If You're Considering Going on Anti-Depressants

Consider how hard it is to come off them. Pharma Industry watchdog, Philip Dawdy works his ass off chronicling the endless side effects while on and tapering off anti-depressants (as well as anti-psychotic meds) on his blog, Furious Seasons. He populates his blog with three to four, if not five posts a day with facts and stories on patient experiences, his own experiences, and the daily goings on in the psychotropic drug world.

Not to mention the brave guy has to suffer endless abuse from readers that he is either anti-psychiatry, or oddly pro-pharma - neither of which are true. I think what Mr. Dawdy is doing is incredibly vital, and an important reminder that we're still far from a truly functional paradigm that relates the brain, consciousness, and mood.

An excerpt from one of his posts today:

I was out on a walk yesterday afternoon and ran into a friend in the neighborhood, one who I don't run into so much these days. She's in her late-20s and told me she was feeling crappy. Why? I asked.

"Oh, I finished tapering off my anti-depressant and I feel all slowed down."

The anti-depressant in question was citalopram (Celexa in branded form) and she'd tapered down from 10 mgs. over four weeks, a bit too fast in my experience. But she wanted off the drug, which she'd been on for two years, because she felt it wasn't doing much for her, so she went for it. We talked and as it came out she'd experienced some of the buzzing in the back of the neck that many people experience coming off an SSRI. No brain flashes though.

I assured her the sluggishness she was feeling was fairly common following SSRI withdrawal and that hopefully it would clear up in a week or two. But it could take longer. She was worried about having to go back on citalopram. I told her about some I know in Seattle who's been hooked" (his term for it, not mine) on Prozac for 20 years, despite several lengthy attempts to taper off the drug.

I sensed she hadn't looked into any outside resources for managing her withdrawal--Peter Breggin would've argued for a much longer taper--and I told her that what she was experiencing was almost entirely unresearched by researchers.

It's just astounding, seems like an added bonus for drug makers that the withdrawal from these pills are so painful. I try not to be extreme on this blog, but the way these drugs are sold, marketed, and prescribed is just irresponsible and evil. The irony is that these anti-depressants are billed as "medicine" by your doctors who so often seem to oversell their benefits. Makes me so angry.

Anyway, thanks to your continued hard work and sacrifice, Philip. Keep fighting the good fight.

Seroquel, Another Apparently Fun Antidepressant

From a reader comment on Furious Season's Blog:

"I took 200 mgs. of Seroquel daily for two years after a questionable diagnosis for Bipolar II (manic symptoms appeared only after treatment with antidepressants or with high doses of IV steroids). Now, a year after withdrawing from Seroquel, I still wake up every two hours, and I still have episodes of akithisia. I believe this drug has permanently damaged my nervous system. I struggled with deep depression the entire time I was taking Seroquel; since withdrawing (a painful process) my mood has improved."

Another example of akathesia and SSRI's - not good.

Big Pharma Worse Than I Thought

And I already thought it was pretty bad. More from Furious Seasons about a great Slate article exposing another group of doctors and scientists that are on the take from Big Pharma companies like Glaxo Smith Kline, Eli Lilly, Pfizer, and Novartis.

What's most disturbing is that these guys structure the DSM, which determine diagnoses and recommended treatments for mental illnesses. And their influence is huge - WNYC's "Infinite Mind" recently aired a show called "Prozac Nation Revisited" with its host, Fred Goodwin. The goal of this show was for Dr. Goodwin and his guests to quell the "overblown" fear that there is a link between antidepressants and suicide. Here's the disturbing part:

"All four of the experts on the show, including Goodwin, have financial ties to the makers of antidepressants. Also unmentioned were the "unrestricted grants" that The Infinite Mind has received from drug makers, including Eli Lilly, the manufacturer of the antidepressant Prozac."

"The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners—instead, each was introduced as a prominent academic."

How can it be this bad? It's just getting harder and harder to trust scientific experts anymore. I know I must sound like a creationist here, but the science community has really been showing its holes lately. It is as susceptible to bias and corruption as politics. The danger of that is that science is supposed to be this impenetrable fortress of truth. And while it's the closest thing we have to that, it gets consumed by the public as unquestioned gospel. We seem to exist in an age of scientific zealotry - just quote a peer-reviewed study, and theory becomes fact.

It's a tricky gray area because it leaves established and monumentally important truths like evolution vulnerable to attack by indoctrinated religious thinkers. But when it comes to amorphous ideas like depression and consciousness, the "facts" are very malleable and susceptible to manipulation - especially when it's part of the mutli-billion dollar antidepressant industry.

