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Crazy? Not Crazy? Bipolar? or PTSD?

Thu, 31 Mar 2011 07:19:16 -0400

Review of: Not Crazy: You May Not Be Mentally Ill
by Charles L Whitfield MD, Muse House Press, 2011
Review by Tony Giordano, Mar 20th 2011 (Volume 15, Issue 11)

A well-known physician and psychotherapist, Charles Whitfield is the author of numerous books and articles on mental health, including the best-selling book, Healing the Child Within. In his latest offering, Not Crazy, Dr. Whitfield contends that most psychiatric drugs do more harm than good due to their severe toxicity and addictive properties, about which patients are rarely forewarned. They are especially harmful, he argues, when used long-term, but this is exactly what the trend has been.

The entire economics of mental healthcare rests squarely on the marketing of psych drugs, he argues. Drug profits fund nearly everything the public sees, including the "opinions" of experts and the "findings" of drug tests, creating a massive conflict of interest. The book charges that millions of patients are being misdiagnosed and mistreated, largely due to the fact that the big drug makers fund most of the key players, from medical schools and psychiatric journals to the DSM itself (Diagnostic and Statistical Manual of Mental Disorders).

A result of "Big Pharma's" dominance of mental healthcare is that psychiatric practitioners are trained to view and treat mental illness primarily as "biochemical imbalances," even though as Whitfield says, this has never been scientifically proven. But through the marketing and public relations efforts of the pharmaceutical companies and professional psychiatry, the public has come to accept this model. And people keep taking the drugs because they're repeatedly told it's best for them. This advice is called into question.

As an example of the compelling evidence cited in the book, Whitfield found that 90% of drug trials are funded by the drug companies themselves, and most negative results are never published. He also found that over half of the authors in medical and psychiatry journals have conflicts of interest, and most journals are largely subsidized by drug ads. The toxic "side effects" of many psychiatric drugs that the author details include disruption of metabolism, mental and emotional numbing, decreased memory, brain dysfunction and atrophy, insomnia, chemical dependence, and shortened life span.

Whitfield's extensive clinical experience and his review of hundreds of research studies and tests tell him that most psychiatric symptoms result from the effects of repeated trauma, often from childhood. But these effects are generally ignored and untreated by practitioners, and therefore, go unhealed. The whole body of Whitfield's work from Healing the Child Within and on is based on the conclusion, supported by ample evidence, that most so-called mental illnesses are trauma-based and really a variation of Post Traumatic Stress Disorder. And PTSD is not classified as a mental illness; hence the book's sub-title, You May Not Be Mentally Ill. The book includes recommendations on how to safely get off psych drugs and how to treat common "mental" illnesses without drugs.

One caution to readers-- much of the book is quite technical and may be confusing to many. The numerous charts in particular, while important to lay out the relevant evidence, can be difficult to follow. I found myself wondering at times exactly what the primary audience was for the book. Therapists? Psychiatrists? Sufferers? Regulators? Though much of the book seems to be addressed to sufferers, it might have been better if a simplified, less technical version were written for them.

But all in all, this book is a definite must-read for anyone diagnosed with a condition such as depression, bipolar, schizophrenia, dissociative disorder, or related disorders. Readers can skip the more technical sections and still grasp most of the book's key messages. Not Crazy is nothing less than revolutionary in how it exposes and refutes the current mental illness paradigm. A depression sufferer like myself needs to know who and what to believe. Do sufferers continue to take the psych drugs they were told to take, sometimes forced to take, despite these dire warnings? There's so much at stake. It's not just how one feels; it's literally a matter of life or death for many.

Despite being inundated and virtually brain-washed by the current mental illness paradigm, I for one have come to believe and trust Whitfield and the small but growing number of experts who oppose "Big Pharma's" dominance of the way mental illness is diagnosed and treated today. The bottom line is you cannot trust sources of information so corrupted by conflicts of interest on a massive scale.

http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=6006&cn=392

© 2011 Tony Giordano

Military Psychiatric Drug Abuse

Sun, 13 Feb 2011 07:43:55 -0500

The New York Times, in the article below and other articles, has done an excellent job of documenting much that is wrong about the abuse of psychiatric drugs in the military--but it would be nice if the newspaper did more to question similar endemic psychiatric over-medication or mis-medication problems for the general American public.

Recently the media reported the scandal that a pharmaceutical company had ghost written an entire apparently professional and scholarly book for general practitioners, to encourage prescribing psychiatric medications for their patients. The company allowed two doctors to claim they had “co-authored” the book, to create the illusion that the conclusions came from years of frontline medical treatment, not from what the psychopharmaceutical industry wanted the public and physicians to believe about the drugs.

