Blog des AK Psychiatriekritik der NFJ Berlin

Monat: Oktober, 2012

Hooked on happy pills for 30 years

by dailymail

When Caroline Ashrafi stopped taking the drugs, she was totally unprepared for the debilitating withdrawal symptoms that followed — from crippling stomach pains and crushing headaches to dizzy spells that left her unable to drive.

But Caroline wasn’t coming down from anything illegal. The 49-year-old tax manager from Market Harborough, Leicestershire, was being weaned off something far more prevalent among middle-class women — antidepressants.

Only now, eight years later — and an astonishing 30 years after she was first put on antidepressants — she has finally stopped taking them altogether.

Long-term pain: Caroline, left, and Lynda have taken antidepressants for years
Long-term pain: Caroline, left, and Lynda have taken antidepressants for years

Long-term pain: Caroline, left, and Lynda have taken antidepressants for years

While it is shocking that a woman can spend decades on medication, Caroline’s experience is far from unusual.

This year, it emerged that a record number of adults rely on antidepressants. NHS figures revealed that almost 47 million prescriptions for the drugs were handed out last year — a 9 per cent increase on the previous 12 months.


And it’s women, in particular, who are caught up in the antidepressant epidemic: recent research reveals one in three takes the medication at some point in their lives. For men, it’s one in ten.

Women are twice as likely to be diagnosed with depression as they were 40 years ago, and the rise has been put down by some experts to the increased pressures of modern life, particularly on those juggling motherhood and work in an increasingly harsh financial climate.

But others believe an alarming number of women are being placed long-term on powerful antidepressants when their emotional distress could be dealt with by talking through their problems with a professional or adapting their lifestyles.

And there are also those who say many are simply misdiagnosed. ‘Depression has become an umbrella word for all kinds of ills,’ says Mandy Saligari, clinical director of Charter Day Care, which treats people with depression and addictions.

‚Antidepressants enable you to cope and get on with life, but they don’t tackle the cause‘

‘Clinical depression must be medicated, but only around a quarter of people who say they’re depressed actually are.’

As a result, it’s feared thousands of women are finding themselves pulled into a never-ending — and unnecessary — cycle of antidepressant dependence.

According to a study by women’s campaign group Platform 51, nearly half of those using antidepressants have taken them for at least five years, while a quarter have used them for ten years or more.

Rebecca Gill, of Platform 51, says: ‘These shocking figures reveal an escalating crisis in use of antidepressants.

‘We know from working with women and girls in our centres that drugs have a role to play, but they are too readily prescribed as the first and only remedy.’

When Caroline was prescribed antidepressants at 17, she never expected still to be taking them 30 years later. She had gone to her doctor when she began experiencing devastating bouts of bleakness. As her mother had struggled with depression, she knew the signs.

‘Unlike many teenagers, I’d never had mood swings and was happy and sporty, but suddenly had crushing lows,’ says Caroline. ‘One minute I’d be hyperactive, the next flat on my back, exhausted, tearful, irritable and unable to get out of bed or talk to people.

‘My GP discussed my symptoms and family history before prescribing antidepressants. I stuck with it, even though they made me feel detached from reality and I suffered terrible dizziness.’

Caroline was still taking antidepressants a year later when she started a sports science degree.
After graduating, she was on and off antidepressants for the next six years, during which time she trained to become an accountant and met her first husband.

Desperate for an alternative: Brooke Christian has been on happy pills for seven yearsDesperate for an alternative: Brooke Christian has been on happy pills for seven years

Then, in 1991, after starting a new job, Caroline once again found her mood plummeting, so her GP changed her medication, putting  her on Prozac.

‘I took it for the next six years, on repeat prescription, but had assessments by my GP every three months,’ she says. ‘It suited me and stabilised my mood, which enabled me to lead a normal life. I married and had my son William, who is now 17.’

But when reports — later disproved — suggested Prozac might trigger violent behaviour, Caroline’s doctor swapped her medication for Seroxat.

That change was trouble-free, unlike when she came off Seroxat in 2003, after research suggested it increased suicidal tendencies, and once again found herself taking Prozac.

