Another Antidepressant Has Been Called Out

Steven Moffic, MD
114
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Though not receiving front page coverage in the New York Times, like the recent Times article on Adderall discussed on this blog site by Mr. Whitaker, maybe this topic should as well. One of the longest running independent newsletters on prescription drugs just called out Cymbalta (duloxetine). Led by Sidney M. Wolfe, M.D., “Worst Pills, best Pills News” (www.worstpills.org) is a trusted resource for physicians and the public who are concerned about unknown problems with medication. Call it the Consumer Reports of medication.  Dr. Wolfe is the medical protégé of the renowned consumer advocate and  past Presidential candidate, Ralph Nader.

In the June, 2012 issue which I just received, Dr. Wolfe starts out with “Do NOT Use” this medication.

Now, one of the particular aspects of Cymbalta, which may have been a marketing strategy, is that it was put into a category different than all of the serotonin reuptake inhibitors. Supposedly, it was also an advance form the one previous such medication, Effexor (venlafaxine), which was touted to have dual action on inhibiting the uptake of both serotonin and epinephrine (SNRI). As we know about the other antidepressants, this is simplistic at best, erroneous at worst. TV ads directed to the public were voluminous and effective, with many patients coming in asking for Cymbalta in particular.

Not surprisingly, Cymbalta has been a commercial blockbuster, not only for those reasons, but another. Even more than other antidepressants, it is prescribed by non-psychiatrists. Why? It has become a favored drug for pain, such as that associated with Fibromyalgia. This usage was never really well-studied, although older antidepressants like Elavil also supposedly relieved pain without any significant depression. Moreover, Cymbalta was valued because it was not addictive like stronger opiate pain meds, would supposedly not cause withdrawal, and was easy to prescribe.

Dr. Wolfe cites two organizations that recommend not using Cymbalta in any circumstance. The first was the French (who are also way ahead of the USA in their more equitable healthcare system) journal of drug safety and efficacy, Prescrire, in February 2009. Now it is the American Public Health Research Group.

Except for one, the risks described by Dr. Wolfe (and let alone the questionable effectiveness) do not actually seem much different than the so-called serotonin reuptake inhibitors. However, a new one for me was “Liver toxicity and liver failure”, which even if rare, is very serious. This is the same sort of “side effect” that previously doomed the antidepressant Serzone (nefazadone).

Like many on this website, he recommends gradual discontinuation, though he also states that this is best done under medical supervision. It’s certainly given me pause about this medication, and a desire to find out more. Although I had waited quite a while before even prescribing Cymbalta, knowing the bias of the short-term studies used for FDA approval, I did end up prescribing it on a limited basis.

Now I also wonder if another antidepressant, supposedly in a category all by itself, Wellbutrin (buproprion), will be the next to evoke more concern. It was not mentioned in Mr. Whitaker’s book, nor by Dr. Wolfe, but is widely used not only for depression and anxiety, but also ADD, smoking cessation, and even occasionally for cocaine abusers.

In this same issue of Worst Pills, Best Pills News, Dr. Wolfe lists all the “Drugs That Can Impair Your Response to Heat”. This is very important and timely for the summer. Many of these medications are psychiatric, including antidepressants and antipsychotics. There are also many medications for the heart listed.

For all sorts of medications, as medicine becomes more and more like a big business, the business warning of “buyer beware” seems to be becoming more relevant for medicine.

114 COMMENTS

  1. Cymbalta has been called out for about as long as I’ve been blogging and reading Internet mental health sites: 6 years. Cymbalta is an antidepressant that was trialed by Lilly for incontinence. A healthy college student named Traci Johnson entered the study labs in Indiana to earn money for college–trialing Cymbalta for incontinence. She hung herself inside the Lilly drug trial site. The drug has been re-purposed by marketing as a pain relief drug. ALL meds are big business! the pharma companies promote and market illegally–to sell. The Dept of Justice fines those companies and they still do it. Most all psych meds will eventually reinvent themselves to milk the patents, and many people suffer at the hands of that business practice. Abilify, Seroquel are antipsychotics and those are being touted as add-on depression drugs, some for insomnia off-label. Once a patient understands they are a cash cow and a victim of an industry selling pills, they can understand more about their meds and why they at times don’t work!

    • Stephany,

      If memory serves, Prozac was a approved with a six-week clinical trial (although I may stand corrected on that)…

      The bottom-line is that it’s highly questionable whether ANY of the antidepressant drugs should have ever been approved.

      When you take out a few things such as fraudulent research (including tossing out undesirable data), spellbinding, placebo effect (these drugs need only beat the placebo by a few points)… There’s NOTHING LEFT to show that they are either “safe” or “effective”…. and they are NEITHER.

      Every Mad in America readers should take a look at this (regarding antidepressants) –

      http://www.woodymatters.com/

      Just say NO.

      Duane Sherry
      discoverandrecover.wordpress.com/warning

      • And keep the source in mind.

        Most psychiatrists have NO clue about just how dangerous (and useless) these drugs are.

        Many readers of this site know much more (obviously) than the board-certified psychiatrists.

        Pretty frightening, if you asked me…

        “Seeing a psychiatrist has become one of the most dangerous things a person can do.” – Peter Breggin, M.D. (the ‘conscience of psychiatry’) –

        http://www.breggin.com

        Duane

        Duane

      • Peter Breggin actually chronicles the Prozac trials in Toxic Psychiatry (1991) and they were completely fraudulent. SSRI’s should not have been approved in the first place. Just like the opium trade was used to destroy China, PHRMA is being used to destroy the US.