Please select and click on the article link below to learn about problems of over-medication and mis-medication in the U.S. military.

For Some Troops, Powerful Drug Cocktails Have Deadly Results

By JAMES DAO, BENEDICT CAREY and DAN FROSCH (NYT)

In trying to treat the effects of war, doctors are prescribing drugs that can have fatal interactions.

DSM Warnings Of Antidepressant-Induced Manic Episodes & Serotonin Toxicity

Mon, 14 Jun 2010 12:37:40 -0400

With 10’s of millions of people having taken SSRI antidepressant medication, it is increasingly common for adults and teens to be diagnosed with a bipolar disorder, while they are already taking antidepressant medication. But wait. The DSM-IV itself, published in 1994, and the first DSM since the 1987 FDA approval and widespread use of Prozac, specifically warned the mental health community not to diagnosis the manic episode required for a diagnosis of bipolar disorder, if such a manic episode was artificially induced by illegal or legally prescribed drugs. That is, bipolar disorder was not to be diagnosed if the symptoms were the result of the well-documented capacity of antidepressants to induce “manic symptoms” in some people.

What is extraordinary about the DSM-IV warning, is that the DSM-IV was published in 1994, after years of meticulous discussion and debate through several revised drafts. That is, nearly 20 years ago, and very shortly after the popularization of Prozac and Zoloft, the DSM-IV itself was cautioning against the erroneous diagnosis of bipolar disorder, if manic symptoms were induced by prescription drugs, including antidepressants.

Yet how many teenagers and adults today are diagnosed with bipolar disorder while taking antidepressants? The typical psychiatric response is often, “Well, obviously, the bipolar disorder was already present, but the patient must have been in a depressive episode at the time antidepressants were prescribed, or must have been otherwise misdiagnosed.”

In another entry on this blog, about the potential fallacies of diagnosing bipolar disorder, I mention the case of Susan, whose mother called me as Susan was in a manic psychosis while on an anti-depressant drug. I pleaded with her to page the psychiatrist, in order to ask if she should lower the antidepressant. Susan’s mother, a friend of mine who was in understandable distress, became very angry at me and asked how in the world it would help to lower the antidepressant when her daughter was so obviously in psychiatric distress?––if anything didn’t she need more antidepressant? Of course, the next morning the mother called and apologized, and indicated that the psychiatrist suggested the same approach of immediately lowering the antidepressant medication as exacerbating the manic episode.

But in Susan’s case, she had already been diagnosed as bipolar and was on bipolar medication. The far more unfortunate situation is when the antidepressant is “missed” as the cause of the manic symptoms, at which point a bipolar diagnosis, and medication, is suddenly added to the picture--often while the antidepressant is left in place, or sometimes increased.

Recently, I consulted with a middle aged man who had described collapsing on the street. Later, when I was talking to him on the phone, he on two occasions suddenly became disoriented and started talking irrationally about weird subjects, as if he suddenly had shifted into some bizarre dream state. It turns out, after all kinds of neurological scans and workups, he was diagnosed with “serotonin toxicity” from an unfortunate combination of two antidepressant medications. Increasingly, the medical and psychiatric communities––and emergency rooms-––are encountering such cases, of course related to the widespread overuse or misuse of antidepressant drugs.

Consequently, ruling out apparent “manic” symptoms, induced by illegal or prescription drugs (including antidepressants) is, or should be, a critical element of the differential diagnostic process.

Of course, once someone is experiencing manic symptoms, whether induced or not by an antidepressant, a physician may in fact choose a drug prescribed for manic symptoms, such as certain atypical antipsychotic medications, to “turn off” the “manic episode.” However, the effectiveness of such an intervention alone, for such drug induced symptoms, does not necessarily establish a “bipolar” “diagnosis.” (See the, Diagnosis By Pill? entry on this website.)

The Fallacies of Diagnosing Bipolar Disorder for Real Life Trauma: Ophelia & The “Diathesis Stress Model”

Mon, 14 Jun 2010 08:08:47 -0400

Consider the case of Susan [a pseudonym], a woman in her late twenties, living in another part of the country, who is the daughter of an old acquaintance of mine.

She called me last month, after her HMO psychiatrist refused to change or lower her 5 psychiatric medications, but instead insisted on adding a sixth.

