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Psycotropic drugs are downers that harm


http://healthfully.org/rg/id8.html   6/3/16


 This is an exceptional article by another senior scientist and professor whose conscience comes first.  What is commonly thought about psychotropic drugs and taught physicians is one more of many examples of pharma’s ability to frame the discussion.    Peter Gotzsche has not only has wide notice for his work in helping to set up the Nordic Cochrane Review, but also for his many journal articles and medical books--for more on Prof. Peter Gotzsche.  His two recent books on bad pharma, Deadly Psychiatry and Organized Denial and Deadly Medicine and Organised Crime:  How Big Pharma Has Corrupted Healthcare places him first among critics of bad pharma.  The Latter has won an award from the British Medical Association (the UK equivalent of the AMA) and forwards by editors of the JAMA and the BMJ (two of the 4 top English medical journals).  The two national associations of physicians have endorsed both the quality of his work and the message. There are over a dozen books published in the last 2 decades by noted professors who relying upon a large body of published research have exposed that psychotropic drugs do more harm than good when taken more than a couple of months; and when taken short-term these sedatives barely pass regulatory scrutiny based upon the doggy standard of improving sleeping.  There are even more documentaries and lectures on YouTube driving home that message. 


Using population figures from the Danish data base Prof. Gotzsche calculated controlling for confounding variables the number of excess deaths among seniors age 65 and above who were taking psychotropic drugs.  He found that this class of drugs is the 3rd leading cause of death after heart failure and cancer, and ahead of strokes.  He then extrapolated the figure for excess deaths in his country to that of the European Union and the United States, and found that 500,000 people yearly just among seniors die early.  These numbers have withstood a journal review and of course criticisms by industry,     


http://www.sciencedirect.com/science/article/pii/S2215036614702809


Note: the Lancet is one of the 4 leading English medical Journals


Peter C. Gotaxche  Lancet Psychiatry   Volume 1, Issue 2, July 2014, Pages 104–106

Why I think antidepressants cause more harm than good


In The Lancet Psychiatry, David Nutt and colleagues1 stated that headlines such as “Antidepressants do more harm than good” plumb a “new nadir in irrational polemic.” I disagree and describe here the evidence that supports my argument so that readers can judge for themselves what they think about the defence of these


drugs by Nutt and colleagues.


 


With regard to the benefits of antidepressants, in its large meta-analysis of 100 000 patients, half of whom


were depressed, the US Food and Drug Administration (FDA) noted that 10% more patients responded on


antidepressants than did those on placebo,2 and the Cochrane review of depressed patients reported similar


results3 (ie, one patient might benefit for every ten patients treated).


 


I believe those results were exaggerated, however, for several reasons.4 Most importantly, the trials were not effectively blinded. Antidepressants have conspicuous side-effects and many patients and their doctors will therefore know whether the blinded drug is active or placebo. A systematic review of 21 trials5 in a variety of diseases that had both masked and non-masked outcome assessors, and which had mostly used


subjective outcomes, found that the treatment effect was exaggerated by 36% on average (measured as odds ratio) when non-masked observers rather than masked ones assessed the effect. The effect of antidepressants is assessed on highly subjective scales (eg. The Hamilton scale[1]), and if we assume that the blinding is broken for all patients in the trials and adjust for the bias, we will find that antidepressants have no effect (odds ratio 1·02).4


 


However, I do not believe that the blinding is always broken, only that the reported effect is highly likely to


have been exaggerated. 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, clinically insignificant  effects of tricyclic antidepressants compared with


placebo (standardised mean difference 0·17, 95% CI 0·00–0·34).6


 


Another worrying finding in randomised trials is that as many patients stop treatment on SSRIs as on placebo


for any reason.7 After only 2 months, half the patients have stopped taking the drug.8 This finding suggests that, overall, considering benefits and harms together, the patients find the drugs useless.[2] More importantly, no research shows whether these drugs work for the outcomes that really matter, such as saving relationships


and getting people back to work.