  2. Thanks for this warning. I had not read a lot about Cymbalta, and also agree that Wellbutrin has skated by with very limited attention. It is sometimes astounding to me what it takes for the FDA to actually raise concerns. When something makes the NYT as a dangerous drug, it’s probably got to be pretty bad!

    —- Steve

    • You’re welcome for the Cymbalta info Dr Moffic. When you say you haven’t read much about Cymbalta, my first reaction was ” I hope he has never prescribed it then”. I think the readers here can definitely fill you in on many meds of all categories of meds with stories like Traci Johnson’s or similar.

    • Yes, Dr Moffic, to make it to the NYT it has to be bad (lol) good example is Zyprexa and the internal documents exposed by Jim Gottstein, and the NYT articles on Grassley investigating Joe Biederman for non disclosure of pharmaceutical income. Though the NYT is not the only source for info, many times they print news many of us bloggers have known for years re mental health and meds.

      • Pleas don’t confuse me with Dr. Moffic! I am Steve McCrea, an advocate and mental health professional from Portland, OR. My point was exactly that – issues are known for years in scientific and advocacy circles before they ever make the papers. For instance, the problems with suicidality and aggression associated with SSRIs were known in the ’80s, causing a ban on Prozac in Germany and one other country, I believe Italy. But it didn’t make the press until 2002 or so. And it’s still being denied by some. Most of the time, hard evidence that a drug is bad is buried deep, or if mentioned at all, it’s in the third page of the science section, whereas a single positive study, however flawed, is generally page 1 news. So if the NYT is saying something is bad, IT’S BAD!

        —- Steve M

    • Here’s some info on Wellbutrin. You are wise to raise a red flag for that drug–

      “In other words, the number of violence cases was 3.9 times greater for bupropion than for all other drugs.”

      That is from PLoS open access;

      Prescription Drugs Associated with Reports of Violence Towards Others

      http ://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015337

      Chantix is in there too…

  3. Cymbalta has been overhyped for pain as well — see these polls of patients:

    – Cymbalta dead last among 85 treatments for fibromyalgia http://curetogether.com/blog/2011/08/10/patients-say-fibromyalgia-drugs-make-things-worse-rest-is-best/

    – Cymbalta dead last among 35 treatments for neuropathy http://curetogether.com/blog/2011/08/16/neuropathy-study-results-800-people-rate-35-treatments/

    – Cymbalta, Wellbutrin, and other antidepressants very mediocre among 83 treatments for depression (Effexor and Paxil barely effective) http://curetogether.com/blog/category/research-findings/ — exercise, pets, adequate sleep, art therapy, talk therapy rate much higher.

    The “effectiveness” of psychiatric drugs is touted after a drug ekes out statistical significance over placebo. Often it’s only when a new drug enters the market are they compared head-to-head by the challenging pharmaceutical company with the hope their contender will beat the others.

    They are rarely compared to other therapies — in the fibromyalgia poll, the less-expensive but unadvertised generic drug naltrexone is rated much more highly by patients.

    This is another reason why gathering post-marketing data is important.

    From what I’ve seen, Cymbalta easily rivals former withdrawal champions Paxil and Effexor for difficulty in discontinuation. Some people can tolerate a dosage reduction of only one pellet per month.

    Because of its formulation — each pellet is coated; Cymbalta is destroyed by stomach acids — Cymbalta cannot be made into a liquid for tapering.

    I have several people on my Web site who have attempted a gradual taper and found they cannot discontinue Cymbalta at all. They are suffering terribly with side effects nonetheless.

    Cymbalta is utterly oversold for all indications. Its safety has been grossly misrepresented. If the truth were known, it would be considered too dangerous to be prescribed at all.

  4. Your right Stephan, Lilly’s claim back in 2004 was that although 5 of the 9,000 people who took Cymbalta back then killed themselves, but the company saw no connection. “We have not been able to discern any signal between duloxetine and suicide,” an Eli Lilly spokesman told the NY Times back in Feb. of 2004.

    The suicide rate for all Americans at that time was 10.8 per 100,000, according to the Surgeon General Report. This means 5 suicides would be expected in a group of 46,000 people, not in a group of 9,000. In a group of 9,000, one person would be expected to commit suicide, which suggested Lilly’s own trials showed that Cymbalta was likely causing subjects to kill themselves at FIVE times the expected rate.

    The rates are suicides per 100,000 are per year though, and presumably Cymbalta trials took much less than a year. Thus, you likely would have seen an even higher rate if the clinical trials had run for patients over a full year, as up/down regulation of the neurotransmitter system causes the super-sensitivity to feeling depressed and manic/psychotic.

    According to the Surgeon General Report back then, the suicide rate for those 15 to 19 years of age was 9.7 per 100,000. That meant a group of about 50,000 of that age normally would be required to find 5 suicides. The presence of young people in the Lilly trials should be offsetting the presence of those with depression symptoms, again resulting in Cymbalta trials participants killing themselves at about 5 times the expected rate.

  5. Steven,

    I do understand your feelings and I agree that your presence or the presence of any psychiatrist perceived to be “mainstream” is a lightning rod for controversy and anger. Perhaps it is useful to distinguish between psychiatrists (who are human beings with a wide range of attitudes, beliefs and reactions) and the profession of psychiatry as a whole, which has a rather sordid history of dishonesty and brutality, some of which continues to the present day. I think it is very difficult to trust the PROFESSION of psychiatry, based on that history, even if individuals within that profession are doing their best to be ethical. I would hope that posters can be careful (as I think Stephany has been) to distinguish between individuals and the profession as a whole.