Like many, if not most people told by a psychiatrist that they have a “genetic predisposition” for a “biochemical imbalance,” the problem that brought Susan to psychiatric attention was actually caused by a “real-life” trauma or problem: the divorce of her mother from an unstable and abusive father. As she literally witnessed her mother being abused during her high school years (which led to a sudden move, new house, and marital separation) she began feeling anxious, agitated and had trouble sleeping and concentrating.

In the midst of this crisis during high school, she was told her symptoms were really evidence of a “bipolar disorder” resulting from a “biochemical imbalance.” (No one ever administered to her one of the leading psychological tests designed to confirm such a diagnosis.)

Since that time, about a decade ago, she has never been off of a staggering procession of psychiatric medication “cocktails,” a term for taking a daily combination of several different psychiatric drugs, often working at cross purposes, and sometimes prescribed to counter the side effects of each other. Now, after being on various antipsychotic medications for six years (prescribed for her presumed bipolar condition), she is reporting an internal feeling of agitation and restlessness which can be a side effect of such medications, but which is often diagnosed as a sign of further mental illness calling for higher doses of psychiatric medication. A former swimmer and lifeguard, she had also gained at least 40 pounds––a common side effect of some of the drugs she was told specifically “targeted” bipolar symptoms.

When she contacted me, she was on lithium and an anti-convulsant medication, also supposed to treat her hypothesized bipolar disorder. In addition to these two “mood-stabilizing” medications, she was on a heavily sedating antipsychotic medication, a further sedating anti-anxiety medication and a popular prescription sleep medication known to induce possible dissociative states. Over the years, she had been on all manner of mood stabilizing medications, anti-depressants and anti-psychotic medications. She called me terrified, after she had an apparent drug induced psychotic episode in which she was drooling, and had an experience of laughing uncontrollably as she looked down upon herself from the ceiling. At times she was so paranoid she would crawl around her home to keep below the windows.

Fortunately she had a very supportive and loving mother and husband. Susan called me, feeling distraught that her psychiatrist was now insisting on adding a sixth medication, an antidepressant medication, even though Susan told the psychiatrist that in the past antidepressants had repeatedly triggered manic psychoses requiring trips to the emergency room--a possibility specifically warned of in the DSM-IV. (See the next blog entry.)

When Susan contacted me she was so over-medicated she could barely concentrate on graduate school. When she lowered one of her mood stabilizing drugs (against medical advice) and her antipsychotic medication, she reported that soon, when she walked her dog, even colors outside seemed brighter and she could think more clearly.

When she questioned if she was really “bipolar,” her psychiatrist became upset, analyzed her “denial” as further evidence of her mental illness, and refused to refer her to a psychologist who could have administered psychological testing to confirm or disconfirm the diagnosis. Instead, the psychiatrist, who, as a psychiatrist, was not licensed to administer standardized psychological testing, used a common technique to silence patient objections. She asked Susan to take a 5 question “test” to “see” if she was “really” “bipolar.” The “test” contained ridiculously broad questions that could apply to many different real life stresses or mental disorders, such as whether there had ever been a time in her life she felt agitated or had trouble sleeping.”

Today Susan is down to one medication, which her new psychiatrist has suggested she at least keep temporarily in place while she gives her body and brain a chance to stabilize after getting off all the other medications. She feels better than she has in years and has lost much of the weight she had gained from medication side effects.

The psychiatric community acknowledges that presumed “bipolar” “biochemical imbalances” only seem to come “out of the blue” in otherwise happy and unstressed people, for a very small percentage of the population. However, a pseudoscientific rationale is often offered to explain why the presumed underlying “biochemical imbalance” is so often obviously “triggered” by real life traumas. The argument is called, “the diathesis stress model.” In plain English, the idea is, as in asthma, that there may be some underlying physiological weakness, anomaly or predisposition that is triggered, or reaches a threshold, when the body is placed under stress, in the case of asthma for example, perhaps severe emotional distress, or high levels of pollution.

Perhaps, in some psychiatric cases, this may be a reasonable hypothesis. But the problem is, how many people, who are not bipolar at all, are assigned this diagnose erroneously, based on simple symptoms of real life stress that can mimic bipolar symptoms: agitation, impulsive behavior, sleeplessness, racing or preoccupied thoughts, irritability, etc?