 


With respect to the harms of antidepressants, most patients who take these drugs will experience side-effects. The package inserts list many common side-effects, of which one of the most frequent is sexual problems. In a study9 designed to assess this side-effect, sexual problems developed in 604 (59%) of 1022 patients who all reported no problems with sexual function before they started using an antidepressant. The symptoms include decreased libido (50% of patients on fluoxetine), delayed orgasm or ejaculation (also 50%), no orgasm or ejaculation (39%), and erectile dysfunction or decreased vaginal lubrication (22% for both combined).


 


Even when tapering off them slowly, half the patients have difficulty stopping the drugs because of withdrawal


effects, which can be severe10 and long-lasting.4   We noted that withdrawal symptoms were described in similar


terms for benzodiazepines and SSRIs and were very similar for 37 of 42 identified symptoms.11 However, they were not described as dependence for SSRIs.11  To define similar problems as “dependence” in the case of


benzodiazepines and as “withdrawal reactions” in the case of SSRIs is irrational. For patients, the symptoms are just the same; it can be very hard for them to stop either type of drug.


 


Psychiatrists often argue, as did Nutt and colleagues,1  that antidepressants protect against suicide. However,


I believe that no good evidence in support of this idea exists. Good observational studies have refuted it,12 and results from randomised trials13 have shown that antidepressants are associated with increased risk of suicide attempts (5·6 more suicide attempts per 1000 patient-years of SSRI exposure compared with placebo). Antidepressants have not only been associated with suicide but also with homicide.4,14–16  The FDA’s analysis2 showed that suicidal behaviour is increased with antidepressants until about the age of 40 years—but in fact, the situation is much worse than this. Suicides and suicide attempts were vastly underreported in the FDA’s analysis for various reasons.4  For example, only five deaths by suicide were recorded in 52 960 patients on antidepressants in the 2006 FDA analysis2 whereas five deaths by suicide were recorded in 2963 patients on paroxetine alone in a meta-analysis from 1993.17


 


SSRIs are particularly harmful for elderly patients. Results from a carefully controlled cohort study18 of people older than 65 years of age with depression showed that SSRIs led to falls more often than did older antidepressants or if the depression was left untreated.  For every 28 elderly people treated for 1 year with an


SSRI, there was one additional death, compared with no treatment.18 SSRIs have also stimulant effects and might precipitate conversion to bipolar disorder in about 10% of children aged 10–14 years under the care of mental health services .19


 


SSRIs are very poor drugs and I doubt they are safe at any age. The first SSRI was fluoxetine, which the German drug regulator deemed “totally unsuitable for the treatment of depression”.14,20 I, and others,4,21 have written about the controversy surrounding this drug and the process by which it nevertheless came to be approved and widely used. I have written previously4 that there has been heavy marketing and widespread crime committed by drug companies, including fraud, illegal promotion, and corruption of psychiatrists. In the USA, psychiatrists receive more money from the drug industry than any other specialty.4,22 As a result, enough antidepressants are prescribed every year in Denmark to provide treatment for every person in the country for 6 years of their lives.4  I believe this situation is not sound and that it also partly portrays the fact that many patients cannot stop these drugs because of intolerable withdrawal symptoms.


 


SSRIs have been shown to have minimal or nonexistent benefit in patients with mild or moderate depression23 and I think they might not even work for severe depression.4 They should be used very sparingly, if at all, and always with a clear plan for tapering off them.  The so-called maintenance studies, in which patients after successful treatment get randomly assigned to continue with the drug or a placebo, cannot be interpreted as showing that the patients still need the drug because withdrawal symptoms, which can include depression, are inflicted on the placebo group.


 


Nutt and two of his co-authors, Guy M Goodwin and Stephen Lawrie, have between them declared 22 conflicts of interest in relation to drug companies.1 I wonder whether this declaration explains their dismissal of psychotherapy (although it is effective and recommended by NICE) and their description of my evidence-based views as a somewhat irrational polemic that is insulting to the discipline of psychiatry and is reinforcing stigma against mental illnesses. They also talk about anti-psychiatry, anti-capitalism, and a conspiracy theory. This is the language of people who are short of arguments.




