A New Silver Bullet? The Lurasidone Story

Sandra Steingard, MD
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There has been much handwringing within corridors of academic and guild psychiatry about the “dry pipeline” for new psychoactive drugs.  So it is surprising that I have of late been the target of much wooing by my local Sunovion rep.  I think he leaves messages for me almost weekly and he sends me missives; glossy brochures and reprints from a major psychiatric journal. What is the subject of this attention? The drug lurasidone (Latuda).

This drug was first approved by the FDA in 2010 for the treatment of schizophrenia. At the time, I did not think there was much enthusiasm for this drug. It did not seem to have much to offer above and beyond what the earlier so-called atypical antipsychotic drugs offered and since most of them were now off patent, there seemed to be no good reason to prescribe it. Sunovion boasted about its relative lack of impact on metabolism (weight gain, elevated blood sugar and cholesterol). But we have ziprasidone. They boasted about its possible impact on cognitive function, but the data were weak. This seemed like another “me too” drug, and reviewers – both those critical of and sympathetic to psychiatry – seemed to agree.

So what is the fuss about now? The FDA has just approved lurasidone for the treatment of depression in individuals who have been diagnosed with Bipolar Disorder. This has been the trend in psychiatry – many of the newer antipsychotic drugs have indications for mood disorders. The advantages for drug companies are clear; there are vastly more people who are diagnosed with a mood disorder than with psychosis. The market is much larger.

The push is huge. I have received multiple reprints of the studies that have just come out in the American Journal of Psychiatry. There are advertisements on TV. I have already had people ask me (just as instructed in the commercial), “Is this drug right for me?” In addition, the US government is reconsidering its rules regarding the privileged position the psychoactive drugs have with Medicare D, the program that pays for drugs. When the law went into effect, all psychiatric drugs in any given class had to be offered (albeit with a significant co-pay for some). The government wants to amend the rules. A number of groups are trying to block this. Sunovion is highly active in this fight. I was quoted in a Boston Globe story saying that I did not think we would lose anything if the branded antipsychotic drugs were not included in a formulary.

To be honest, I am agnostic about what approach is best for any individual.  I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments.  If there is a drug that will help, I will offer it.  Some of the people who comment here seem a priori against the notion of using a drug to reduce suffering.  I do not share that view.  Humans have ingested substances – to relieve pain and suffering or just to have a good time – for thousands of years.  Some people want to ingest something in order to feel better.  Others want to surround themselves with caring people and caring communities.  Some turn towards spiritual practices.  I see my role as much as an educator or guide as anything else.  My gripe with psychiatry is not on methods per se but on its hubris at overstating what it knows, its failure to report on studies honestly, its creation of a narrative that does not fit the data, and its rampant conflict of interests.

So I think I have an obligation to understand lurasidone and how it may help and not help the people who consult with me.

Last week, I wrote about cognitive behavioral therapy.  I tried to look at the study as critically as I would review a drug study.  To be honest, I am not sure I succeeded.  In some subtle ways (using the title “Paradigm Shift”, calling the study “important”), I may have tilted in favor of what I thought was a study showing modest and preliminary support of CBT.  So I am mindful of being even-handed here.

In two studies (here and here), both published in the American Journal of Psychiatry, the researchers (and all authors of these studies with two exceptions were Sunovion employees) evaluated the effect of lurasidone on individuals diagnosed with Bipolar Disorder who were depressed. In one study, the drug was compared against placebo. In the other study, lurasidone was added to lithium or valproic acid; the comparator group remained on the mood stabilizer but had placebo added instead. These were both double blind, multi-center studies. This is what allowed for the FDA approval and the presumed patent extension. I am not going to review the studies in detail. In both, the authors reported a significant reduction in symptoms in favor of lurasidone with an effect size of 0.3 to 0.5. This is similar to the effect size reported in the CBT study I reviewed recently. The studies each lasted for 6 weeks although extension studies are underway. They report that the drug appeared to be fairly safe and well tolerated. There was little weight gain or impact on metabolic parameters.

There are more detailed descriptions of the study on 1 Boring Old Man’s site and I want to give him credit for the investigative work he is doing (more and more).

What I want to focus on is the accompanying editorial written by R. H. Belmaker who reports no COI. He ponders what it means that so-called “antipsychotic” drugs appear to be effective for Bipolar Disorder. After all, for over 100 years, psychiatry’s diagnostic classification system is based on the Kraeplinian distinction between Schizophrenia and Bipolar Disorder. He wonders if by the time DSM-6 rolls out, we will need to have a “unitary psychosis” categorization. He then asks if this heralds “a new era in psychiatry and psychopharmacology”? He answers this question modestly. He points out that in the first textbook of psychopharmacology by Klein and Davis,  “the usefulness of typical old-fashioned neuroleptics such as chlorpromazine in many forms of depression was emphasized . . . It could be said that we have rediscovered the wheel.”