Think of Ophelia, in Shakespeare’s Hamlet. We, as the audience, know exactly what really drove her crazy. First, this tragic teenager feels betrayed, used and falsely accused by her lover, Prince Hamlet, after the adults around her try to manipulate her against him. Second, her lover, Hamlet, then mistakenly murders her own father. Third, her brother then races back from France to kill Hamlet, in revenge. We, the audience, know full well why Ophelia “snaps” under all this pressure and the resulting unbearable conflicts of love and loyalty, and we know she can’t dare speak the truth. So instead, under the veil of being “crazy,” she hands out, to the main characters, flowers, which in Shakespeare’s day were loaded with psychological symbolism, and she sings songs or ditties to communicate, in a hidden way, the truth of what the audience knows to be the real causes of her distress.

However, today, there is no question that the adults around Ophelia would have rushed her to a psychiatrist who would have “explained” that bipolar disorder or schizophrenia can frequently “onset” in late teenage or early college years, that her stress brought out this “underlying biochemical or genetic predisposition,” and that medicating away her pain and anxiety would “correct” her “biochemical imbalance.” Further, the leading bipolar medications (Lithium, atypical antipsychotic medications and anticonvulsants used for epilepsy) really don’t “target” a specific “bipolar mechanism” but rather simply tamp down or limit the neuronal activity of very large areas of the brain––which might likely take the edge off anyone’s level of agitation, irritation, anxiety, restlessness and sleeplessness––no matter what the cause––thus convincing the adults around her of the validity of the “diagnosis.” (See the entry on this blog titled, “Diagnosis By Pill?”)

Recently, the New York Times noted that, in many ways, the outmoded concept of a “nervous breakdown” is perhaps a more accurate term to describe the kind of distress that brings many people to both a psychiatrist and a therapist. But this has a special stigma--of not being to handle stress, versus having a presumed “genetic predisposition” for a “mood disorder” one cannot control. In the 1950s or 1960s Ophelia might have been sent to a sanitarium to “rest” after a “nervous breakdown.” In this decade, she would have been quickly diagnosed with a biochemical imbalance labeled schizophrenia or bipolar disorder and quickly over-medicated.

The popular movie, Garden State, written and directed by Scrubs actor, Zach Braff, depicts a young adult finally coming out of a fog of lithium, mood stabilizers and anti-depressants prescribed to him throughout his childhood and teenage years––after he was “diagnosed” as a child for pushing his mother, resulting in an unintended serious injury.

This is not to suggest that some people do not have true or classic “manic” tendencies, or episodes, however, like Susan and Ophelia, too often, teenagers and young adults amidst obvious real life distress are erroneously assigned such diagnoses.

[As an epilogue, today Susan is on no medication, happier than ever, and she and her mother are consulting attorneys for a malpractice suit. However, as a psychologist who also testifies in court cases, I suspect it will be difficult to “prove” their valid case, even though it is a sad story shared by hundreds of thousands, if not millions of Americans.]

How the Fallacies of Modern Psychiatry Harm and Demoralize Our Most Brave and Wounded Soldiers

Sun, 25 Apr 2010 10:58:27 -0400

The excerpt below is from the New York Times. It will most certainly dismay you, about how little we “treat” some of our most brave and wounded soldiers. However, the cause of this outrage is obviously not that the U.S. Army set out to harm, demoralize and even drive some of its own traumatized soldiers to suicide. Rather, one cause is the questionable model of psychiatric “treatment,” which is based on the belief that pills, more than human beings and human interaction, are most central for recovering from “psychiatric conditions” caused by real life trauma.

If you feel this statement is hyperbole, consider the case, discussed in the next blog entry, of Susan [a pseudonym], a woman in her late twenties, living in another part of the country, who is the daughter of an old acquaintance of mine. She called me last month, after her HMO psychiatrist refused to change or lower her 5 psychiatric medications, but instead insisted on adding a sixth.

So when you read below the fate of these wounded soldiers, blame the Army, but not completely; also be sure to blame the psychiatric model of “treatment” that the Army mistakenly thought was the real “cure” for emotional dysfunction following such profound and real life trauma.

Here are some things to look for in the article excerpt, below. Note how the Army places far more importance on psychiatrically drugging and over-medicating these soldiers than actually providing them real psychotherapeutic treatment--for post-traumatic stress disorder, or for coping with and facing themselves after devastating physical or emotional wounds. The Army is more than happy to pay for cheaper pills, but can’t seem to find the funds to provide these wounded soldiers more skilled psychotherapeutic treatment than an hour a week with a “nurse manager,” according to the New York Times.