[1] It is much worse than Gotzsche claims.  For one thing Prof. Irving Kirsch has researched breaking blinds for SSRIs, and found it to be over 85%for both doctors and patients. “The Emperor’s New Drugs, p13,  Secondly the Hamilton Depression Rating Scale (HDRS) consists of 17 question, of which often only 13 are used.  Of those used three are for sleeping better, (early night, mid-night, and early morning).  Since SSRIs are tranquilizers (cause people to sleep more) there will be 23% benefit based on those 3 questions.  

[2]  This again is a major place for distorting the results.  The standard practice (not mentioned in the journal articles) is that of last observation is carried forward.  The last observation before the patient dropped out is carried to the end of the study thus inflating the number of patients who completed the study and deflating side effects which aren’t reported by the patient who dropped out. See Ben Goldacre’s Bad Pharma, p 69. 


4) Diet

*****The Obesity Code: Unlocking the Secrets of Weight Loss, Jason Fung, MD, 2016, has a through grasp of the processes behind the diabesity (obesity & diabetes) pandemic.  As a nephrologist he has treated many end-stage type-2 diabetics with diet to cure their diabetes.  He, like Taubes below, places the blame on fatten carbohydrates which causes insulin resistance that drive up fat storage.  An excellent work that doesn’t repeat the cholesterol-fat myth and puts together a large body of evidence Excellent

.   

***** Good Calories, bad calories:  fats, carbs, and the controversial science of diet and health, Gary Taubes, 2008, award-wining science writer who spent years researching the topic of diet including its history, starts with the anti-fat-cholesterol diet, then the carbohydrate hypothesis, next obesity and the regulation of weight, and ends with fat metabolism and fattening carbohydrates.  It is an extensive examination of the historical literature on diet--for a college readership, which was followed by a less technical book which he hoped would both educate doctors who have the 2nd greatest influence upon diet after the media.  Excellent

*****Why We Get Fat, and What to Do About It, (also audio version):  Gary Taubes, award-wining science writer spent years researching the topic of diet; starts with the history of diets and the research, then the biology that causes of obesity, and ends with what to do.   The work is on the level of a freshmen college book.   Soft on political issues and how in a corporatist state both the media and politicians have been bought.  He covers all aspects, one of the few books I nearly totally agree with. Avail in audio books.  If the history is too tedious, then I recommend starting in the middle of the book, section 36 on the CD.  Excellent

***** Fat Chance Prof. Robert Lustig MD, Hudson Street Press, 2013.  He focuses on high fructose (and thus sucrose) as a poison similar to ethanol in effects on body.  For a mass audience,   It is very instructive, organized, and easy to follow; on the obesity epidemic all aspects, then ends with healthful advice.  He avoids offending pharma. His success on the internet has made him a leading critic of the food manufacturers (for his lectures and documentary click on link  Excellent

Sugar Salt and Fat:  How the food giants hooked us, Michael Moss, 2014, 4.5 stars 621 Amazon reviews.  A very thorough conservative review of how the food manufacturers compete in the market place.  It has little on consumers’ health (a topic beyond the scope of this book).  A lot of interviews and research makes the book insightful and thus worth reading –also in audio books.   Very good

The New Atkins for a New You Profs. Eric Westman, Stephen Phinney, and Jeff Wolek, 2010.   The book has 2 goals, to make it easy to follow their long-term program of dieting, and to cover the important basics on nutrition relative to the ketogenic (very low carbs) diet so as create confidence in their dietary program. It accomplishes all this in a way that appeals to a wide audience.   If you want to know more, then study the books by Taubes and by Fung—below.  Excellent.  Note, I would add the short-term or alternate day fasting to hasten progress and health benefits, which is particular relevant to those who have type-2 diabetes, morbidly obese, or who weight lose has slowed-- see Dr. Jason Fung’s Obesity Code supra.    Very good    

The New Atkins Made Easy Colette Heimowitz, 2013, a book for those who like testimonials and receipts.  Weak on science but enough to know that carbs are bad and fats are good—see appendix.  She presents the 4 stages of the New Atkins diet, well written, easy to follow.  Very good

 

5) Polypharmacy

Are Your Prescriptions Killing You?   How to Prevent Dangersous Interactions, Avoid Deadly Side Effects, and Be Healthier with Fewer Drugs Armon B. Neel, Jr, Phar.D. CGP and Bill Hogan Atria books, 2012, contains list of drugs to avoid (quite incomplete) and abuse by doctors who dutifully give multiple drugs for the same condition and then treat side effects with more drugs.  Neel as consulting pharmacist helps patients suffering from the interaction of drugs.  The elderly, especially those in assisted living homes are the biggest victims. Neel has some very good sections & some glaring errors thanks to pharma’s.  He should shift most of the blame from physicians to pharma who is very good at marketing and educating.  good.  