    That being said, I believe that sometimes statements which you make, that may seem innocent or even scientifically valid to you, may reinforce underlying belief systems that are associated with the negative history and current practice of the profession of psychiatry, and this does lead to attacks and anger that is often directed toward you as the blogger. I thought this post, in particular, was pretty devoid of such statements, except perhaps that you did decide to prescribe Cymbalta on a limited basis despite the warnings. However, I believe some of your earlier posts may have polarized people against you, as you seem to defend the biological paradigm of mental illness, even when you question specific drugs or the overuse of drugs in general. Perhaps it’s not so much about whether people recognize that some folks find psychiatry and drugs helpful – perhaps it’s more a need for recognition on your part that the biological paradigm itself is a part of the problem that leads to the harm that you fairly acknowledge happens to many recipients of psychiatric care.

  6. Excerpt from Psychiatric Times

    How to End a Psychiatric Epidemic: The Redemption of Psychiatry
    By H. Steven Moffic, MD | June 11, 2012

    “Not surprisingly, reactions have been emotional and mixed. There is room for concern, but most likely not as much as Mr Whitaker claims. Certainly, rising rates of disability may be caused by other factors: economic, social, cultural, and political issues and, most significantly, escalating alcohol(Drug information on alcohol) and drug abuse. Not only could most of Mr Whitaker’s concerns not be disproved by the studies he cites, but the necessary studies to disprove his theories may be almost impossible to do: a large naturalistic study would be needed to follow and compare a cohort of patients taking various psychiatric medications for many years.
    We are most influenced by our own practices. When we are asked about justification for treatment, invariably the answer is that it is based on our own experiences.1 In my practice, there are many patients who do well with a simple antidepressant, antipsychotic, or mood stabilizer for years and years, with or without psychotherapy. There is a smaller percentage for whom the medication seems to stop working well after years for no apparent reason. Other patients are treatment-resistant and we try a variety of medications, sometimes in combination, but the symptoms never fully remit. Some patients have very strong and unexpected withdrawal symptoms; others, don’t have any withdrawal symptoms, even though I expect them.
    At this point, I’m not sure that there really is an epidemic of psychiatric disorders. The unreliability of epidemiological studies and changing diagnostic categories necessitate uncertainty. What clearly seems more like an epidemic, other than the epidemic number of administrators now in our field, is the criticism, often vitriolic, toward psychiatry and psychiatrists. As Dr Pies quoted in his recent blog for Psychiatric Times, “I hate shrinks. Shrinks should die. Shrinks are evil.”8
    So, what then? We are still unsettled, what do we do? Somewhat tongue in cheek, I’d reframe the title of Mr. Whitaker’s book to something like “Whitaker’s Warning, Wallace’s Wisdom, and the Possible Redemption of Psychiatry in America,” and suggest that a confident humbleness may be the necessary antidote. We’ve been wrong many times in the past—this may be because of the state of the knowledge base or our desire, often desperate, to help in any way possible. Remember lobotomies, cold mothers blamed for autism in their children, or the broad application of psychoanalysis to societal problems? Even Robert Spitzer, MD, the chief developer of DSM-III and called by some the psychiatrist of our time, recommended reparative psychotherapy for homosexuality in 2003—he recently apologized and recanted his arguments.9 Before psychiatry, treatment consisted of blood-letting, exorcism, burning at the stake, and various snake oils (some harmless, some very harmful).
    Wallace’s wisdom
    Mike Wallace, the investigative journalist who died recently, had publicly talked about his periodic depressions and serious suicide attempt. Despite this suffering, he improved and went on reporting until very late in life. When asked what he would recommend to others who are depressed and suicidal, he unflinchingly said, “find a good psychiatrist.” He did not say find any psychiatrist, but rather a good one. I don’t know whether Mr Wallace ever read Mr Whitaker’s book. I wish he had and had reported on it. But Mr Wallace was not wrong about much once he completed his investigation, so I would conclude he was right about his recommendation for a good psychiatrist.
    But how do you become a good psychiatrist and how does a would-be patient find one?
    The redemption of psychiatry in America
    In light of our problems and uncertainties about the state of current psychiatry, or perhaps because of them, what might describe good psychiatry? Following are some suggestions for what we, as psychiatrists, can do:
    • Play a larger role in primary care clinics (eg, provide more accurate psychiatric diagnoses, optimize psychiatric treatment, address medication adverse effects, assess patients for suicide risk); conversely, make sure that patients in psychiatric care settings have good medical care10
    • Re-embrace the biopsychosocial model developed by the internist George Engle, and perhaps expand it to a biopsychosocial spiritual model, given that attention to the spiritual may improve outcomes, even in patients with Alzheimer disease11,12
    • Work to improve mental health and well-being to prevent psychiatric disorders, even if that makes some of us obsolete13,14
    • Create a practice in which health care and business coexist—the patient is always the first priority but cost-effectiveness needs to take second place15
    • Be vocal in your efforts to educate the public about the so-called epidemic and how they can contribute to improved mental health by politically advocating for adequate funding of mental health care
    I know that I’ve learned much from Mr Whitaker’s book. I hope you have, or will, too. Ignoring his findings may prolong whatever epidemics are occurring. It is constructive criticism that relates to other challenges that we also need to address. The stakes are very high. If we ignore or dismiss our critics and they turn out to be right, we may inadvertently cause more (ethical) harm. When the critics are wrong and we don’t challenge them, then patients will suffer by avoiding necessary, sometimes lifesaving treatment.
    Sleep on it. Sweet dreams.”–Moffic

    http ://webcache.googleusercontent.com/search?q=cache:2-4xzY4EEKwJ:www.psychiatrictimes.com/blog/moffic/content/article/10168/2081905+robert+whitaker+moffic+psychiatric+times&cd=1&hl=en&ct=clnk&gl=us

    • Dr. Moffic,

      You wrote:

      “When the critics are wrong and we don’t challenge them, then patients will suffer by avoiding necessary, sometimes lifesaving treatment.”