I have highlighted, in bold print, how over-medicating these soldiers is part of the process of demoralizing and warehousing them. Notice how the unit commander instead blames the problems on the soldiers’ so-called “identity crisis.” And four soldiers killed themselves on this unit since 2007--how could that happen at any psychiatrically oriented facility in which “standard operating procedure” involves screening for suicidality and placing at-risk patients on suicide precautions, such as multiple checks per hour to prevent such tragedies?

NEW YORK TIMES
By JAMES DAO and DAN FROSCH
Published: April 24, 2010

COLORADO SPRINGS — A year ago, Specialist Michael Crawford wanted nothing more than to get into Fort Carson’s Warrior Transition Battalion, a special unit created to provide closely managed care for soldiers with physical wounds and severe psychological trauma.

A strapping Army sniper who once brimmed with confidence, he had returned emotionally broken from Iraq, where he suffered two concussions from roadside bombs and watched several platoon mates burn to death. The transition unit at Fort Carson, outside Colorado Springs, seemed the surest way to keep suicidal thoughts at bay, his mother thought.

It did not work. He was prescribed a laundry list of medications for anxiety, nightmares, depression and headaches that made him feel listless and disoriented. His once-a-week session with a nurse case manager seemed grossly inadequate to him. And noncommissioned officers — soldiers supervising the unit — harangued or disciplined him when he arrived late to formation or violated rules.
Last August, Specialist Crawford attempted suicide with a bottle of whiskey and an overdose of painkillers. By the end of last year, he was begging to get out of the unit.
“It is just a dark place,” said the soldier, who is waiting to be medically discharged from the Army. “Being in the W.T.U. is worse than being in Iraq.”
Created in the wake of the scandal in 2007 over serious shortcomings at Walter Reed Army Medical Center, Warrior Transition Units were intended to be sheltering way stations where injured soldiers could recuperate and return to duty or gently process out of the Army. There are currently about 7,200 soldiers at 32 transition units across the Army, with about 465 soldiers at Fort Carson’s unit.
But interviews with more than a dozen soldiers and health care professionals from Fort Carson’s transition unit, along with reports from other posts, suggest that the units are far from being restful sanctuaries. For many soldiers, they have become warehouses of despair, where damaged men and women are kept out of sight, fed a diet of powerful prescription pills and treated harshly by noncommissioned officers. Because of their wounds, soldiers in Warrior Transition Units are particularly vulnerable to depression and addiction, but many soldiers from Fort Carson’s unit say their treatment there has made their suffering worse.
Some soldiers in the unit, and their families, described long hours alone in their rooms, or in homes off the base, aimlessly drinking or playing video games.
“In combat, you rely on people and you come out of it feeling good about everything,” said a specialist in the unit. “Here, you’re just floating. You’re not doing much. You feel worthless.”
At Fort Carson, many soldiers complained that doctors prescribed drugs too readily. As a result, some soldiers have become addicted to their medications or have turned to heroin. Medications are so abundant that some soldiers in the unit openly deal, buy or swap prescription pills.
Heavy use of psychotropic drugs and narcotics makes it difficult to exercise, wake for morning formation and attend classes, soldiers and health care professionals said. Yet noncommissioned officers discipline soldiers who fail to complete those tasks, sometimes over the objections of nurse case managers and doctors.
At least four soldiers in the Fort Carson unit have committed suicide since 2007, the most of any transition unit as of February, according to the Army.
Senior officers in the Army’s Warrior Transition Command declined to discuss specific soldiers. But they said Army surveys showed that most soldiers treated in transition units since 2007, more than 50,000 people, had liked the care.
Those senior officers acknowledged that addiction to medications was a problem, but denied that Army doctors relied too heavily on drugs. And they strongly defended disciplining wounded soldiers when they violated rules. Punishment is meted out judiciously, they said, mainly to ensure that soldiers stick to treatment plans and stay safe.
“These guys are still soldiers, and we want to treat them like soldiers,” said Lt. Col. Andrew L. Grantham, commander of the Warrior Transition Battalion at Fort Carson.
The colonel offered another explanation for complaints about the unit. Many soldiers, he said, struggle in transition units because they would rather be with regular, deployable units. In some cases, he said, they feel ashamed of needing treatment.
“Some come to us with an identity crisis,” he said. “They don’t want to be seen as part of the W.T.U. But we want them to identify with a purpose and give them a mission.”
[End of article excerpt, which continues in the New York Times.]

Properly Diagnosing Children Before Treating and Medicating Them

Sat, 13 Mar 2010 11:23:31 -0500

The last 20 years as seen a disturbing increase in diagnosing and labeling children and teens with mental disorders, and a corresponding troubling increase in medicating them. This time period, not coincidentally, corresponds to the FDA approval for the first popular anti-depressant, Prozac. Soon, along with diagnoses of depression, “bipolar” and “attention deficit disorder” diagnoses were applied to 100s of thousands, if not millions, of children and teens.

