Is the use of coercion and force in psychiatry ethical?

via The New York Times:

LETTER

Forced Drug Treatment

an excerpt:

"In a society presumably under the rule of law, is it proper for physicians and other mental health professionals to coerce innocent individuals and force them to ingest dangerous drugs?"

DAVID COHEN
TOMI GOMORY
STUART A. KIRK
Los Angeles, July 31, 2013

read the letter here

The writers are professors of social welfare and co-authors of “Mad Science: Psychiatric Coercion, Diagnosis and Drugs.”

hat tip:

Forced Drug Treatment http://t.co/fRYbB78mlb #mentalhealth #coercion
— MARY HALL (@PsychVictim) August 5, 2013

Whenever a doctor cannot do good, he must be kept from doing harm.  Hippocrates 

via American Journal of Psychiatry:
The Cost of Assisted Outpatient Treatment:
Can It Save States Money?

Insel's assumptions are biased beliefs predicated on a hypothetical etiology that is reminiscent of eugenics

via NIMH The Director's Blog

Transforming Diagnosis

an excerpt: 

NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. Through a series of workshops over the past 18 months, we have tried to define several major categories for a new nosology (see below). This approach began with several assumptions:

A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,

Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior, (emphasis mine)

Each level of analysis needs to be understood across a dimension of function,

Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

Apparently, Thomas Insel is unaware that in order to ethically determine the direction and the focus of scientific research requires an open mind; not a pre-determined agenda. Insel's announcement that the NIMH will no longer use the DSM is a political decision. Insel acknowledges the NIMH adopted a biological research focus based on assumptions; instead of using ethical scientific principles, and allowing the existing empirical data to guide the direction of psychiatric research; he says, "because we lack the data"!? What a crock! Insel knows there is little to no scientific basis in his assertion that "Mental disorders are biological disorders."

It is an assumption that is and has been embedded in the language of psychiatric diagnosis and treatment, an assumption that was entrenched along with the eugenic theories that spawned it. Eugenic theories which are still used in an attempt to justify the inhumane "standards of care" that are without empirical support, standards without empirical support should not be considered "standards of care" since by definition, standards are theoretically to be derived from the evidence base; instead, psychiatry validated their standards of care by consensus,  a quasi-democratic political process, not using ethical medical judgement and empirical data from psychiatric research.  By consensus, psychiatry effectively determined that some people with certain  psychiatric diagnoses don't need their Human Rights protected; people of all ages are effectively stripped of their Human Rights by psychiatry, based on a belief that a diagnosis of mental illness is evidence the person has an incurable brain disease, that requires life-long treatment with teratogenic drugs. Without any definitive evidence to validate the brain disease hypothesis, it's simply a hope-filled belief in a hypothesis that is still seeking validation; it's not even a theory...let alone an actual disease.

Insel's assumptions are beliefs reminiscent of eugenics.  The eugenics movement in this country also proceeded without any empirical evidence to validate it's ignorant assumptions. 

The NIMH will assume that the brain disease hypothesis is a brain disorder or disease in the absence of  empirical evidence that would validate the hypothesis. According to Thomas Insel, the NIMH is going to proceed as if an assumption, i.e."Mental disorders are biological disorders," is a sufficient substitute for using critical thinking skills, and for relying on the existing research data on "mental disorders" exercising sound judgment to determine what the focus and direction for psychiatric research should be. I wonder, if the best interests of those who experience cognitive, emotional and behavioral symptoms were even considered? Is there empirical data that supports Insel's use of biased assumptions that are without empirical support to justify this biased and myopic focus on brain biology for psychiatric research? Insel's announcement that the NIMH will focus on seeking evidence that "mental illness" is caused by a brain disease is not 'news;' the NIMH has been focused on seeking the evidence which would validate the brain disease hypothesis for decades...Insel's announcement that research funded by NIMH will no longer be guided by the DSM, due to it's lack of validity; is long overdue. The irony is, in the same blog post, Insel uses biased assumptions as if bigotry-based assumptions are a sufficient substitute for valid information when making mental health research policy decisions (theoretically) in the public interest. There is no ethical justification for the NIMH to continue to fund research looking for the still illusive genetic defects, brain diseases and bio-markers as it's  main agenda. The pre-occupation with proving schizophrenia and/or any other psychiatric diagnosis, is caused by a biological defect or disease seems to purposely exclude research on known and suspected social and environmental risk factors that cause cognitive and emotional difficulties; worse it neglects the cognitive/behavioral/psycho/social/ therapeutic treatments that can help people right now in real world practice, if the treatments were actually available...