It just doesn't seem like the standard, reductionist approach towards a true understanding of human consciousness and mental illness is going to suffice. For now, mental illness is just a ripe marketplace for corporate interest. Not to say there haven't been advances - there are some great therapists and psychiatrists out there (though few and far between it seems). Otherwise, we've just been grasping at straws (or ice picks). The solution to this problem is in dire need of a paradigm shift.

Major kudos to the writers of the Slate article, Shannon Brownlee and Jeanne Lenzer.

(Interesting tidbit, I can't find Infinite Mind on WNYC)

You Can't Make This Stuff Up

Which is why the writers of crappy TV shows like Grey's Anatomy probably scour the internets for stories like these. The one time I caught an episode there was a patient with Persistent Genital Arousal Disorder, which turns out to be a real phenomenon. Though like Restless Leg Syndrome, it strikes me as one of those odd disorders that occurs as a side effect of other psychotropic drugs or hormone therapies. Then again, I'm sure there are other causes of PGAD linked to menopause or pregnancy that send the nerves and hormones out of whack (see a video blurb on 20/20 here).

Anyway, here's the real catch - the best medication for PGAD? Anti-depressants. The decrease of libido associated with many anti-deps, Paxil in particular, are so extreme, they actually help ameliorate the symptoms of this surreal condition. Unfortunately, in the blunt-instrument-treatment of anti-deps, they can also masterbate...i mean...exacerbate the problem (I'm sorry):

"Dearmon [a PSAS sufferer] was about to embark on a long road trip in 2000 when she had a panic attack. She knew the car’s vibrations would be torturous, so she visited her primary care physician, who prescribed the antidepressant Paxil, a drug that lists decreased libido as a possible side effect.

"It had a good benefit," she said. "It put a damper on the sensations; they weren’t as strong. I could masturbate once and as time went on, it was every other day; then every few days. Now, I can go until the seventh or 10th day — and by then I can’t even concentrate."

Unfortunately, Paxil doesn’t work for everyone with PGAD. Some patients have said antidepressants actually act as a trigger to the disorder, Leiblum wrote."

(from Furious Seasons)

More Random Marketing of Anti-depressants

From Furious Seasons:

"This is certainly a fabulous Friday for pharma execs in the land. Abilify gets approved for kids this morning and this afternoon we learn that the FDA just approved Pristiq for depression. The drug is made by Wyeth and is essentially a rejiggered Effexor, only this one was originally developed to help women with hot flashes. You know Wyeth is going to give this drug a huge roll out since Effexor goes off-patent fairly soon and I'm sure that the made-for-hot-flashes-but-good-for-depression sales pitch is going to work wonders with men and women of every age."

Classic. I use to work at a clinical research organization that ran clinical trials on Meridia. Originally marketed as an anti-depressant, the drug struggled for an identity in the crowded playing field. After searching for trends in the data, they noticed people lost weight while on the drug. And lo and behold, a new psychotropic weight loss drug hits the market. This drug isn't just an SSRI, it prevents reuptake of dopamine and norepinephrine as well. Oh, and Monica Lewinsky was hired as the spokesperson.

My Power To Will

I've become a bit obsessed with the idea of a "will" center in the brain, and the endogenous neurochemicals associated with it. Obviously it's never as simple one location in the brain for any complex behavior - but there are circuits that have a lot to do with the conscious impulse to perform a physical act, which in a lot of ways is the foundation for the link between our thinking and behavior. Maybe it's where each conscious decision is made at its most fundamental level?

Today's surreal science fiction-esque phenomenon du jour is the newly diagnosed (and, of course, medicated) condition called Restless Leg Syndrome, or RLS as it's commonly referred.

In relation to a prior post, I was not surprised to find that:

"Certain medications may worsen RLS in those who already have it, or cause it secondarily. These include: anti-nausea drugs, certain antihistamines (often in over-the-counter cold medications), drugs used to treat depression (both older tricyclics and newer SSRIs), antipsychotic drugs, and certain medications used to control seizures."

It would surely be interesting to see the numbers of people with "RLS" that are on or have taken anti-depressants. My own (totally unsubstantianted) theory is that the effect of leaving dopamine and/or serotonin in their synapses (as is the goal of reuptake inhibitors) may be creating some kind of feedback loop of movement circuits. These circuits were the result of willed impulses originally, but are now on a highly uncomfortable auto pilot, where the individual can no longer consciously inhibit these looped movements.

It is also noteworthy, that certain medications for RLS have also been used to treat Parkinson's patients. Also of note are the bizarre side effects of Mirapex, a new RLS drug:

"Several unusual adverse effects of this medication may include compulsive gambling, hypersexuality, and overeating"

Akithesia and Anti-depressants

A side effect of certain SSRI's - Akithesia:

"...a syndrome characterized by unpleasant sensations of “inner” restlessness that manifests itself with an inability to sit still or remain motionless."

