Teens are prescribed more medications than ever, while teenage suicides are soaring.

One of the paradoxes of child and adolescent psychiatry is that, at a time when teens are prescribed more medications than ever, teenage suicides are soaring. Antidepressants and antipsychotics are supposed to decrease suicide, not increase it.

A report of the Centers for Disease Control (CDC) of March 6, 2015, says that suicides per 100,000 population among persons aged 10-24 increased from 1.8 in 1994 to 3.1 in 2012, an annual increase of 3.0 percent. This is almost doubling over that 18-year period.

See the report here

Male rates are far higher than female, and suicides among male adolescents rose annually by 2.2 percent. But here is the shocker: suicides among female adolescents rose from 0.5 per 100,000 in 1994 to 1.7 in 2012, an annual change of 6.7 percent.

Hanging (“suffocation”) has soared among young women, and the CDC report noted a grim landmark: “Suffocation surpassed firearm as the most common mechanism of suicide among females in 2001.”

Whatever medications these young men and women receive are not working. A truly alarming increase in the consumption of psychopharmaceuticals has taken place at the same time as the increase in suicide. For example, the prescription of antipsychotic medications for patients under 20 rose from 300 per 100,000 population in 1993-95 to almost 1500 in 2002. (New York Times, “Beyond Ritalin,” June 6, 2006, 18)

Could there possibly be a connection?

Or do you "double down" and insist that the problem is that what we need is more drugs?

Guess what this shrink says. Yep, more DRUGS. without figuring out the source.

American Kids are the Most Medicated in the World I would say this is very suggestive.

Drug poisoning statistics in the US

Note how prevalent psych drugs are as a danger to kids.

Information on drug poisoning suicide deaths in the US is not available at a very granular level. However, the following table¹ does give a breakdown of 2012 suicide drug poisoning deaths:

Method	No.	%
Other and unspecified drugs, medicaments and biological substances	3,632	54.0%
Other gases and vapours	1,003	14.9%
Anti-epileptic, sedative-hypnotic, anti-parkinsonism and psychotropic drugs, not elsewhere classified	969	14.4%
Narcotics and psychodysleptics [hallucinogens], not elsewhere classified	662	9.8%
Non-opioid analgesics, antipyretics and anti-rheumatics	160	2.4%
Organic solvents and halogenated hydrocarbons and their vapours	126	1.9%
Other and unspecified chemicals and noxious substances	78	1.2%
Alcohol	47	0.7%
Other drugs acting on the autonomic nervous system	42	0.6%
Pesticides	10	0.1%
Total	6,729

According to the CDC¹, 81% of intentional poisoning suicides were caused by drugs - both legal and illegal. The most commonly used drugs identified in drug-related suicides were psychoactive drugs, such as sedatives and antidepressants, followed by opiates and prescription pain medications¹. Self-harm poisoning was the leading cause of emergency department visits for intentional injury in 2010². In 2011, it was estimated by SAMHSA³ that attempted suicide led to 228,366 emergency department (ED) visits. Almost all involved a prescription drug or over-the-counter medication. It is worth noting that with only 5,465 actually succeeding in suicide using drugs, it means there were 42 ED visits for every successful suicide. Sobering odds of success, and there are probably lots of attempts that don’t even end up in hospital. Most patients attempting drug-related suicide had some form of follow-up after their ED visit, with the outcomes of their ED visits as follows:

• 49% were admitted for inpatient hospital care (18.3% to an intensive or critical care unit [ICU]), 9% to a psychiatric unit, and 22% to other units including combination psychiatric/detox units)
• 25% were transferred to another health care facility for specialist treatment
• 7% were referred to detox/treatment
• 15% treated and discharged to home

Evidence suggests that alcohol had been ingested in around a third of people who died by suicide, and in 29% of those admitted to ED departments. In nearly two thirds of cases more than one drug was involved. Pain relievers were found to be involved in 38% of drug-related suicide attempts. Narcotic pain relievers were involved in over a third of that number, and cetaminophen products were involved in just under a third. Benzodiazepines (anti-anxiety drugs) were found to be involved in 29.3% of drug - related suicide attempts. Alprazolam (Xanax) and clonazepam each accounted for about a third. Antidepressants appeared in 19.6% of visits. About half of those visits involved an SSRI antidepressant such as citalopram, sertraline, or fluoxetine. Trazodone, a SARI antidepressant, was involved in about a quarter. Antipsychotics, as a whole, appeared in 12.9% of visits, with the vast majority being the newer types of atypical anti-psychotics e.g. Quetiapine. The American Association of Poison Control Centers (AAPCC)⁴ publishes data on phone calls they receive into their 55 centers which are designed to track the incidence of poison exposure (both intentional and unintentional) nationally. In 2012 they recorded 2,873 deaths by poisons (itself some way short of the figures provided by US Department of Health and Human Services for suicide alone), and the table below shows the drugs that appeared most frequently as the cause of death by poisoning. Top 25 substance categories associated with deaths reported by 55 U.S. Poison Centers 2012