      My comment:

      WHAT lifesaving treatment?!
      Do you mean the “lifesaving” treatment that COSTS lives?… Are you talking about THAT “lifesaving” treatment?!

      Duane

    • Hi Dr. Moffic,

      Just a comment related to the Psychiatric Times excerpt that was indeed posted.

      I also saw a Psychiatric Times editorial (May 1, 2012) by Dr. Pies who disputed Whitaker’s notion of an epidemic. My sense is that, for adults, Whitaker doesn’t argue an “epidemic” as meaning literally a rapid growth in “new diagnoses”. His focus is more on the increased chronicity of health problems following diagnosis (and being medicated). This might not meet some people’s strict definition of “epidemic”; maybe it could be argued that Whitaker’s use of the word “epidemic” was not precise enough for literalists. And for children, Whitaker does discuss the false epidemic (using the strict definition of new diagnoses) of childhood bipolar diagnoses.

      A large increase in chronicity is a serious individual and public health problem. It’s very bad if people aren’t getting better as quickly or as easily as they did before medications became prevalent. The editorial by Dr. Pies seems to briefly acknowledge this legitimate concern about increased chronicity, but then goes back to arguing mostly about the use of the word “epidemic” being inaccurate, based on a strict “new diagnoses” definition.

      So if the main argument of Pies and others is that Whitaker used a word imprecisely (more in the colloquial sense and maybe not the strict medical definition), I don’t know if Whitaker would argue that point too much. But let’s not have this argument over word meanings detract from Whitaker’s main point (as I see it), that medication, over the long term, might be greatly worsening the chronicity of mental health problems.

      – Phil

  7. I am not interested in “attacking” individual Psychiatrists. However, Psychiatry is a profession which (in my experience) feels it’s perfectly fine to lie to their patients, and give them prescriptions for drugs which they have no idea how they actually work, and/or the long term affects.

    Directly because of the trauma I experienced at the hands of that profession, I will never seek help from it. Even though I know there is a strong likelihood that an “emergency” situation may arise for me in the future. Sleep on that, if you can.

    I am somewhat sympathetic to arguments by professionals that they don’t get all the information about drugs etc. For individual General Practitioners, I can understand how that can happen.

    But in my experience, I find that the Psychiatrist I had the misfortune of being treated by either:
    a) Was lying; or
    b) Was frightfully ignorant of the medication/medical model which is the apparent backbone of her profession; or
    c) A combination of the two.

    My mind boggles how in the last few months, even I (who definitely isn’t a Doctor) can seemingly learn more about this “bio” facade than professionals who are paid to “know”. If the medical profession wants to continue to belittle the “peasants” that don’t have medical degrees, then may I suggest that they continue to put their degrees to use! Getting a medical degree in your twenties and not keeping up with the changes in science, to me suggests they’ve lost their medical degree.

    I’m a lawyer, yet I don’t give advice to individuals because I know I am not up to date on the caselaw developments since getting my degrees…isn’t it worrying if Doctors aren’t doing the same, when there’s people’s well being at stake?

    p.s. Dr Moffic, I think some of the confusion may lie in your “bio-psycho-social-spiritual” model may be just “one bio” too many…After listening to Daniel Carlat’s “Grand Confession” (article on this site) I simply don’t know how anyone can still talk about any kind of biological model with a straight face.

  8. Dr. Moffic,

    This comment was left earlier in the thread, which you left unaddressed –

    On Jack Carneys’ blog (Mad in America), you asked me if I wanted to be indirectly responsible” should someone committ suicide because they did not getting treatement. –

    https://www.madinamerica.com/2012/05/dsm5-boycott-growing-some-legs/

    I ask you the same question.

    Do you really want to be “indirectly responsible” (in your case, DIRECTLY responsible) for a suicide because somebody did get “treatment”…

    The kind you offer, DRUGS?

    Do you?

    And this is an important question, Dr. Moffic, for you and others in your profession to answer.

    I came on strong on this post, because the last exchange you and I had on Jack Carney’s blog.

    Re: hopes to work together

    I started reading your blog with an open-mind, and with hopes that you would have some things to say in the area of reconciliation and reform. Unfortunately, in my opinion, you continue to represent the status-quo…. a profession that refuses to efforts to reform.

    Answer the question, Dr. Moffic.

    Do you want to be directly responsible for a suicide as a result of putting someone on an antidepressant?

    Because the drugs increase the rates of suicide.

    Duane

  9. Duane–that’s what we need is accountability for actions and there won’t be. Doctor write suicidal behavior and actions off as “symptoms” of the “illness”.

    Also about medical advice? don’t worry, they don’t dispense it either! lol after all this is not a medical illness, it is about someone’s interpretation of how a human being is presenting with human emotions.

    Seriously, to all of the readers who have been injured, harmed or saw loved ones harmed or maimed or killed by psych meds, has ANYONE ever received an apology from that prescribing psychiatrist?