20 years is not a long time to collect “longitudinal data” on the social and biological impact of years of childhood medication. The popular movie “Garden State,” written and directed by Scrubs actor, Zach Braff, depicts a young adult finally coming out of a fog of lithium, mood stabilizers and anti-depressants prescribed to him throughout his childhood and teenage years.

The “Diagnostic and Statistical Manual of Mental Disorders-IV,” the DSM-IV, permits several diagnoses of children and teens to avoid such premature and pathological labels. However, often insurance companies want to see pathological diagnoses if they are to reimburse for “covered” mental health services. Clinicians often feel pressure to assign diagnoses emphasizing individual child psychopathology, since insurance companies don’t like to pay for family counseling. Often, such stigmatizing labels and treatment regimens are initiated after brief diagnostic interviews, without a thorough psychosocial history, and without psychological testing that could easily confirm or disconfirm these trendy diagnoses.

While adults have a difficult enough time articulating what is really troubling them, children and teens often behaviorally “act out” their inner distress. For example, behavioral problems in school could be related to underlying depressive, anxiety, bipolar, attentional or learning disorders—or to family or abuse issues. Discovering the real etiology, or cause, would certainly be relevant to choosing the correct therapy approach, or medication, if one was really needed.

Fortunately, there are good personality and diagnostic inventories for college students, teens and pre-adolescents (ages 9-12). These tests indicate into what national percentile a child or teenager falls regarding depressive, anxious, bipolar or attentional symptoms, compared to other children of the same age and gender.

For about the cost of a single therapy session one can administer a complete psychodiagnostic personality inventory assessing many different symptoms and traits. These tests involve the youth marking a series of true false questions at a desk, and only take 25-45 minutes.

Psychoeducational testing (IQ, LD, ADD & GT testing) tends to take longer, because it is time-intensive for the therapist. To conduct these tests the psychologist must administer and asses each test item and response, and then score it.

Symptoms of Depression or Antidepressant Withdrawal?

Tue, 9 Mar 2010 13:52:46 -0500

Suppose you had a friend who was drinking alcohol heavily. He tells you that he once tried to stop drinking, but he says he had such terrible symptoms when he tried to stop, that it just proves how great alcohol really is for him, and that he probably can’t emotionally afford to stop drinking for the rest of his life. What would you think of his logic?

After a psychiatrist became nationally known for advocating the bipolar diagnosis and bipolar medication, she revealed later in her career that she herself had a bipolar disorder all along. She was very influential in popularizing the diagnosis as socially acceptable, because, for years, she claimed in her professional writings that several creative geniuses in history (presumably just like her) had bipolar disorder as well.

When she “came out” she claimed that the distressing symptoms she once experienced after temporarily stopping her medication “proved” that she needed it, and that she was definitely bipolar. (See the blog entry on this website titled, “Diagnosis By Pill.”) This apparently obvious logic may be true in certain cases, but certainly not in others, according to another distinguished psychiatrist, Harvard’s Dr. Joseph Glenmullen. In his books on how to withdraw from psychiatric medication he tries to educate the public about the difference between a symptom of a psychiatric disorder, versus a symptom of withdrawing from a psychiatric medication.

I have seen patients, and friends, who experienced extremely serious problems when they tried to get off SSRI antidepressants, such as Paxil. One friend, who is a responsible medical professional herself, told me that if she runs out of the drug, her withdrawal symptoms will become so severe that she needs to go to an emergency room to obtain medication. On another occasion, a long term therapy patient of mine, a bright young woman with an M.B.A, thought she was having a mental breakdown when she tried to stop taking Paxil. (In fairness to the pharmaceutical companies, the drug dosages need to be reduced very slowly and carefully under medical supervision.)

But here is a question: if such drugs are only intended to “restore” your hypothesized biochemical “imbalance” to a “normal” biochemical “balance,” why are withdrawal symptoms so potentially distressing and, at times, even dangerous? There is even a syndrome called, Prozac Discontinuation Syndrome.

In fact, for a long time, the makers of some antidepressant medications claimed they were not habit forming or addictive, perhaps in the sense that drugs like Valium could become habit forming. However, recently, some pharmaceutical companies have been pressured to be more cautious in their claims that the drugs are not habit forming or “addictive.” If you read the introductory entry for this blog, it cites a book by Dr. Joseph Glenmullen on withdrawing from antidepressants. The word “Addiction” appears in the title of the book.

