The field of psychiatry is awash with systematic reviews, meta-analyses and other published articles proclaiming various discoveries. But can this research be trusted? Is it of good quality? Is it ethical? Let us examine one such article and see.
In his article “Suicide prevention strategies revisited: 10-year-old review,” Zalsman (2016, p. 1)1 shares with us his discoveries:
“The anti-suicidal effects of clozapine and lithium have been substantiated, but might be less specific than previously thought.”
Clozapine and lithium have âanti-suicidal effectsâ?
As I found this statement shocking, I decided to check the sources.
This has led me into a quite extensive maze of variable quality meta-analysis and research. Although this analysis is not exhaustive, it proposes to study the first articles cited by Zalsman, to see if he correctly reports them and if they are good quality.
Insofar as we are not going to find very good science in this journey, it is an encouragement for the public to systematically check the questionable sources of publications.
About Clozapine
Clozapine according to Zalsman
Clozapine is the only drug indicated in the USA for reduction of suicide risk in psychosis. A meta-analysis (Asenjo Lobos, 2010) of the effects of clozapine in comparison with other dopamine and serotonin-receptor antagonists (eg, olanzapine and risperidone) demonstrated anti-suicidal effect in schizophrenia. (Asenjo Lobos, 2010)
(Zalsman, 2016, p. 3)
By design, this meta-analysis can not demonstrate that clozapine has an anti-suicide effect. This meta-analysis compares neuroleptics with each other: it is quite possible that all neuroleptics increase the risk of suicide, but that clozapine does it a little less than the others. But more importantly:
Do the authors of the review tell the truth?
Clozapine according to the sources
Asenjo Lobos, 20102
Here are all the citations of Asenjo Lobos (2010) about clozapine and suicide, in the abstract and in the body text. Citations from the study cards and from the tables were omitted because they are difficult to present and they are essentially the same content. This publication is open access.
I highlight some interesting passages:
Other findings that should be replicated were: clozapine improved social functioning less than risperidone and fewer participants in the clozapine group had to be hospitalised to avoid suicide attempts compared to olanzapine.
[âŚ]
1. Comparison 1. CLOZAPINE versus OLANZAPINE
[âŚ]
Only two studies reported the mortality during the trials (Conley 2003; Meltzer 2003). Deaths from any reason (1 RCT, n=980, RR 1.50 CI 0.62 to 3.64), natural causes (2 RCTs, n=993, RR 1.40 CI 0.45 to 4.38) and suicide (2 RCTs, n=993, RR 1.67 CI 0.40 to 6.94) were all similarly likely whether allocated to clozapine or olanzapine.
[Note: the Conleyâs study reports all discontinuations and none of them is the death. (Kelly, 2003 p. 183 pdf p. 3)]
[âŚ]
1.19 Service use: Hospital re-admission
Most of studies did not provide data on service use. Only one long term study (Meltzer 2003) reported the hospitalisation for imminent risk of suicide as a rescue intervention. Significantly fewer people taking clozapine (20%) were hospitalised compared to those taking olanzapine (26%)(1 RCT, n=980, RR 0.78 CI 0.62 to 0.98, NNT 18 CI 9 to 230).
[âŚ]
5. Comparison 3. CLOZAPINE versus RISPERIDONE
[âŚ]
5.1 Death
Only two short term studies reported on death. There were no reports of suicides (Wahlbeck 2000). Regarding death due to natural causes, no difference was found between clozapine and risperidone (2 RCTs, n=293, RR 0.98 CI 0.06 to 15.48).
[âŚ]
Other findings that should be replicated were that clozapine improved social functioning less than risperidone and fewer participants in the clozapine group had to be hospitalised to avoid suicide attempts in comparison with those from olanzapine group.
[âŚ]
1. Comparison 1: CLOZAPINE versus OLANZAPINE
1.1 Death
Only two studies assessed this outcome. Data on deaths for any reason as well as for natural causes and suicide were available. A tendency in favour of olanzapine was observed, but these differences were not statistically significant. Hence, it can be concluded that the incidence of death was generally low and similar between treatment groups.
[âŚ]
1.19 Service use
A long term study, Meltzer 2003, showed a significant difference, where more participants in the olanzapine group had to be hospitalised to avoid suicide attempts. The relevance of this finding is limited due to the small effect size and the CI observed, which showed that it is possible that the true RR value is likely to be very close to 1.