Substance	No.	%
Sedative/hypnotics/antipsychotics	377	14.1%
Miscellaneous cardiovascular drugs	350	12.2%
Opioids	255	8.9%
Acetaminophen (paracetamol) in combination	183	6.4%
Miscellaneous stimulants and street drugs	176	6.1%
Acetaminophen (paracetamol) only	159	5.5%
Miscellaneous alcohols	145	5.0%
Miscellaneous antidepressants	126	4.4%
Selective serotonin reuptake inhibitors	89	3.1%
Miscellaneous antihistamines	69	2.4%
Tricyclic antidepressants	69	2.4%
Miscellaneous fumes/gases/vapors	67	2.3%
Acetylsalicylic acid	65	2.3%
Miscellaneous muscle relaxants	57	2.0%
Miscellaneous anticonvulsants	56	1.9%
Oral hypoglycemic	56	1.9%
Non-nonsteroidal anti-inflammatory drugs	50	1.7%
Miscellaneous unknown drug	44	1.5%
Miscellaneous unknown drugs	44	1.5%
Miscellaneous chemicals	33	1.1%
Miscellaneous hormones and hormone antagonists	31	1.1%
Anticonvulsants: gamma aminobutyric acid & analogs	29	1.0%
Miscellaneous anticoagulants	23	0.8%
Miscellaneous diuretics	23	0.8%
Cannabinoids and analogs	20	0.7%
Miscellaneous hydrocarbons	19	0.7%

It should be noted that these percentages from their source do not add up to 100% as they are only the top 25 causes. It should also be noted that the above figures each represent the number of mentions in cause of death, not number of deaths. Any one fatality may have had exposure to more than one substance. Indeed, consistent with data from SAMHSA, the breakdown of drugs shown for many of the fatalities reported by AAPCC showed more than one drug. Sources

1. Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (WISQARS), fatal injuries report figures (http://webappa.cdc.gov/sasweb/ncipc/leadcaus10_us.html).
2. National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary Tables (10 and 17) (www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf). See also Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (NCIPC), Prescription Drug Overdose in the United States: Fact Sheet www.cdc.gov/homeandrecreationalsafety/overdose/facts.html.
3. Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. Drug Abuse Warning Network (DAWN): National estimates of drug-related emergency department visits for 2011, Table 22 (www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf).
4. James B Mowry, PHARMD; Daniel A Spyker PHD, MD; Louis R Cantilena  JR, MD, PHD; J Elise Bailey MSPH; and Marsha Ford MD; 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report, Clinical Toxicology vol. 51 Oct 2013 (available from www.aapcc.org/annual-reports).

The Psychiatric & Mental Health Rape Reporter says that up to 25% of psychiatrists & psychologists use their patients for sex.

Psychiatric diagnosis of schizophrenia is not compatible with the facts of modern science

A Few thoughts prompted by this article in Psychology Today

The Oct 16 issue of the Scientific American has a short piece on “Massive Study Reveals Schizophrenia’s Genetic Roots.” These roots are, we learn, incredibly complicated. A huge consortium involving more than 300 scientists from 35 countries found “128 gene variants associated with schizophrenia, in 108 distinct locations in the human genome.”

Wow, eh?

This “genome-wide association study” found so many mutations in the molecular pairs of the 113,000 people it studied that . . . I can’t tell you. The mind boggles at how complicated “schizophrenia” must be.

Unless there is no such thing as schizophrenia.

The obvious conclusion seems not to have occurred to the Scientific American commentators: It is not that schizophrenia is “incredibly complicated,” but that there are several different diseases buried under the term “schizophrenia,” each with a genetics of its own.

[...]

It is a sign of the diminished American interest in psychopathology that all of these symptoms, which are highly diverse, each pointing in a different direction, have all been lumped together as “schizophrenia,” which makes as much sense as lumping measles, syphilis, and gangrene together as “skin diseases.”

[...] it was all dumped together in the same cauldron. Catatonia, adolescent insanity, psychosis at midlife, paranoia, who cares? It was all “schizophrenia.”