    THAT could be a start of something new, but I doubt it will happen. Same old tool kit, same old drugs, old drugs w new names and adverts, it just keeps spinning on and on.

    • They never apologized to me. The arrogant hubris in insisting that they alone are “right”, and refusal to even consider alternative explanations remained. And this was in the context of inpatient treatment, where if you don’t follow the “yes Doctor, no Doctor, three bags full Doctor” mantra, then they can keep you longer until you do.

      Despite the shifts in Psychiatry to checklist DSM etc, David Rosenhan’ findings are still there…and they are as spot on today as then.

      I’d like to understand whether at med school the textbooks even mention the Rosenhan experiment? Does anyone know if that study is ever taught to med students these days? (FYI, this isn’t sarcasm, I’m genuinely curious).

      • That’s what upsets me the most. I’ve walked in with clear and unambiguous evidence of hand tremors, akathesia, aggression, or psychosis that was clearly related to starting psych meds (no other variables were present), and still it is denied. The kid with the hand tremors was told it was because she was “nervous.” I would be less concerned about the use of medications if their experimental nature and inherently short-term benefits (if there are any benefits in a particular case) were fully discussed, and if doctors were HONEST about admitting when a treatment didn’t work or made things worse. But inevitably, all improvements are attributed to medication, all deterioration is attributed to the client. Even the term “treatment-resistant depression” evokes the idea that the depression is something to be defeated but is being unreasonable about not giving in to the doctor. The human being involved is just plain invisible.

        Honesty is the starting point for change, including honesty about the speculative and intellectually shallow basis on which each and every DSM diagnosis is founded. I don’t see that happening any time soon.

        — Steve M

  10. Steve Moffic, leaving aside psychiatrists’ hurt pride and feelings when they are criticized, when is the profession going to stand up en masse for patient safety?

    That’s what psychiatry’s critics are talking about. And you don’t need an MD to read and critique scientific studies. Sometimes it seems you are saying only psychiatrists can criticize psychiatry (a risky career path), non-doctors have no right to even an informed opinion.

    I find it interesting that you are getting your information about Cymbalta dangers from http://www.worstpills.org rather than the American Journal of Psychiatry or even Psychiatric Times. How many doctors apprise themselves of risks via http://www.worstpills.org?

    (By the way, Cymbalta comes in 20mg capsules — so what? Patients sensitive to dosage reductions still have to open the capsules and count out the pellets.)

  11. RE: the Moffic book review excerpt from Psychiatric Times above of Whitaker’s ‘Anatomy of an Epidemic’:

    It is amazing to me that the author of a blog at Mad In America (Moffic) wrote a review of the book on another site for psychiatrists to read. The tone of the writing in that review is directed toward those doctors.

    I would like to know what Whitaker has to say about this, because it’s got an edge to a double-edged sword, conflict of interest feel to it.

    Psychiatric Times is entrenched and fully loaded with scrolling psych med ads all around that book review.

    Why not write the review here?

    Why write here?

  12. From Moffic’s book review of Anatomy of an Epidemic:

    “If we ignore or dismiss our critics and they turn out to be right, we may inadvertently cause more (ethical) harm.”

    He is writing that to other psychiatrists. Sure makes it feel like the old “us and them”.

    And guess what? we ARE right. I would love to have never had horror stories to tell about a child whose life has been ruined and needs care for daily living! but I have them! learn from it!

    • “And guess what? we ARE right”…

      Here, here!

      In the concluding chapter of Pharmageddon (pg. 252-3), David Healy writes :” But we know that over 80% of the reports on the adverse consequences of treatment, dismissed as anecdotes, have turned out to be correct. We also know that close to 30 percent of the clinical trials that have been undertaken remain unreported, and that of the 50 percent that are reported almost all will be ghostwritten and roughly 25 percent of the published trials alters to the extent that a negative result for a drug will have been transformed into evidence the drug works well and is safe. In 100 percent of cases, the data from the trials remain inaccessible to scrutiny Given these facts it is not reasonable to suggest that the observations of doctors or patients are any less reliable than clinical trial evidence.” (references for citations appear in original text).

      YES,. the point has been made: The CRITICS ARE RIGHT!

      It is not a matter of IF to anyone who can read.

  13. Dr. Moffic,

    I have been reading alot of your posts and wanted to post some general comments.

    Many people in my opinion, have been very respectful in their replies to you but you seem to take every post that disagrees with you as being vitriolic. In other words, you come across as very defensive even if that wasn’t your intention.

    By the way, even though I feel psych meds destroyed my life, I don’t hate psychiatrists. There is one I would go to in a heartbeat if he was in my area. So please don’t accuse me of taking my anger out on you because I am not.

    Perhaps if you took the tactic of Dr. Chris Gordon, a psychiatrist who did a workshop with Bob Whitaker, you would receive more positive responses.

    I am sure I am missing something but essentially, Dr. Gordon said that he recognized the people have been grievously harmed by psychiatry and that psychiatrists needed to keep that in mind everytime they dealt with someone new.

    He wasn’t defensive at all. And unlike you when I feel you falsely accused Dwayne of practicing self medicine, he recognized that many patients were getting better by stepping outside of psychiatry and said that psychiatry needs to tell patients to get the hell away from us (meaning psychiatrists).

    Anyway Dr. Moffic, clearly what you are doing is not working. Why not try something different to have a dialogue with people on this site?

    Instead, you want to blame everyone else instead of looking at your own behavior. What a pity.

