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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by detroitpistons on February 10, 2006, at 13:39:25
I just wanted to share this article about the role of medications in treating mental illness, and the trends associated with the rise of psychopharmacology.
http://www.altuit.com/webs/TruthTrustConsent/JNF/BobW_x.htm
I think this is fascinating and it just confirms my suspicions after having been diagnosed bipolar II.
Posted by linkadge on February 10, 2006, at 14:13:15
In reply to The dramatic rise of mental illness, posted by detroitpistons on February 10, 2006, at 13:39:25
Its true.
Linkadge
Posted by detroitpistons on February 10, 2006, at 14:23:40
In reply to Re: The dramatic rise of mental illness, posted by linkadge on February 10, 2006, at 14:13:15
I should have just gone to psychotherapy from the start...Now I'm in this mess.
> Its true.
>
> Linkadge
Posted by bipolarspectrum on February 10, 2006, at 15:36:59
In reply to Re: The dramatic rise of mental illness » linkadge, posted by detroitpistons on February 10, 2006, at 14:23:40
I think this has to be taken with a grain of salt... I think there could be other reasons for an increase in mental illness... 1. A greater openness to discuss and receive treatment.. and 2. which i think is big, that people who would normally have committed suicide (especially bipolars), are living fruitful lives due to proper medication and procreating.. hence, increasing the number of individuals with the genetic inclinations to mental illness...
just some thoughts...
bps
Posted by detroitpistons on February 10, 2006, at 15:52:42
In reply to Re: The dramatic rise of mental illness, posted by bipolarspectrum on February 10, 2006, at 15:36:59
BPS,
You make very good points. I have also thought about the factors that you mentioned. However, I think the article is intriguing because it shows a direct correlation (via different studies cited) between treatment with meds and worsening of disorders.
It's a tricky situation because some people simply need to be medicated in order to survive and/or to function even minimally. There is mental pain and anguish that simply cannot be tolerated without meds, regardless of the quality and frequency of psychotherapy. I have often felt this way myself. I just think it's interesting to note some of the points stated in the article.
I believe this is a healthy debate within the psychiatric community that will hopefully yield some fruitful conclusions.
> I think this has to be taken with a grain of salt... I think there could be other reasons for an increase in mental illness... 1. A greater openness to discuss and receive treatment.. and 2. which i think is big, that people who would normally have committed suicide (especially bipolars), are living fruitful lives due to proper medication and procreating.. hence, increasing the number of individuals with the genetic inclinations to mental illness...
> just some thoughts...
> bps
Posted by linkadge on February 10, 2006, at 16:27:40
In reply to Re: The dramatic rise of mental illness » linkadge, posted by detroitpistons on February 10, 2006, at 14:23:40
I know what it is trying to say. There will, of course, be many people who would oppose that sort of thinking, but I cannot because all I have seen is the destructive effects of taking psychiatric medications long term.
They dammaged my health, my cognition, etc. I have many aunts and uncles who have dealth with derepression, some have medication others have not. The ones who did not medicated got better, and the difference is like night and day. No weight gain, no cognative impariment, no movement problems, no thyroid stuff, the list goes on.
I'd like to say I know people who take these drugs and then their lives get better from that point on, but I *honestly* just don't know any.
I also urge people to follow others long term. What I mean is this. Sure you'll hear of so-and-so who feels great on such-and-such, but follow them long term. My mother would praise the drugs for one period in her life, but they took their toll. Very slowly.
Linkadge
Posted by linkadge on February 10, 2006, at 16:30:27
In reply to Re: The dramatic rise of mental illness » bipolarspectrum, posted by detroitpistons on February 10, 2006, at 15:52:42
The rates of suicide do not show any clear reduction as a result of the use of psychiatric drugs, and of course, there is recent debate as to whether they infact do the opposite.