In effect, Insel is announcing all cognitive and emotional symptoms of distress, including undesirable, or disapproved of behavior, is caused by a yet to be identified, biological disorder or disease process---while simultaneously ignoring the overwhelming evidence of environmental causal factors such as  sexual, physical, and emotional abuse and neglect, poverty, malnutrition, environmental violence, socio-economic-political status and intra- and inter-personal conflicts are highly correlated with, and known to exacerbate (if not cause) what Insel 'assumes' are biological disorders...

Allen Frances, had a OP-Ed published in New Scientist, which concludes with the statement, "Anything that goes into the manual should already have passed rigorous research testing; the manuals are far too important to include untested hypotheses. DSM-5 is not, and cannot be, an appropriate guide to future research." 

I agree. I would add that assumptions about the scientific validity of a hypothetical, neuro-biological cause for any psychiatric diagnoses (or anything else) is also inappropriate. An assumption is not an ethical scientific basis for psychiatric research; it is not an ethical foundation for a new nosology either.  

I wonder if Insel can explain why dangerous neuroleptic, or "antipsychotic" drugs that are minimally effective for a minority of people diagnosed with schizophrenia, are prescribed off label, to children? 

Human Experimentation is "effective psychiatric treatment." 

It's the standard of care used in psychiatric practice. 

via National Advisory Mental Health Council 219th Meeting September 18-19, 2008 

NIMH Director's Report: 

an excerpt:

"Results from the NIMH-funded 6-year multisite Treatment of Early Onset Schizophrenia Study (TEOSS) found no significant differences in outcomes with first- or second-generation antipsychotic medications. There was a striking difference in side effects, but there was no evidence that any of the medications was the best choice for the entire group of people being treated. Similar results were obtained in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial, the Cost Utility of The Latest Antipsychotics in Severe Schizophrenia (CUtLASS) trial from the United Kingdom, and the large-scale Veterans Administration trial. Despite the lack of a clear superiority in overall effectiveness of the second-generation drugs, they account for more than 90 percent of the market and cost about 20 times more than the first-generation compounds." Thomas Insel 

via National Institutes of Health:

The NIH Public Access Policy ensures that the public has access to the published results of NIH funded research. It requires scientists to submit final peer-reviewed journal manuscripts that arise from NIH funds to the digital archive PubMed Central upon acceptance for publication. To help advance science and improve human health, the Policy requires that these papers are accessible to the public on PubMed Central no later than 12 months after publication.

photo credit:Psychiatry is junk science

Richard Bentall: Treating Psychosis: The limits of anti-psychotics

via IAI:
Clinical psychologist and author of Doctoring the Mind and Madness Explained, Richard Bentall is a leading critic of biological explanations of mental illness and the pharmaceutical industry. He teaches at the University of Liverpool.
The Talk

The clinical psychologist and author of Madness Explained presents new evidence for the limitations of anti-psychotic medication and of the psychiatric establishment.

Watch more videos on iai.tv

Abilifried: 3 takes on Abilify®

via Drug Discovery News' Virtual Break Room

by Amy Swinderman, ddn Chief Editor

Pharma news of the weird: Cartoons, government and beer

Have you ever seen a new drug commercial and literally said, out loud, “WTF?” Pharmaceutical company commercials often raise the ire of critics, but one in particular really has me scratching my head, and tops my little collection of weird news developments in the pharma arena.

A recent commercial for Bristol-Meyers Squibb Co.’s (BMS) antidepressant Abilify depicts a patient-doctor interaction, done in cartoon form, in which a patient sheds her “blue robe” of depression and heads in to ask her doctor if Abilify is right for her.

You can see the commercial on YouTube here.

BMS’ choice to use cartoons instead of real people is puzzling—but wait, the commercial is about to get weirder. Inexplicably, instead of telling his patient about the drug and its possible side effects and drug interactions, the doctor pulls down a projection screen … and allows a different cartoon version of himself to do the talking. Meanwhile, the animated blue robe looks on, blinking.

Are you following that? Me neither. Aren’t these commercials controversial enough without rocking the boat this much?

Meanwhile, in government news (which is frequently weird) … while the U.S. Food and Drug Administration (FDA) is often criticized for the speed by which it approves new drugs—and lawmakers continue to put forth legislation that aims to ease bottlenecks in the process—a recent report claims that new drugs are actually approved faster here in the United States than in Europe or Canada.

According to Yale University School of Medicine researchers, their recent study of drug-approval decisions made in the first decade of the new millennium refutes the common belief that the FDA’s drug-approval process is especially slow.