‘During the eight weeks I was weaned off Seroxat, I suffered dreadful stomach pains, crushing headaches and dizzy spells so severe I was unable to drive or go to work,’ she says.

While antidepressants aren’t clinically addictive, many experts believe they can cause dependence.

This is partly because taking them reinforces the idea that a person can’t cope without them, and also because of the severe withdrawal symptoms many suffer when coming off certain types of the drugs.

‘You get dependent on them physically because you are putting chemicals into your body,’ says Caroline. ‘Then you get used to them psychologically, because you can’t imagine coping without them.’

Her GP eventually referred her for cognitive behavioural therapy — a talking therapy that teaches you to challenge your thought processes — which she found effective.

But while she started sessions on the NHS, she was only able to access the extensive CBT counselling she needed because she had private health insurance.

Finally, last December, she felt ready to stop taking medication. While her first marriage broke up in 2002 (not due to her depression), Caroline says her second husband Feri, 56, is very understanding.

And she believes CBT techniques and a strong support network have contributed to a successful transition to a pill-free life. It’s been a long journey, and while it’s not one Caroline regrets — ‘I am still here, and I can’t fault my GP’ — she is scathing about the way antidepressants are seemingly handed out so freely.

As someone who has close links with mental health charities Rethink and Depression Alliance, she hears the experiences of many others.

‘Antidepressants enable you to cope and get on with life, but they don’t tackle the cause,’ she says.
‘Too many doctors hand them out without proper assessment. Mental illness is complex, but GPs often don’t have proper training.

‚These drugs just numb me. I’d give anything to feel like myself again‘

‘People get into a spiral where they can’t help themselves. You need to take responsibility for your own depression, but if you are given antidepressants and sent away, that’s never going to happen.
‘You need so many other tools, such as talking therapies and being part of a network of those who have had depression, because learning that it is possible to get better is also very powerful.

‘As my psychologist says, the best way to conquer depression is how you live your life. So far, my mood is stable and positive and, while I have good days and bad days, this is no different from everyone else.’

Caroline has come off medication, but full-time mother-of-two Brooke Christian is desperate to finish with the antidepressants she’s been taking for seven years.

‘Over the years, I’ve tried so many drugs — at least five.I feel like a guinea pig,’ she says. ‘I know all I’m doing by taking antidepressants is putting a sticking plaster over a wound that needs to be given a proper chance to heal.’

Given her medical history, there are few who would deny medication has, at some points, been the most appropriate course for Brooke, who lives with her fiancé Jonathan in Bolton.
She began taking antidepressants in her late teens, when she felt suicidal after the birth of her daughter, Isabel.

‘I wasn’t eating and couldn’t stop crying. I went to the doctor and was immediately prescribed an antidepressant called Citalopram,’ she says. ‘I needed help so I tried the pills, only to find that after two months my symptoms were worse and I felt suicidal again.’

Some in the medical community feel this is just one of the drawbacks of antidepressants: they drive as many people to suicide as away from it.

Withdrawal symptoms: Many people struggle when they try to wean themselves off the drugs (posed by model)Withdrawal symptoms: Many people struggle when they try to wean themselves off the drugs (posed by model)

When Brooke, now 25, explained how desperate she was feeling, her GP changed her prescription. But since then Brooke — mum to Isabel, seven, and Zoe, two — has been reliant on one antidepressant or another.

‘I’ve tried to come off the drugs many times,’ she says. ‘When I was pregnant with Zoe, I stayed off them because I didn’t want to drug my unborn baby — but once she was born, my mood dipped and I was prescribed more drugs. I’m constantly going back and forth to the doctors, who seem keen to try different medications when what I’ve wanted all along is some therapy to get me off these drugs.’

There is evidence that one-to-one therapy or group sessions can be just as effective as drugs — and far less expensive. It’s something Brooke feels would help her condition, but she says waiting times are too long and what’s on offer is insufficient.

‘I was constantly fobbed off by doctors telling me about 18-month waiting lists and the cost,’ says Brooke.