[âŚ]
5. Comparison 3: CLOZAPINE versus RISPERIDONE
5.1 Death
Death is an outcome not usually evaluated in studies. There was no evidence of any difference between short term treatment groups with respect of the incidence of death due to natural causes. In the case of death by suicide, a small study reported that it did not occur, therefore the treatment effect was not estimable.
[âŚ]
3. For managers/policy makers [âŚ] Service use was reported by only one large study [clozapine vs olanzapine] which showed fewer hospitalisations to avoid suicide attempts. This evidence base is too limited for making recommendations.
That’s it, that’s all.
Meltzer, 20033
Subsequently, I checked the only study according to which clozapine might have a slight advantage over olanzapine.
The principal publication of this study (Meltzer, 2003) is open access.
This study initially gathered 980 suicidal subjects for two years. There were more suicides in the clozapine group than in the olanzapine group (1.0% vs 0.6%, table 4), but this difference is not significant.
To prevent suicides, it was planned to hospitalize subjects in suicidal crisis, drug them and submit them to electroshocks (Alphs, 2004, p. 583, pdf p. 7)4. âAll other appropriate means were allowed.â Even psychotherapy.
Almost all subjects were subjected to massive polypharmacy (Glick, 2004, abstract)5. 90% of subjects took at least two psychotropic drugs. On average, the clozapine group took 4.8 drugs and the olanzapine group 5.2. The olanzapine group took higher doses than the clozapine group.
The olanzapine group took more antidepressants (55.1% vs 49.1%) and more axiolytics/soporifics (69.4% vs 60.2% ) than the clozapine group (Meltzer, 2003, table 4).
38.7% of the subjects left the study along the way: 39.2% in the clozapine group and 38.2% in the olanzapine group (ibid., table 3). 28.7% of the subjects were considered âmuch worsening from baseline,â 24.5% in the clozapine group and 32.9% in the olanzapine group (ibid., table 4).
1.3% died: 1.6% in the clozapine group, and 1.0% in the olanzapine group (ibid., table 3), the majority by suicide in both groups (ibid., table 4).
This study was sponsored by Novartis Pharmaceuticals Corp.
* * *
In summary, Zalsman cites a single meta-analysis in support of his claim that clozapine has âanti-suicide effects.â
In this meta-analysis, no studies compare clozapine to placebo or to no medical treatment. Only one study shows that clozapine is associated with a slightly lower rate of rehospitalization due to suicide crisis compared with olanzapine. The authors of the meta-analysis report that no one should rely on it.
Finally, Zalsman attributes to his assertion âan anti-suicidal effect of clozapine in psychosis has been demonstratedâ the level of evidence 1a according to the Oxford criteria â the highest level (table 2, p. 5).
Very well.
Let’s move to lithium.
About Lithium
Lithium according to Zalsman
âReasonably strong evidence from randomised controlled trials (RCTs) shows that lithium is effective in reducing the risk of suicidal behaviour in people with mood disorders, (Cipriani, 2013; Baldessarini, 2006; Kessing, 2005) which was supported by the findings of a large-scale naturalistic cohort study (Goodwin, 2003) comparing lithium with valproate. A specific anti-suicidal effect of lithium was suggested in a population of people who had attempted suicide and who were treated with lithium, compared with people who had attempted suicide and were treated with placebo, (Lauterbach, 2008) although the number of deaths was very small (three deaths vs no deaths on lithium). A large-scale naturalistic study (Gibbons, 2009) suggested that anticonvulsant mood stabilisers might also have protective effects against suicide attempts.â
(Zalsman, 2016, p. 3)
If there is less suicidal behavior in a lithium group than in a valproate group, it does not prove that lithium has anti-suicide effects.
But at least here, it seems that there are studies vs placebo. We will focus on studies comparing lithium to placebo.
Lithium according to the sources
Cipriani, 20136
This is a meta-analysis in open access.
Let’s go straight to the part that talks about placebo studies.
Lithium versus placebo
Lithium was more effective than placebo in reducing the number of suicides (Peto odds ratio 0.13, 95% confidence interval 0.03 to 0.66; fig 2â)
[âŚ]
fig. 2
Bauer, 2000, lithium: 0/14, placebo 1/15
Lauterbach, 2008, lithium: 0/84, placebo 3/83
Prien, 1973a, lithium: 0/45, placebo: 1/39
Prien, 1973b, lithium: 0/101, placebo: 1/104
Suicide rate in placebo groups is absolutely insane. Letâs check the sources.