After studying decisions made by the FDA, Health Canada (the Canadian drug regulatory authority) and the European Medicines Agency (EMA), the researchers found that the FDA’s reviews were more than three months faster than those of its Canadian and European counterparts.  here

The study mentioned above, "Regulatory Review of Novel Therapeutics — Comparison of Three Regulatory Agencies" Nicholas S. Downing, A.B., Jenerius A. Aminawung, M.D., M.P.H., Nilay D. Shah, Ph.D., Joel B. Braunstein, M.D., M.B.A., Harlan M. Krumholz, M.D., and Joseph S. Ross, M.D., M.H.S.
N Engl J Med 2012; 366:2284-2293

Why would anyone want to take this drug? at Beyond Meds

Psychiatric Drugs are Killing American Soldiers

 

Marine patroling a poppy field in Afghanistan. Photograph: Patrick Baz/AFP/Getty Images

via The Guardian:

Friday 1 February 2013 12.00 EST

Simon Rogers
US military suicides in charts: 

how they overtook combat deaths

US military suicides are increasing as deaths in action are going down. 

Find out what we know about the trend• Download the data
• More data journalism and data visualisations from the Guardian

US military suicides have never been so high since data was recorded:up to 349 for 2012.

It exceeded the Pentagon's own internal projection of 325. US government began closely tracking suicides in 2001 through the Department of Defense Suicide Event Report (DoDSER). It exceeds the 311 Americans who died in war zones last year. read the rest here

By the way...

Why in the hell are American soldiers guarding poppy fields?  Intentionally or not, it facilitates  "greater heroin availability, rising purity, and lower prices." 

Beginning of original post from 8-23-2011:

Antidepressants, neuroleptics and other psychiatric drugs can kill the person who takes them, or compel the person to commit acts of violent aggression including homicide.  Why are these events, and the psychiatric drugs which contribute to and/or cause them, not being reported more accurately in the news in the United States?  Does the income derived from direct-to-consumer advertising of drugs serve another purpose?  Is the mainstream news media not reporting the news due to a Conflict of Interest? Is deriving so much revenue from the pharmaceutical industry preventing journalists from accurately reporting stories which are unfavorable or critical of a source of income for their corporate employers?  The United States and New Zealand are the only countries in the world where it is legal to market prescription drugs direct to consumers through print, electronic, radio and television advertisements.  

Who does all of this benefit most?

VIA: 

Column: Martha Rosenberg

Are US Soldiers Suicides Caused by Prescription Drugs?

by Martha Rosenberg,

Chicago 

"The suicide rate among US troops is astonishing.

"In 2009 there were 160 active duty suicides, 239 suicides within the total Army including the Reserves, 146 active duty deaths from drug overdoses and high risk behavior and 1,713 suicide attempts, says the Army's suicide report, released in July.

"Not only are more troops dying from their own hand than combat says the Army report, titled Health Promotion, Risk Reduction, Suicide Prevention, 36 percent of the suicides were troops who were never deployed.

"Also astonishing is the psychoactive drug rate among active duty-aged troops, 18 to 34, which is up 85 percent since 2003 according to the military health plan, Tricare. Since 2001, 73,103 prescriptions for Zoloft have been dispensed, 38,199 for Prozac, 17,830 for Paxil and 12,047 for Cymbalta says Tricare 2009 data, which includes family prescriptions. All of the drugs carry a suicide warning label.

"In addition to the leap in SSRI antidepressants, prescriptions for the anticonvulsants Topamax and Neurontin rose 56 percent in the same group since 2005 says Navy Times, drugs which the FDA warned last year double suicidal thinking in patients.... "

"Over 4,000 published reports of violent and bizarre behavior of people affected by antidepressants on the web archive ssristories.com reveal the same out of character violence and self harm in civilians, currently seen in the military.

"Twenty people set themselves on fire. Ten bit their victims (including a biter who was sleepwalking and a woman, on Prozac, who bit her 87-year-old mother into critical condition.) Three men in the 70s and 80s attack their wives with hammers. Many stab their victims obsessively -- one even stabs furniture after killing his wife -- and 14 parents drown their children, a crime seldom heard of before the 2001 Andrea Yates case. Yates drowned her five children on the antidepressant Effexor which manufacturer Wyeth (now Pfizer) "issued no public warning" about says the Associated Press.

"Then there's the North Carolina pilot on Zoloft who sings, "I'm going down for the last time," into the cockpit voice recorder before he crashes his plane in June. And the Mayor of Coppell, Texas, Jayne Peters who kills herself and her daughter in July over the grief of losing her husband. Police find antidepressants at the home.

"Such murder-suicides committed by women used to be rare says Betty Henderson the web site's moderator and researcher. "Before the SSRI antidepressants, women committed five percent of the murder-suicides and now they account for almost 15 percent of this type of violence," she said in an interview.

"Antidepressants are also causing women to become neo sexual predators says Henderson. "There have been more than a dozen recent cases of women school teachers molesting their young students under the influence or withdrawal of antidepressants. Who heard of this type of sexual aberration before the antidepressant craze?"
"In fact, the high percentage of civilian suicides on psychoactive drugs is probably the clearest indication that military life is not the only cause of the shocking troop suicides: In September alone, there were 18 civilian suicides, 11 murders, 2 murder suicides and other violence linked to people who were using or had used antidepressants, according to published reports.