Linkadge
Posted by bipolarspectrum on February 10, 2006, at 16:33:46
In reply to Re: The dramatic rise of mental illness, posted by linkadge on February 10, 2006, at 16:27:40
I personally think that it is possible that the population is over medicated... However, I believe that meds are still necessary... I for instance, could not exist without meds... Its that simple for me personally... Your argument link about comparing those with depression who are medicated and non-medicated is not a simple comparision... often times the severity of the illness forces people to medicate.. so your comparision between the two groups is not necessarily fair because the 'medicated' group may suffer from a much more significiant illness... and with a more significant illness the probability of comorbid problems, like the ones you mentioned, rises...just some more thoughts... as u can tell, im a med fan... without lithium i would have committed suicide a long time ago..
bps
Posted by forgetful mary on February 10, 2006, at 17:39:50
In reply to Re: The dramatic rise of mental illness, posted by bipolarspectrum on February 10, 2006, at 16:33:46
I've been noticing a growing increase for years. Personally I always felt it was due to 3 reasons:
1. Nutrition-lousy in developed countries.
2. Chemicals- In food, atmosphere etc...
3. Fast paced lives- no time for recovery-need a quick fix!Oh and I'll add another one...alcohol no longer 'approved' as a coping mechanism for people...now a disease!!!
20 years ago my sister said to me ...you think everyone should be on Prozac!!
Today I say to her "Guess what everyone "is" on something now!"
Posted by linkadge on February 10, 2006, at 19:21:27
In reply to Re: The dramatic rise of mental illness, posted by forgetful mary on February 10, 2006, at 17:39:50
You are right, everbody is on somthing.
We use the excuse that this is a board of treatement resistant patients, and our experiences are by no means indicitive of the population at large. I would argue that our experiences are *very* indicitive of the effects in the population at large.
We're just a group that is computer literate.
Linkadge
Posted by Phillipa on February 10, 2006, at 20:33:42
In reply to Re: The dramatic rise of mental illness, posted by linkadge on February 10, 2006, at 19:21:27
Good point link as I was on benzos for over 30years and the minute I added an SSRI everything went from good to bad and I haven't worked since. Fondly, Phillipa ps I've even cut back on the valium as it is a depressant. I'm starting to substiture supplements for the AD's.
Posted by Schess81 on February 10, 2006, at 22:38:39
In reply to The dramatic rise of mental illness, posted by detroitpistons on February 10, 2006, at 13:39:25
A scary, but very convincing paradigm of drugs and mental illness. Unfortunatly the article doesn't propose any solutions- but that's the harsh reality; we don't really know enough about the brain at present to cure these disorders. I fear that as long as we stick to the neurotransmitter theories, no dramatic improvements in the treatment of mental illness will ever occur.
Posted by yxibow on February 11, 2006, at 7:45:32
In reply to The dramatic rise of mental illness, posted by detroitpistons on February 10, 2006, at 13:39:25
> I just wanted to share this article about the role of medications in treating mental illness, and the trends associated with the rise of psychopharmacology.
>
> http://www.altuit.com/webs/TruthTrustConsent/JNF/BobW_x.htm
>
> I think this is fascinating and it just confirms my suspicions after having been diagnosed bipolar II.
Well I'll get snapped at but this article smells of the Quack word. Quotes from Healy and Breggin....What has really happened is that between early psychiatry in the 50s and the present, greater knowledge and ability to treat people has happened. I'm not saying that GPs should be handing out happy pills left and right -- in fact, I dont think GPs should be treating psychiatric disorders unless they've been taking CE courses, especially on P450 interactions. Psychiatrists and Psychopharmacologists should be treating patients. But there are costs involved of course.
When the aunt with BP2 I never knew took her life with a gun in 1971? Somewhere around then, the only real medications around were Lithium and possibly Elavil may have just come in, I dont know. But that was just early days. We have come so far in treatment of psychiatric patients, and not just psychiatry, but medicine in general, that we are entering in the 21st century, politics willing, a phase of genetically tailored medication. Roche has introduced the AmpliChip, which tests people's responses to the P450 system. It hasn't yet won the approval of all insurance, but some day it will.
My point is that, we have had "crazy people" since the dawn of time. But they were ostracized out of the general population, given all sorts of strange medieval interventions, religions incantations, etc. People "got through" life, but that debates the question.. what is a life worth living to "get through it." If you're religious, you may have your own explanation. I'm agnostic, so don't fault me for it. But only over recent time has the very brain images of patients even been discovered. I was very fortunate to meet the team of people who discovered PET scans of OCD and control patients. Stunning.