And this is the inheritance we’re now living with, as the geneticists take the phenotypes they’ve inherited from psychiatry and try to make sense of the anomalies they find on the DNA – which up to now, after billions of dollars and decades of research – have been indecipherable.

So, hunting for schizophrenia’s “genetic roots,” are we? Good luck with that.

But it all gets worse. As seen in this blog article "Biology and Genetics are Irrelevant Once True Causes are Recognized"

As superbly reviewed by psychologist John Read in the 2013 second edition of Models of Madness: Psychological, Social and Biological Approaches to Psychosis, since the turn of the 21st century many studies have linked schizophrenia and other psychotic conditions to childhood adversities such as having experienced bullying, emotional abuse, incest, neglect, parental loss, physical abuse, or sexual abuse—findings that are well known to clinicians who work with people diagnosed with psychotic disorders.

Read reviewed research linking schizophrenia and other psychotic disorders to social environments such as poverty, racism, migratory stress, and urbanicity. He concluded, “There is ample evidence that inequality, deprivation and discrimination, filtered through their social and personal meanings, are key causal factors in psychosis.” Psychological processes identified by Read and his colleagues, through which childhood adversities may lead to symptoms of psychosis later in life, include attachment, dissociation, dysfunctional cognitive processes, psychodynamic defenses, problematic coping responses, impaired access to social support, behavioral sensitization, and revictimization. A biologically oriented commentator might object that even if these factors play a role in causing schizophrenia and psychosis, only people who are genetically predisposed will develop them, and it is therefore important to understand and study hereditary factors. Aside from the fact that the evidence in support of genetics is weak, a clear understanding of the environmental causes of a condition frequently renders potential genetic factors irrelevant.

For example, 33 miners were trapped underground for 69 days in a copper mine near Copiapó, Chile in 2010. Although the miners were finally rescued and were treated as heroes, and in some cases as celebrities, many subsequently developed severe psychological symptoms caused by their ordeal, such as depression, anxiety, nightmares, and avoidant behavior. Because the causes of these symptoms are obvious and recognized, no one to my knowledge has suggested that the miners have genetically based brain disorders or “chemical imbalances.” It is clear that the miners’ experiences caused their symptoms, and the symptoms of most psychiatric conditions can also be seen in this way.

Simply, psychiatric diagnoses are not compatible with the facts of modern science

Antidepressants may damage male fertility

As reported via Reuters

Common antidepressant drugs may reduce some men's fertility by damaging the DNA in their sperm, according to scientists.

A study of 35 healthy men given paroxetine - sold as Paxil or Seroxat by GlaxoSmithKline - found that, on average, the proportion of sperm cells with fragmented DNA rose from 13.8 percent before treatment to 30.3 percent after just four weeks.

Similar levels of sperm DNA damage have been linked to problems with embryo viability in couples trying to have children. The research by Peter Schlegel and Cigdem Tanrikut of the Cornell Medical Center in New York was reported in New Scientist magazine and is due to be presented in November at a meeting of the American Society for Reproductive Medicine.

A copy of the study abstract was made available to Reuters.

"The fertility potential of a substantial proportion of men on paroxetine may be adversely affected by these changes in sperm DNA integrity," the experts concluded.

The study adds to concerns voiced by the same doctors in 2006, after finding that two men had developed low counts of healthy sperm following treatment with two different selective serotonin-reuptake inhibitors (SSRIs).

SSRIs like Paxil/Seroxat and Eli Lilly's Prozac, both of which are now available generically, are the most commonly prescribed class of antidepressant.

Glaxo said it was reviewing the investigators' findings, since the study was not conducted by the company.

"These medicines remain an important option, in addition to counselling and lifestyle changes, for treatment of depression and this study should not be used to cause unnecessary concern for patients," a spokeswoman said.

"Patients should discuss their situation with their doctor before stopping use of their medicine."

Allan Pacey, Senior Lecturer in Andrology at the University of Sheffield, said the apparent increase in sperm DNA damage was "alarming", although he noted the level at which damage becomes clinically significant was open to debate.

"It is a shame that the authors appear not to have conducted a randomised controlled trial which would be the most scientific way to investigate the drugs effects, but I agree that the results are of concern and need to be investigated further," he said.

SSRIs have long been known to depress libido in some men and previous research has also found that women taking the medicines are more likely to have a low birth weight baby.