"Also in the thirty day period, a 60-year-old grandmother in Seattle killed three family members and herself; a disc jockey in Bristol, UK set himself on fire; and a man in Exeter, UK man was determined to have stabbed himself in the heart. All were on antidepress-ants. Finally, in the month of September, legal proceedings began against two mothers and a father charged with killing their own children. read here.

Via: 9News in Australia:

Suicide brings a decade of war home

12:30 AEST Tue Aug 23 2011

A soldier kills himself and his wife. Another war veteran hangs himself in despair. Yet a third puts a gun to his head and pulls the trigger outside a gas station in a confrontation with Texas lawmen.

Suicides by veterans like these once would have left people reeling in this military community. But troops and their families here these days call it the "new normal" for a US Army that's spent a decade at war.

Melissa Dixon sees the stress in the tattoos she draws on soldiers back from combat.

"Some of them have issues with their wives or their loved ones, where they're fighting, or one will have a friend commit suicide," she said.

There's no place like Fort Hood in the Army. A post that sent soldiers from two divisions to Iraq three times since the invasion, it's logged more suicides since 2003 than any other — 107.

Soldiers at big posts like Fort Hood that have played key roles in deployments are at the greatest risk of killing themselves.

The post here in Killeen, northwest of Texas' state capital, Austin, set an Army record last year with 22 suicides.

Elsewhere, Fort Bragg, North Carolina, home of the 82nd Airborne Division, has lost 77 soldiers to suicide since 2003.

At Fort Campbell, Kentucky, home to the 101st Airborne Division, 75 soldiers have died by their own hand over the last eight years.

But the problem is widespread. Last year, a record 300 soldiers in the active-duty, Reserve and National Guard killed themselves.

The numbers appear to be down slightly in 2011, but 32 active-duty staff killed themselves in July, the highest since the Army began tracking the phenomenon in January 2009.  read the rest here.

SSRI Stories Note: The Physicians Desk Reference states that antidepressants can cause a craving for alcohol and can cause alcohol abuse.   Also, the liver cannot metabolize the antidepressant and the alcohol simultaneously, thus leading to higher levels of both alcohol and the antidepressant in the human body.

via guestofaguest.com from 2007

We came across something very disturbing in today's Metro.  In an article titled"A Soldier's Suicide: Did He Have to Die?" we read about the story of soldier Jason Scheuerman.  Jason took his own life in Iraq after numerous displays of suicidal characteristics and behaviors.  What was more horrifying was this statistic, imbedded halfway down in the article:

"At least 152 U.S. troops have taken their own lives in Iraq and Afghanistan since the two wars started, contributing to the Army's highest suicide rate in 26 years of keeping track."

This is so, so sad.  Not only are we loosing thousands of troops to the enemy (whoever that may be at the time), we are loosing hundreds of sons and daughters to despair.  And it doesn't end when they return home.  America is suffering an epidemic of suicides among traumatized army veterans.

"More American military veterans have been committing suicide than US soldiers have been dying in Iraq. At least 6,256 US veterans took their lives in 2005, at an average of 17 a day." [TimesOnline]

 As a nation, we need to step things up.  Jason is an example of several military leaders failing to take action.  On a mental health questionnaire he had admitted thoughts about killing himself, also that he was uptight, anxious, depressed, and had feelings of hopelessness and despair.  He had also made calls home saying goodbye, and spoke several times about wanting to kill himself.  His leaders many of the times played these claims of his off as exaggerated jokes by the soldier, and even gave him back his gun after serving him with 14 days of extra duty as punishment (minutes later they found him dead in his room).  Imagine the angst of his parents, who were soldiers themselves, and feel this should have been prevented.  His dad Chris:

"We will not see a statistical decrease in Army suicides until the Army gets serious about holding people accountable when they do not do what they are trained to do."

It IS time for our leaders both in the military and back home to step up and start aiding in the mental health of our troops and our veterans. Read it here.

Check out the website SSRI Stories link to stories specific to members of the military and veterans

Prosecute Psychiatrists

via the OC Register Letters to the editor:

Prosecute psychiatrists  

GARDEN GROVE, Clay Bock: The deadliest mass murder that has ever occurred in Orange County ends the lives of eight wonderful people, most of whom are in the prime of their lives. Hundreds of family members and their friends lives are terribly damaged forever after the loss of their loved ones. As it turns out, as in just about every one of these bizarre, brutal acts of violence, Scott Dekraai was in the hands of a psychiatrist and on psychiatric drugs. 

