Scientific American - The Hidden Harm of Antidepressants - Feb 2016

http://www.scientificamerican.com/article/the-hidden-harm-of-antidepressants/

From 1boringoldman, Dr. Mickey Nardo's blog on this article:

"My post-retirement involvement in the business of psychiatric medications came as a surprise to my colleagues [and to me]. I practiced and taught another brand of psychiatry, and so they often ask "What got you into this?" I know some of the answer and have talked about it probably more necessary, but I haven’t mentioned the most important thing – disillusionment. One can make the case that human psychological development is a story of illusion/disillusionment cycles from beginning to end. The devoted mother of early life is replaced by the same mother encouraging self sufficiency. A solid principle of effective parenting is allowing illusion, then shepherding a disillusionment at the rate a child can both tolerate and even appreciate. And good doctoring is sometimes helping a person find a decent life as a chronically ill person when the illness is one that’s come to stay — in spite of the accompanying disillusionment. But while it’s interesting to reflect on the topic from an armchair, actually living with it isn’t so easy.

I was a late comer to what this Scientific American article is about, in my later sixties, retired from a psychotherapy practice that had been more out of the mainstream than I knew at the time. In retirement, I had started volunteering in some general clinics and was struck with a couple of things. First, the patients were almost universally taking a lot of medications in odd combinations unfamiliar to me. But even more striking, they came with expectations from the medications that were well beyond any possibilities I knew. To borrow a book title, I felt like a stranger in a strange land. About that time, I read in the New York Times that the chairman of the department I had been affiliated with for over thirty years was under investigation for unreported income from pharmaceutical companies [Top Psychiatrist Didn’t Report Drug Makers’ Pay]. And somewhere in there, I had prescribed an SSRI to a 17 year old young man who became confused, agitated, and suicidal within days – all thankfully clearing as fast as they came when the medication was discontinued. At the time, I didn’t know that could happen.

I’m surprised at how much the disillusionment I felt affected me. I had experienced my share of such things before, but this one was different. Reading back over the blogs I’ve written since then, I’ve bounced from place to place in how I understood [or didn’t understand] it all. I was lucky. I had a strong hard science background from a former career and could look into the science involved. And I’ve met a number of like minded people along the way who brought a wealth of experience and wisdom my way – helping me answer questions I didn’t even know were there to be asked. But there were two concrete experiences that helped me with my own uncomfortable disillusionment. The first was going to the Allen Jones TMAP Trial in Austin in January 2012 where I watched any number of regular people caught up in some little piece of the drama without allowing themselves to see the whole picture. The second was being involved in the research for one of those articles up there and seeing the details – another example of people neither stepping back far enough to see the big picture nor getting close enough to see what they were involved in. In both instances the main problems were at the top, and had to do with unnecessary secrecy.

Medical advances have often been accompanied by high hopes and enthusiasm [illusion] followed by the more accurate reality that comes with clinical experience [dis·illusionment]. This sequence has been eroded at both ends. The Clinical Trials that are meant to be a simplistic starting place have been jury-rigged and given an undeserved enduring authority. Meanwhile, academic medical departments and journals have not only become engaged in the hype, but have also failed in their traditional role as watchdogs and skeptics. In the process, the appropriate disillusionment that comes with clinical experience with medications is being replaced with a disillusionment with medicine itself – an unacceptable trade-off.

I’m less disillusioned [and less naive] than I once was. I guess I had assumed that the ethics of medicine would protect us from all of this and I was bitter that it didn’t. I don’t have any global solutions, but I do feel a resolve to stay wide awake and stop counting on the inertia of medical tradition to keep us on the right path. And all I really know is that the forces inside and outside of medicine that have lead us here lose their power when they see the light of day in articles like this…"

http://1boringoldman.com

Great blog, btw.

Ali