Medications, like all 19th, 20th, and 21st century tools became more honed, and less harsh, as we transcended from TCA through to the SSRI era. Now we are upon the SNRI/SSNRI era and there is more yet to come.
If you live in a big city like a certain one on the west coast that I might happen to inhabit, you'll notice people on the freeway ramps with their signs and change boxes. In the 1960s, funding failed and early antipsychotics emptied out the mental hospitals at the time which were extremely crude by todays standards. Today the sunny shores of Santa Monica are faced with one of the toughest homeless issues outside of Berkeley.
But if tougher depot compliance with antipsychotics were able to control the roughly 1-2% of the population who have severe Schizophreniform disorders, things might be completely different. Patients might actually willingly go into the VA for continued treatment.
But I stray. My point is, we're arguing chicken and eggs. The chicken has always been around, and he's been laying eggs. Some of the chickens never layed the best eggs. But now we have the tools available to help those chickens lay the best eggs. Are there miracle cures. No. But will those chickens live better, more productive lives. Absolutely without a doubt. There will be mishaps along the way. But at the end of the day, the eggs will be layed, and society will function in a better fashion than it ever had before. Millions of "sick days" lost in industry because people were too afraid to tell the truth about themselves would vanish if the stigma of mental -- biochemical illness was lost.
Anyhow its getting late and I'm starting to talk about chickens. :)
Something to ponder about.
To Torino !
Tidings
-- Jay
Posted by linkadge on February 11, 2006, at 8:44:31
In reply to Re: The dramatic rise of mental illness » detroitpistons, posted by yxibow on February 11, 2006, at 7:45:32
The problem as I see it is this devide that we create. Doctors and patients don't see any inbetween. We take black and white stances on the safety and efficacy of these meds. Drugs are either miracles, or they are the demonic. People don't take any inbetween ground.
We can easily push of stuff as fluff, but whenever I do that at least, there is always a voice that comes asking all the unanswered questions.For instance, the FDA ruled again just a little while ago, that drug companies do NOT have to provide long term information about the safety and efficacy of their medications.
The safety of these drugs is based on drug company's assumption that we are not going to use them for more than 6 months.
But when one injests these substances so chronically: months, years, decades even, there are absolutely no guarentees.
They didn't do the studies back whenever that showed that APs cause irreversable structural problems to the brain. Alterations that cannot be attributed to the disease since these changes can easily be produced in healthy mice taking the drugs.
Its easy to say, oh well this study sites Breggin, so I don't need to believe any of it. But no matter how I take my medication, there will always be those nagging telltale signs for me that perhaps these people are on to something.
Linakdge
Posted by Meri-Tuuli on February 11, 2006, at 8:57:49
In reply to Re: The dramatic rise of mental illness, posted by linkadge on February 10, 2006, at 19:21:27
I have to agree with you link.
I do think that we are overmedicated in general. People seem/demand/expect to take a pill for every slight nuance of disorder (or even for 'personality enhancement'), rather than trying to uncover the underlying problems. I think that pills just mask the underlying problems, and they won't go away once you've finished the pills. I likened it to taking an aspirin for a hangover headache - the aspirin masks the headache so it doesn't hurt, but you've still got a hangover, you just can't feel it anymore, but your bodies still recovering from all that alcohol you drank!
Anyway, perhaps the pill companies are very keen to have as many people as possible diagnosed with mental illness - thats one way to boost sales. You don't see counselling companies making the ftse 100 do you?
I also tend to think that there's this 'ideal' that we prescribe to - being super happy and successful all the time. Media stereotypes enhance this, making us feel more inadequant if we don't have supermodel looks, a brillant career etc etc, which, lets face it, who does?
And I also think that people are less likely to put up with negative life experiences without some form of chemical enhancement from the doc - life is very painful at times for everyone, thats just plain fact. And it wouldn't be human if we didn't experience these things. It is unrealisitic to expect to be full of energy/happy/productive/shiny at all times.
