’re pushing inappropriate use. What they likely don’t know is the amount of maiming that will occur and the suffering the children will go through later in life.
There is simply no excuse for it and in my opinion many of these KOL’s, industry executives, and FDA officials really need to go to jail.
Yes I took the medications as do my children but I was UNable to make an informed decision about the long term consequences because the information was covered up.
Now I know and I’m struggling with how much, how long, how many drug holidays and what else I should do. The information simply isn’t there.
I wonder to what extent am I helping my children avoid going through what I went through or am I condemning them to dying by the time they’re 35.
I think Congress should get the information out and let everyone know before we permanently maim and disable a substantial fraction of our youth.
Meg
There is meager to no information as to long-term use of atypical antipsychotics in children and youth, except that adolescent boys grow breasts. Many, many more of our young are on this class of drugs now, partly because the SSRIs have a black box.
I have worked hard to get pharmas and FDA crooks to jail, so far to no avail. They knew these drugs were lethal before they ever were put on the market, yet the drugs were approved back in the late nineties. One of them, Zyprexa, killed my son before Lilly finally had to admit that checking blood glucose might be a good idea.
I will hand ONE thing to Dr. Goodwin, though this is not a plug for his/Jamison’s bipolar book. The list of lithium toxicity symptoms in the book saved the life of my daughter, who was going to see a HOPKINS-trained doctor who had no idea why my daughter appeared to have athetoid CP. And if Goodwin chooses to eventually have humility along with his ruined career, he can spend some time promoting lithium, a generic drug that is truly the first-line drug for manic depression. My son did well on lithium for many years.
truthman30
Liz…
No one here is arguing that these drugs can be “helpful” in some cases, but they should absolutely always be used as a last resort..
But, what really pisses people off is when drug companies hide and deceive them about the adverse and side effect profiles!!!!
This has happened with countless psychiatric (and other) drugs for decades..
When a drug company buries bad data, it harms patients, and this is all too common a practice in the industry..
Check out my blog for the background on Paxil and you will see why people are so outraged about these issues..
Maggie
Hi,
I’m not a doctor or anything, but I am a Bipolar Type 2 patient. I don’t deny that these companies can be Bad with a Big B, but I’d also like to speak in favor of both SSRIs and Lamictal - specifically in regards to suicidal feelings.
Since Bipolar Type 2 tends to manifest depression more strongly than hypo-mania, I have been treated for “just depression” - which often manifested as suicidal thoughts and self-harm - for over 10 years.
I really resisted taking drugs because I was concerned they wouldn’t be healthy. I was getting regular therapy, and tried every natural remedy in the book.
But my depression worsened as I got older, and I finally broke down and started taking SSRIs around year 5 when I was about 22 - and my only regret was that I didn’t do it sooner.
SSRIs weren’t perfect, but they did decrease the suicidal thoughts that I had and greatly improved my memory and functionality. They served well as “band-aids.” Of course, I would feel better and then go off them, (as I’m bipolar!! Haha), but sooner or later I would be back on them. I didn’t take Paxil; I took Celexa, Wellbutrin, and most recently Zoloft, and I know that two years ago Zoloft kept me from doing something rash.
I was finally diagnosed with Bipolar 2 and put on Lamictal, and for the first time in my life, I felt “normal” - as in, I finally felt that being alive wasn’t a horrible thing. I don’t have a suicidal thought as long as I am taking it regularly, and I can’t tell you the hell of forgetting to take it and being right back where I started in a matter of days. It’s even worse knowing that it’s _possible_ to feel “normal,” but I just can’t stop the thoughts that I would be better off dead.
Drugs are certainly overused and of course they can make some situations worse, but if it weren’t for them, I’d likely be crying in my bed or not here at all to post this response.
Maggie
This is not withstanding the terrible sudden suicides attributed to these (though I think it’s telling that “real suicides” may have risen after the labels, if this can be backed up).
But to those who are rightly concerned about long-term side-effects, and I am as well, this is the way I have had to think about it:
Would it be better for me to die at 45 having lead a relatively productive life without the feelings of worthlessness and futility that depression has inspired, would it be better for me to die at 85 having spent my life in bed feeling horrible?
My answer came to be “yes” - but of course if anyone’s answer is “no”, then these drugs should be avoided.
Anonymous
Maggie,
I’m glad for you and that things are better. The issue with suicide and antidepressants is complex.
I think the facts do indicate that antidepressants actually cause suicides and suicidality especially in teens. Around the end of March 2004 the FDA issued a quiet statement that there had been some post marketing reports of suicides. Around a week later it was first reported in the news that Andy Mosholder a psychiatrist at FDA had actually found a evidence for increased suicides by examining head to head placebo controlled studies and he had been prevented from presenting this to an advisory committee. This prompted Congressional inquiries and FDA punted and said well it’s inconclusive and turfed the question to Colombia University for a re-review. After Columbia University looked at the data and came to the same conclusion, the FDA re-did Columbia University’s analysis and again came up with the same result. Finally in January 2005 FDA issued a black box warning. (Most later reports saying there was no increase did not include placebo controls or were based on publications without the level of detail. Although those that were good placebo controlled ones did replicate the FDA results and found a link.) Now prior to the 2005 labeling change FDA had a public meeting and there was Medco data that said there was a 20% drop in teen usage and IMS data that said there was a 7% increase in teen usage in 2004, (the IMS data reflects all sources and tends to be what is typically used). There’re also complicating factors like it might be worse for some drugs than others (in particular ones like prozac that are ‘activating’ and cause anxiety) and it is probably higher in kids being treated for GAD. Plus the risk goes down as you age and your brain matures. Also from 2003 to 2004 the reported rate of suicide in teenagers increased by about 10 -15% but if you look at stats from earlier depending upon how you analyze them you get decreasing rates until different years. Plus by 2004 the use of atypical antipsychotics was increasing and substantial (which may be the cause of increased suicide rate from 2003 to 2004. So ON AVERAGE they do cause suicide and suicidality.
You point out something that’s very important. There’s a difference between what happens on average and what happens in a particular individual. You were older with multiple episodes that had lots of suicidality as a feature of the illness. So your individual risk benefit ratio and analysis may be different. Depression and bipolar are not due to a single cause and different causes may cause different responses in different people, plus you had good responses fairly quickly with resolution of suicidal thinking (i.e. suicidality). If I were you I would probably do the same thing you’re doing. (In fact I did for many years, but after my life stabilized and I was older and learned how to manage early symptoms I was able to go off drugs because the risk benefit for me had changed. But for a kid with a first even a couple of mild episodes with a lot of anxiety and no suicidality the decision to use a drug and to use it long term may be entirely different.
The problem I have is that the companies, paid off KOL’s, and FDA will not allow the education of the prescriber as to what we really know in order to make an educated guess and so that patients can decide for themselves and also know what the alternatives are and what the data actually says.