Tuesday, 30 April 2013

A time to grieve, a time to console, and a time to profit?

Eli Lilly and Co. are not slow to seize a business opportunity. As the American Psychiatric Association has opened up the way for the excessive diagnosing and treating of grief (through DSM-5), Eli Lilly has, it seems, a drug ready and waiting in the wings - Cymbalta.

In reality grief is not a sickness waiting for a cure; rather, it is a natural response to the loss that is an unavoidable part of life. And sadly, the older we get the more likely we are to experience the loss of family and friends.

With this in mind there are those who think that medication is an answer to the experience of grief in the elderly. In fact, the antidepressant Cymbalta (duloxetine) has been trialled as a “treatment on grief” - assuming that grief could really be treated. Dr John Shuster was the principal investigator in this drug trial of Cymbalta - sponsored by Eli Lilly. And as with most trials, it was a mere 8 weeks – not long enough to accurately assess the side-effects. In passing, it is worth mentioning that out of 44 patients referred and screened for this trial, 26 were enrolled and only 18 actually completed (3 dropped out because of the drug side-effects).  [You can read the trial specifications here.]

It seems that Eli Lilly are ahead of the game in testing Cymbalta for “bereavement-related depression” - now that DSM-5 has changed the diagnostic guidelines so that many more people are likely to be medicated for feeling down following a bereavement. As you may realise, the previous guidelines (DSM-IV) had a 2 month “bereavement exclusion” built in - to delay the experience of grief from being hastily diagnosed and medicated as depression.  But the whole notion of trying to put a time-scale on grieving seems to me quite absurd. I touch on this in my blog on grief here, “No stranger to Grief”. [...]

Thursday, 25 April 2013

There it is again – depression and chemical imbalances in the brain

There it is again. Why oh why do people still keep on perpetuating this very tired (and tiresome) old myth – the one about depression being a direct result of an imbalance in brain chemistry which is then corrected by antidepressants? I say this because I stumbled across this in a health website the other day: “Antidepressants help correct chemical imbalances in your brain by affecting certain brain chemicals called neurotransmitters.”

Why does this matter, you may ask? It matters for various reasons. First, it matters as people deserve the truth and it isn't just or helpful to oversimplify the facts to mislead people.  I say more about chemical imbalances and depression here. Second, it turns our attention away from addressing the concerns and situations that might be getting us down.  That’s why I write about the importance of the context of our lives here. Third, it can make people feel pressurised into thinking they need a drug to correct this so-called chemical imbalance, when in reality, antidepressants can actually create all manner of chemical imbalances, possibly leading to, for example: disrupted sleep, mood swings, mania, feelings of depression, sexual problems, and even suicidal feelings or violent thoughts and actions too. That’s not to say that some people may not find them helpful some of the time.

I also read in that article that: “Antidepressants are not habit forming (addictive).” A quick search on the internet will soon reveal countless people struggling to come off antidepressants such as Seroxat (US Paxil) as they can be so difficult to stop. I call that “addictive” even though a person is unlikely to crave them in the same way as someone might crave some of the street drugs. I mention the addictive power of antidepressants here (number 20 in my list of “20 Reasons To Be Cautious About Antidepressants”).

Yesterday I wrote down a few thoughts about trust and betrayal in my blog here. Being mislead about mental health drugs is also a betrayal of trust. It’s only right that we are clearly told what these drugs do and do not do, and to be clearly told about their limitations and the risks – so then we can make more informed choices. Fair?

“I'm not upset that you lied to me, I'm upset that from now on I can't believe you.”
― Friedrich Nietzsche

Monday, 22 April 2013

Should a mum-to-be continue with antidepressant drugs whilst pregnant?

A few thoughts on "There's a Pill for That" by Anne Kingston, here.

It can be a difficult decision to make. Should a mum-to-be continue with antidepressant drugs whilst pregnant? In this press article conflicting views are presented. What about the risks of the mother’s depression? What about the risks of the drugs to the unborn child?

As you will see, in this article some doctors claim the drugs are 100% safe; however, others contest that antidepressants can cause all manner of damage to the unborn child, including damage to the developing brain, heart defects, an increased risk of miscarriage and even autism.

In this article Dr Healy is quoted as saying that “there’s no good data suggesting untreated depression is more dangerous to mother and child than SSRIs [antidepressants]”. He also warns that “Women often aren’t told about addiction risks or the difficulty of withdrawal, which creates problems if they become pregnant.” And yet, even the makers of Seroxat (US Paxil) have issued an advisory that this drug may pose “an increased risk” of cardiovascular defects when taken in the first trimester.

Though not mentioned in this article, I quote Dr Adam Urato, assistant professor of obstetrics and gynaecology at Tufts University School of Medicine, in Boston:
“We are witnessing a large-scale human experiment. Never before have we chemically altered human foetal development on such a large scale…Many of the experts in this area receive funding from the anti-depressant majors. These experts continue to downplay the risks of these agents and to promote the benefits of their use in pregnancy.”
I mention some of the risks (including birth defects) of antidepressants here.

As antidepressants are so widely prescribed many mums-to-be will be taking them when they become pregnant.  Some doctors may then advise a careful withdrawal from these drugs to reduce the chance of risk to the unborn child. But this Dutch study indicates that the risk of birth defects continues 6-9 months after stopping these drugs.

Mick Bramham is an Existential Psychotherapist based in Dorset, UK.
He has a particular interest in ethical issues and also how our lives are shaped by the society, circumstances and culture in which we live.
Although he has serious concerns about the inappropriate and excessive use of mental health medications, he supports the freedom to choose (to take or not to take these drugs) and the right to be fairly informed of their limits and the risks. He offers support for people who are considering reducing or coming off psychiatric drugs.
He has a long-standing interest in non-clinical (and non-coercive) responses to mental and emotional distress. You can read more about his work and find his contact details here.

Sunday, 21 April 2013

Medicine at its best - Defeating polio

A report just out in the British Medical Journal announces that the world could be free of polio by 2018. In fact, one prediction is that the last case may be in 2014. This is wonderful news as medicine excels in eradicating such a terrible disease.

Polio was not unusual here in the UK when I was a child. A neighbour’s child contracted polio when I was just 4 years old. At that time I became suddenly very ill, reached a temperature or 106 F (that’s a colossal 41.1 C) and was of course delirious. As it was assumed that I too had polio I was rushed into what was then termed an “isolation hospital”. 

Fortunately (in comparison), it transpired that I had a serious case of measles and had not been infected with the polio virus - and was thus spared its crippling effects - and fully recovered.

I have clear memories of the hospital. I was behind a glass screen so visitors could only view me at a distance. I recall a small multi-coloured plastic train on my bed-side locker, an aunt peering through the window, and the fact that all my toys had to be destroyed when I left as this was an isolation hospital.

I say a lot in my web site about the risks of medications and how drug companies can have their sights set more on profits than the public’s health. But with the polio vaccine this is surely a time to celebrate! 

(The image shows a 14th century BC Egyptian with what appears to be a polio disability, courtesy of Wiki)