The second-deadliest O.C. mass murderer, according to the newspaper, Edward Allaway, also had a long history of psychiatric “treatment” before he killed seven people at Cal State Fullerton in 1976. There are hundreds of those treated by psychiatrists in between, including the man who killed innocent shoppers with the sword in Irvine or Eric Harris at Columbine.  

Psychiatrists know that these drugs cause a certain number of people to become violent. Here is a list of a few of the side effects for their drugs from the National Institute of Mental Health website: Irritability, aggressive or violent behavior, acting without thinking, extreme increase in activity or talking, sudden or unusual changes in behavior and even suicide.


If Dr. Conrad Murray can be prosecuted for Michael Jackson’s death due to misapplication of prescription drugs, it is time to prosecute psychiatrists behind these mass murderers. read here

Neuroleptic Origin: 1955–60;  French neuroleptique, equivalent to neuro- neuro- + -leptique < Greek lēptikós disposed to take, equivalent to lēp- (verbid stem of lambánein to seize) + -tikos -tic; see -lepsy  via Dictionary.com 

It is a relatively new concept for people with a diagnosis of schizophrenia to be considered "violent."  Violence has only been associated with a diagnosis of schizophrenia in the last 50 or so years----after the introduction of neuroleptic drugs.  It is significant that this shift in perception occurred around the time it became apparent that people treated with what were then, relatively new drugs, the neuroleptic, or "antipsychotic" drugs became aggressive or violent.   The neurological and cognitive impairment many attribute to the psychiatric diagnosis of schizophrenia are in reality caused by the teratogenic, neuroleptic drugs.

When one considers how little we know about the pathophysiology of schizophrenia for which these nerve-seizing or "nerve affecting" drugs were initially prescribed; it is more than a little frightening.  The neuroleptic drugs have been used for 60 years, and we know they cause cardio-vascular, metabolic and neurological dysfunction; we know that neuroleptics cause intellectual, neurological, cognitive and physical impairments, that are disabling; and can cause sudden or early death.  Neurological impairment was not identified as a symptom attributed to the progression of schizophrenia before the advent of these teratogenic drugs; but it is listed along with aggression and violence and now attributed to the diagnosis of schizophrenia; which seems less than acurate, or honest to say the the very least. 

via The Lancet:

“Why are the mentally ill still bearing arms?”

an excerpt:"As but one example, the second edition of the Diagnostic and Statistical Manual of Mental Disorders, published in 1968, redefined paranoid schizophrenia as a condition of “hostility” and “aggression” and projected anger in ways that encouraged psychiatrists to conceptualise(sic) violent acts as symptoms of mental illness." read           

In psychiatry, "successful treatment" is defined totally differently than in any other medical specialty. In psychiatry, successful treatment is not dependent upon diagnostic validity or the effectivenss of the treatment; it is solely based upon the patient's willingness to be "treatment compliant."

via the Journal of the Royal Society of Medicine, a personal paper asks, Does psychiatry stigmatize? The author concludes "psychiatry may have very little specific to offer" to many with a psychiatric diagnosis.  The paper asks whether it is possible that psychiatry harms some, and also agrees this is probably so, due to the limited ability to explain problems caused or exacerbated by social and environmental conditions.  read the paper here. 

via Reuters:

French psychiatrist sentenced after patient commits murder

A French psychiatrist whose patient hacked an elderly man to death was found guilty of manslaughter on Tuesday in a groundbreaking case that could affect the way patients are treated.

A court in Marseilles said Daniele Canarelli, 58, had committed a "grave error" by failing to recognize the public danger posed by Joel Gaillard, her patient of four years.

Gaillard hacked to death 80-year-old Germain Trabuc with an axe in March 2004 in Gap, in the Alps region of southeastern France, 20 days after fleeing a consultation with Canarelli at Marseilles's Edouard Toulouse hospital.

Canarelli was handed a one-year prison sentence and ordered to pay 8,500 euros to the victim's children, in the first case of its kind in France. Defense lawyers said the ruling would have serious repercussions for treatment of the mentally ill.

"If a psychiatrist lives in fear of being sentenced, it will have very real consequences and probably lead to harsher treatment of patients," said Canarelli's lawyer, Sylvain Pontier.

The court said Canarelli should have requested Gaillard be placed in a specialized medical unit or referred him to another medical team, as one of her colleagues suggested. Her stubborn refusal had equated to a form of "blindness", the court president Fabrice Castoldi said.

Gaillard had already been forcibly committed to a secure hospital on several occasions for a series of increasingly dangerous incidents.

The victim's son, Michel Trabuc, said he hoped the case would set a legal precedent.

"There's no such thing as zero risk, but I hope this will move psychiatry forward and, above all, that it will never happen again," he said.

