Antidepressants

Alex Langford is a British trainee psychiatrist. He blogs at The Psychiatric SHO, and on April 21, he posted an article titled Antidepressants are not ‘happy pills.’ Thanks to Jean Davison for the link. The article is an impassioned attack on psychiatry’s critics. Here are some quotes, with my responses: "I am sick and tired of the way the press portrays depression as unhappiness and antidepressants as ‘happy pills’." This is interesting, though my general impression is that the mainstream media lean a good deal more towards psychiatry than towards our side of the debate. In addition, the words "depression" and unhappiness are pretty much synonymous. So it's difficult to see why that, or the characterization of antidepressants as "happy pills," should be so upsetting to Dr. Langford. We all, of course, have our linguistic likes and dislikes. I personally don't care much for the growing trend to pronounce the indefinite article as "ay," or for psychiatry's insistence on calling neuroleptic drugs "anti-psychotics." But what can you do? I just Googled the phrase "antidepressants are happy pills" and got 204,000 hits! So the notion has some traction and is probably here to stay. One can't legislate for the way people use words. Or perhaps psychiatrists imagine that they can. "For problems in other areas of health we’d only trust the experts to comment, but when it comes to mental health it seems like anyone can cast judgement." ...

In June 2011, Rif El-Mallakh, MD, et al. published an article, Tardive dysphoria: The role of long term antidepressant use in inducing chronic depression, in Medical Hypotheses. The article is a thorough and wide-ranging study review. Here are some quotes from the abstract: "Treatment-resistant and chronic depression appear to be increasing." "Depressed patients who ultimately become treatment resistant frequently have had a positive initial response to antidepressants and invariably have received these agents for prolonged time periods at high doses." [Emphasis added] ...

There’s a new study in the January 2014 issue of the BMJ: Grigoriadis et al, Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. Thanks to Nanu Grewal for the link. PPHN is a relatively rare condition. The authors report that the estimated prevalence is about 1.9 per 1000 live births. The disease is essentially a failure of the newborn’s circulatory system to switch from oxygen supply via the placental blood, to oxygen supply via the baby’s own lungs. The condition is usually diagnosed at birth or shortly thereafter. Symptoms include: rapid and difficult breathing, fast heart rate, and blue skin color. PPHN is a serious condition. A 2010 article by Robin Steinhorn, MD, states: ...

There was an interesting article, Antidepressant regulations tightened following suicide, in the Copenhagen Post on January 7. Thanks to Mad in America for the link. It is reported that Danilo Terrida, aged 20, committed suicide in 2011 "…eleven days after he was prescribed antidepressants following an eight-minute-long conversation with a doctor." The doctor has been deemed responsible for the suicide by the National Agency for Patients' Rights and Complaints. According to its website: "The National Agency for Patients' Rights and Complaints functions as a single point of access for patients who wish to complain about the professional treatment in the Danish health service." ...

Last month (December 2013) the American Journal of Psychiatry published Antidepressant-Induced Liver Injury: A Review for Clinicians, by Voican C.S. et al. The study was a literature search from 1965 onwards. Here are the authors’ results: All antidepressants can induce hepatotoxicity, especially in elderly patients and those taking more than one drug Liver damage is generally unpredictable and unrelated to dose Liver damage can occur within a few days of initiation Antidepressant-induced liver failure can be life threatening Antidepressants with higher risk for liver failure include: iproniazid, nefazodone, phenelzine, imipramine, amitriptyline, duloxetine, bupropion, trazodone, tianeptine, and agomelatine Antidepressants with lower risk: citalopram, escitalopram, paroxetine, and fluvoxamine Although an infrequent event, antidepressant-induced liver injury may be irreversible   ...

On December 27, 2013, Connecticut State Police issued a 7,000-page, heavily redacted, report on the massacre that occurred at Sandy Hook Elementary School just over a year earlier (December 14, 2012). For the record, I have not read the 7,000-page report, but I have read the Wikipedia article Sandy Hook Elementary School shooting, last updated January 4, 2013, and several media reports on the matter, including reports from the New York Times, the Hartford Courant, and the Washington Post. ...

ANOTHER VIDEO FROM DR. LIEBERMAN On October 28, Jeffrey Lieberman, MD, President of the APA, made another video. This one is titled An Important Look at Mortality in Mental Illness: A Decade of Data on Psychotropic Drugs, and was made for Medscape. You can see the transcript at the same site. Medscape is a web resource for medical practitioners. The video is Dr. Lieberman’s commentary on an article that appeared in JAMA Psychiatry online on August 28: Comparative Mortality Risk in Adult Patients With Schizophrenia, Depression, Bipolar Disorder, Anxiety Disorders, and Attention-Deficit/Hyperactivity Disorder Participating in Psychopharmacology Clinical Trials, by Arif Khan, MD, et al. ...

SSRI’S AND SUICIDE Bob Fiddaman has a post up today called MHRA Consultant Calls for Antidepressant Use in Young. The article highlights some of the dangers associated with SSRI’s, and also describes some of the attempts to suppress or discount the significance of this information. Apparently in 2010, Swedish psychiatrist Göran Isacsson, MD, PhD, published a paper in Acta Psychiatrica Scandinavica. The piece was titled Antidepressant medication prevents suicide in depression, and reported that of a group of 1,077 depressed people who had committed suicide, only 15.2% had measurable amounts of antidepressants in the blood stream at the time of the suicide. ...

I’ve been reading another great book: Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare, by Peter C. Gotzsche [Radcliffe Publishing, 2013]. The book is an exposé of pharma’s fraudulent research and marketing. The author is a Danish physician who has been involved in clinical trials of drugs, and in drug regulatory matters. He is a professor at the University of Copenhagen. He has published more than 50 papers, including papers in the BMJ, Lancet, JAMA, Annals of Internal Medicine, and the New England Journal of Medicine. ...

There’s an interesting exposé in the London Daily Mail, September 29, titled Critics claim antidepressants are being handed out like sweets… Thanks to Leonie and Antidepaware on Twitter for the link. To find out how easily people could get prescriptions for antidepressants, the Mail sent "…three women of differing ages — all of whom had no current mental health issues — to their doctors, reporting fictional symptoms of mild depression which had lasted for three to six weeks." ...