His comment betrays humility for the field;

Clinicians have become a bit jaded during a long era of ‘me too’ compounds where new antipsychotics and new antidepressants seem to appear daily—hailed by leaders of the field and feted with dinners and weekends for clinicians willing to attend, later to lose their patents and be discarded on the scrap heap of history.

He also raises an important question, “Could there be some more practical mechanism in play here such that perhaps only sedative atypical antipsychotics are useful in depression?”

I appreciated the general modesty of this editorial, but these are the questions I would have asked if I had been asked to editorialize:

  • How can we put any stock in a 6 week trial when we now know that over the long term, these drugs may pose some serious risks for individuals? We know that although studied for 6 weeks, these drugs tend to be prescribed for a much longer period of time.
  • How can we consider a study that has no active placebo? Dr. Belmaker hints at this issue with his comment about sedation.
  • How can we allow ourselves to be influenced solely on the basis of drug company funded studies when we know from past experience that they can be so misleading?   By this time, we need to recognize that FDA approval meets the minimum standards of information we require to fully understand drug effects.  We also need to know that the initial FDA reviewer did not recommend approval of this drug for Schizophrenia.  Why is it that I need to go to the blog of a retired psychiatrist (albeit of a very smart and tenacious one) to find out what other studies were registered (this is critical since the FDA only requires two studies for approval but companies can do as many studies as they want)?
  • We know that earlier studies were likely biased by dosing issues. Why not have as an active comparator ultra low dose of a neuroleptic such as perphenazine? It is cheap, it has little impact on weight, it is as effective as other neuroleptics. A major problem with how we prescribed neuroleptics in the 70’s ad 80’s was due to excessive dosing. We began to reckon with this in the late 80’s but the message got lost as the newer drugs were brought on to the market.  Why not have as a comparator a sedating non-neuroleptic drug? Even if the drug company was not required to do that, why not specifically point out these limitations rather than just hint at them?

• On a more basic level, doesn’t the lack of specificity of these drug effects support Joanna Moncrieff’s notion of a drug centered vs. disease centered approach to evaluating psychoactive drugs? How much more tortured will DSM 6 be in an effort to explain the disparate effects of these drugs? A unitary psychosis hypothesis will not address this. After all, most people who are depressed, even when the label is bipolar depression, are not psychotic. Dr. Moncrieff points out how the disease-centered approach has, among other things, blinded us to the long-term consequences of drug use. It has blinded us to the risks of drug withdrawal. These are not the challenges of “anti-psychiatrists”, these are questions posed by psychiatrists who want to have a full understanding of the benefits as well as the risks a person takes when she chooses to ingest these drugs.   I pointed out that I am agnostic on interventions. But I am also agnostic on the basic “disease” premise. For me, it remains a hypothesis, one that becomes increasingly weaker in its evidence base as we learn more about the brain.   This is an area in which I join company with Dr. Insel, the Director of the NIMH. When will we begin to address this serious concern?

Dr. Belmaker, to his credit, addresses the loss of confidence in our profession. But I wish he would have addressed more directly why, over time, these other drugs were discarded.

72 COMMENTS

  1. “To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it.”

    Dr. Steingard,

    While I wholly welcome what you’re saying there, as it seems quite reasonable, it also seems to contradict what you’ve said in the past, of your professional practices.

    Therefore, with all due respect, I ask you:

    Should we presume that, perhaps, you’ve come to a turning point, in your career? I.e., you’ll no longer order nor condone any forced drugging of anyone, and you’ll not support coercive drugging (nor any other coercive ‘treatment’) in any instances?

    I certainly hope that’s the case…

    Respectfully,

    Jonah

  2. Well, I suppose I qualify as “anti-psychiatry.” But I am not totally against the use of psych drugs short term, especially since most of the time “psychosocial interventions” are not available. When I was representing inmates at commitment hearings, I not infrequently postponed the hearings for a few days when I perceived that the drugs they were on would soon clear their minds enough for them to be released by the hearing officer.

    But there is already plenty of evidence that non-drug approaches work a lot better without damaging people’s metabolism and neurological functioning. We can go back as far as the Quaker retreats in the 19th century, and as recently as the Soteria Houses and Diabasis House and even the (I think) L Ward at a county hospital here in Northern California. All showed large percentages of people who recovered from their “illnesses” without drugs.

    And of course I could mention many other facts and studies that show how people overcome their problems and are left undamaged when they are not drugged. This is nothing new for MIA readers.

    I guess I am writing this to encourage Dr. Steingard and others who have some substantial position within psychiatry to say openly what they know without unnecessary qualifications. I suppose part of this is that you don’t want to get too far ahead of your colleagues, who have a lot invested, both intellectually and financially, in believing the lies of their profession.

    Since I am not their colleague but one of their victims (though not, thank God, of their drugs), I have little ability or interest in having any intellectual discussion with them. I think at this point in time, there is no excuse for ethical psychiatrists not to be aware of the destructiveness of their profession as it is now practiced. The only way they will change is if and when the force of public opinion and the legal system forces them to change.