‘Finally, a few months ago, I got some therapy on the NHS and felt it was really starting to help, but they will fund only 12 sessions, which barely touches the surface. I’m not in a position to pay for it privately.’

Brooke has also suffered the complete suppression of any mood.

‘These drugs just numb me. I’d give anything to feel like myself again,’ she says. ‘I’ve put on a stone and a half, suffer from a fast heartbeat, confusion, forgetfulness and loss of libido. I’m lucky, because my partner has been so supportive and loving.’

Lynda Hamilton has also suffered unpleasant side-effects. The 34-year-old company director from Fife has been on antidepressants for the past four years, and while she admits they transformed her life when they were first prescribed, she doesn’t want to be on them for the rest of her life.

‘I worry I’m reliant on medication as my body doesn’t seem to function properly without it,’ she says.

‘I can’t remember what is normal any more. And though weight gain isn’t listed as one of the side-effects of this drug, I’ve gone from a size eight to a size 16 and I’m convinced that’s not all down to diet.’

Lynda says she first experienced the symptoms of depression after the birth of her eldest daughter, Hannah, now 13.

‚I forgot to take them on holiday once. I was a wreck‘

Her doctor prescribed Prozac, but put off by stories of people feeling emotionally numb on the drug, she resisted taking it.

After taking a supplement from a health food shop, and getting more independence as her daughter grew older, she found her symptoms dissipated. But then she got post-natal depression after the birth of her daughter Jessica five years ago.

‘I didn’t want to get out of bed, and felt ugly and insecure,’ Lynda recalls. ‘My GP immediately prescribed Citalopram. It felt as if as soon as I walked through the door he was writing the prescription. Nothing else was offered to me such as therapy. I felt I was just another statistic, not an individual.

‘It makes me wonder whether I’d still be taking drugs if I’d been offered a talking therapy, but I was put on repeat prescription and haven’t been offered a review since.’

Lynda adds: ‘Maybe it was mind over matter, but within hours of taking the first pill I felt a sense of euphoria I’d not felt in ages.’

But recent Australian research suggests antidepressants often have nothing more than a placebo effect. People feel better because they are told the drugs will make them less depressed. Some argue the theory works in  reverse: people revert to depression when they come off drugs because they no longer have this crutch.

Lynda doesn’t want to remain on drugs, but admits she fears what might happen if she does stop them.

‘I forgot to take them on holiday once. I was a wreck,’ she says. ‘I’ve managed to reduce my dose so I take my pills every two days, but I’m scared to reduce it further.’

One can only hope that, like Caroline, Lynda and Brooke manage to find a strategy that works for them.

Because while a growing body of evidence suggests antidepressants are not the miracle drugs they were once thought to be, it seems more women than ever now find themselves trapped in a cycle of pill-popping that can be dauntingly hard to escape.



Genetic Predictors of Response to Serotonergic and Noradrenergic Antidepressants in Major Depressive Disorder: A Genome-Wide Analysis of Individual-Level Data and a Meta-Analysis

by PLOS Medicine



It has been suggested that outcomes of antidepressant treatment for major depressive disorder could be significantly improved if treatment choice is informed by genetic data. This study aims to test the hypothesis that common genetic variants can predict response to antidepressants in a clinically meaningful way.

Methods and Findings

The NEWMEDS consortium, an academia–industry partnership, assembled a database of over 2,000 European-ancestry individuals with major depressive disorder, prospectively measured treatment outcomes with serotonin reuptake inhibiting or noradrenaline reuptake inhibiting antidepressants and available genetic samples from five studies (three randomized controlled trials, one part-randomized controlled trial, and one treatment cohort study). After quality control, a dataset of 1,790 individuals with high-quality genome-wide genotyping provided adequate power to test the hypotheses that antidepressant response or a clinically significant differential response to the two classes of antidepressants could be predicted from a single common genetic polymorphism. None of the more than half million genetic markers significantly predicted response to antidepressants overall, serotonin reuptake inhibitors, or noradrenaline reuptake inhibitors, or differential response to the two types of antidepressants (genome-wide significance p<5×10−8). No biological pathways were significantly overrepresented in the results. No significant associations (genome-wide significance p<5×10−8) were detected in a meta-analysis of NEWMEDS and another large sample (STAR*D), with 2,897 individuals in total. Polygenic scoring found no convergence among multiple associations in NEWMEDS and STAR*D.