Source? Source? The bibliography is not available online: you have to ask the author for it. But thanks to the internet, we can find these studies by another way.
Bauer, 20007
This is the abstract:
OBJECTIVE:
Use of lithium to augment antidepressant medication has been shown to be beneficial in the acute treatment of depression. The authors examined the efficacy of lithium augmentation in the continuation treatment of unipolar major depressive disorder.
METHOD:
Thirty patients with a refractory major depressive episode who had responded to acute lithium augmentation during an open 6-week study participated in a randomized, parallel-group, double-blind, placebo-controlled trial of lithium augmentation during continuation treatment. After a 2-4-week stabilization period following remission, patients were randomly assigned to receive either lithium or placebo for a 4-month period (?!). Antidepressant medication was continued throughout the study.
RESULTS:
Relapses (including one suicide (!!)) occurred in seven (47%) of the 15 patients who received placebo in addition to antidepressants. None (0%) of the 14 patients who received lithium augmentation with antidepressants suffered a relapse during the double-blind phase of the study. Five of the seven relapsing patients in the placebo group developed a depressive episode, and the other two experienced a manic episode.
CONCLUSIONS:
Lithium augmentation in the continuation phase of treatment of unipolar major depressive disorder effectively protects patients against a relapse. Patients who respond to lithium augmentation should be maintained on lithium augmentation for a minimum of 6 months or even longer.
Withdrawal! Bauer gradually increases the dose of lithium with antidepressants, then⌠he removes it! With antidepressants! Result⌠a dead person!
The design of this study had some limitations that could confound interpretation of the data. First, the 1-week duration of lithium withdrawal was relatively short. There is a controversy in the literature about the existence of a rebound phenomenon caused by rapid withdrawal of lithium.
(p. 1433, pdf p. 5)
Ho yes! A âcontroversyâ! Antidepressants increase the risk of mania and lifted inhibitions while lithium decreases it. By acute augmentation and fast withdrawal of lithium, Bauer maximizes the risk of suicide caused by antidepressants and lithium withdrawal.
Is this how science is done? Of course! Read more:
Of the seven relapses in the placebo group, five were depressive relapses and two were manic relapses. The two patients with a manic relapse had never before experienced a manic episode, and both patients subsequently received a diagnosis of bipolar disorder.
(p. 1431, pdf p. 3)
Is he completely unconscious? It’s crazy.
Lauterbach, 20088
167 suicidal people followed for one year.
This is not a true placebo-controlled study: 60.5% of the cohort took antidepressants at the same time as lithium (66.7%) or placebo (52.2%) (Table 1, p. 474, pdf p. 6).
In our sample, about 60% of all recruited patients and more than 80% of suicide attempters and completers received antidepressant co-medication.
(p. 476, pdf p. 8)
In addition, there is no significant difference in the number of suicidal acts between the two groups, the number of suicidal acts is very high in both groups (lithium: 8.4% and control: 12.0%) (Table 4, p. 475, pdf p. 7). 68.9% of participants left the study before the end (fig. 1 p. 473 pdf p. 5). The annual suicide rate in control group was 6.5% and in the experimental group 0% (Table 4).
Because the dropout rate is huge, and the antidepressants are a confounding factor, no conclusions can be drawn from this study, only hypotheses.
One of these hypotheses is that lithium could delay the suicidogenic effects of antidepressants, but not for a very long time. Indeed, the number of suicide attempts under lithium + antidepressants or other drugs increases sharply after 300 days, while there are no more new suicide attempts in the antidepressants or other group after 150 days. If the study had lasted longer, it is possible that the lithium + antidepressants or other group would have more suicide attempts than the antidepressants or other group (fig. 2 p. 475 pdf p. 7).
Prien, 1973b9
205 people at the beginning, 122 at the end, two years of follow-up.
This is not a placebo study but a brutal withdrawal study:
Following remission of acute manic episode and prior to discharge patients were stabilized on maintenance doses of lithium carbonate which yielded serum lithium level of 0.5 to 1.4 mEq/liter. Medication was administered in unmarked 250mg capsules. At discharge, the patients were randomly assigned to lithium carbonate or placebo.