But then, there are severe instances out there that do need pills - what I'm saying is that we shouldn't be nearly so quick to pop pills in the first place and alot more emphasis should be placed on other approaches....okay so they might take alot more dedication/hard work (I'm thinking exercise/therapy/nutritional/time/etc other approaches) but they are harder work and people just want a 'quick fix' - I mean who doesn't? But thats not how it works, does it? Its like taking diet pills - you might lose alot of weight and fast, but when you start eating like you did and stop the pills, you put it straight back on. Permanent, lifestyle changes are needed - there's no quick fix.
Hmm....well just my two cents, or whatever the phase is.....
> You are right, everbody is on somthing.
>
> We use the excuse that this is a board of treatement resistant patients, and our experiences are by no means indicitive of the population at large. I would argue that our experiences are *very* indicitive of the effects in the population at large.
>
> We're just a group that is computer literate.
>
> Linkadge
>
Posted by linkadge on February 11, 2006, at 9:05:54
In reply to Re: The dramatic rise of mental illness » detroitpistons, posted by yxibow on February 11, 2006, at 7:45:32
I don't think we're all that advanced either. Sure we have more tools these days to poke around, but are people actually getting any better?
Sure there are cases of people commiting suicide before meds, and there are also cases of those who do so even on meds. My mother tried to commit suicide and she claimed it was the tegretol that made her so depressed.
We are so far from individually tailoring meds. If you are depressed, you three options, tweek your serotonin, tweek your norepinephrine, or both.
If the drugs were half as efficatious as doctors claim, we would see significant declines in mental illness, and suicide rates but we havn't.
Suicide rates have wobbled up and down since Thorazine. The lowest suicide rate in the century was pre-meds.I've been on more meds than people thrice my age, but they never really did anything. If we were really "hitting the target" then people wouldn't have to keep upping their dose every two weeks.
Linkadge
Posted by ed_uk on February 11, 2006, at 9:08:54
In reply to Re: The dramatic rise of mental illness » yxibow, posted by linkadge on February 11, 2006, at 8:44:31
>The problem as I see it is this devide that we create. Doctors and patients don't see any inbetween. We take black and white stances on the safety and efficacy of these meds. Drugs are either miracles, or they are the demonic. People don't take any inbetween ground.
That's very true Link. I always try my best to see the middle ground.
Ed
Posted by linkadge on February 11, 2006, at 9:13:40
In reply to Re: The dramatic rise of mental illness, posted by Meri-Tuuli on February 11, 2006, at 8:57:49
I agree with everything you've said.
How to we create depression in animals? We subject them to mild chronic stressors.
Life can be a mild chronic stressor. I think the pain is a signal. A signal that something is wrong with the way we are doing things.
Its easy to push away all those signals and just say I am chemically imballanced.
I have a theory that poop out is simply: "your brain knows better, and it can't be fooled that easily"
Linkadge
Posted by pseudoname on February 11, 2006, at 12:00:21
In reply to The dramatic rise of mental illness, posted by detroitpistons on February 10, 2006, at 13:39:25
What a great thread. Thanks for starting it, DP.
I am also deeply ambivalent and skeptical about psych meds, even as I keep taking them. But without denying any of the comments in this thread, I still want to point to some problems in Whitaker's essay.
As others have said, our current infrastructure, motivations, and techniques for diagnosing mental illness are enormously different than they were even 50 years ago, let alone 100. The rates are just not comparable. From my own family's anecdotes, I know of a dozen cases in my extended family 1900-1950 that were not formally diagnosed or "in the system" but would surely be diagnosed and in the system now.
Whitaker cites Healy saying the response rate for in-patients was better 100 years ago, even though they were worse off at admission. But if one group is worse off, their higher improvement rate could be explained simply as regression to the mean. If there are different inclusion criteria, then the two groups are simply not comparable. And since the 1900-era inpatient non-horrific treatments are all still available and given at least to a lucky few (rest, seclusion, beautiful surroundings, etc), current persuasive data for that approach should be available. Whitaker doesn't cite any. I've tried the rest/seclusion thing: it's better than high-stress living, but it was no cure for me. Very sadly.
Whitaker focuses on SSRI-induced mania. But that real problem doesn't explain why there are more people diagnosed with depression (and thus taking the SSRIs) to begin with. Whitaker also doesn't back up his assertion that people who have bad responses to SSRIs are "well along on the road to permanent disability", but it's a sobering possibility.