No single common genetic variant was associated with antidepressant response at a clinically relevant level in a European-ancestry cohort. Effects specific to particular antidepressant drugs could not be investigated in the current study.

Full Article

A willfully maintained ignorance of the reality of antipsychotic withdrawal syndrome

by ALT_Mentalities

SCIENCE. (Read that with a deep, booming, authoritative voice)

SCIENCE has achieved an exalted level of infallibility in our society. Start a sentence with “researchers say…” and you’ll not be questioned.  We mortals can only look to our pantheon of data collectors with wonder and awe. We dare not question their pronouncements, percentages.

“Blessed are the 64.3% of all statistics that are made up on the spot, for they shall make your argument mighty.”

Here’s the thing about SCIENCE as a new religion: the way it’s framed, there’s no faith involved. You’re not asked to believe anything. Instead, you’re given data, objective facts, supposedly THE TRUTH as derived through the scientific process. Either you accept the truth, or you deny it. But you can’t argue with it; the facts don’t lie, do they?

The Facts Don’t Lie; Researchers Do

Lie.  That’s an inflammatory word, not to be used lightly. It means willful deceit.

But what do we call deceit achieved by willfully maintained ignorance? Is that a lie?

Whatever it’s called, that’s what I witnessed time and time again during my employment with the Research Scientists of Children’s Mental Health: careful avoidance of any idea that challenged their painfully constructed, government-funded, biopsychiatric house of cards. And it’s what I saw this morning, staring up at me from a press release about a new study in the New England Journal of Medicine.

HEADLINE: Some with Alzheimer’s better off staying on antipsychotics (study)

Essentially, the study found that abrupt discontinuation of Risperdal doubled the risk of “relapse” (defined as a return of psychotic/aggressive symptoms), when compared to continuation of Risperdal. In the “Conclusions” section, the authors write:

In patients with Alzheimer’s disease who had psychosis or agitation that had responded to risperidone therapy for 4 to 8 months, discontinuation of risperidone was associated with an increased risk of relapse.

Sounds like they just demonstrated that going off antipsychotics can lead to withdrawal symptoms.

But here’s how principal investigator Dr. D.P.Devanand, who currently has disclosed financial ties to Janssen (makers of Risperdal), Novartis, and Eli Lilly (makers of Zyprexa), interpreted this data:

Caregivers should be aware of the increased mortality associated with these medications in people with dementia… [However] if a patient is taking an antipsychotic and doing reasonably well without any major side effects, they should stay on it.

– D.P. Devanand, principal investigator

Caregivers SHOULD be aware of the increased mortality associated with antipsychotics and dementia patients.  A black box warning issued by the FDA for antipsychotics risperidone, olanzapine, and aripirazole reads (in part) “Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo… These drugs are not approved for the treatment of patients with dementia-related psychosis.”

Caregivers should ALSO be aware of a long and scandalously illegal history of off-label promotion of these drugs to treat dementia when they were not and are not approved for this purpose. Fines for dementia-related off-label marketing prosecuted under the False Claims Act alone have totaled almost $2 billion. And who can forget Lilly’s clever sales pitch for the use of Zyprexa in nursing homes, “5 at 5”?

Lilly even devised a LTC sales slogan used nationwide – ’5 at 5 pm,’ which was shorthand for dosing elderly [nursing home] patients with 5 milligrams of Zyprexa at 5 pm to keep patients calm throughout the night… It’s particularly disturbing that such a potent drug, with so many serious adverse side effects, was so blatantly abused in a vulnerable patient population whose health is already at risk. [A]t many nursing homes this potent antipsychotic was essentially used as a ‘chemical restraint’ for the elderly for whom Zyprexa had no other health benefit.