    The best way to accomplish this is for some criminal prosecutions of people like Doctor Biederman, who are responsible for the disability and deaths of thousands of people. A few prison sentences for these “opinion leaders” will work wonders to change standard psychiatric practices.

    • Ted, I agree that in the short term psychotropics can be useful. I appreciate that you mention that few can actually access psychosocial interventions. This results in medication being not just a tool but the only tool.

      The irony is that so many agencies routinely represent recovery based care, care predicated on the domains of wellness, evidence based practices, and best practices, under the general heading of consumer choice, respect and empowerment. Unless all of the aforementioned can be measured in milligrams of medications we are left with no more then the Potemkin Village words and meds can create.

      Regards,

    • I absolutely agree, Biederman should be tried and put in jail. Not just for his non-disclosure crimes, but rather for encouraging the entire American psychiatric community to go off committing iatrogenic harm on a massive scale via malpractice (according to the DSM-IV-TR) by misdiagnosing a million plus little children with bipolar.

      When in reality they were dealing with the known adverse effects of antidepressants and ADHD drugs – the DSM, itself, specifically states symptoms caused by other drugs should never be diagnosed as bipolar.

      Antipsychotics absolutely do not cure adverse effects of antidepressants and ADHD drug. Slowly weaning the person off the drugs that made them manic, or suicidal, or violent, or gave them brain zaps or whatever is how to help the person heal. Some people do not react well to pharmaceutical drugs, especially when mandated for fictitious or iatrogenic diseases!

      • Someone Else,

        As many have come to realize, frauds like “Dr.” Nassar Ghaemi continue to emulate the great drug company shill, Mitch Daniels, who advocated always blaming the victims’ so called mental illness for any and all toxic effects of their lethal drugs. Dr. David Healy has exposed this gem in his many articles. Thus, Ghaemi and his cohorts insist that drugs like SSRI’s “uncover” the bipolar that existed all along when victims get manic, irritable and suffer other SSRI effects well described in THE PHYSICIAN’S DESK REFERENCE. The same is true for ADHD kiddie cocaine. Note, the side effects in this classic reference are attributed to the toxic drugs and not uncovered bipolar as Ghaemi would have it based on the usual bogus studies. Ghaemi cites every vicious, bogus fraud lie to help push the fad fraud bipolar on everyone on the planet since that is his so called specialty bread and butter to everyone’s huge peril. He’s thrilled that the DSM 5 has expanded the evil bipolar stigma to include abuse trauma victims misdiagnosed as borderline, PTSD victims and anyone else they can sucker into this life destroying death trap by medicalizing normal behavior. Bipolar is the new “sacred symbol” or garbage can stigma of biopsychiatry increasingly replacing schizophrenia to expand stigma/drug markets as any drug rep can tell you. I feel nothing but contempt for Ghaemi and his pals as I’ve read the garbage he posts all over the web for unsuspecting victims of this monstrous bipolar fad fraud. Ghaemi pushes toxic, deadly lithium while justifying the work of paid drug company shill Biederman who created the child ADHD and bipolar fad frauds which leads to increasing numbers of destroyed victims of course. Ghaemi says he sees nothing wrong with taking drug company money for “research” as did Biederman that led to the great studies proving the efficacy and safety of toxic neuroleptics for children before the studies were even done on Biederman’s watch. Ghaemi is also a big fan of stigmatizing young children with bipolar a la his mentor Biederman — big surprise!

        It’s all too clear that those like Biederman and Ghaemi pushing the life destroying bipolar fad fraud to force lethal poison drugs on millions of people from cradle to grave have no conscience and obviously suffer from psychopathic malignant narcissism.

  3. Excellent including the questions you posed. I fear we are far away from the time when new psychotropics are not automatically greeted with the notion that they are safer and/or more effective when they bring little or nothing to the table except added expense.

    Curious. Where did the notion that a trial of but six weeks was of sufficient duration? After all, we are often told that we will have to take one or more psychotropics for a lifetime?

    Regards,

  4. I think physicians need to look at wider impacts than that of a treatment on a patient. There are pubic health impacts and other impacts: early death effects friends and family, long term disability effects the economy and increases welfare payments, type two diabetes increases the burden on the health system, the expense of drugs is another burden.

    If safer and cheaper alternatives are available doesn’t the physician have a duty to use those for both the patient and the public good? if they are are not available doesn’t the physician have a duty to campaign for them to be commissioned?

  5. Sandy, Have you read this book yet?

    http://www.amazon.com/Mad-Science-Psychiatric-Coercion-Diagnosis/dp/1412849764

    https://www.madinamerica.com/2013/07/book-review-mad-science-psychiatric-coercion-diagnosis-and-drugs/

    http://csw.fsu.edu/articles/mad-science-psychiatric-coercion-diagnosis-and-drugs-book-launch/

    If you haven’t read it, I highly recommend it to you since it covers all the damage done by biopsychiatry including its bogus, life destroying stigmas, toxic/useless drugs and its constant real main focus of coercion and social control in the guise of medicine. Dr. Joanna Moncrieff covers the latter issue well in articles like Psychiatric Imperialism, De-Medicalizing Misery and other works like many others. As you also know, even Dr. Insel has declared DSM stigmas invalid so anyone with a conscience should not be using them to destroy more lives.