Overdosed American:  The broken Promise of American Medicine, John Abramson, MD, well received for the general public, a message of how pharma as a corporation works to expand the market and thus increase profits and its consequences.  Develops their methods for putting lipstick on a pig and worse. Very good

 

6) Psychiatric drugs. 

***** Deadly Psychiatry and Organised Denial, Prof. Peter Gotzsche, 2014. College freshmen level. Clearly the best; it covers nearly all major points concerning the use of psychiatric drugs in a way that doesn’t get bogged down in details (e.g. Moncrieff).  The book provides a detailed example of pharma at work, in what Gotzsche calls organized crime in his previous book---supra.  Incredibly, pharma has succeeded in market with the support of psychiatry addicting sedatives as a panacea for the hundreds of “illnesses” listed in their DSM V Manual:  they have sold gasoline as a way of fighting fires, and blame the patient’s deterioration on the condition instead of the adverse consequences of the prescribed tranquilizers.  Deadly Psychiatry is the best account of how this crime against public developed and its consequences.  Only Kindle edition in US $20, however, available through the UK Amazon for nearly $50 with shipping—worth the price.    Excellent

***** The Emperor’s New Drugs:  Exploding the Antidepressant Myth. Irving Kirsch, PhD. Basic books 2010.   An important book on how psychiatric drugs are worse than nothing at all.  College level, exposes many issues with mind altering drugs.  Raises the important issue of “breaking blind”, that about 85% of patients and physicians know who is getting a placebo based upon side effects.   Excellent.  Note on Basic Books; it is a series of titles for university graduates who still can think at that level.  I have read 7, all rating 5 stars. 

***** Pharmageddon,  Pharmaceutical companies have hijacked healthcare in America, and the results are life-threatening 2012.  Prof. David Healy Welsh, documents a riveting and terrifying story that affects us all. Starts slow, then there is a wealth of information historical and current on the topics covered by the other books reviewed here.   High-quality topic development, well organized, for educated audience familiar with medical issues.    Excellent

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Robert Whitaker, 2010, Random House.  Some valuable section, such as on Prozac and that behavioral therapy should in most cases be tried before drugs.  He exposes the myth that the new psychiatric drugs in 1965 emptied mental hospital; truth, they were shipped to nursing homes--for general public, Good

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs 2013.   Prof. Joanna Moncrieff, 2009.  On antipsychotic drugs, she proves that they are sedatives (tranquilizers), thus they inhibit emotions, pleasure, and libido, excitation, and cognitive functions. They do not treat the underlying neural cause, though they are pitched as doing that (based on tobacco science).  Starts with the history of the antipsychotic drugs in the early 1950s.   Each major marketing claim is addressed in a chapter.  College level, dull reading Very Good

The Myth of the Chemical Cure:  A Critique of Psychiatric Drugs Joanna Moncrieff, 2013, basically a rework of the above material expanded to include more areas of treatment.  She explains that the names applied to the drugs as well as their method of operation are pure marketing

Death Grip:  A Climber’s Escape from Benzo Madness, 2/13, $2.48 Matt Samet 4.5 stars 37 reviews Good

So-So, books which point out problems with psychotropic drugs and the ever expanding market, but limited coverage of harm done and limited in scope of topics:  it is not what they say, but rather what they don’t.  

