Psychiatric Drugs

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John Nash and neuroleptic drugs are making us crazy

On John Nash and his experience with psychiatric drugs with an historical look of mind-altering drug trends, personal observation, then article on over-prescribing antidepressants, the lack of positive results.

From an email sent by JK to friends on the death of John Nash

Friends:    at http://healthfully.org/dta/id7.html   ---   5/30/15

 

John Nash the mathematician died on the 23rd of May of 2015.  I read his biography, A Beautiful Mind, which was made into a film of the same name in 2001.  Of particular interest to me in the Wikipedia article: in it John Nash describes how the psychiatric drugs made him worse, and that is why he did all he could to avoid their usage (this is the norm, and explain the low patient compliance).  The book and film spin a different account of his being medicated, which John attributes to the author’s mother who is a psychiatrist who promotes psychiatric drugs.  The evidence in support of their usage is lacking, but pharma is very good at marketing, and the FDA standards are too low.  John Nash reaffirms what is well supported in the medical literature, namely that in a sample of a 100 or more patients psychiatric drugs, that after one year those on the drugs are worse off than those who just get talk or behavioral therapy.[1]  In 1981 I did a term paper in which I reviewed the literature, and that was the conclusion of the evidence back then.  Today it has gotten worse because back then pharma merely funded clinical trials and allowed the university professors to run them.  Today pharma is involved in all aspects of the clinical trial; as they put it “to protect their investment”.  An examination of the details reveals the depth of the tobacco science. 

 

The standard by which the FDA approves neuroleptic drugs (one that effect neurons) is comparable to fishing in a barrel full of carp.  20% of the Hamilton Rating Scale for depression (HRSD) is based on sleeping better.  It is the questionnaire upon which proof of efficacy is “proven” for the FDA[2]. These drugs with one exception (Wellbutrin) are major tranquilizers. They all cause drowsiness, thus based on the Hamilton Rating Scale     they are approved by the FDA. Moreover, the clinical trials are not blinded because over 80% of the patients know if they are given a drug that makes them drowsy versus a placebo; and the same for the physicians who monitor the trial—this is called breaking blind.  The trials ran for submission to the FDA last just 6 weeks (with some exceptions), and on a very select group of health patients (usual only about 1 in 7 applicants are selected).  And it gets worse, typically there is a wash-out-period where the patients are given the drug, and then depending on results they are included in the trial are dropped out; after which the trial is started.  Finally, pharma owns the results, which they refuse to supply to the medical journals.  Thus the journals cannot know the actual results or the methods.  The journal only gets the finished article.  In over 70% of clinical trials, the data is given to companies hired by pharma which ghost write the articles (yes articles, because pharma publishes the results in an average of 8 journals).  Neither pharma nor the ghost writing company sign off on the article, rather it is given to a KOL who puts his name on the article as lead researcher, along with others who worked on the trial.  KOLs are Key Opinion Leaders who in medicine rise to prominence through the support from pharma.  A study where a group of professors obtained the raw data on psychiatric drugs clinical trials submitted to the FDA upon application for a patent.  The raw data was obtained through the Freedom of Information Act. They found comparing the data to the 74 published journal article derv ied from those phase -3 trials that there was an average of 32% positive bias in the journal articles pharma KOLs signed off on.   

 

If this all seems like I am cherry picking the worse of pharma, read Prof. Ben Goldacre’s Bad Pharma (I will gladly give you an audio copy of that book), or watch Harvard Prof. Marcia Angell President’s Lecture at University of Montana on bad pharma.  And if you doubt the harm that psychiatric drugs do, then go to my video library and watch the documentaries on YouTube—or if you desire I can give you a DVD in MP4 format.

 

One last warning psychiatric drugs (tranquilizers dressed as Asclepius) have been approved for treating pain, back medication, premenstrual syndrome, hypertension, smoking, epileptic seizures, and a dozen other uses. If just a few patients on Flexeril (cyclobenzaprine)[3] in a phase 3 clinical trial for back pain, the participants in sleep more, than then there will be less pain in the drugged group compared to the sugar pill group.  This is sufficient for FDA approval.    Moreover the majority of blockbuster are over 70% of the time administered off-label (not for FDA approved uses).   In it was exposed in a court case over Pfizer’s promoting off-label usage for Neurontin, an SSRI, that it was prescribed 94% of the time for off-label uses.  Neurontin is one of the top five best-selling psychiatric drugs--total sales.   What was uncovered in the court case over Neurontin is in pharma’s standard business procedure.  If drowsiness is a side effect it is a tranquilizer (downer), unless it is an opiate or an antihistamine.   

 

When I was young, I observed people lower their quality of their life by doing recreational drugs, mostly alcohol.  Two of my uncles were alcoholics.  Other legal popular recreational drugs:  in the 50s barbiturates, followed in the 60s amphetamines and the diazepam (Valium) family of drugs, in the 90s it was and still is the SSRIs.  It amounts to just another of way relieving boredom by handicapping the brain.  Today I watch pharma create a market (like tobacco in the 1920s) for their mood altering downers.  I know two who have committed suicide, a major side effect of psychiatric drugs.  My mother had her health ruined and spent the last two years on her back with a broken hip because she was given a bisphosphonate for osteoporosis, rather than the older, safe-and-very-effective off-patent estradiol.  Terry diagnosed with terminal lung cancer had the quality of life last 9 months made much worse by the side effects from pointless chemotherapy.  The average month or 2 of life extension wasn’t worth it.  Everyone I know over the age of 60 is taking (with 3 exceptions) is taking drugs that aren’t worth their side effects.    