    Though I admire Dr. Nardo for exposing much of the fraud of biopsychiatry’s drug studies and so called science, he still subscribes to the nasty paradigm that such bogus stigmas like bipolar and schizophrenia are real biological brain diseases and horrific assaults to the brain/body like neuroleptics and ECT are effective remedies for these fake diseases as exposed in the above book, Mad Science with no evidence whatever showing his own many blind spots. Perhaps the fact that he believes his daughter had/has ADHD influence him while perhaps the truth may be a need to look within one’s own stubborn belief system.

    You and I discussed the desire to take antibiotics for illnesses when they not only would not help, but would also do more damage like making one immune to these drugs when really needed. As I told you, as I became sadder and wiser about medicine, I realized that the doctor who wouldn’t prescribe them was right and ethical and I admire her now. That is true of most so called medications in all areas of medicine today including the bogus, useless statins with ever expanding goals to get everyone on the planet using them.

    I hear your frustration when you get upset that such fraud exists in all areas of medicine and that is certainly true now for sure making one want to avoid all areas of main stream medicine like the plague today.

    The problem is much, much worse with biopsychiatry in that a fraudulent life destroying stigma is used to subject people to known toxic body/brain damaging drugs with great withdrawal problems that can render the person permanently disabled as Robert Whitaker and many others expose as well as losing all human, civil, democratic and other rights forever. And this destruction of people’s lives is based on pernicious fraud created when psychiatry decided to sell out to Big Pharma when they felt at risk when Freudian analysis was waning to hijack the entire system. Thus the fraud of mainstream medicine pales in comparison to the huge harm done by the fraud of the APA KOL’s in power who callously created this debacle for such self serving purposes as so well documented by Dr. Peter Breggin, Dr. Thomas Szasz and all too many others. Dr. Fred Baughman, Neurologist, calls biopsychiatry with its life destroying stigmas and drugs 100% fraud and the worst medical crimes ever perpetrated against humanity.

    You said that you found it frustrating to try to establish causes of severe emotional distress in your earlier years in psychiatry so you felt more comfortable when the DSM paradigm allowed you to simply apply bipolar and schizophrenia “diagnoses” to such human suffering. Since you and I are both older and did not grow up with this fraudulent paradigm of stigmatizing normal human suffering, crises and emotional distress caused by abuse, loss and other reasons, I find it difficult to accept that you would have so eagerly accepted such an obvious fraudulent paradigm because of its greater ease and convenience. You also contributed to a book on the toxic effects of psychiatric drugs. Did you ever consider the real horrific effects of such stigma and toxic drugs on the victims as equal human beings with equal human rights? As you watched women especially blow up 100 pounds, did you not realize how much this added to society’s contempt, disgust and prejudice against them not to mention all the other losses described by psychiatrists Dr. Judith Herman, Dr. Frank Ochberg and Dr. Carole Warshaw? If not, I hope you are thinking about it now that you have had contact with many victims of such a vicious, corrupt paradigm of so called mental health.

    You are right that people may demand these toxic, useless drugs in their desperation, but that is because they are ignorant about their real short and long term effects. That is why some drugs are illegal in this country in that their potential for damage is well known. However, hypocrisy and greed are alive and well as Dr. Loren Mosher pointed out in his resignation letter to the APA in that the only “good drugs” were those from which biopsychiatry could make a profit while those illegal or other “bad” drugs that didn’t line the pockets of biopsychiatry/Big Pharma could only serve for dual diagnoses and vilifying the victims using them.

    Anyway, though I appreciate your efforts to expose some of the fraud of the biopsychiatry/Big Pharma paradigm, books like Mad Science are critical in terms of exposing that biopsychiatry is rotten to the core and the only solution is that is should be completely abolished.

    As you continue to sit on the fence of the deadly biopsychiatry paradigm, I hope you will consider the above along with many other factors I haven’t included here.

    • Sandy,

      Despite the fact you claim to prefer Dr. Moncrieff’s drug centered model, isn’t it true that you would have to give a person a DSM label to pay for any such drugs you may prescribe where you work or in most places deadling with health insurance or Medicare/Medicaid?

      Since Dr. Moncrieff is also in our age group, I was horrified when she claimed neuroleptics were necessary for psychosis at the Vatican conference no less. This certainly burst my bubble about Moncrieff’s so called antipsychiatry stance when she has also written about the toxic effects of these useless drugs including lithium too.

      Such fence sitting when knowing the truth deep inside reminds me of when I was a child and like others didn’t want to admit I no longer believed in Santa Claus because I worried I wouldn’t get as many gifts.