Many Popular Drugs Linked to Suicide

From News Inferno.com

Suicide is common in the US, representing the fourth leading cause of death for those aged 18 to 65 and the third leading cause for those aged 15 to 24. Add to those figures the complexity of medications. In recent years, disturbing reports have suggested that side effects of some popular drugs - such as Chantix, Accutane, Singular and Paxil - include suicidal thoughts and behavior.

Reports have been filed with drug makers and the Food and Drug Administration (FDA) on at least six drugs or drug classes that may be linked to suicide or suicidal thoughts. Recently, the FDA released notices about several such medications including Singlulair; Epilepsy drugs including carbamazepine, gabapentin, felbamate, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, and valproate; and the smoking-cessation drug Chantix. Reports have been filed on SSRI antidepressants including Paxil and Prozac, the influenza drug Tamiflu, and the acne medicine Accutane. “The brain is a complex organ, and most of the drugs are complex as well,’’ says Dr. Thomas Laughren, head of the division of psychiatric products at the FDA. “It’s not unreasonable to think that a drug that gets into the brain may have effects other than you hope they would.’’

Kelly Posner, principal investigator at the Center for Suicide Risk Assessment at Columbia University in New York, is working with the FDA to determine suicide risks and at-risk categories; Posner’s quantitative tools and questionnaires are being applied to drugs on the market and in testing. “We know that whether or not these drugs actually cause suicidal thought or action is a question we have to answer, but up until now, none of the clinical trials for the drugs were set up to address the question,’’ says Posner.

There are theories, says Jason Noel, director of clinical pharmacy services at Rosewood Center in Owings Mills, Maryland. Asthma medication Singulair has a similar chemical pathway to steroids, which can affect behavior and mood and an asthma diagnosis can trigger suicide or depression because it adversely affects daily living. Fatigue is a symptom of depression, the initial benefit of antidepressants is increased energy, and improving depression can take weeks; therefore, some may use extra energy to act on suicidal thoughts. Suicidal thoughts in patients taking epilepsy drugs have been reported in patients on such medications for epilepsy, depression, or other psychiatric conditions; however, not generally in those on the drugs for migraines. Chantix blocks pleasure pathways that make nicotine so satisfying, which suppresses other pleasure and happiness, leading to depression. But, stopping smoking can be a risk factor for depression and smoking is a risk factor for suicide.

Finding links has risks. When the FDA discovered an increase in suicidal thinking in children and young adults taking antidepressants, warnings were added to Paxil and Prozac labeling. “Use of antidepressants went down and the suicide rate went up,’’ says Dr. Paula Clayton, medical director of the American Foundation for Suicide Prevention in New York.

Meanwhile, Congressman Bart Stupak (Democrat-Michigan) reported his teenage son B.J. killed himself in 1999 after several months on Accutane and said in 1998, the FDA publicly noted reports of depression, psychosis, and suicidal thoughts and actions with Accutane; in 1999 when B.J. was prescribed Accutane, their doctor did not inform them of the risk and the prescription’s patient information did not include it.

Half of Americans are in some way mentally ill, and one-quarter of the population has taken anti-depressants, not including that one time at a rave

Another person is waking up to the fraud the is Modern Psychiatry. An Editorial in the NY Sun, by Christoper Lane

America has reached a point where almost half its population is described as being in some way mentally ill, and nearly a quarter of its citizens - 67.5 million - have taken antidepressants.

These statistics have sparked a widespread, sometimes rancorous debate about whether people are taking far more medication than is needed for problems that may not even be mental disorders. Studies indicate that 40% of all patients fall short of the diagnoses that doctors and psychiatrists give them, yet 200 million prescriptions are written annually in America to treat depression and anxiety.

Those who defend such widespread use of prescription drugs insist that a significant part of the population is under-treated and, by inference, under-medicated. Those opposed to such rampant use of drugs note that diagnostic rates for bipolar disorder, in particular, have skyrocketed by 4,000% and that overmedication is impossible without over-diagnosis.

To help settle this long-standing dispute, I studied why the number of recognized psychiatric disorders has ballooned so dramatically in recent decades. In 1980, the Diagnostic and Statistical Manual of Mental Disorders added 112 new mental disorders to its third edition, DSM-III. Fifty-eight more disorders appeared in the revised third edition in 1987 and fourth edition in 1994.

With over a million copies in print, the manual is known as the bible of American psychiatry; certainly it is an invoked chapter and verse in schools, prisons, courts, and by mental-health professionals around the world. The addition of even one new diagnostic code has serious practical consequences. What, then, was the rationale for adding so many in 1980?