Gaillard was not held responsible for his actions and was freed under medical supervision.

(Reporting by Jean-François Rosnoblet; Writing by Vicky Buffery; Editing by Alison Williams) here

The Rise and Fall of Atypical Antipsychotics: The belief in pharmaceutical marketing messages

 

via BJPsych:

Editorial

The rise and fall of the atypical antipsychotics

TIM KENDALL

Declaration of interests:
T.K. receives about £1.4 million per year from the National Institute for Health and Clinical Excellence (NICE) to develop clinical practice guidelines for the National Health Service in England and Wales. He also receives funding/grants from other bodies including the Academy of Medical Royal Colleges, the Department of Health and NICE International to undertake systematic reviews or guideline development. T.K. is a co-opted member of the Council of the Royal College of Psychiatrists and contributed to the development of the College Report CR148 on psychiatrists’ relationship with the pharmaceutical industry

the final two paragraphs:

In the recently updated NICE schizophrenia guideline we also found that there were no consistent differences between atypicals and typicals, SGAs and FGAs; there were no important differences between any of the antipsychotics in terms of clinical or cost effectiveness (except for clozapine in treatment-resistant schizophrenia); the side-effects varied from drug to drug and were not determined by class; and all the antipsychotics were associated with potentially serious dose-related and other side-effects. 4 Although some of the newer drugs are associated with lower rates of EPS/tardive dyskinesia, they are also linked to different and equally severe side-effects such as diabetes, and some other newer drugs may have similar rates of EPS to the older drugs. From Girgis et al in this issue, it now seems unlikely that there are any longerterm benefits for using atypicals or SGAs in the first episode.

In creating successive new classes of antipsychotics over the years, the industry has helped develop a broader range of different drugs with different side-effect profiles and potencies, and possibly an increased chance of finding a drug to suit each of our patients. 4 But the price of doing this has been considerable – in 2003 the cost of antipsychotics in the USA equalled the cost of paying all their psychiatrists. The story of the atypicals and the SGAs is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing. The study published today is a small but important piece of the jigsaw completing a picture that undermines any clinical or scientific confidence in these classes. With the industry reputation damaged by evidence of selective publishing and its deleterious effects, 15,16 and the recent claims that trials of at least one of the new atypicals have been knowingly ‘buried’, 2 it will take a great deal for psychiatrists to be persuaded that the next new discovery of a drug or a class will be anything more than a cynical tactic to generate profit. In the meantime, perhaps we can drop the atypical, second-generation, brand new and very expensive labels: they are all just plain antipsychotics. here

As interesting as the above article is, I found what the editor of the British Journal of Psychiatry, Peter Tyrer said about the SGAs interesting, and the response to Tim Kendall's editorial from The Last Psychiatrist, illuminating.

From the Editor's desk

1. Peter Tyrer

Spotlight on antipsychotics

The act of prescribing an antipsychotic drug in psychiatry is like sex; it is almost universal in practice yet indiscriminate use can lead to multiple pathologies. Where it differs from sex is that the act is almost completely devoid of pleasure for most parties involved. Patients tend to hate these drugs because of their panoply of adverse effects – not for nothing was chlorpromazine named Largactil – and practitioners, unless they are avid psychopharma- cologists, feel their prescription is a necessary evil that is likely to change the relationship with their patients from a cooperative to a coercive one, particularly in a hospital environment.^1,2 We would all feel a lot better if this range of drugs was replaced by one that was at least equally effective and did not have the potential to attack every organ system in the body when it wasn’t looking, or even looked for, in clinical and research practice.³ Six papers in this issue touch on this subject from different angles. After looking at the similarities between the long-term benefits of clozapine and chlorpromazine in schizophrenia (Girgis et al, pp. 281–288), Kendall (pp.266–268) goes for the full frontal assault on the way guidance has been distorted by the pharmaceutical industry, ‘a story of fabricated classes, money and marketing’, with most changes being no more ‘than a cynical tactic to generate profit’. I have to declare my own interest here; I cannot see any justification for separating first- and second-generation antipsychotics and think these terms should be dropped far, far away from rediscovery by gullible psychiatrists.⁴ But Leucht & Davis (pp. 269–271) rightly emphasise the variability of antipsychotic drugs and that prescription should follow a ‘shared decision-making process’ with the patient, provided, some would add, that this is an honest and genuine one.⁵ Frighi et al (pp. 289–295) show that in those with intellectual disability, adverse effects are not usually major. My own explanation of this somewhat surprising finding is that because shared decision-making is much more difficult with this group than with those of normal IQ and that a minority of patients is unduly sensitive to these drugs, much lower doses are prescribed than in others and so there are fewer adverse consequences. Suzuki et al (pp. 275–280) confirm my own impressions from clinical practice that if there is no clinical response to an antipsychotic drug fairly soon after prescription (within 6 weeks) then its further prescription should be questioned, and long-term usage regarded as rare. (emphasis mine) here

via The Last Psychiatrist:
The Rise And Fall Of Atypical Antipsychotics [sic]

His point is that the atypicals aren't really better than the typicals (duh.)  Of course he's right, but in being factually accurate he is being deliberately deceitful.  

