We're in the Dark About the Drugs We Use

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Sun, 3 Oct 2004 22:49:27 -0400

[sSRI-Research] We're in the Dark About the Drugs We Use

 

Antidepressants: do they produce true bipolar disorder or are they

" triggering " the symptoms of bipolar disorder in people who do not

have bipolar disorder: article in the Washington Post

 

Paragraphs fourteen & fifteen state: " Meanwhile, some psychiatrists

report increasing numbers of young patients with severe psychiatric

symptoms, including anxiety and mania, which appeared after they began

taking SSRIs. Yet rather than seeing those symptoms as possible side

effects of the medication, many academics have interpreted them as

signs of previously undiagnosed manic depression, or bipolar disorder.

The SSRIs, in their view, are " unmasking " bipolar disorder, which was

there all along " .

 

" But there are no studies that support the notion that an individual

patient's " underlying " bipolar disorder would have emerged at some

later date had he or she not taken the drug. It is equally plausible

that the drugs themselves trigger bipolar disorder, rather than

uncovering it -- just as LSD is known to alter the brain's wiring and

cause flashbacks, and the street drug MPTP can trigger a

Parkinson's-like disorder " .

 

http://www.washingtonpost.com/wp-dyn/articles/A1928-2004Oct1.html

 

 

Mysteries of the Mind

 

We're in the Dark About the Drugs We Use

By Shannon Brownlee

Sunday, October 3, 2004; Page B01

 

For anyone sitting in a nondescript ballroom at the Bethesda Holiday

Inn last month, the testimony from families whose children had killed

themselves -- by hanging, by knife wound -- while taking

antidepressants was heartbreaking. For the families, however, the

subsequent decision by the Food and Drug Administration panel that

heard their stories -- to require a suicide warning on the

antidepressants' labels -- was a vindication. And a long-awaited one

at that. Several of the family members who testified have been arguing

for more than 13 years that the drugs can trigger devastating side

effects.

 

Still, many of those who have been involved in the effort to get the

word out are undoubtedly wondering why it took so long. Psychiatric

researchers first reported that the antidepressants known as SSRIs

could spark suicidal thoughts and actions in young patients back in

1990, just three years after the first major SSRI, Prozac, hit the

market. Since then, there have been thousands of scientific papers

published on these medications. You'd think the psychiatric research

community would have noticed that the drugs can be dangerous for some

patients -- particularly kids -- and may not be terribly effective for

most.

 

The fact is, many academic psychiatrists did notice, and some spoke

up, but practically nobody listened. " There has been a collective

decision to ignore the evidence, " says Jane Garland, head of pediatric

psychiatry at the University of British Columbia Children's Hospital

in Vancouver. " Our clinical practice guidelines say these things are

safe and effective. The published papers say these drugs are effective

and well tolerated. But the argument is very weak when you really look

at the data. "

 

That collective decision has its roots in the problem that has beset

psychiatry since the days of Sigmund Freud: Understanding the mind is

really hard to do. It's not as if physicians can administer a blood

test to determine if a patient is depressed or anxious or

obsessive-compulsive. Rather, psychiatry defines -- and diagnoses --

psychiatric disorders on the basis of subjective symptoms that are

reported by patients or observed by doctors.

 

As a result, what gets counted as significant mental illness versus,

say, unusual behavior or a minor disability has tended to expand and

contract with changing social mores. Homosexuality was classified as a

mental illness one year and a lifestyle choice the next, while severe

shyness has now been elevated to a disease known as social anxiety

disorder. Meanwhile, what's actually going on inside a patient's brain

remains a cipher.

 

The diagnosis of mental illness has also been dictated in part by

whatever is available to treat it. The psychiatric community has a

long history of falling in and out of love with a succession of drugs

that have been touted by the drug industry for whatever mental

disorder is in vogue at the moment. In the 1960s, the vast majority of

symptoms were interpreted as signs of anxiety disorders, and

tranquilizers such as Valium were seen as the antidote for patients

who weren't sick enough to be hospitalized. By the 1980s, the

diagnosis du jour was depression, and the tranquilizers gave way to

antidepressants such as Elavil and Nardil.

 

Unfortunately, this earlier class of antidepressants had their own

problems. Nardil and other drugs of the class known as monoamine

oxidase inhibitors (MAOIs) could trigger dangerously high blood

pressure, while the so-called tricyclic antidepressants such as Elavil

could be used to commit suicide by overdose. Enter Prozac, which was

touted by manufacturer Eli Lilly as being safe at any dose. Never mind

that studies showed that Prozac and the other SSRIs that soon followed

(Zoloft, Paxil, Serzone, Luvox, Effexor, Celexa and Lexapro) were no

more effective than older antidepressants, and that patients stopped

using them in droves because they didn't like the side effects;

psychiatrists greeted the new drugs with open arms.

 

Bernard Carroll, a professor emeritus of psychiatry from Duke

University recalls, " You never saw anything like the mass hysteria

over the 'next generation' antidepressants. " This enthusiasm was

driven in part, he says, by thought leaders in academic psychiatry,

who were " desperate to demonstrate that all the federal research

dollars that had been shoveled their way for 25 years actually had a

payoff. "

 

But the new antidepressants were also appealing because they fit

neatly into the nascent understanding of the role of

neurotransmitters, or brain chemicals, in mental illness. According to

the prevailing theory, depression and suicide were linked to low

levels of the neurotransmitter serotonin. The SSRIs, which stands for

selective serotonin reuptake inhibitors, were thought to restore the

chemical to healthy levels in the brain.

 

The notion that depression is a biological ailment, like Alzheimer's,

proved enormously appealing to patients. It relieved much of the

stigma of mental illness, which could now be viewed not as a personal

or moral failing, but as a glitch of biology. The serotonin theory

also appealed to the medical community, for a slightly different

reason. It made the mind seem more knowable, less like a black box,

and psychiatry seem more like real science, instead of a lot of

Freudian talk about repression and sex. Psychiatrists could now say to

patients, you are sick because of a deficiency, and these drugs will

restore you to normalcy and mental health.

 

If only psychiatric disease were that simple. In reality, there is

little research to show that being a quart low on serotonin leads to

depression, and even less to suggest that patients who commit suicide

have lower levels of serotonin than normal people. And nobody really

knows what SSRIs actually do in the human brain.

 

Yet the serotonin theory lives on in the public's mind, while many

members of the psychiatric community seem so invested in the power of

the SSRIs that they have lost touch with the fact that all psychiatric

drugs can have powerful side effects. Many in the field have long

insisted that it is the depression that makes patients commit suicide,

never the drugs, despite evidence that at least in some cases, it is

indeed the medication. Studies of healthy volunteers, for example,

have shown that people with no history of mental illness can suddenly

begin having suicidal thoughts after taking the drugs.

 

Meanwhile, some psychiatrists report increasing numbers of young

patients with severe psychiatric symptoms, including anxiety and

mania, which appeared after they began taking SSRIs. Yet rather than

seeing those symptoms as possible side effects of the medication, many

academics have interpreted them as signs of previously undiagnosed

manic depression, or bipolar disorder. The SSRIs, in their view, are

" unmasking " bipolar disorder, which was there all along.

 

But there are no studies that support the notion that an individual

patient's " underlying " bipolar disorder would have emerged at some

later date had he or she not taken the drug. It is equally plausible

that the drugs themselves trigger bipolar disorder, rather than

uncovering it -- just as LSD is known to alter the brain's wiring and

cause flashbacks, and the street drug MPTP can trigger a

Parkinson's-like disorder.