Monday, September 14, 2009

Why doctors are still "crazy" about antidepressants

I just received a wrenching email from a woman in North Carolina who was prescribed a SSRI antidepressant because she was having trouble eating due to a "horrible metallic taste" in her mouth. After her blood work came back negative, her doctor decided the problem must be "emotional" and prescribed the antidepressant. Now I'm not a doctor, but I know from personal experience that a metallic taste can be caused by any number of things, such as a reaction to surgery or another drug. Why this lady's doctor would automatically link a bad taste in her mouth to depression is beyond me. Perhaps he decided that her real problem was anxiety and that an SSRI might ease that, I don't know.

What I do know is that an inordinate number of women continue to be given antidepressants at the drop of a hat, as I've written about here. And indeed, the North Carolina woman writes:

I know so many women on SSRI antidepressants that it's mind boggling! I hear friends talk about how they "need a little something" because they are feeling stressed out so they go to the doc and get a prescription.

Of course, this problem of overmedication is not limited to SSRI antidepressants or women, for that matter. As Philip Dawdy notes in Furious Seasons, 60 percent of antipsychotics prescribed in the VA system in 2007 were prescribed off-label for conditions such as post-traumatic stress disorder, depression and anxiety. This disturbing data comes from a new study in Psychiatric Services, in which the authors themselves conclude:

Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness for off-label usage, they should be used with greater caution.

So why do so many doctors continue to prescribe such potent psychoactive drugs with limited efficacy and potentially dangerous side effects? Or as the North Carolina woman put it, why are so many doctors still "crazy about the SSRIs?" It all comes back to the aggressive marketing of these drugs by the drug industry and the reality that so many key opinion leaders in psychiatry are on the pharm companies' dole. It also has a lot to do with the fact that an astonishing percentage of studies published in supposedly reputable medical journals are ghost-written, usually by paid writers for the drug industry. For example, as much as 10.9 percent of studies published in the prestigious New England Journal of Medicine were ghost-written, according to a new study released at an international meeting of journal editors in Vancouver and first reported in The New York Times.

This kind of disclosure doesn't inspire much confidence in the way doctors get their medical information, does it?

This latest wrinkle on ghostwriting didn't, of course, make much difference to my North Carolina pen pal; she had already taken matters into her own hands. After imbibing the prescribed antidepressant for a week and experiencing some weird side effects -- bad mood swings and shaking -- she went off the drug and is now working with her doctor to find another way to deal with her symptoms. Getting off the SSRI is a good start.


mary weiss said...

Ms. Bass and lady from North Carolina:

I would suggest to the lady that she contact her state Dept. of Pharmacy to see if information is available on how much money her doctor receives from pharmaceutical companies. Also, if we laypeople know that the depression/lack of serotonin theory is a fallacy, the doctor should certainly also know this. Ask your doctor for a lab test to check your serotonin level! Of course, it can't be done. The SSRIs are merely a case where a symptom is made to fit the drug.

The same is true of antipsychotics. When they first appeared, they were touted as "chemical lobotomies" which is pretty much true. They cure nothing, they simply sedate, and cause a host of side effects, including death. Yet - schizophrenia, one of the worst mental illnesses, is cureable. Read Robert Whitaker's "Mad in America" paying special attention to Chapter 2: The Healing Hand of Kindness, or read Soteria: From Madness to Deliverance about the Soteria Project in California run by Dr. Loren Mosher. Google his letter of resignation to the APA (American Psychiatric Assn). My son, Dan Markingson, died in a clinical study he should never have been in, and I was forced to learn about the horrors of these drugs - and also about the doctors who do the bidding of Big Pharma!

Mary Weiss

Howard S. King, MD said...

How can parents decide their physician can be trusted in how he or she went about prescribing an anti-depressant for stressed-out moms? Here are some suggestions that might help them decide if their physician was thoughtful in his or her medical decision-making.

In the clinical interview, did the doctor incorporate the following questions?

1. Did he attempt to diagnose emotional problems in children at the earliest possible time?
2. Did he focus on the entire family and not just the child?
3. Did he ask himself, "Who is the real patient in this family?"
4. Did he ask parents, "What are your worst fears? Whom does he remind you of?"
5. Did the pediatrician consider whether his own issues might be interfering with understanding the family dynamics more clearly?
6. By understanding family functioning better, we might be able to reduce our dependence on medicating some of the children we see.
7. Did the physician attempt to improve parents' capacity as decision-makers, including esteeming them as our teachers, in their role as storytellers?
8. Did he seem mindful of how family secrets including mental illness, domestic violence, and the addictions, are sometimes passed on from one generation to another?
9. Did he appreciate the role of the routine office visit has the potential of becoming a corrective emotional experience?
10. Was he aware that "spending time" can actually save time and increase our efficiency?
11. Did he seem to know that not every parent is psychologically-minded and that it takes time to build trust?
12. Did he offer support, understanding and empathy as a valuable intervention
13. Finally, did he seem to understand that "half of therapy is preparation for therapy" and that pediatricians should value their strategic role in helping patients and their families follow through with mental health referrals.”

If the parent believed the doctor considered all these issues during the visit, then the parent might conclude that the antidepressant was prescribed thoughtfully.

Rob said...

Interesting hypotheses as to why MD's may be overprescribing SSRI's. I agree that the drugs are heavily marketed, ghost-writing is a problem, and that a number of shrinks are paid shills.

But to attribute the whole problem to that is too simple a villification of GP's as doe-eyed innocents. The reality is, GP's in fact know of all three problems you describe, and they probably knew about those problems before you did. And yet, they still prescribe these drugs by the ton, for all sorts of soft or even plain whacky indications.

In reality, the question you claim to answer is in fact an empirical question, one which needs to be carefully posed to GP's themselves, in well organized surveys, to ascertain their actual thoughts on the matter. Only then will we begin to get to the truth of this complex matter.

Unknown said...

Great post. I might need some anti-depressants after reading it though( in the form of steak). It just saddens me to see (and know) people who have a pharmaceutical fix for every emotion that they feel. It’s a vicious cycle of masking the real problem over and over again. I see it especially in college with young adults now…I guess all we can really do is make people aware and set an example.

Alex Neil said...

Not very many people in my life know that I was also once on antidepressants but I found them helpful for just getting me into a better place to get on with things and to manage the longer term things I needed to put in place to look after my mental health for the rest of my life.

Unknown said...

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