    • “people have been grievously harmed by psychiatry and that psychiatrists needed to keep that in mind everytime they dealt with someone new.”

      I think this is key. Even if you believe that grievous harm is rare and there has been a lot of good from psychiatric intervention, every psychiatrist, regardless of their personal practices/belief, carry the history of psychiatry with them, whether they like it or not. Not all harm was caused by individual bad doctors, but by systemic power of psychiatry, and anyone who embodies that power in both real and metaphoric senses, has to keep that in mind.

      This isn’t unique to psychiatrists (though psychiatrists do have unique state-sanctioned powers to coerce others). Social workers experience this (no matter what kind of work they do), public health professionals do too. Clergy also experience this carrying of historical and contemporary abuses/damage of religious dogma with them when they work. Part of being a professional in these fields (and deciding to become one) is to own and unflinchingly study and understand harm done, work to mitigate harm now, and move forward in work with others that acknowledges those harms and being explicitly and authentically intentional (if you believe in your profession) to make a more helpful and ethical future.

      Sometimes an apology is helpful in this regard, though I understand that it is difficult and in many ways unreasonable to apologize for things that you didn’t yourself do. Perhaps apologies are proxy for attuned acknowledgement, a demonstration of understanding of harm and willingness to try to undo or support in moving forward from it.

      • In a comment on another MadinAmerica blog, Steve Moffic did apologize to anyone who had been harmed by psychiatry.

        This must have been difficult for him and should be honored for what it is.

        I also take this post condemning Cymbalta as a peace offering of sorts.

        • You are right, Alto. I was doing a bit of thinking out loud so to speak. I did not mean to apply that Dr. Moffic should personally apologize or hasn’t, just that the acknowledgement of hurt often comes and can be received in that form.

          I also did see this article as an attempt to reengage in a novel way and I appreciated it.

    • AA,

      You’re right on the money!

      I see a pattern of blame… It’s as if there are “talking points” with psychiatrists.

      They tend to blame:

      1) Managed Care
      2) Drugmakers
      3) “Anti-psychiatrists”

      They don’t seem to be able to take responsibility for their own actions.

      And when their drugs fail, they blame:

      1) The drugmakers (again)
      2) The patient – either “non-compliant” or “treatment resisistant”

      They seem to not be able to come to terms with the injury they cause.

      It’s not only based on denial.
      It’s based on lack of conscience… huh, what’s the term they like to use? –

      Sociopathic Behavior

      Duane

      • And the other thing they like to do, when they themselves have violated someone is to write an article on human rights violations.

        When they use a drug that causes damage, they write an article on the danger of the drug.

        When they are unable to build trust, relationships with others, they write an article on relationships.

        This is like a really polished thief.
        One who steals you kid’s bike, and then comes by your home to tell you to be careful, “There’s a thief in the area.

        Nobody suspects him, especially if he knocks on all the doors in the neighborhood, warning everyone in sight, while he continues to rip off their property!

        Duane

  14. Dr. Moffic,

    I’ve followed your posts on MIA and with this one I am reminded of your interest in human rights issues with regard to Managed Care.

    I am wondering if you have considered that the lacking in “science” as an evidence base for the prescription of psychotropic drugs puts them in the same category assigned to alternative/complementary medicine treatments. What rationale prohibits health care consumers from choosing “alternative” treatments from licensed professionals at the same rate of reimbursement as the “little known about and unproven” treatments you prescribe?

    As the PUBLIC becomes better informed, what rationale can be established by MDs/psychiatrists, who are definitely NOT practicing Science backed evidence based medicine, for their status as “Approved Providers” for health insurance payments?

    Isn’t this simply virtue ethics? Established status by title— regardless of adherence to acceptable standards or guidelines within the “medical profession”?

    Human rights in Managed Care? How about humans have the right to CHOOSE which ‘non-scientifically’ proven treatment they believe will have the least dangerous adverse effects?

    A little ‘healthy competition’ would go a long way towards reforming psychiatry..IMO.

    • So, Anonymous, you see no merit in forcing the hand of psychiatry to legitimize their claim to substantial financial gain in a *free market* system?

      I’ll share a story that explains my outrage at ‘health care insurance’ dictates to patients.

      I had multiple major abdominal surgeries–3 in one year that greatly increase my risk for small bowel obstruction—actually my last surgery was due to a SBO. So–I began to see a Doctor of Traditional Chinese Medicine, also a lic. acupunturist who upon consultation that laste 1 hour and 45 minutes gave me a *diagnosis* and offered me a treatment plan option. Highly effective! My first experience with *digestive health* . A few times I was treated with acupuncture-early for symptoms of bowel obstruction with great success. THEN, I found myself in an emergency situation, requiring immediate medical intervention—in the middle of the night. Greatly relieved by the insertion of a nasogastric tube , I was all set to leave the ER and seek treatment from Dr. Zhu, when a surgical resident informed me that my CT scan showed 98% occlusion in my small bowel. He arrived with surgical consent form in hand. I refused to sign. I insisted that I be discharged to seek the treatment I trusted. He and his attending refused to discharge me due to *life threatening* risks without surgical intervention. Finally a compromise was reached. My acupuncturist was allowed to treat me in the hospital— with total success, and I was discharged in great condition after 3 days. My health insurance paid for everything I received from the hospital. I paid *out of pocket* for 2 visits from my acupuncturist around $400. (included Chinese herb tea to drink for 5 days at home)

      I do not mean to dictate anyone’s choices for medical care— only wish to drive home that we have NO basic human rights in our health care system. It is controlled by those who profit financially — with no real regard for what is in the *payees* best interest. AND there is a ton of waste of our health care $$ that is perpetuated by arrogance and greed.