High-functioning patients have described the feeling as a sense of inner tension and torment or chemical torture.

Akathisia makes some patients act out in violent fits of rage throwing and breaking things or harming others. Ironically antipsychotic drugs are many times prescribed as “mood stabilizers” but then have the opposite intended effect, which often leads to increased doses further escalating the symptoms when the intent was to ameliorate the symptoms."

(antipsychotics are different than anti-depressants, but Akisthesia is a known side effect of anti-deps as well.)

It certainly gives the impression that anti-deps enhance "will." Neurologically, it's difficult to define will, but the idea of initiating physical movement seems a good start, which is also something many people diagnosed with clinical depression complain of - being paralayzed, stuck in bed, etc. Could this effect of anti-deps be responsible for these perceived positive and negative effects?

Anti-depressants and Homicide, Suicide

Terribly sad case of a 12 year old kid sentenced to 30 years in jail, for the brutal murder of his grandparents. Christopher Pittman is now 19, and his murder case was recently appealed to the supreme court, and was denied a hearing today, which is terribly tragic given his background and the fact that he was on heavy doses of Zoloft.

(from the CNN article linked to above) "The Food and Drug Administration in 2004 ordered Zoloft and other such medications to carry warnings of an increased risk of suicidal behavior in children."

The extremely weak and unproven theory of depression treatment consists of keeping serotonin in the synapses longer, supposedly "regulating" the baseline of the neurotransmitter in the brain (a baseline that has never been established). Seemingly, the difference between most SSRI's and placebos is the restoration of will power that was formerly missing.

It explains why certain people live by the stuff - many have trouble getting out of bed in the morning; they don't feel like they can function. It seems many anti-deps enable you to act on your will better.

Now imagine giving a drug with those effects to someone with suicidal or homicidal tendencies. It certainly provides one possible explanation for why we're seeing these violent homicides/suicides and finding out the perpetrators are usually dosed with some kind of SSRI.

In Christopher Pittman's case:

"At the time of the crime, the boy had bounced around homes for years, experiencing a half dozen family splits and divorces after his mother had twice abandoned him as a child. She has not been in Pittman's life for years."

"Just days before [the shooting], a doctor had begun prescribing Zoloft, another antidepressant. The family contends the abrupt substitution of drugs caused a bad chemical reaction, triggering violent outbursts."

Most interesting, Pfizer's [maker of Zoloft] comments about the trial:

"[Zoloft] didn't cause his [Pittman's] problems, nor did the medication drive him to commit murder. On these two points, both Pfizer and the jury agree."

This awful, heartless comment is half right. Pittman had problems alright, none of which were his fault either - he was bounced around from home to home with no semblance of structure while often getting abused. No, Zoloft didn't cause his problems either, though it's ironic it's prescribed to somehow cure them.

But did Zoloft drive him to commit murder? In a sense, I would absolutely agree. I believe they provided him with the will to act on his understandable impulses - he was a troubled, angry, and neglected teenager. And it saddens me that despite the overwhelming evidence of a correlation between SSRI's and homicidal/suicidal behavior, this poor young man will be in jail until his 40's. This kid didn't need psychotropic drugs, he needed attention and someone to care for him, and that simple fact is grossly misunderstood.

Here is the old bizarre Zoloft ad that looks like something out of a Kurt Vonngeut novel:

"While the cuase is unknown, depression may be related to an imbalance of natural chemicals in nerve cells in the brain, presscription Zoloft works to correct his imbalance."



Thank you Zoloft for spreading this toxic crap into the American public (232 million prescriptions of Zoloft and other anti-deps in 2007) without really knowing what's causing the depression you're so-called treating.

I'd say we're better off with ecstacy.

Doctors Banning Pharma Reps

One of my absolute favorite blogs, Philip Dawdy is one of the few journalists I've read that understands the horrible anti-depressant industry - from their missing data, to their aggressive, careless marketing.

In his bio he talks about his history with manic depression (or as my father, a psychiatrist I think Mr. Dawdy would like has repeatedly reminded me, bipolar disorder is an insensitive title, "people aren't batteries," he says - here here). He expounds daily on the state of mental health care in the US over the last 20 years. I'll be posting a lot about the pitfalls of anti-deps, so I'm sure I'll be referring to his work frequently.

Back to the original point of this post - this one doctor, finally fed up with reps for the popular anti-depressant, Seroquel (now being prescribed for manic depression) has banned all pharma reps from his office. Bravo, doctor.

(Despite my struggles to find a consistent source of income, I'm so glad I never gave into becoming a drug rep coming out of college armed with a neuroscience degree. Bravo...me)