Pillaged

Ronald W. Maris

Description

An examination of the efficacy and safety of psychiatric medications in light of how little is understood about how they work

It is estimated that forty-five to fifty percent of all Americans will suffer a mental disorder at some time during their lives. Increasingly, the treatment for these disorders is management with one or more psychiatric drugs, often prescribed by general practitioners. In Pillaged Ronald William Maris evaluates the psychiatric medications commonly used to treat several major types of psychiatric disorders—-including depression and mood disorders, bipolar disorders, anxiety disorders, and psychotic disorders—asking "do they work as advertised?" and, more importantly, "are they safe?"

Answers to these questions are more ambiguous than we might think, Maris explains, because drug manufacturers tend to minimize the adverse effects of their products. Furthermore, the underlying neurobiological theories of how psychiatric drugs work are complex, poorly understood, and often conflicting. Still Americans spend tens of billions of dollars a year on antidepressants and antipsychotics alone.

While Maris questions the rampant prescribing of psychiatric medications especially in young people, Pillaged does not suggest that anyone cavalierly discontinue potentially beneficial psychiatric medications without the advice of a qualified mental health professional. The book acknowledges that psychiatric medications are often necessary in treating some psychiatric conditions, but it reminds readers of medication's potential for degrading one's quality of life, contributing to self-destructive behaviors, and even leading to death in a vulnerable minority of patients. Maris advocates an open and honest discussion of data on psychiatric drugs, their effects, and their dangers, and he reminds readers of available alternative, nondrug treatments for psychiatric disorders. By reviewing the history and effects of medications for mental disorders, Maris hopes to educate health care consumers and prescribers to make careful, informed decisions about the treatment of psychiatric disorders.

Sujets

• Médecine
• Médecine de laboratoire
• Sociologie, société et politique
• Cyclothymia
• Psychological dependence
• Suicidal ideation
• Nefazodone
• Oculogyric crisis
• Phenobarbital
• Dysthymia
• Amotivational syndrome
• Psychopathology
• Stimulant psychosis
• Hypoventilation
• Contraindication
• Abnormal psychology
• Alcohol abuse
• General officer
• Valproic acid
• Hypomania
• Pharmacology
• Psychology
• Antidepressant
• Thioridazine
• General
• Hysteria
• Acide valproïque
• Castration

Informations

• Publié par: University of South Carolina Press
• Date de parution: 15 février 2015
• Nombre de lectures: 0
• EAN13: 9781611174625
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