      And bogus biopsychiatry has been the gift that keeps on giving for those profiting from it while Scrooge and bah humbug prevail for its many victims driven to destruction, poverty, ill health, destroyed marriages and careers, loss of custody of children, loss of friends and family and even homelessness and needless to say a welcome early death of about 25 years thanks to the stigma coupled with lethal drugs. That’s if the victim isn’t driven to suicide due to their very real despair and/or lethal drugs known to cause aggression and suicide that will be attributed to their bipolar or other bogus stigma, of course.

  6. Sandy,

    Just because something is old and has been around a long time does not make it true as Dr. Mary Boyle like others have exposed in such works as Schizophrenia: A Scientific Delusion? And Dr. Thomas Szasz exposed that schizophrenia has long been psychiatry’s sacred symbol or justification for its existence, stigmas, torture treatments and coercion that they are replacing with the latest bipolar fad fraud as exposed on the web site Yoism with Robert Whitaker, Dr. Loren Mosher and others speaking about this fraud on videos. That’s also why blood letting is no longer used in medicine as an all around remedy thanks to some progress and we no longer worship Zeuss. Sadly, despite books like Mad Science, little progress can be made as long as vested interests rather than human health and well being dominate.

    Yes, convenient parts of Kraepelin were hijacked when biopsychiatry created its biological paradigm while putting less outward emphasis on Kraepelin’s focus on psychopathy, one of the greatest threats to modern humanity per Dr. Robert Hare and many others that biopsychiatry ignores for the most part, and on eugenics in the guise of genetics which is alive and well in biopsychiatry to blame the victims for gross social problems to keep the current robber barons in power. This was just a preference chosen by those promoting biopsychiatry since it fit their bogus paradigm with no evidence whatever. There have been many competing views that focused more on obvious social factors causing human distress that have been outlawed by the current DSM that even Dr. Robert Spitzer, editor of DSM III admits with regret supposedly. Spitzer admitted that if any causes of DSM stigmas were acknowledged, this whole house of cards would fall apart as it has been recently. This is why we have rape victims destroyed with the bipolar fraud fad stigma since admitting the trauma of rape, domestic violence, school/work bullying is outlawed by DSM with its sole, soulless focus on mere outer symptoms. The fact that such admitted bogus junk science stigmas can still be inflicted on vulnerable people shows that our country, medicine and psychiatry especially have lost their moral compass and are totally corrupt with only their huge profits the goal in my opinion.

    I have just tried to quote/cite your views from other posts to understand your current position.

    I am very glad you are reading Mad Science since it is a current critique of all the problems/junk science of DSM biopsychiatry that has received much praise from experts in the field without conflicts of interest.

    Yes, those like Phineas Gage with obvious brain injuries did behave much differently, but there was obvious and well known brain damage in these cases. If I break a leg, it will also behave differently as is true of any bodily INJURY. This is certainly not true of so called schizophrenia and bipolar for sure that have been declared invalid stigmas with no physical evidence whatever to back them up even by Dr. Insel, Head of NIMH. And that’s sure not for lack of billions and decades of effort and search for the holy grail of seeking The Missing Gene and The Gene Illusion per Dr. Jay Joseph and many others exposing the fraud of the current eugenics of biopsychiatry for those in power. And the never ending search for so called “biomarkers” goes on with the latest debacle seeming to use the effects of stress and trauma as evidence for these vile stigmas like bipolar. They seem to be trying to EQUATE bipolar and PTSD now while blaming the victims’ inferior brains/bodies, which is so evil it boggles my mind. Dr. Moncrieff does admit that by stigmatizing individuals for the nefarious effects of unjust, evil social policies and abuse, society/government is acting without conscience (or psychopathic).

    Despite the problems with psychoanalysis that also blamed the victims for social and other problems, there is common sense which is not so common unfortunately.

    I regret if I offended you. I hope you will post on Mad Science, but given the above, I am not sure it will make much difference if you read it since you seem very set in your views that appear to maintain the status quo with a bit of tweaking of the amount of toxic drugs prescribed. The huge damage done by biopysychiatry to its victims goes way beyond its toxic drugs such as life destroying stigma, the violation of all human/civil rights and the out and out fraud to make billions for those in power used to justify the murder of millions of people from cradle to grave for the psychopaths in power described in Political Ponerology not that I necessarily agree with the supposed causes of psychopathy since I believe the potential for human evil and greed plays the major role.

    Finally, though Mad Science has gotten much praise for its comprehensiveness in focusing on the big picture of corrupt biopsychiatry, such exposes have been done before while being happily ignored by those in power, which is proof that biopsychiatry has nothing whatever to do with health or well being for sure:

    http://www.antipsychiatry.org/br-pibp.htm

    • As someone who is not used to this kind of advertisement, I’m always baffled that it has some positive effect for the drug companies (patients asking for it, increased subscriptions).

      In my country (as in all other countries with the exception of the US and New Zealand) direct-to-consumer prescription drug advertising is forbidden. There is also no advertising of non-prescription drugs for sleep, mood and psychological disorders.

    • I know someone whose psychiatrist told them that since the prozac they were taking wasn’t working as well as it once did, that they needed to increase the prozac and add abilify because the abilify would “jump start the prozac and make it work faster and better!”