To be clear: I am obviously aware of the buried data and the obfuscatory shell games of Big Pharma, but the truth of these medications has been available even without resorting to studies no one would have read anyway.  But in order to hide the fact that no one really paid much attention to the actual data that was in front of them (they took the word of the local thought leader and figured that was that) they pretend that the problem is the buried data. (empasis mine) here

photo credit

An eye-opener: from a psychiatrist and a healthy volunteer in study of the effects of 2 psychotropic drugs

A note: the drug lorazepam is referred to as an antipsychotic in the article below; it is a benzodiazepine.

Open Mind 93 September-October 1998
An eye-opener

Psychiatrist Gwen Jones-Evans PARTICIPATED IN A HEALTHY VOLUNTEER STUDY  LOOKING  AT THE EFFECTS  OF THE ANTIPSYCHOTICS  DROPERIDOL  AND LORAZEPAM

Read also "Unravelling Madness" an interview with Richard Bentall, Ph.D. about his experience taking an antipsychotic as a healthy volunteer in a drug study by Chris Barton in the New Zealand Herald.

photo credit

Neurotrauma and Psychological Health Project and Cooperative Studies

Violating the Hippocratic Oath and the Oath to preserve and defend the Constitution.

Broken Warriors

via Stars and Stripes:

Army, VA partner for PTSD drug study

By COURTNEY MABEUS

The Frederick News-Post

Published: July 15, 2012

Studies show the average person with PTSD waits 12 years before being treated. Col. Charles Engel, a Walter Reed National Military Medical Center doctor, said each month 100,000 soldiers are screened for PTSD.

RUSSELL MIDORI/DVIDS

"An Army office at Fort Detrick and a veterans program are teaming up to study drugs that could help treat combat-related post-traumatic stress disorder.


"The U.S. Army Medical Materiel Development Activity's Neurotrauma and Psychological Health Project Management Office has signed an agreement with the Department of Veterans Affairs Cooperative Studies Program that will help guide the studies, which could begin in about a year.


"Clinical studies at locations across the U.S. will take an additional 24 to 36 months to complete, according to Maj. Gary Wynn of USAMMDA, which is based at Fort Detrick.


"We're not just looking to do a study, we're looking to do a program," Wynn said.


"Wynn, a research psychiatrist who also works at Walter Reed National Military Medical Center in Bethesda, is chairing the effort for the Department of Defense.


"The goal is to identify drugs already on the market that may help in treating PTSD and seek U.S. Food and Drug Administration approval for their specific use in treating the disorder, Wynn said. In some cases, health care providers may already be using certain drugs off-label to help, Wynn said, but they are not approved for use.


"Providers have found certain drugs help aspects of (PTSD), but nothing has been studied to the FDA level," Wynn said.


"Only two drugs, paxotene, known as Paxil, and Zoloft, are approved for the treatment of PTSD, Wynn said.


"The disorder's symptoms include flashbacks, loss of sleep and nightmares. Its cause is unknown, according to the National Institutes of Health.


"Studies have shown that 10 to 15 percent of soldiers who deploy in a given year may develop PTSD, Wynn said.


"Researchers are eyeing 10 to 20 drugs that might be helpful for treatment, Wynn said, including Seroquel, an antipsychotic, and Lunesta, which is used to treat insomnia." here

This announcement comes less than three months after the Army Surgeon General and Army Medical Command warned doctors against using psychotropic drugs for PTSD; citing fatal risks and lack of efficacy.

The question is why is the DoD and the Department of Veterans Affairs partnering to study drugs that are known to have fatal risks when it is known the drugs are not effective treatment for PTSD? The answer is given by Major Gary Wynn; a psychiatrist, who reports the purpose of the drug trials will be to, "seek U.S. Food and Drug Administration approval for their specific use in treating" PTSD.  This is not a valid ethical purpose for conducting a drug trial using human subjects. It is what is referred to as a 'seeding trial,' the primary purpose of which is to expand the market for a particular drug; or in this case, multiple drugs.  Why is the US Government planning on conducting and paying for research which is obviously unethical, and plainly nothing more than a part of the pharmaceutical industry's drug marketing strategy?

Why is the DoD and Veterans Affairs not announcing that it is going to make it a priority to fund the type of treatment that has empirical evidence of being effective for treating PTSD?  Apparently, ensuring that the military continues to be a source of revenue long term for the pharmaceutical industry takes precedence over providing effective non-lethal treatment for our troops with Post Traumatic Stress Disorder.

