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Ear to the Ground

Antidepressant Nation Revisited

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Posted on Jul 31, 2011
Flickr / Robin Dude

Dr. Marcia Angell has drawn harsh criticism from members of the psychiatric community for her essay doubting the efficacy of antidepressants, published in The New York Review of Books last month. This week, the Review published three reactions to her piece online, from some of the country’s major psychiatrists: Dr. John Oldham, president of the American Psychiatric Association; Dr. Daniel Carlat, professor of psychiatry at Tufts School of Medicine; and Drs. Richard Friedman and Andrew Nierenberg, professors of psychiatry at Cornell and Harvard medical schools, respectively.

It is worth noting that Angell’s critics take up only one of the major points of her original essay: the issue of whether or not antidepressants work. Serious attempts to comment on the potentially damaging effects of long-term drug use, the dubitability of the American Psychiatric Association’s “Diagnostic and Statistical Manual for Mental Disorders,” and the accelerating, arbitrary prescription of psychoactive drugs—to the effect of enriching the pharmaceutical industry as well as select psychiatrists—are conspicuously absent.

Among numerous finer points, the psychiatrists claim that Angell has failed to understand crucial research, misrepresented the psychiatric community’s prevailing views and otherwise mistaken fiction for fact. If true, these errors are serious, especially for someone as broadly credentialed as her. In a manner befitting her background, she carefully responds to each dispute, starting with what appears to be a fundamental difference between her and them: Her critics simply insist that psychoactive drugs are effective without offering up the hard evidence that science demands. She does not.

Angell has spent most of her professional life assessing the quality of clinical research on these drugs and is eminently qualified to speak on the subject. For the moment, her primary thesis remains intact: For the well being of psychiatric patients and the sake of understanding, the public, the press and the scientific community must resist settling for assurances from industry professionals and psychiatrists who benefit from current accepted standards of practice, and demand a program of rigorous research that will help us understand how antidepressants affect the human brain. —ARK

Marcia Angell in The New York Review of Books:

All three of these letters simply assume that psychoactive drugs are highly beneficial, but none of them provides references that would substantiate that belief. Our differences stem from the fact that I make no such assumption. Any treatment should be regarded with skepticism until its benefits, both short-term and long-term, have been proven in well-designed clinical trials, and those benefits have been shown to outweigh its harms. I question whether that is so for many psychoactive drugs now in widespread use. I have spent most of my professional life evaluating the quality of clinical research, and I believe it is especially poor in psychiatry.

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Daye's avatar

By Daye, July 31, 2011 at 7:20 pm Link to this comment

Truthdig gets my appreciation for keeping us
apprised of the exchanges between the scientist,
Angell, & the physicians who - embarrassingly
for them - so clearly do not understand what
science does to expose their, er, uh, lower
practices & prejudices.

As some may not know, an MD is not a scientific
degree, & the practice of medical psychiatry is
not a science based one.

I’m strongly in favor of what psychologists used
to do (the best ones, anyway), which is meet &
talk with people experiencing pain in order to
work together to reduce it, to make life
somewhat more meaningful & decent. Alas, that
was before Big Pharma & Big Insurance, which
are criminal enterprises that manufacture pain &
lock us in social & political cells with it from
which escape is increasingly impossible.

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By Rosiecee, July 31, 2011 at 4:52 pm Link to this comment
(Unregistered commenter)

The Physicians Desk Reference states that SSRI antidepressants and all antidepressants can cause mania, psychosis, abnormal thinking, paranoia, hostility, agitation, etc.  These side effects can also appear during withdrawal. Also, these adverse reactions are not listed as Rare but are listed as either Frequent or Infrequent.

Go to a serach engine and type in SSRI Stories where there are over 4,600 cases, with the full media article available, involving bizarre murders, suicides, school shootings/incidents [65 of these] and murder-suicides - all of which involve SSRI antidepressants like Prozac, Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant the perpetrator was taking or had been using but sometimes the media article just says “antidepressant” or “medication for depression”.

On December 15, 2010, PLoS Medicine released a study which showed that, in regard to prescription medications and violence, the FDA had received the most reports of violence from the SSRI & SNRI antidepressants (except for Chantix, the smoking cessation drug.)  The evidence of an association with violence was weaker and mixed for antipsychotic drugs and absent for all but one of the mood stabilizers. Yet, the antipsychotics and mood stabilizers, given for the most serious mental illnesses, bipolar disorder and schizophrenia, would be the most likely culprit involved in violence but, instead, it was the antidepressants which had the most reports of violence.  They were given to patients that traditionally were the least likely to commit violence, the depressed and the anxious.

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prisnersdilema's avatar

By prisnersdilema, July 31, 2011 at 2:45 pm Link to this comment

Without psychotic medications psychiatry, would be done fore. Where else can
psychiatrists make $250 for fifteen minutes work? Except maybe by dealing drugs.

The also have the necessary experience, and their used to making life and death

Psychiatry long ago abandoned talking people as a waste of time.

Of course they can’t prove that psych meds are effective, how could they when in many, 
many,  of those aforementioned studies, the studies themselves have been shown to be

The Pharmaceutical companies don’t care, ( I mean the FDA ) they are used to killing
hundreds of thousands of people. Each day there is a new warning or law suit in a drug
they marketed. They have a new strategy, have vitamins and supplements declared
drugs, since they actually work. Then have doctors sell them, while of course jacking up
the price to the stratosphere.

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kerryrose's avatar

By kerryrose, July 31, 2011 at 1:36 pm Link to this comment

Of course she’s getting a backlash!  How dare she disturb those that are suckling at the Pharmeceutical tit.

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Queenie's avatar

By Queenie, July 31, 2011 at 12:58 pm Link to this comment

A doctor at a nursing home where my mother was because of Alzheimer’s murdered her with an anti-depressant drug. It took her five days to die. I have never been able to find out which doctor it was at the time. He is long gone now and everyone involved is covering up for whoever it was. If I ever find out who it was I will rip his intestines out, slowly, with a dull can opener.

Doctors are not the same as when I was a kid, 50, 60 years ago. They used to think of patients as human beings. Now they think of us as guinea pigs and medicine is “practiced” as if we were captives in a laboratory. Head doctors are the worst. They go into the field because there is so much wrong with them that they use us to find out about themselves. I heard one admit this is so.

The mentally ill treating a gullible public.

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By TDoff, July 31, 2011 at 12:33 pm Link to this comment

Marcia Angell is totally wrong. Anti-depressant drugs are extremely efficacious.

Name one other product that creates such lavish lifestyles for pill-pushing witch ‘doctors’, who charge $300 and up per 50-minute hour to ‘counsel’ disturbed ‘patients’. During which hours the charlatan-pushers review their last golf game while automatically nodding their heads and mumbling ‘Um hum’, and ‘Ah hah’ occasionally. Until the 45 minute alarm in their heads goes off and they whip out their prescription pad, tear off the top pre-printed script, and hand it to their victim.

And for the icing on the cake, these days, with automatic computer tracking of filled prescriptions, these voodoo docs get regular kick-backs from the Pharma-Phirms whose products they push.

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