Dr. Glenmullen attempts to educate patients to understand the difference between a symptom of depression versus the effects of antidepressant withdrawal. This information has the added therapeutic benefit of helping patients learn to monitor, and feel in control of, their different physical and emotional symptoms.

Psychiatric Meds: “Selective”or “Sledgehammers?”

Tue, 9 Mar 2010 09:00:09 -0500

Years ago, I worked in a group practice which had a short-term inpatient unit at an upscale psychiatric hospital. One day I was finishing a chart note in the nursing station when a gifted, smart and funny psychiatric nurse walked in. She just looked at me sadly and ironically, and then sighed, “Psychotropics are such sledgehammers.” Then she went to pour a cup of coffee. I just kept writing and said, “Yep.” Of course, knowing the jargon of our field, we understood each other perfectly. But let me try to translate this conversation:

What she was trying to say is that drugs, such as antipsychotics, might help “zap” someone’s brain enough to control or tamp down their acute psychotic symptoms, but that they had many other short and long-term side effects, some of them serious, even affecting the movement of their bodies.

Of course, this psychiatric nurse was probably talking about anti-psychotic and bipolar medications, not the modern SSRI antidepressants such as Prozac, Zoloft, Paxil, Celexa and Lexipro.

No matter what position you take on the prevalence of psychiatric drugs, and especially of SSRI antidepressants in our society––one point is indisputable. Prozac, the first popular SSRI, benefitted from a brilliant marketing campaign, followed by anecdotal books such as, Listening to Prozac. Dr. Peter Breggin, a psychiatrist critical of such drugs, sarcastically countered with a book in the mid-1990‘s titled, Talking Back To Prozac: What Doctors Aren't Telling You About Today's Most Controversial Drug.

Prozac was portrayed as a revolutionary new “breakthrough” which “selectively” “targeted” the specific mechanisms in the brain that “caused” depression. In fact, the very phrase, SSRI, reflected the way the drug was marketed. SSRI stands, for “selective serotonin reuptake inhibitor.” The idea is that the drug helped to “selectively” prevent or slow the re-absorption or “reuptake” of released chemicals between neurons that cause electrical signals to pass between them. In other words, the drugs pick up, or boost, the neural activity in the brain neurotransmitter system mediated by serotonin.

But how truly “selective” are these “selective” drugs in their mechanisms, actions and side effects?

There are actually not that many neurotransmitter systems in the brain that directly influence psychiatric symptoms. And one neurotransmitter system can have several different functions in the brain and body.

Further, affecting one neurotransmitter system can affect other neurotransmitter and hormonal systems. The brain is a “homeostatic system,” somewhat like the rainforest: interfering with one part of the rainforest, like cutting down a lot of trees, or using pesticides, can affect functioning in the overall system. The brain is always trying to adjust and stabilize itself in response to the introduction of chemicals, even chemicals like caffeine and alcohol. This is why we have withdrawal symptoms when we suddenly stop taking these drugs.

Zoloft, a very common and one of the first SSRI antidepressants, is associated with sexual arousal side effects for significant percentages of men and women. In fact, this drug is sometimes prescribed to sex offenders, not only for obsessive thinking, but for its well-documented possible sexual side effects. Zoloft now comes with a warning about another “side effect:” a documented increase in suicidal thinking among some teenagers and young adults taking the drug. So how “selective” are these “selective” serotonin reuptake inhibitors in their various actions and side effects?

Prior to the SSRIs, most the the available pharmaceutical antidepressants were tricyclics, which affected two of the few brain neurotransmitter systems, involving both serotonin and norepinephrine. The problem is, these drugs had even more side effects. For example, in the body, epinephrine is adrenalin. Is this what “selective” really means, that the drug “only” affects one of just a few major brain neurotransmitter systems with many emotional and physiological functions? But this is not what the public is led to believe. The public is led to believe that the drug is “selectively” “targeting” their depression, and “restoring” to “normal” their “biochemical imbalance” in the brain.

Despite these limitations, anti-depressants are among the most “selective” of psychiatric drugs. Many patients don’t realize that when they are prescribed a drug for a “bipolar disorder” or mood swings, the drug was likely not developed as a bipolar drug at all, but from two other classes of other drugs: 1) antipsychotics; and 2) anticonvulsant or seizure medications. Obviously both of these drugs could “tamp down” certain bipolar symptoms. But their broad actions have other side effects. Usually the pattern is that the drug is developed for one condition but then later researched by the pharmaceutical company and approved by the FDA for other conditions, as occurred with Abilify, described in the introductory entry to this blog.