      Call it RUBBISH— but sooner or later we have to decide how to regain some control over our own destinies! Since $$$ is at the top of every topic on this site, I am merely suggesting we actually establish a *free market* system—pay for what works; what we want and/or need and choke off the bottom feeders!!!

      • Wasn’t saying rubbish in response to you Sinead. If you look closely it is not even a reply to your post, it is a stand alone post all on its own, not in a thread tied to your comment.

        You *also* might *want* to *think* about how distracting all those bizar*re asteri*sks you place in the m*iddle of your sentences are. They are very distracting**

        • Thank Anonymous. Guess I am just not used to one word stand alone comments from you. When I consider this one here, as your one word response to this blog, I do see the consistency: In brevity there is strength, or the other way around!

          Sorry about the *** I am already rethinking them!

          I think *this* happens because I depend on so many aspects of communication that are unavailable in these on-line forums. I use my hands , facial expressions and even interpretive dance to get my points across. Rereading some of your posts, I have to applaud your example of plain talking that is both articulate and eloquent all by itself.

          I want to trust that words all by themselves are enough. Just the words. Just the facts. No more bizarre @@ of any ### kind! Especially NOT ****.

          And when you behold the new me, picture that I am singing, not talking when I write, and breaking for the occasional big production number.

          xoxo,
          Sinead

        • Sinead,

          We share a common concern, and common medical situation as well – I had six major abdominal surgeries (seven hospitalizations) for obstructive bowel….

          The first was a mekals diverticulm – got infected in the hospital (in for a month), which led to the other six.

          And the first was probably not necessary to begin with!

          And I learned (the hard way) that good absorption plays a key role in mental heatlh.

          “All diseases begin in the gut.” – Hippocrates

          Some good links here (including Natasha Campbell-McBride, M.D. – Gut and Psychology Syndrome – scroll down the page) –

          http://discoverandrecover.wordpress.com/wellness

          Duane

  15. I think it’s imperative for doctors (psychiatrists, because they are the “specialty” of topic) to also understand that much angst and suffering when inside a locked psychiatric hospital has been felt by writers and readers, and by loved ones of those. When inside a psych hosp against your will, the pain begins.

    The only person who can sign out the patient for discharge is the doctor.

    That doctor is also the one who says comply with meds inside the psych hosp or no discharge.

    This is a precarious relationship based on trust, being forced to do something against a person’s wishes, lack of trust, etc. The patient learns (many do) quickly what it will take to “get out”. I can’t imagine a more frightening, degrading set of circumstances to happen to a human being. If the care FELT compassionate, patients might respond differently, and they might hold their doctor in high standards after they get out. The people I’ve witnessed over the years have suffered great emotional trauma just by that setting alone–how does one gain back their delicate spirit after that? after possibly being strapped to a gurney, or having a forced injection?

    How does a doctor/psychiatrist gain that trust back?

    This is why writing here as a doctor must also come with that in mind, to understand exactly what people have experienced, and when hearing some stories, one cannot help but shed tears for them.

    Trauma from care! do cardio patients have that to deal with? cancer patients?

    • stephany asked: ” Trauma from care! do cardio patients have that to deal with? cancer patients?”

      Children and adolescents suffer from traumatic experiences as ‘medical/surgical” patients– become anxious, depressed, even suicidal. They then become psychiatric patients receiving *drugs* to *treat* their *trauma reactions*.

      This scenario is not limited to kids, but they are the most vulnerable to both the *misdiagnosis* of the traumatic effects of *medical/surgical procedures* and have the most to lose in terms of long term damage from *psychiatric treatment*.

      Destructive life -altering decisions, devoid of scientific evidence, are called *guidelines* for treatment , while alternative/ complimentary therapies are called *unproven* and to further discourage their use, most health insurance providers cover very little if any of the costs.

      Can you request “another opinion” if you or your loved one is being *detained* in either a hospital ER or a locked psychiatric unit? Can you or your loved one disagree with the *scientifically unfounded and unproven* treatment plan offered by psychia try and seek some other EQUALLY *unproven scientifically* treatment ?

      WHY NOT? I think it is because that we have no “human” rights in our health care system; that is, we do not have the RIGHT to employ the human capacity for REASON to determine a course of treatment for ourselves that minimizes the risks of serious harm to ourselves!

      WE do NOT have human rights to employ the capacity for human REASONING to challenge an authority figure— regardless of his/her transgressions from REASONABLE guidelines for humane care of others.

      WE DOhave limited choices that fall into the category of choosing the lesser of many evils. When I am feeling totally radical, I fantasize EVERYONE decideds torefuse to pay health care insurance premiums—CUT off the FUNDING for the abuse we are forced to take…AT THE ROOT!

      How many *humanistic* psychiatrists who are so worried about those of us who will be swayed from receiving THEIR treatments would fund OUR care out of THEIR pockets??

  16. Cymbalta is evil. So is Effexor. I was on both. Effexor, 10 years ago, for depression. It worked great for a while. Then I had to up it. And up it. And up it. Then it just stopped. The withdrawal syndrome coming off it was horrendous. Cymbalta was more recent, given to me for my fibro. It didn’t help the fibro, didn’t help the depression, and made my anxiety shoot through the roof. And even though I’d only been taking it for a month, the withdrawal syndrome coming off of IT was almost worse than that of the Effexor. When another doc suggested I try Savella for the fibro, I laughed at him and said not a chance in heck.