-Brian Kenney, attorney for the plaintiffs in Zyprexa whistleblower suit resulting in a $1.415 billion fine for off-label marketing

ONE MORE THING caregivers should be aware of that Devanand et al. neglected to mention:

Antipsychotic Discontinuation Syndrome (IE, withdrawal)

When a person whose brain is accustomed to the presence of an antipsychotic agent abruptly stops ingesting that agent, discontinuation syndrome (withdrawal) is a very likely result. The brain attempts to maintain normal dopaminergic function in the presence of a dopamine-suppressing chemical (antipsychotic) – it does this by significantly enhancing dopaminergic activity.  When the chemical is removed from the equation, there is no longer a counterbalance for the dopamine-enhancing adjustment built up over time in the brain. This is the probable cause of antipsychotic withdrawal symptoms, which can include both psychosis and aggression.

Even in the case of gradual discontinuation of the drug, withdrawal may occur – but take it away abruptly, and you’re essentially guaranteed a display of withdrawal symptoms in a significant portion of the study population.

So Devanand’s study really isn’t all that newsworthy. His data plainly shows that stopping the use of antipsychotics can cause a withdrawal reaction, which is what the FDA-approved label essentially already says – “To prevent serious side effects [read: withdrawal], do not stop taking ZYPREXA suddenly.” And a 2006 literature review summing up many antipsychotic discontinuation studies shows the same thing:

There is evidence to suggest that the process of discontinuation of some antipsychotic drugs may precipitate the new onset or relapse of psychotic episodes. Whereas psychotic deterioration following withdrawal of antipsychotic drugs has traditionally been taken as evidence of the chronicity of the underlying condition, this evidence suggests that some recurrent episodes of psychosis may be iatrogenic.

– Joanna Moncrieff, in “Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse

Here’s the ground-breaking bit: Devanand and co-authors chose not to describe what they observed during the course of the study as “withdrawal” – that word is studiously avoided in the press release and abstract.* Rather, here’s how the results are characterized: the risk of “relapse” should antipsychotic medication be abruptly discontinued is evidence of the need for elderly patients to keep taking their Risperdal.

A classic case of willfully maintained ignorance.

Is it possible that Devanand and co-authors are ignorant of the concept of “withdrawal,” its causes, its symptomatology? Is it possible that they haven’t read the FDA-approved label for Risperdal, haven’t familiarized themselves with the scientific literature surrounding the discontinuation of antipsychotics, and are therefore innocent in their public charactarization of the results of their study as “relapse” best treated with continued use of Risperdal? Yes, it’s possible. It’s even likely that these authors averted their eyes from a mere glimpse of any such information, given the strong financial incentives and conflicts of interest disclosed in conjunction with the publication of this article.

But that’s a shaky foundation to build your innocence on.

The foolish man builds his house upon the sand; the wise man builds his house upon a rock.

* I’d like to tell you the word “withdrawal” is entirely absent from the article itself (and I highly suspect it is!) but, even though this is a publicly funded National Institutes of Health study, the article is not freely available to the funders (we, the people) and I have been thwarted in my attempts to obtain it. Big bonus points if you send it to me.

Madness Radio: Madness and Renewal Michael Cornwall

What if people struggling with madness could explore their emotions in a supportive sanctuary? Do frightening ‚psychotic‘ experiences also have the power to transform and heal? Is breakdown also breakthrough? Michael Cornwall became a therapist after surviving his own crisis — without medication or psychiatric treatment. For more than 30 years he has worked in the tradition of Carl Jung and R.D. Laing to support people to go through psychotic
states in medication-free community settings, including
John Weir Perry’s Diabasis House in the 1970s.……


New psychiatric drugs low priority for pharmaceutical firms


The pharmaceutical industry has largely abandoned drug development for mental illnesses even though depression is a leading cause of disability, experts say.

Authors of papers published in this week’s issue of the journal Science Translational Medicine argue that drug discovery for treating psychiatric disorders such as autism, schizophrenia, bipolar disorder and depression are at a near standstill.

„Antipsychotics and antidepressants have been some of the most profitable agents for companies over the last two decades,“ said Dr. Thomas Insel, director of the U.S. National Institute of Mental Health and one of the authors.