There is something about a “doctor” telling us anything that makes us suddenly think uncritically, especially when we are in an emotional crisis and feeling out of control, according to Dr. Peter Breggin, the author of, Brain Disabling Treatments in Psychiatry: Drugs, Electroshock, and the Psychopharmaceutical Complex.

Suppose you went to your doctor feeling physically ill, not emotionally ill and out of control. Your doctor rushed into the examining room and asked you six vague and general questions about how you were feeling, like whether you were tired or sleeping well or concentrating clearly. He then says, “Mmm, what you have is called “liver disease,” and your liver clearly has a ‘biochemical imbalance.’ I am writing you this prescription to keep it in a normal biochemical balance,” as he rushed out of the examining room. You might say something like, “Wait a minute, how do you know that I really have liver disease from asking me those quick questions that sound like they could apply to so many other conditions and people? Don’t doctors usually run tests to confirm a serious diagnosis, like blood tests or urine tests or MRIs?” And what if the doctor responded, “Well, we don’t really have a test proving that your liver has a ‘biochemical imbalance’ that we are willing to give you or that your insurance company is willing to pay for, but we still think you may need to take this drug affecting your liver for the rest of your life, even though it has many potential side effects.” And what if you responded, “Well, actually I have just gone through a divorce (or my mother dying, or my son committing suicide, or losing my job), couldn’t that be affecting the way I am sleeping or concentrating?” And the doctor says, “Well, that just proves that you have liver disease.” How “selective” would you think this diagnostic process was?

This blog is not the appropriate place to discuss the specific potential short and long term side effects of specific psychiatric medications. However, such information is easily accessible from responsible web sites, the Physician’s Desk Reference, pharmacists, and other resources. While the pharmaceutical companies making the drugs are not objective sources of information, they are nonetheless required to report known side effects.

Anyone who has ever been concerned about taking any drug, psychiatric or otherwise, may have carefully read the inserts or warnings that come with the drug, or read a Physicians’ Desk Reference about potential side effects. You only need to look at the list of possible side effects the pharmaceutical companies are required to report, to begin to question just how “selective” these drugs are in their actions, mechanisms, biochemistry and side effects.

Do you understand now what that psychiatric nurse was trying to say?

Diagnosis By Pill?

Mon, 8 Mar 2010 21:12:40 -0500

When I was in graduate school, shortly before the FDA approved a new antidepressant called, “Prozac,” a professor specializing in the treatment of schizophrenia taught us the concept of “diagnosis by pill.” Diagnosis by pill refers to the logical fallacy of rendering a diagnosis based on one’s reaction to taking a drug.

This is the old “cause and effect” problem in logic. Example: if a person with an anxiety disorder gets some relief from the tranquilizing effects of an anti-psychotic medication for schizophrenia, does this really “prove” that the person “has” schizophrenia instead of an anxiety disorder? This is an important question, because there are plenty of drugs for anxiety that do not have the short and long term side effects of certain anti-psychotic medications, not to mention the stigma and implications of a diagnosis of psychosis.

Suppose I were to construct a study in which subjects completed a checklist of their depressive or anxiety symptoms after two weeks of drinking three beers a night, or smoking marijuana every night. And, like a major pharmaceutical company, suppose that by doing this I could prove in a “double blind study” that the marijuana group reported a slight lessening of symptoms, at a degree of “statistical significance” compared to a control group? Does this prove that marijuana is an effective “cure” for depression? Or does this prove that marijuana “corrects” an hypothesized “biochemical imbalance” in the brain? Or, does this prove that because marijuana has its effect by acting on certain neurotransmitter systems in the brain, that these same neurotransmitters “cause” depression?

Here is a less theoretical example. Several modern “bipolar” medications were actually developed as epilepsy or anti-seizure medications. The billions of neurons in the brain communicate with each other through tiny electrical impulses caused by the positive or negative charges on certain brain chemicals. One can therefore think of epilepsy as a kind of little electrical storm or discharge. Some drugs designed to control epilepsy reduce the “seizure threshold” for these events. In recent years, these drugs have also been approved by the FDA for “bipolar disorders.” It does makes sense that such drugs affecting the way neurons “fire,” or don’t fire, could provide some relief to a person who has anxious or “manic” symptoms. But what does this really “prove” about the actual mechanisms and causes of bipolar disorders?