pillaged
pillaged
Psychiatric Medications and Suicide Risk
Ronald William Maris Foreword by David Healy
2015 University of South Carolina
Published by the University of South Carolina Press Columbia, South Carolina 29208
www.sc.edu/uscpress
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Library of Congress Cataloging-in-Publication Data can be found at http://catalog.loc.gov/
ISBN 978-1-61117-460-1 (cloth) ISBN 978-1-61117-461-8 (paperback) ISBN 978-1-61117-462-5 (ebook)
Cover photograph by Keith McGraw
To my wife and daughters, who stand watch
Contents
List of Tables, Cases Vignettes, and Figures
Foreword David Healy
Preface
Acknowledgments
Part I Overview of the Problems
1 The Suicide Risks of Psychiatric Medications
2 Resolving Suicidogenic Claims
Part II The Medications
3 Antidepressants
4 Mood Stabilizers and Antiepileptics
5 Anxiolytics
6 Antipsychotics
7 Residual Suicidogenic Drugs
8 Conclusions, Resolutions, and Alternatives
Bibliography
Index
Illustrations
Tables
2.1: Depression Scores for Suicides and Natural Deaths
3.1: Antidepressant Medications
3.2: Efficacy and Acceptability of Antidepressants
3.3: Primary Scientific Data on Antidepressant Medications and Suicidality
4.1: Mood Stabilizers and Antiepileptics
4.2: Primary Scientific Data on Mood-Stabilizers and Suicidality
4.3: Suicide Risk Factors
5.1: Antianxiety Medications
5.2: Primary Scientific Data on Anxiolytics and Suicidality
6.1: Antipsychotic Medications
6.2: Primary Scientific Data for Antipsychotics
7.1: Effects of Alcohol
8.1: The Top Prescribed Drugs in the United States
Case Vignettes
3.1: Lauren Slater
4.1: Kay Jamison
5.1: Judith Rapoport
6.1: Mark Vonnegut
6.2: Elyn Saks
7.1: John Belushi
Figure
4.1: Bipolar Disorders
Foreword
The question of whether antidepressants or other psychotropic drugs can cause suicide or homicide or other serious adverse effects in those who take them in the hope of preventing suicide or homicide is more than just a story of adverse events. It is one of the central issues of modern medicine and modern healthcare.
This is a story that pits clinical evidence in the form of what a patient experiences or a doctor witnesses in front of their own eyes against clinical trial evidence put forward by drug companies. This clinical trial evidence, however, is not independent evidence but is company sponsored, and only the evidence that suits company marketing purposes appears in the academic literature, which is almost completely ghostwritten.
When faced with a patient in difficulty, doctors and other healthcare providers are placed under enormous pressures to go by the evidence, and as a result patients increasingly have their experiences invalidated. Doctors or other providers who take the patient s side when it comes to adverse events find themselves marginalized. Because the treatments do not produce the benefits that are claimed for them but are prescribed on a scale that supposes they do, our healthcare systems are becoming ever more inefficient and are leading us to the brink of national bankruptcy.
Ron Maris s book is not just about psychotropic drugs and suicide. The same forces that obscure the fact that antidepressants can produce exactly the wrong outcomes in some cases also obscure the fact that drugs prescribed for asthma, diabetes, or osteoporosis-or other drugs-regularly produce the wrong outcomes.
The bigger problem is that clinical trials, even if they are independent, are not a reliable safeguard. They are ineffective when both the treatment and the disease produce the same outcome. In all cases, they obscure safety issues because they require a focus on one primary outcome when drugs often have a hundred outcomes, ninety-nine of which are more important to the patient than the one outcome which makes money for a drug company.
But it is now close to impossible for many doctors to recognize this. The power of company marketing explains why, even though the antidepressants come with black-box warnings and have come with these warnings for close to ten years, quite extraordinarily the majority of clinicians still deny that these drugs can cause problems.
David Healy
Preface
In cases involving suicidal patients, one of most common types of problems is various psychiatric (especially depressive and mood) disorders, and the prevalent treatment for them is psychiatric medication. These powerful psychotropic (affecting the mind) drugs-antidepressants, anxiolytics, antipsychotics, and antiepileptics-can cause harm to a vulnerable minority of the consumers, even if these medications provide benefits to a majority of patients. This risk is often minimized, hidden, and even buried by the companies that manufacture the drugs; for example, by not publishing negative clinical trials in which their drugs do not work or even cause harm.
Columbia University and the FDA evaluated nine common antidepressant medications. It turns out that, if you are under age twenty-four, then taking an antidepressant doubles your suicidality risk. This is paradoxical and disturbing. After this meta-analysis, the FDA required that a black-box warning (the strongest available) be added to the nine antidepressant product descriptions (for example, in their package inserts and in the Physicians Desk Reference ).
Patients deserve to know the true risks of their treatment. Similar sagas can be described for antianxiety medications (which can cause paradoxical rage and aggression), mood-stabilizing medications (which the FDA found also doubles the patient s suicide risk), and many other psychiatric medications (including antipsychotics). Science and clinical trial data (what is now called evidence-based psychiatry) can shed light on major types of psychiatric medications and their alleged associated suicide risks and adverse effects. Obviously, as a Ph.D., and not an M.D., the author is not licensed to prescribe medications. Any decision to start or discontinue psychiatric medications ought to involve a serious discussion between patients and their physicians.
Although medicine can loot, steal, or compromise one s life quality through unintended adverse effects, it also should be noted that untreated psychiatric disorders pose a serious suicide risk, too. Patients should never cavalierly discontinue possibly life-saving or life-improving medication treatments.
Acknowledgments
My wife, Beth Troy Maris, M.S.W., critically read the entire manuscript. My daughters, Gabriella Eliese Maris, M.D.; Amanda Leigh Maris, J.D.; and Elizabeth Anne Maris, J.D., advised me in resolving medical and legal questions. My artist daughter, Catherine Lynn Maris, M.A., taught me how to see a world I never knew existed. Several of my honors students, medical students, and residents at the University of South Carolina helped me hone various aspects of the book. A special thanks goes to Colin M. Johnson, who assisted in preparing the tabular materials, and Jim Denton at the University of South Carolina Press, who was both encouraging and yet determined to get it right.
Part I
Overview of the Problems
1
The Suicide Risks of Psychiatric Medications
The argument in a nutshell is that psychiatric medications are powerful and psychotropic (mind or mood altering). Ingesting them can do harm in a small, vulnerable minority of patients (much like allergies to peanuts or shellfish); they can contribute to suicide or worsen mental disorder (see Angell, 2011; compare Schwarz, 2013). Also, psychiatric medications may simply be ineffective or not work as neurobiological theories claim they do. All the manufacturers of psychiatric medications flatly deny that their products cause suicide. However, David Healy (in Whitaker, 2010: 283; compare Healy, 2012) says there are more dead bodies in psychiatric medication treatment groups than there are in placebo control groups.
If psychiatric drugs do harm, then the public should be warned about their adverse effects, have full access to the clinical trial data (see Leaf, 2013) and be able to make informed consent about their use. It is not just the mental illness (such as a depressive disorder) that causes suicide; sometimes it is the treatment of that illness with psychiatric medications (see Maris, 2007).
You should not take psychiatric medications cavalierly or whimsically. For example, you should probably take antidepressants only for severe to moderate depressive disorder (not for mild depression), other things being equal (compare Whitaker, 2010: 353; about two-thirds of the patients clinicians give antidepressants to do not meet the criteria for major depression), even though most psychiatrists routinely pharmacologically manage their patients mental disorders through fifteen-minute medication checks. Psychiatric diagnoses have grown astronomically, such as the hotly contested bipolar disorder diagnosis in children (see Carlat, 2010, chap. 7, The Frenzy of Diagnosis ; Angell, 2011; and Whitaker, 2010: 208; compare the new Dysruptive Mood Dysregulation Disorder, code 296.99 in the DSM-5 ).
Unless you clearly benefit from them and only if your risks do not outweigh your benefits, perhaps in some cases you should not take psychiatric medications at all. It may be hard to determine your drug risks, since drug manufacturers obviously do not advertise them, even though they purport (see Turner, 2008, on how negative clinical trials are often not published at all) to list them in their package inserts from the pharmacy. When you look at all the possible side effects of psychiatric drugs without the guidance of a trusted physician, the possibilities can make your head swim.
Reactions to starting on psychiatric medications should be monitored closely, especially in children and adolescents. Psychotherapeutic treatments (like Beck s cognitive behavioral therapy or Linehan s [1993] dialectical behavioral therapy) often work a