      When I quit laughing I told the person that this was just plain and simple bull feces put out by the drug company that sells abilify. Plus I told him that the prozac is dangerous and if it does work it works no better than a placebo. The person got angry with me but a month later had a very severe “manic” experience lasting a number of days. I’ve known this person for over five years now and they’ve never been so-called “manic.” By then my friend had been shunted off to another psychiatrist at the “community mental helath center” and this psych had enough sense to tell him that he needed to be taken off of both drugs because they were what caused the “manic” experience! Thank goodness for a few good psychiatrists out there! Abilify makes the SSRI work faster and better! Give me a freaking break!

  7. Thanks as usual for your thoughts Sandra. I really appreciate that you take the time and effort to post here, even when it is likely to feel pretty uncomfortable. I really appreciate this part of your post even if I don’t agree with it fully…

    “To be honest, I am agnostic about what approach is best for any individual. I think my role as a physician is to educate the people who consult me, to explain what I know and do not know about the problems they are having, and what I know and do not know about available treatments. If there is a drug that will help, I will offer it. Some of the people who comment here seem a priori against the notion of using a drug to reduce suffering. I do not share that view.”

    I know a number of people who say that drugs have seriously helped them. Even saved their lives. They get very emotional, angry, if I, or others talk about the potential negative effects of psych drugs. I get that, in a lot of cases, people feel their suffering diminish. Why interfere with that?

    I honor where people are coming from. If an antipsychotic, or an antidepressant is “working for them”, who am I to suggest they are wrong? Or should stop. However, if I am a friend or their therapist, I do keep a careful eye on whether that drug or combo of drugs are causing greater health or emotional problems. And if they are, to be careful of what doctors usually suggest, which is to change to another med, up the dose or add another med. I frankly rarely hear about doctors looking at tapering the meds, or offering comprehensive programs that involve diet, exercise, therapy, sleep hygiene and peer support.

    This is where I believe psych doctors could do a world of good. Just as doctors look at holistic programs for those with diabetes, heart disease and obesity, holistic health programs could deeply serve those suffering with emotional distress as well, and serve as alternatives to just one more drug.

    Anyways, always enjoy hearing your point of view.

    • I’ll bring up the pubic good argument again here. Dr’s have a duty wider than to just the patient. Dr’s are encouraged and have a duty to not give out anti-bio-tics to whoever wants them because of the public harm of disease resistance that is caused by excessive use of anti-bio-tics. Dr’s use the least harmful treatments to minimize the harm cause by dangerous medicines to both the patient and the wider community.

      Major tranquilizer withdrawal can be serious. It can result in suicide or violent outbursts. This is a public health risk.

      Anti-depressants are associated with suicidal and violent outbursts. The physician needs to consider more than whether a drug may help the patient and whether the patient likes the drug.

      • I don’t think there’s necessarily a conflict between “public good” and listening to the desires of one’s patients; and I think it’s indicative of some larger themes in the debates here on MiA.

        I am NOT suggesting here that I’m a supporter of psychiatry. Having been a victim of its (many) flaws and still struggling to get off psych medications (after 25 years), I do strongly believe that doctors need to have FAR more discretion with prescribing, and in general, the lack of holistic thinking, as Jonathan and Sandra seem to understand (thank you!) is pretty appalling and tragic.

        Yet if someone says, as Jonathan does, they are satisfied with their medications, is it his (or our) job to discourage the individual from taking them? I know I have expressed this sort of thing in the past, and received some rather unfortunate accusations from some, but the concept of ‘Recovery,’ ‘self-determination’ needs to be just that – respecting individual choices, even when we disagree with those choices. If we think about “the public good” in a way that diminishes personal choice, are we actually helping people or denying them the autonomy of choice that is so often denied to us? To me, that makes us part of the problem. Of course, presenting alternatives is of utmost importance – but still, the choice is up to the individual.

        In my opinion, a ‘professional’ must acknowledge the individual good and the public good…I worry that both “pro-psychiatry” and “anti-psychiatry” (for lack of a better term right now) can both impose ideologies that limit personal choice and freedom.

  8. Sandy,

    Just for the record I think Jonathan Keyes makes some good points.

    For example, I mentioned the horrible statins known to cause muscle damage and other serious harm while being mostly useless for their stated purpose of preventing heart attacks per the evidence.

    I was on these horrible drugs for a while when under much stress. When I went on a health kick, lost weight, adopted a healthy diet and exercised regularly my cholesterol levels were back to normal and my doctor didn’t dare mention the horrible statins I had dumped like the plague they are after learning the truth about them. And I really resent the fact that my doctor put me on these toxic drugs without informed consent when there is no evidence that higher cholesterol causes heart attacks or related problems. As you probably know, they have just lowered the standards again to include just about everyone as potential statin imbibers. This is why I don’t go for annual physicals any more because I know what I should be doing to stay healthy by reading expert opinions like those of Dr. Joel Furhman. I also avoid all Big Pharma drugs like the plague now that I do careful research whenever they are prescribed to me or my loved ones and mostly find very bad news. Now, they are saying mammograms are dangerous and don’t prevent cancer. I’m sure glad I ignored all the prescriptions to get those. Same with hormone replacement “therapy.” Prostate cancer and much other similar cancer screening is now seen as dangerous due to false positives resulting in so called treatments that make matters far worse when no treatment was required in the first place. This is the result of main stream medicine being paid for specific procedures, prescribing drugs, etc.