Major Gary Wynn is a psychiatrist and is going to head this project.  Since the drugs are already known to be ineffective, and multiple warnings have been issued cautioning against using them to treat PTSD due to risk of fatality and the drugs inefficacy; it is a violation of the ethical guidelines of the medical profession, to even prescribe them for PTSD. "First, do no harm..." These drug trials are not for the primary benefit of the troops who have PTSD. It is obvious that the preservation and defense of the individual rights; i.e. Constitutional Rights, of the troops who will be used as research fodder in what is clearly Human Experimentation is not even a concern; it's morally reprehensible. 

last month in Navy Times:
DoD cracks down on off-label drug use

"The message from Air Force Lt. Gen. Brooks Bash informed White that U.S. Central Command had decided in March to remove the powerful antipsychotic drug Seroquel from its approved formulary list." here


via Air Force Times: 
Army launches study of PTSD meds

By Patricia Kime - Staff writer
Posted : Tuesday May 8, 2012 16:21:49 EDT

"Military and Veterans Affairs Department physicians often prescribe medication to ease the symptoms of combat-related post-traumatic stress disorder, even though only two antidepressants — Paxil and Zoloft — are approved specifically by the Food and Drug Administration to treat the disorder.

"But little data exists on which “off-label” medications work and which don’t.

"The Army is hoping to change this, launching a major research initiative next year on the effectiveness of commonly prescribed medications for PTSD.

"Speaking at the American Psychiatric Association meeting in Philadelphia on Monday, Army Maj. Gary Wynn of the Walter Reed Army Institute of Research and Col. David Benedik, associate director for the Center for the Study of Traumatic Stress at the Uniformed Services University of the Health Sciences, said the service will start clinical trials next year to evaluate commonly prescribed PTSD medications such as the antidepressant Cymbalta, mirtazapine, prazosin, and atypical antipsychotics like Seroquel." here

via NextGov Broken Warriors April 25, 2012:

ARMY WARNS DOCTORS AGAINST USING CERTAIN DRUGS IN PTSD TREATMENT


"The Army Surgeon General's office is backing away from its long-standing endorsement of prescribing troops multiple highly addictive psychotropic drugs for the treatment of post-traumatic stress disorder and early this month warned regional medical commanders against using tranquilizers such as Xanax and Valium to treat PTSD.

An April 10 policy memo that the Army Medical Command released regarding the diagnosis and treatment of PTSD said a class of drugs known as benzodiazepines, which include Xanax and Valium, could intensify rather than reduce combat stress symptoms and lead to addiction.

The memo, signed by Herbert Coley, civilian chief of staff of the Army Medical Command, also cautioned service clinicians against prescribing second-generation antipsychotic drugs, such as Seroquel and Risperidone, to combat PTSD. The drugs originally were developed to treat severe mental conditions such as schizophrenia and bipolar disorder. The memo questioned the efficacy of this drug class in PTSD treatment and cautioned against their use due to potential long-term health effects, which include heart disorders, muscle spasms and weight gain."  read here

via NextGov Broken Warriors August 2011: 

VA SPENT $717 MILLION ON A DRUG DEEMED AS EFFECTIVE AS A PLACEBO

"Over the past decade, the Veterans Affairs Department spent $717 million for an anti-psychotic drug to treat post-traumatic stress disorder that a recent study shows is no more effective than a placebo."

"While the paper on risperidone published earlier this month reported the results of the first large trial measuring the effectiveness of second-generation anti-psychotics in the treatment of PTSD, previous research found little evidence the drugs were effective and VA's own clinical practice guidelines, first published in 2004, when the department spent $66 million on risperidone and $56 million on Seroquel, warned against using the drugs to treat PTSD." here


In 2011 it was announced that Venlafaxine became a "First- Line Treatment" for PTSD even though it is not FDA approved to treat PTSD.

via Clinical Psychiatry News 3-11-11
Venlafaxine Becomes First-Line PTSD Therapy in Latest VA Guidelines


"The new Veterans Affairs/Department of Defense (VA/DoD) evidence-based guidelines strongly recommend that all adults with PTSD be offered pharmacotherapy with a first-line agent. That means either an SSRI, for which the strongest evidence of benefit exists for sertraline, paroxetine, and fluoxetine, or a serotonin norepinephrine reuptake inhibitor (SNRI), among which venlafaxine has the strongest supporting evidence, said Dr. Villarreal, a psychiatrist at the University of New Mexico, Albuquerque, and the New Mexico VA Health Care System." here

The Entire Broken Warriors Series from NextGov

Soldiers who have committed suicide / homicide while on psychiatric drugs