Even if the actual incidence of mental illness is rising (not just the diagnoses), the fact that it roughly correlates with increased prescriptions proves nothing in itself. When sales of sunglasses increase, the rate of drownings also increases, but sunglasses don't cause drownings. Both are caused by a third factor, people going to beaches and pools in warm, sunny weather.
As others have posted, there are many possible "third factors" that may be making people today more likely to have mental illness. I always think of the study showing that exposure to lots of TV images before age 3 changes brain development and leads to attention problems at the very least.
Another factor Whitaker leaves out is current research showing that untreated depression leads to actual, long-term physiological changes in the brain and other increased illness and mortality. (Like Peter Kramer summarized in "Against Depression".) Maybe without psych meds, our overall statistics today would be even WORSE. That idea has as much of a basis as Whitaker's conclusion.
That said, I agree that psych meds are oversold by pdocs and the media, and the many problems with them are not considered enough by docs or authorities. Maybe articles like Whitaker's, for all the problems I see in them, help by getting more people talking about it. My fear is that they lead to defensive, dismissive reactions from the system's "experts".
Like I said, this is a great discussion. I hope I've contributed to it and not detracted from it. Sorry I went on so long.
Posted by ed_uk on February 11, 2006, at 12:20:28
In reply to but correlation is not causation, posted by pseudoname on February 11, 2006, at 12:00:21
An excellent post PN.
Ed
Posted by detroitpistons on February 11, 2006, at 12:20:55
In reply to but correlation is not causation, posted by pseudoname on February 11, 2006, at 12:00:21
> What a great thread. Thanks for starting it, DP.
Glad I could contribute!
Posted by pseudoname on February 11, 2006, at 13:09:12
In reply to Re: but correlation is not causation » pseudoname, posted by ed_uk on February 11, 2006, at 12:20:28
Posted by pseudoname on February 11, 2006, at 13:36:48
In reply to Thanks! (nm) » ed_uk, posted by pseudoname on February 11, 2006, at 13:09:12
Sorry, I can't resist. :)
Another possible reason the DIAGNOSIS RATE of mental illness may be rising:
Almost all other diseases are getting diagnosed effectively. So a doctor in 1900 might say (half-guessing) that his patient had "poor blood" or whatever. Today's doc knows tons more about blood and has super-excellent blood tests. She rules out all blood problems and is left to say (half-guessing) that her patient is depressed.
Another possible reason the ACTUAL INCIDENCE of mental illness may be rising:
Most other diseases are getting treated effectively. So, people who would've died from infections, injuries, diabetes, heart attacks, etc, are surviving long enough to develop mental illness. If people had lived longer in 1900, they might've developed mental illness at the same rate.
Hmmm. Is that flawed reasoning?
(PS: Not saying ADs & APs are off the hook.)
Posted by zeugma on February 11, 2006, at 14:23:06
In reply to two other factors?, posted by pseudoname on February 11, 2006, at 13:36:48
cited in the article.
That study is now generally acknowledged to have used a dose of phenelzine that was inadequate (45 mg/day). Healy, in "The Antidepressant Era", cites this as the study which defined 'typical' depression as that which responds to TCA's, because MAOI's were 'shown' to be placebos. Hence the strange terminology imposed on the DSM in which 'atypical' depression is probably actually typical, if we take 'typical' to refer to commonest subtype. Now we have 'atypical' antipsychotics that appear to be typically applied to everything, including subtypes of bipolarity earlier generations of psychiatrists would doubtless have called anxiety disorders because they responded to benzodiazepines.
it's very easy to be impressed by studies, whether positive or negative. Too easy, I think.
-z
Posted by pseudoname on February 11, 2006, at 14:47:42
In reply to about that 1965 MRC study, posted by zeugma on February 11, 2006, at 14:23:06
> it's very easy to be impressed by studies, whether positive or negative. Too easy, I think.
A few months ago I read a scientist (not in mental health) saying that the best way to look at peer-reviewed, published studies is that they're just "suggestive", no matter how solid or persuasive they seem.
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