„But that doesn’t mean they’re effective. What it means is that they sell and they can be marketed.“

Sales of antipsychotics and antidepressants reached $25 billion in the U.S. in 2011, Dr. Thomas Insel says.

Sales of antipsychotics and antidepressants reached $25 billion in the U.S. in 2011, Dr. Thomas Insel says. (Dennis Cook/Associated Press)

In the last five decades, more than 20 antipsychotics and 30 antidepressants have been marketed with over $25 billion in sales in the U.S. in 2011 alone, Insel said.

The drugs are descended from serendipitous discoveries such as the mood stabilizing effects of lithium in 1949, said Steven Hyman of Harvard University in Cambridge, Mass., and the author of the second paper.

„The central problem is clear: Neither vast unmet medical need, nor large and growing markets, nor concerted sales campaigns that attempt to recast ‚me-too drugs‘ as innovative can illuminate a path across very difficult scientific terrain,“ Hyman wrote.

„Advances continue to be made in modes of cognitive psychotherapy and device-based psychiatric treatments; but despite the growing market opportunities, major pharmaceutical companies recently announced substantial cutbacks or complete discontinuation of efforts to discover new drugs for psychiatric disorders.“

There are no drugs to target the main symptoms of autism such as social deficits and language disorder, Insel said. Those deficits often respond well to intensive behavioural treatments, which suggests there’s potential for a pharmacological approach.

Antidepressants available today are modestly effective after six weeks of treatment in randomized clinical trials — a long time to wait for a disorder with such a high burden, he added.

Drug needs unmet

„We absolutely need better drugs,“ agreed Zul Merali, a neuroscientist and head of the University of Ottawa Institute of Mental Health Research. „Unfortunately right now, the first line of treatment when the patients get treated, only about a third of the patients respond really well. The other third show you a mild symptom relief, which really is not much to speak about. And the last third will not respond no matter what you do.“

In the cancer field, diagnosis is shifting from being based on clinical symptoms and where it occurs in the body to the DNA signature of the tumour. But the basic biological underpinnings in the brain behind mental illness are poorly understood, Insel said.

Partly that’s because the brain isn’t as accessible as other organs to study. Other complex diseases such as cancer are often treated with combinations of therapies, but most psychiatric patients receive multiple drugs with little scientific evidence guiding their use, Insel said.

‚Unfortunately a lot of these companies are abandoning neuroscience because it’s becoming more and more expensive to develop new drugs.‘— Dr. Pierre Blier

Rx & D, the group that represents the brand-name pharmaceutical industry in Canada, told CBC News it’s not in a position to comment on specific therapeutic areas.

Merali’s colleague, Dr. Pierre Blier, a professor in the department of psychiatry at the University of Ottawa and Canada Research Chair in psychopharmacology, is researching the use of new drugs to help people with depression who don’t respond to current medications.

„Unfortunately, a lot of the large pharma have dropped out of research, have actually closed down their research centres,“ said Blier, a psychiatrist at Royal Ottawa Hospital.

„Unfortunately a lot of these companies are abandoning neuroscience because it’s becoming more and more expensive to develop new drugs.“

Antidepressant medications didn't work for Mandi Luis-Buckner, who says the drugs act like a mask.

Antidepressant medications didn’t work for Mandi Luis-Buckner, who says the drugs act like a mask. (CBC)

Blier said mental health has never received the attention or funding as some other medical problems, likely because of the stigma associated with psychiatric illnesses.

Antidepressants made Mandi Luis-Buckner feel like a „walking zombie.“ After a 27-year career in the financial industry, she was out of work for five years as she began her recovery. Luis-Buckner now works as a return-to-work coach at Sheridan College in Oakville, Ont.

„In my own experience and the experience of people I hear, medication, it’s like a mask,“ she said. „It doesn’t really uncover what’s really going on inside. There’s a lot underneath.“

Luis-Buckner said she was sad to hear the pharmaceutical industry is retreating from antidepressants but added that perhaps they’ve realized the impact of current drugs.

Meanwhile, the public sector is funding research. Merali said the federal government’s last budget included a $5-million investment to create a national network for depression research and intervention, which he heads.