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Robert Whitaker, 2010, Random House.   So-so

Saving Normal:  An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, Allen Frances psychiatrist, 2013, misses much, a gripe book.    So-so

Tracking Medicine: a Researcher’s Quest to Understanding Health Care, John E. Wennberg, Oxford Press, 2010, Tedious, understating the problem, So-so

A warning about deceptive marketing:  From a nurse in a book review:  “WELL DONE, THOUGHT PROVOKING [referring to Bitterest Pill].  I PERSONALLY LEARNED A LOT AND IT CONFIRMED MANY OF MY SUSPICIONS. I HAVE BEEN TAKING LEXAPRO FOR LOW-BACK PAIN. TRIED TO STOP SO MANY TIMES BUT COULD NOT BECAUSE OF SEVERE WITHDRAWAL. STARTED LYRICA, WENT OFF THE LEXAPRO, NOW HAVE TO WITHDRAW FROM THE LYRICA. HOPE IT HAS A SHORTER HALF LIFE--LINDA, RN, at.  In 1988 I knew that sedatives were widely marketed for back pain, and that acted exclusively as a muscle relaxant.  I very clearly told the doctor that I do not want a sedative.  Eighteen hours later I woke up and flushed the pills down the toilet.  Don’t rely on your pharma-educated physician to know what time it is.  Pharma markets sedatives for all sorts of conditions including hypertension, back pain, pre-menstrual syndrome, migraines, pain, COPD, and so on.  It is insidious because these drugs are addicting and diminishing cognitive function; thus they increase the dependence upon physicians. Thus in 2 ways pharma profits from sedatives.  In the hospital they are life-threatening because the drugged patient often is not aware a worsening of their condition or a medical emergency, moreover, vital signs are reduced when drugged.       

 

7) Other topics

***** Testosterone for Life: Recharge Your Vitality, Sex Drive, Muscle Mass, and Overall Health by Abraham Morgentaler , 2008, 80, 4.5 stars Amazon.  While for a wide audience, the essential science is covered accurately, and he is the first to expose the mechanism by which using research of others that testosterone doesn’t promote the spread of prostate cancer unless that patient has low testosterone, which often happened as part of the therapy through drug castration; very thorough, Excellent  

Who’s in Charge? Free Will and the Science of the Brain, Michael S. Gazzaniga, 2012, very insightful as to how the brain subconscious portions determine our behavior and thoughts.  It has helped me understand why people do things that are irrational, such as physicians attending continuing education classes given by pharma, give junk treatments, and patients take them.  Several chapters are academic twaddle.  Very good      

An Aspirin a Day:  What you can do to prevent heart attack, stroke, and cancer  Michael Castleman 1993, (San Diego Library) each chapter has a list of references.  New possibilities prevention of diabetic retinopathy, pregnancy, Gallstones 95, cataracts 92, migraine headaches 91. popular style, sounds balanced   Good

 Aspirin the miracle drug, Eric Metcalf, 2005 UCSD Journalistic, full of explanation but weak on evidence and links.  Good

 

8) Thumbs down

Side effect A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial (Plavix), Alison Bass, 2008way to chatty. 

Tracking Medicine: a Researcher’s Quest to Understanding Health Care,  John E. Wennberg, Oxford Press, 2010, Very limited

How we do Harm:  A Doctor Breaks Ranks…. Otis Webb Brawley & Paul Goldberg  —tedious, small issues. SUCKS

Beyond Aspirin: Nature’s Answers to Arthritis, Cancer and Alzheimer’s disease, Thomas Newmark & Paul Schulick Herbal junk 

 Dosed: The medication Generation Grows Up, pro-pharma, from the kids perspective. SUCKS

The Anti-Estrogenic Diet, Ori Hofmekler, North Atlantic Books, Bereley CA, 2007, bad science on estrogen and weak on science of estrogen mimic, educated by pharma.  JUNK

 

WEBSITES

Thincs, The International Network of Cholesterol Skeptics (Wiki) is a group of scientists, physicians, and other academicians from around the world who dispute the widely accepted lipid hypothesis of atherosclerosis. THINCS was founded in January 2003, and its founder and current spokesman is Uffe Ravnskov (see his book above).

Nutrition for life on low carbs for public  http://nutritionforlife.healthcare/evidence

http://www.spacedoc.com/ Duane Graveline, MD.

http://www.statinnation.net/action/

INTERNAL SITE SEARCH ENGINE by Google

Harvard Prof. Dr. Marcia Angell: “We certainly are in a health care crisis, ... If we had set out to design the worst system that we could imagine, we couldn't have imagined one as bad as we have.”