    So, it seems the less done in main stream medicine today, the better and I think that holds true of biopsychiatry unless natural, truly healthy alternatives are the main focus. Some doctors are urged to give a prescription for exercise for so called depression.

    I just read the court hearing provided by Jonah with Dr. Loren Mosher’s testimony and he recommended valium as a drug if temporary relief of severe emotional distress is required while he believes neuroleptics should be avoided like the plague as much as possible given his experience with his Soteria project. I hope your agency is still making progress with Open Dialog and other non-drug alternatives.

    Anyway, I know you were doing some creative things to promote natural health where you work and I hope you can focus on those from time to time in your articles at MIA too.

    I also realize that you are very interested in a healthy life style and diet and I think I recall you saying that you have tried to adopt some of these measures in your own practice at your CMHC.

    I know that there have been many good (and bad) developments in biopsychiatry recently that deserve your attention here, but I don’t think anyone could say psychiatric stigmas and snythethic drugs lead to good health. Perhaps more focus on eliminating toxic junk food and drugs including smoking that can cause our brains to go haywire and other healthy measures can be urged on your low dose patients so they will have a better chance of going off the drugs permanently and remaining healthy. Dr. Mark Hyman, author of The Blood Sugar Solution, I recommended and you said you read has many helpful natural strategies to help eliminate “psychiatric” symptoms.

    I guess we went a bit off topic from your post about the new supposed wonder drug or antipsychotic, Latuda, but like you and Dr. Nardo, it is hard for any of us to get too enthused about the latest claims for new wonder drugs for so called schizophrenia and bipolar as we are a very jaded audience about biopsychiatry/Big Pharma claims for very good reason like you and Dr. Nardo. The fact these drugs have been approved for invalid disorders is as hard to swallow as any of main stream medicine’s dangerous drugs and treatments.

  9. Thanks for this piece and for what you’re doing Sandra.

    I also work “in the field” and am faced daily with the challenges of how to make large and substantive changes in a system without alienating those that you need to work with to bring about the change. It’s taxing stuff but people’s lives are on the line so it’s worth it.

    Best,
    David

  10. It seems like so many of these wrongs cycle back to the drug companies’ drive for profit. Sandy, why haven’t you just kicked the Latuda guy to the curb? If more doctors just said no to drug reps and the influence of advertising we’d have fewer of the “me too” patented drugs and the problems that come along with them.

  11. Sandy, as you know, I too, very much appreciate your courageous voice, here, despite the onslaught of negative reactions that can come toward you or any psychiatrist (as well as others) on this site. To me, that makes you a leader in your field, because obviously, you have the willingness to step into the mine field in order to find truth. Finding truth is not the actual intention of all (for some, it is about sabotaging truth, for self-interest or self-protection), but I believe that for you, it IS about finding the truth of the matter. That’s what I intuit, from our interactions.

    I can relate to your position. I am introducing a lot of new information and perspective into healing, personal evolution, and paradigm shifting and it is a helluva task. I get so much resistance thrown at me because it seems impossible to suggest something that challenges a person’s (or community’s) long held belief without it being reacted to as if it were personal. All neutrality and hope for balanced discussion disappears quickly, as it falls on wounded or programmed ears. I find this to be the most challenging part of these discussions.

    I know that personal feeling will come up, that seems natural and reasonable to me. However, this is where I introduce ownership and self-responsibility in my groups. Our emotions can inform us with subtle and interesting information, if we owned that our feelings belonged to US, rather than to the people that trigger us. If we are very empathic and feeling the feelings of others, then that should be acknowledged somehow, with neutrality and compassion. I witness that you do that beautifully. I find you to be very authentic and humble in your communication.

    To me, that’s an internal paradigm shift. To have fruitful discussions, we do need to allow our emotions to surface, otherwise words ring hollow, at least to me they do . Plus, in these particular discussions around ‘mental illness’ and it’s many related complex tangents, I know we’re all fully aware of the rage that has built for a lot of reasons. And I do believe it is reasonable, no doubt about that.

    But I do feel that a sense of our higher self (as in, a self-responsible and self-controlling adult) should be present at all times. When we smear, discard, dismiss, or discredit others when a perspective is presented, instead of being reasonable when we get angry, and a bit curious, communication has broken down, and things remain stuck–unless, of course, we can pull ourselves out of that mindset. All else is a waste of time and a drain on one’s energy. That’s how I see it, anyway.