(p. 337, pdf p. 1)
Moreover, it is not a double-blind trial:
Major treatment decisions such as hospitalization were made by the treatment physician who knew the identity of the patient’s medication.
(p. 340, pdf p. 4)
It was found that only 16% had their dosage raised because of poor clinical response. Another 31% required dosage adjustment for low serum lithium levels while 12% had their dosage increased for unspecified reasons. The remaining 41% had no upward adjustment of dosage.
(p. 340, pdf p. 4)
Twenty-four percent of the patients on lithium carbonate had reactions severe enough to require dosage reduction or temporary drug withdrawal.
(p. 340, pdf p. 4)
In this study, investigators were instructed to increase placebo dosage as well as lithium dosage at the first sign of symptomatology. In practice, placebo dosage was rarely manipulated.
(p. 341, pdf p. 5)
Early Terminations. â Early terminations are summarized in Table 3. There were significantly more early terminations on placebo than lithium carbonate ( Ď² = 13.4, P<0.001). This was due mainly to the high proportion of terminations for poor clinical response in the placebo group (40% compared to 11% in the lithium group). A patient was dropped for poor clinical response when the treatment physician considered that further participation in the project would seriously jeopardize the patient’s mental or physical health.
(p. 339, pdf p. 3)
In addition, Table 1 (p. 338, pdf p. 2) shows that the treatment physicians ordered the hospitalization of 67% of the weaning group and of 31% of the lithium group. According to Prien, hospitalization = âsevere relapseâ (p. 337, pdf p. 1 âAssessment of clinical changeâ).
There is no detail on the person who committed suicide in the weaning group (p. 339, pdf p. 3).
In summary, subjects in the control group were brutally weaned, treatment physicians knew the identity of the patient’s medication, precisely adjusted the dose for a large majority of subjects in the lithium group, but almost never in the weaning group, even when the subjects felt terribly bad; they excluded subjects in the weaning group four times more often than those in the lithium group, and hospitalized them twice as often.
Psychiatric âscienceâ in action. It is not for nothing that there are double-blind trials. Prien may defend himself that:
[âŚ] several investigators were highly skeptical about the prophylactic efficacy of lithium carbonate at the start of the study
(p. 341, pdf p. 5)
The results of his study were literally forged by the experimenters. They did not âdiscoverâ anything.
Prien, 1973a10
It’s the same kind of junk science.
122 unipolar and bipolar subjects at the beginning, 67 at the end (table 3, p. 422, pdf p. 3), two years of follow-up. Brutal weaning. Electroshocks. No blindness of treatment physicians (pdf p. 2). The physicians expelled 20% of the subjects in the lithium group and 54% in the weaning group (table 3).
In less than four months, 67% of the weaning group and 27% of the lithium group relapsed (table 2, pdf p. 3). ~80% of patients who relapse need to be readmitted (pdf p. 3), i.e., ~53% in the weaning group and ~21% in the lithium group.
Five people died during the study (4% of all groups), including one suicide in the weaning group (3% of this group) (pdf p. 3). No details on this suicide.
Other sources
Above are the first placebo-controlled studies from the meta-analyses cited directly by Zalsman. You can read the othersâ sources in the meta-analyses of Tondo (2001)11, Baldessarini (2006)12 and in the ânarrative reviewâ of Lewitzka (2015)13. In addition, Kessing (2005)14 is not a RCT, but an observational study.
Zalsman cites also Gibbons (2009)15, a naturalistic study, which compares anti-epileptic drug treatments to the total absence of pharmacological treatment, and he does not notice that this study also speaks about lithium.
In this study:
- All patients were diagnosed bipolar (abstract)
- 2285 patient-years took only lithium and 40 made a suicide attempt, i.e., 18 suicide attempts per 1000 patient-years (table 1)
- 11,207 patient-years took absolutely no medication and 170 made a suicide attempt, i.e., 15 suicide attempts per 1,000 patient-years (table 1).
Although the difference is significant, it does not prove that lithium increases the risk of suicide attempts (there are many confounding factors and no homogeneity). However, this study does not raise any concerns about not prescribing lithium to bipolar people.