 

The more I dig, the more dirt I find on pharma.  In the an email I got from the British Medical Journal, the publication of the British Medical Association, they have published an analysis by Prof. Peter Gotzsche in which he calculated that there were 539,000 extra deaths yearly from the taking of psychiatric drugs in the US and European Union.  See attachment for his article. 

 

Please take the time to know what time it is, to know of tobacco ethics used by corporations including big pharma.   As Prof. Ben Goldacre puts it, “A perverse system produces perverse results.”  Let the rational side of your brain trump the emotion side which bonds with pharma and your doctor.  Go to the documentary page and become informed.

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[1]  Doctors with selective memory cherry-pick the best cases.  The logic conclusion is that the best cases would have done even better without the medication.  It is like assuming that because John lived to 90 years though he smoked, the smoking didn’t harm him. Rather the logical view is that he would have lived healthier and longer if he didn’t smoke.  The same logic applies to pharma’s neuroleptic drugs—drugs which alter the natural function of neurons.   It gets worse, the drugs are marketed as treating abnormal levels of a neurotransmitter, however the science behind this claim is lacking—though or course pharma has done tobacco science to support their claim.  I recommend reading The Emperor’s New Drugs, Prof. Irving Kirsch.    

[2]The Hamilton is a 51 point scale…. For example, one can get a six-point reduction in Hamilton scores ;merely by sleeping better, even if there is no other change in the person’s depressive symptoms” Prof. Irving Kirsch, The Emperor’s New Drugs, 2010.

[3] Cyclobenzaprine is closely related to the tricyclic antidepressants, at.  The very name bezaprine indicates that it is in the same class as valium, a benzodiazepine type.  Drowsiness is one of its side effects.

http://www.bmj.com/content/348/bmj.g4218/rr/759524

Overprescribing antidepressants: where’s the evidence?

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g4218 (Published 30 June 2014)Cite this as: BMJ 2014;348:g4218

Margaret McCartney questions whether there is overprescribing of antidepressants and doubts that the information provided by the Council for Evidence Based Psychiatry that antidepressant use had increased by 92% in England since 2003 is correct (1).

I can assure McCartney that the use of antidepressants has increased dramatically. An OECD report found an increase in defined daily doses of 88% between 2000 and 2011 in the United Kingdom, similar to the average of 89% in 19 OECD countries (2). In Denmark, sales of SSRIs are so high that every one of us can be in treatment for 6 years of our lives. Marketing and widespread corruption have played a major role for this disaster (3). The increase in sales of SSRIs was closely correlated to the number of products on the market (r = 0.97), and 100% of the DSM-IV panel members who defined what ‘mood disorders’ are had financial ties to the drug makers (4).

It is very likely that antidepressants cause more harm than good (5). There are many problems with the trials (3), one of which being that they have not been effectively blinded. Many years ago, adequately blinded trials of tricyclic antidepressants were done, in which the placebo contained atropine, which causes dryness in the mouth like the active drugs do. These trials reported very small effects of antidepressants (standardised mean difference 0•17, 95% confidence interval 0•00–0•34) (6). This corresponds to about 0.7 on the Hamilton scale, i.e. no effect. Thus, antidepressants might very well be ineffective (3,5), and they have never been shown to work for outcomes that really matter like saving relationships and getting people back to work. In contrast, they cause a lot of harm, e.g. half the patients develop sexual problems and even when tapering off them slowly, half the patients have difficulty stopping the drugs because of withdrawal effects, which can be severe and long-lasting and are very much the same as those seen on benzodiazepines (3,7).

Antidepressants increase the risk of suicide, at least in young people, and I doubt they are safe at any age (3). A carefully controlled cohort study of depressed people over 65 years of age showed that SSRIs more often lead to falls than older antidepressants or if the depression was left untreated (8). For every 28 elderly people treated for 1 year with an SSRI, there was one additional death, compared to no treatment. McCartney doubts that this could be true and argues that a cohort study is “capable of finding association but not causation.”   I find the study pretty convincing, particularly because the authors also did a self-controlled case series analysis - a within patients comparison, which implicitly removes the effects of all characteristics that vary between patients. If we want to learn about the harms of drugs, we cannot afford to dismiss carefully controlled cohort studies. In fact, randomized short-term drug trials are notoriously unreliable for this purpose.

McCartney says that she has “no illusions about the effectiveness of antidepressants in mild to moderate depression.” Since most of those treated have mild or moderate depression, she contradicts what she said in her headline, “Overprescribing antidepressants: where’s the evidence?” She is a general practitioner from Glasgow and should pay a visit to another GP from Glasgow, Des Spence, who recently concluded about antidepressants: “We are doing harm” (9).

1. McCartney. Overprescribing antidepressants: where’s the evidence? BMJ 2014;348:g4218.

2. Health at a Glance 2013: OECD indicators. http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf (last checked 1 July 2014).

3. G°tzsche PC. Deadly medicines and organised crime: how big pharma has corrupted health care. London: Radcliffe Publishing, 2013.

4. Nielsen M, G°tzsche P. An analysis of psychotropic drug sales. Increasing sales of selective serotonin reuptake inhibitors are closely related to number of products. Int J Risk Saf Med 2011;23:125–32.

5. G°tzsche PC. Why I think antidepressants cause more harm than good. Lancet Psychiatry 2014 (in press).

6. Moncrieff J, Wessely S, Hardy R. Active placebos versus antidepressants for depression. Cochrane Database Syst Rev 2004;1:CD003012.

7. Nielsen M, Hansen EH, G°tzsche PC. What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re- uptake inhibitors. Addiction 2012;107:900–8.

8. Coupland C, Dhiman P, Morriss R, et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011;343:d4551.

9. Spence D. Are antidepressants overprescribed? Yes. BMJ 2013;346:f191.

 

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