    Perhaps a bit off the point of your post, but after reading through the comments, I felt compelled to express this. I think you’re a wonderful example of being, both, authentic and respectful in your communication on this website, in a sea of anger, and I appreciate that very much. Thanks.

  12. @Sandra

    Why you are here is one thing….why your colleagues are not is another. Most of the psychiatry chat here is about the science, the blind mans buff and receptor tetris combination game. That can go on anywhere…. and it does.

    The community bit goes largely undressed……but thats the whole point….because if psychiatry wasn’t just a handy way of rooting problems that are the result of problems in society inside individuals…..then society would have to do something about that….politicians would have to do something about that…. something would have to change. But no. Psychiatry serves to prop up the whole crumby shooting match…..as an institution its deeply deeply repressive…..

    So by all means carry on…. carry on talking about brains and how its possible to interfere with them to oh so interesting an effect….. all this chatter does is obscure where the real problems lie….. like I say, I can’t see your colleagues wanting to discuss that either….

    Psychiatry isn’t just scientifically worthless….its socially harmful into the bargain….

  13. I dunno, lurasidone is just another “atypical” neuroleptic drug. It works the same way as other “atypical” neuroleptics, it blocks D2 and potentially gives the same adverse effects that Whitaker, etc, have reported upon. It doesn’t have some of those sedating histamine H1 effects (same as Benadryl). The sedation effects of Seroquel, etc, may very well help with the studies on depression, in the sense the patients with Seroquel get actual sleep, because of H1. I read this new drug may be sedating, or not, through some mechanism through some new serotonin receptor. In any case, the drug very generally works in a similar adverse or beneficial ways as other neuroleptics, of course depending on dose. Really cruel to give it as an antidepressant in my point of view.

    • I mean, when I was actually in the “system”, I was given some SSRI first (I forgot its name), later Abilify. When in a meeting I pointed to them then I read that the metabolism of SSRI interacts with that of Abilify, the psychologist looked at the psychiatrist and after a while, the psychologist said “let’s stop the SSRI, Abilify also helps with depression”. !! Blocking your D2 sometimes does not help with depression, maybe it oftentimes causes it to a horrible degree, likewise as it causes social phobia, etc.

    • Though, some people like to experiment with these different receptors these drugs affect on, such as the people at http://www.crazymeds.us. There are many people who know so much about these different receptors and also often have experience about it. For instance, a short googling showed plenty of reports about akathisia related to lurasidone. It may be that drugs with more metabolic effects have less akathisia, because those exact effects help with akathisia. Or not. I don’t know, I’m done with self experiment on this field!

  14. Sandra,

    Thanks for another intriguing post.

    I would like to add two other frustrations with the field of psychiatry that you have alluded to but left off your list — the need to individualize the approach to each patient and the total lack of awareness of the vast knowledge available in the research literature.

    The first issue is one of how doctors talk about drug efficacy. A drug study can say that 60% of patients significantly improved but 5% were significantly harmed and doctors conclude this is a good drug – and don’t even try to understand you as a patient and whether you have the factors that will predict which group you are most likely to fall into. (Even though if you dig even deeper into the literature, these factors frequently have been identified .) Conversely they do the opposite when the numbers point the other direction.

    Yet ultimately drug efficacy come down to how you as an individual respond and not what some sample produces in means and p-values. Sometimes you are the mean, and sometimes you are the outlier.

    As an MH patient, I fell into this trap for many years – only going after the ‘best bets’ and continually coming up in the bottom 5% group. Once I came to understand that “I am not the mean” I was more open to trying a broader range of interventions and I did find something that works – even though the use of it for my DSM code number was considered ‘off label’ and ‘contradicting the evidence.’ Why? Because the specific underlying biochemical problem I had that was exacerbating my symptoms was not at all related to the baseline levels of serotonin or dopamine (but was apparently messing with them on occasion.)

    Second, there is a lot that is known about these conditions but there are hundreds of interaction variables that can combine to produce symptom patterns and drug response patterns. This type of complexity requires supercomputing (or super-intuitiveness) to decipher and is not something that can be understood in a 15 minute DSM style question and answer session. Yet that seems to be all that psychiatry’s intelligentsia want to talk about — perpetuating the status quo. And all the countermovement wants to do is play semantics games with the medical lexicon and debate brain-mind duality .

    And this is why the field of psychiatry is going no where fast.

  15. The reason all these studies contradict each other isn’t like giving away the secret formula to Kelloggs Frosties or anything…..

    Why olanzapine beats risperidone, risperidone beats quetiapine, and quetiapine beats olanzapine: an exploratory analysis of head-to-head comparison studies of second-generation antipsychotics.

    Of the 42 reports identified by the authors, 33 were sponsored by a pharmaceutical company. In 90.0% of the studies, the reported overall outcome was in favor of the sponsor’s drug. This pattern resulted in contradictory conclusions across studies when the findings of studies of the same drugs but with different sponsors were compared.

    http://www.ncbi.nlm.nih.gov/pubmed/16449469

    Well isn’t this shocking….who would have thought it…..