On the other hand, the suicide attempt rate among this class of patients is much lower in real life than in the experiments cited by Zalsman. The abrupt weaning, the combination of weaning with antidepressants, the emergency hospitalizations in the so-called âplacebo groupâ are certainly what has contributed the most to the insane suicide rate in Prienâs and Bauerâs studies.
Conclusion
You can not trust psychiatrists. Neither in the clinic nor in science. Many published articles are full of lies, many systematic reviews are a complete failure. I think that all psychiatric articles should be considered false until proven otherwise; that is, after careful verification of the original data and confrontation with other contradictory sources. We need, in particular, researchers who focus on the verification and criticism of poorly conducted studies.
Some studies are specifically designed to defeat the âplaceboâ group, which is actually a weaning/antidepressants/electroshocks group. These studies cause more deaths than the conventional clinic. Is this how psychiatrists prove their treatments are effective? Some researchers should be subject to a criminal investigation, not only a scientific investigation.
Well to stop suicide, they could test tying people up and compare that to people who are not tied up and see which one has a higher suicide rate. You know I am joking, but you can extrapolate the drug that inhibits someone from moving (same as a physical rope) would lessen the chances of suicide. Doesn’t really make it anti-suicide medicine.
dark humor on SMBC on suicide. Imagine a day, a pill, a vaccine for suicide! http://www.smbc-comics.com/index.php?db=comics&id=1210#comic
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At the SMBC comic link, click on the red button for a second example of a failed suicide thanks to a vaccine.
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True enough! Or give them enough Risperdal that they’re unable to stand or walk, and suicide rates would be expected to drop. The only problem is “underdosing” such that the patient is still able to move and formulate any kind of plan of action.
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Studies show people will believe anything you say as long as you say ‘studies show’ before saying it.
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7 out of 10 survey results are made up on the spot. đ
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Ha! Good one!
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10 out of 7 people agree that researchers torture the data to confirm their biases.
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….i heard it was really ONLY 9 out of 7….
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9 out of 7 people reported feeling better on the awesome new antidepressant Zombify!
(Should Zombify lose it’s effectiveness there’s the new atypical antipsychotic Xacerbate!)
Here’s a commercial for Zombify. As put out by the pharmaceutical company Pfaker.
Before taking Zombify I was a 125 pound wife and mom trying to maintain the perfect work-life balance between family and my full time career in education. Very depressed.
Now, thanks to Zombify, I’m a 250 pound divorcee, barely able to get out of bed in the morning. I live on disability since even a part time job’s too exhausting. My husband won the custody battle when the judge found out about my bipolar 2 disorder. I have heart problems, diabetes, and cholesterol levels double what most women my age have.
I’m more depressed than ever and can’t stop thinking of ways to kill myself. But think how much worse I’d feel without this life-saving wonder medication.
Zombify changed my life! Let it change yours. đ
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Rachel, are we going to lose you to Madison Ave.?
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Suicide Risk in Placebo-Controlled Trials of Treatment for Acute Manic Episode and Prevention of Manic-Depressive Episode
https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.4.799
That was in this article https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030185
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the conclusion is too extreme…
“you cannot trust psychiatrists”
I trust my psychiatrist….he is
very critical of psychiatry but
he still pays attention to the
model of causation bio/psy/soc…
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How about “you can’t trust the majority of psychiatrists?”
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So what? He still belongs to the well paid system of dehumanization. Psyche does not exists for psychiatry. The have their fake theories, and they have build theological hegemony over human psyche, and now psyche is invisible and condemned. Healthy means good, and evil means ill.
This is not psychology, this is theology.
James Hillman Re -Visioning psychology.
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I knew some nice individual psychiatrists. They were nice since I never questioned them and always did exactly as told. đ
Nevertheless psychiatry is a fake science. As Szazs noted, a lot of kindly, well meaning doctors applied leeches and opened the veins of people with cholera over a hundred fifty years ago. Good intentions notwithstanding, people died from it.
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âYou cannot trust psychiatristsâ
No, you cannot trust western medical doctors, full stop.
Thereâs nothing unique about the psychiatric research literature. This is how pharmaceutical research is conducted pretty much across the board. Doctors are taught in medical school how to match symptoms to drugs. There is no such thing as a search for a cure anymore. How quaint to think it! What we now live with are pharmaceutical âtreatmentsâ which must be maintained at great expense to the patient so that a relatively few can profit massively. Thatâs not medicine.