    I’m on Wellbutrin XL now, and you’ve got me worried. Time to do research, I guess. I’ve been on it for quite some time, and my labs usually come back fine. I had some liver enzymes that were elevated slightly for a while, but they’re fine now. That could have been due to my MS and/or MS medication though.

    (But isn’t an SNRI a ‘serotonin/NORepinephrine reuptake inhibitor’, not epinephrine?)

    Thanks for your article. I wish more psychiatrists would read it and realize how terrible some of these meds are before giving them out like candy. Now, off to do research on Wellbutrin.

  17. Why would anyone take a drug that alters their brain function as a ‘medicine’ when no ‘medical’ person alive on the planet can demonstrate there’s a thing wrong with their brain?

    It’s a bizarre world we live in where people buy into these lies.

      • Clear cut case of career suicide. Perhaps it is due to the guilt of unearned entitlement? Or maybe it is a budding martyr complex that will come to fruition in the DSM VI?

        Until there is a Random Controlled Trial, conducted by Eli Lilly and a ghostwritten article published in a leading journal of psychiatry, we can’t even speculate as to what Disorder this represents, much less which combination of psychotropic drug cocktails will provide undeniable, albeit unscientific evidence for first line treatment!

  18. Re: The topic of this post… “Front-page coverage by the New York Times”

    Dr. Moffic,

    I’m looking forward to the NYT issue (in the not-so-distant future) with the headline and lead-story:

    “Psychiatry is Dead”

    It’s coming, Steve Moffic.
    Sooner than you and your colleagues can possibly imagine.
    And it can’t come soon enough!

    Duane

  19. Going green is good for your mental health
    By H. Steven Moffic, M.D

    “Given the strong scientific consensus that human behavior and lifestyle are a major cause of climate change, humankind is again failing to protect the earth. But we still have the opportunity to change.”

    http://www.jewishchronicle.org/article.php?article_id=11282

    At this point, I’d wonder about the water supply that has been found to have antidepressants like Prozac in it!

  20. “as a clinician I’ve seen many more patients with high suicide become better with short-term usage and careful monitoring.”

    What clinicians see and what actually occurs can be diametrically opposed. When I was involuntarily committed, the first resident I met with told me “we’re saving your life”. And I’m sure she really believed it. But what I heard when she uttered those words was not compassion or concern, but sheer arrogance, and the crushing realization that I was powerless. The commitment lasted for only five days, but it was such a degrading and frightening experience that I relived it every day for a full eight months after my release. Those memories regularly drove me into suicidal panics unlike anything I had ever experienced before. The memory of the psychiatrist’s words, “we’re saving your life,” literally echoed in my mind and drove me on to more than five suicide attempts.

    What does my medical record say? It says that the intervention was justified and successful. The first point I want to make here is that the psychiatrists who treated me have no idea that when I was standing on the edge of the cliff, emotionally speaking, they pushed me over the edge instead of helping me find my way back. I think this kind of experience is one reason that psychiatrists and survivors have such difficulty coming to a shared perspective on this site. The resident who I saw for a grand total of two minutes probably doesn’t even remember meeting me, let alone realize how much harm she did to me. So when individual psychiatrists claim that it was “the other guy” who did the harm, I find this to be less than credible. I think that any psychiatrist who participated in involuntary treatment during their career – and they all have to do it in residency – may well have done great harm to people without ever knowing it.

    The second point I want to make is just to remind everyone that medication is not the only boogeyman here. The psychiatric system is thoroughly competent in causing significant harm without any medication at all, based only on the dehumanizing effects of its institutions and training.

  21. Fellow Readers,

    I would like to say that we are involved in a “revolution” of sorts… not one that will involve bloodshed (thankfully), but one that will require courage.

    Courage to speak up, and speak out – without mincing words.
    Courage to protect young children and youth; elderly; some of our most vulnerable.

    We may not be risking our lives.
    But we are risking our reputations, many of us – with those who will call us names, words that will have pain associated with each – “anti-psychiatry”, “scientologists”, “a fringe group”, “loose cannons”, “hysterical”, “dramatic”, “black and white thinkers”, “people acting like doctors, without a licence”, “unstable”, “hysterical”, “dramatic”, “over-exagerators”… And worse.

    They will try to belittle us, dismuss us, disenfranchise us, marginalize us… at every turn.

    They will justify their own behavior, and continue to point toward so-called “evidenced-based science”, their accolades, their licensures, and degrees, their vitaes… and they will not be kind… in fact, things will get uglier with each passing week, and month.

    But we have a very worthwhile cause. A very just cause… and we will win this battle, because myths do not live forever… they die.

    And this one must die.
    And it must die sooner, rather than later.
    Because lives are at stake, each passing-day.

    In the end, history will make the last call.
    And those of us who were brave enough to stand up, and speak out, will be known as the ones who saved a generation of people – around the world, from a brutal, inhumane form of medicine that has injured and killed more people than any major war in world history.

    Hold the line.
    Be bold.
    Continue to present facts, and to tell the truth.

    And let’s get this job done.

    We can do it.
    And we will!

    Duane

  22. Re: “Scientologist”

    I believe in religious freedom (and freedom of conscience); and have no bone to pick with any religious group, inluding Scientology.

    My point is that term is frequently used to marginalize those of us who disagree with the current paradigm of care, and want to see safer, more effective options, inluding the freedom to say NO!… or even, “Hell NO!”

    Duane