Is it any wonder doctors are dropping from suicide like flies? They can see through this charade and many are realizing that the healing art they chose is anything but and that many of the treatments hasten their patients deaths.
This wonât change without several other changes first: a ban on direct to consumer pharmaceutical advertising, a ban on giving free medications to doctors to distribute and get their patients hooked on, and a ban on for-profit medical/pharmaceutical research.
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There is one difference in psych research, though. They are researching “entities” that can’t be objectively defined or observed, which is perhaps the worst possible sin in science. When we start dealing with metaphorical entities, we’re dealing with philosophy, not science. Not that most doctors are concerned with science, either, mind you. It’s just harder to get away with pure BS when you have to at least demonstrate that your drug has a measurable effect theoretically considered positive by the recipient rather than the doctor and the family and the society at large.
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Dr. Quackenbush says your sense of humor is inflamed–probably from a bad infection of the imagination. The solution is putting you on an IV drip of snake oil immediately! đ
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Well considering snake oil probably comes with fewer side effects than FDA approved pharmaceuticals, I say bring on the snake oil!!
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Actually, pharmaceuticals are like snake oil that can kill you. Do they do anything about “mental distress”, say, but prolong it? Better double check your research results again.
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Steve, the problem is not that real doctors are studying observable events and psych doctors are studying something thatâs less real. The problem really stems from all of medicine suspending reality and calling everything they donât understand psychiatric.
Thereâs zero evidence that chronic Lyme patients are crazy, overly sensitive, or malingering, and an abundance of evidence that doctors have decided to ignore direct and obvious consensus reality physical evidence that patients are sick in favor of a myth about Lyme being easy to cure. What should be an open and shut case of an ongoing disease process is much easier to treat as psychological while patients are literally dying of medical neglect.
Lyme disease isnât the only instance of this, as shown recently with the parents of children with AFM being told their kids are little fakey fakers. And if Mad In America really wanted to point out the hypocrisy built into psychiatry as a legitimate branch of medicine, they could highlight more the widespread practice of psychopathologizing physical illness. The only people who manage to get proper treatment for this seem to be those who are most easily able to defend against the psych labels – people with no personal or family history of psych issues.
Anything a doctor canât easily cure gets relegated to psychiatry.
Pam Weintraub – the former executive editor of Discover magazine – wrote an amazing book (Cure Unknown) about how devastating this illness is and her own familyâs journey through it. She paints a devastatingly clear picture of how Lyme disease patients are psychopathologized in favor of a political narrative that helps insurers and doctors escape their responsibility to properly treat patients with complicated illness.
None of this even touches on the bigger issues with medical research, protecting careers, building scientific prestige, systems set up to seek profit before actual cures, and the throwaway patients whose lives are destroyed by doctorâs hubris and outright medical malpractice when they dump their sickest patients into the psychiatric system.
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I don’t disagree with you. I’m just saying the task is easier for psychiatrists. But psychiatrists are a predictable product of the medical system, almost inevitable. Psychiatry is a symptom of a much larger problem.
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“Some researchers should be subject to a criminal investigation, not only a scientific investigation.” All the “mental health professionals” who’ve misdiagnosed the adverse and withdrawal effects of the antidepressants as “bipolar” “should be subject to a criminal investigation,” too. But to prevent this, the psychiatrists just changed their DSM5, so such DSM-IV-TR malpractice is now acceptable “standard of care.”
“You can not trust psychiatrists.” I guess we can trust them to behave in a manner that benefits themselves, while ensuring ever increasing iatrogenic harm of their clients.
Thanks for pointing out some, no doubt just the tip of the iceberg, of the scientific fraud in the psychiatric literature, Sylvain.
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Crazifying human discomfort has a long history. Like the knowledge of trauma it comes and goes.
In the older days of medicine there was a well known saw horse about new medical students or for that matter put any student dealing with medical issues of some sort. Very many students would come up with a dx they thought they had. It was a part of the process of diagnosis and back then for some docs it was then as not only humorous but a step in the ART of medicine. However, this came with a strong strong caveat- sometimes the med students WERE CORRECT. Any good doc or prof or professional worth their salt would be able to relate a story about someone who dx their own disease.
What has been forgotten is not only medical and other students but many folks have the capacity to figure things out. Lorenzoâs Oil for example.
This has been forgotten. When zi was working a PhD/ md student was complaining of cardiac issues and nothing could be found. He ended up having a cardiac event on the floor of the adult psych unit where I worked.
The thoradtic surgeons heard the code called and laughed because it was from the psych unit. The one doc who did rush down several flights of stairs and literally opened him up was the burn unit doc who always associated burns with stress in folks lives. I heard him speak to that very issue in the late seventies. The student did not make it. The unit had a group meeting to explain to the folks on the unit what had gone down. Not a perfect place but do so so much better than some of the holes I was put into.
This also goes to the past and milinary factories where chemicals literally made folks â mad hattersâ. This is only one example- I suspect many more and more beyond just chemistry but nutrition and other things as well.
Insurance limiting interviews to fire teen minutes no eye contact and in and out slam bang is not care or treatment or medicine it is profit making Clog Wheel Machinary disguised as fill in the blank medicine, banking, education and on and on ad nsusuam.
There was also at the hospital later on the 90âs a push for research for every department and section. As if doing research was a panacea or gold standard. I am sure most of the so called research studies were ethically compromised. I know my sectionâs work was.
So much of the historical ethical research value has been lost or deliberately erased. The English Dr. Jenner inoculated his own family first with his new vaccine. That is the type of moral human being we need now more than ever. We have lost our way many decades ago and I can only hope somehow we can stumble into better days for ALL.
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Thanks for taking the effort to look at the individual studies in detail. Was not aware of the problems.
It should be kept in mind that the paper is coauthored by really high-ranked suicide researchers!
Did you also look at the review of the evidence for antidepressants (AD)? This is severely biased! Several important meta-analysis showing the increased suicide risk for AD are lacking (Stone et al., 2009, Hetrick, McKenzie, Cox, Simmons, & Merry, 2012). Note that the authors claim that the review was systematic!
How can they miss these important studies. They also completely ignored the results from papers before 2005 and write the conclusions as if there was no prior research. The biases are so obvious when you read the conclusion of the paper:
“First, antidepressant pharmacotherapy treatment in adults is associated with reduced suicide risk, while initiation of pharmacotherapy does not lead to an exacerbation of suicide risk. In people aged over 75 years with depression, there is a clear beneficial effect of pharmacotherapy on the risk of attempted and completed suicide. In children and adolescents, increased risk of suicidal thoughts has to be taken into account when starting pharmacotherapy for depression. However, given the increased risk of suicide in untreated depression and the absence of an increased risk of suicide associated with pharmacotherapy, currently available evidence does not support the avoidance of initiation and continuation of pharmacotherapy for depression in children and adolescents. Therefore, the ongoing discussion about possible induction of suicidality in minors should not prevent physicians from prescribing SSRIs.”
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Wow, that doesn’t even make any kind of sense! “However, given the increased risk of suicide in untreated depression and the absence of an increased risk of suicide associated with pharmacotherapy, currently available evidence does not support the avoidance of initiation and continuation of pharmacotherapy for depression in children and adolescents.” Didn’t he just say there WAS an increased risk of suicide with SSRIs???
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Yes, this is weird. There is a lot to say about this review, and I hope that some researcher will debunk it in more detail. But data from RCTs available at the time of the review do not support the conclusions:
“First, antidepressant pharmacotherapy treatment in adults in adults is associated with reduced suicide risk”
This is wrong. For adults, studies were mixed until 2015: some found no significant difference for suicide attempts and suicides, some found an increased risk for suicide attempts. Given the biases in the studies, the right conclusion should be, that there might be an increased risk for suicidal behavior. This was confirmed in two meta-analysis from 2016 that found an increased risk for suicides (!) in the long-term use of antidepressants for adults.
“In people aged over 75 years with depression, there is a clear beneficial effect of pharmacotherapy on the risk of attempted and completed suicide.”
Wrong. This was only found for suicide attempts in the Stone et al 2009 meta-analysis (that was not even cited in the review, BTW). You cannot speak of a “clear” benefit if you only cite one study that even was no RCT at all.
The wrongdoing peaks in this sentence:
“In children and adolescents, increased risk of suicidal thoughts has to be taken into account… ”
Definitely wrong! There is a higher risk for suicide attempts among young people, not just suicidal ideation. The authors must have known the major 2009 meta-analysis of Stone et al. which found an increased risk for suicide attempts among the young people.
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