After several requests to the American Psychiatric Association, I was granted complete access to the hundreds of unpublished memos, letters, and even votes from the period between 1973 and 1979, when the DSM-III task force debated each new and existing disorder. Some of the work was meticulous and commendable.

But the overall approval process was more capricious than scientific.

DSM-III grew out of meetings that many participants described as chaotic. One observer later remarked that the small amount of research drawn upon was "really a hodgepodge - scattered, inconsistent, and ambiguous." The interest and expertise of the task force was limited to one branch of psychiatry: neuropsychiatry. That group met for four years before it occurred to members that such one-sidedness might result in bias.

Incredibly, the lists of symptoms for some disorders were knocked out in minutes. The field studies used to justify their inclusion sometimes involved a single patient evaluated by the person advocating the new disease. Experts pressed for the inclusion of illnesses as questionable as "chronic undifferentiated unhappiness disorder" and "chronic complaint disorder," whose traits included moaning about taxes, the weather, and even sports results.

Social phobia, later dubbed "social anxiety disorder," was one of seven new anxiety disorders created in 1980. At first it struck me as a serious condition. By the 1990s experts were calling it "the disorder of the decade," insisting that as many as one in five Americans suffers from it. Yet the complete story turned out to be rather more complicated.

For starters, the specialist who in the 1960s originally recognized social anxiety - London-based Isaac Marks, a renowned expert on fear and panic - strongly resisted its inclusion in DSM-III as a separate disease category. The list of common behaviors associated with the disorder gave him pause: fear of eating alone in restaurants, avoidance of public toilets, and concern about trembling hands.

By the time a revised task force added dislike of public speaking in 1987, the disorder seemed sufficiently elastic to include virtually everyone on the planet.

To counter the impression that it was turning common fears into treatable conditions, DSM-IV added a clause stipulating that social anxiety behaviors had to be "impairing" before a diagnosis was possible. But who was holding the prescribers to such standards? Doubtless, their understanding of impairment was looser than that of the task force. After all, despite the impairment clause, the anxiety disorder mushroomed; by 2000, it was the third most common psychiatric disorder in America, behind only depression and alcoholism.

Over-medication would affect fewer Americans if we could rein in such clear examples of over-diagnosis. We would have to set the thresholds for psychiatric diagnosis a lot higher, resurrecting the distinction between chronic illness and mild suffering. But there is fierce resistance to this by those who say they are fighting grave mental disorders, for which medication is the only viable treatment.

Failure to reform psychiatry will be disastrous for public health. Consider that apathy, excessive shopping, and overuse of the Internet are all serious contenders for inclusion in the next edition of the DSM, due to appear in 2012. If the history of psychiatry is any guide, a new class of medication will soon be touted to treat them.

Sanity must prevail: if everyone is mentally ill, then no one is.

The Decline of Psychiatry, Part 3

We have another report regarding the decreasing numbers of psychiatrists, this time from Alabama. See our earlier reports here

A shortage of psychiatrists, both in-state trainees and out-of-state recruits, in the state of Alabama has proved to be an increasing problem over the past decade.

In a study conducted by Dr. Richard Powers in April 2007, Alabama has only 7.1 psychiatrists per 100,000, while other neighboring states have 8.1 and the nation has 13.7, according to Understanding the Shortage of Psychiatrists and Selected other
Mental Health Professionals in Alabama.

Powers cites this shortage due to lack of funding for psychiatry programs, a shortage of in-patient beds, difficulties for physicians to obtain practicing licenses and an overall decline in the retention rate of Alabama psychiatrists.

The University of South Alabama offers one of the two only psychiatry programs in the state of Alabama. Both programs at USA and the University of Alabama at Birmingham have experienced difficulties, according to Powers' study.

Each experienced difficulties in training the maximum number of psychiatrists, many of whom practice in other states after training.

"The University of South Alabama suffered from management issues and the program at UAB suffered from a shortage of funding to support the maximum number of candidates," the study states.

[...]

The University of South Alabama College of Medicine department of psychiatry program works to combat these shortages through its funding, programs and output of trained graduates on a yearly basis.

[...]

A draft copy of the study can be seen in full here

Read this doc on Scribd: Understanding the Shortage of Psychiatrists in Alabama

Prozac, used by 40m people, does not work say scientists

As reported in the Guardian, an analysis of unseen trials and other data concludes it is no better than placebo. The study in question can be accessed on the Public Library of Science website

If we didn't know better it would seen that they knew this all along, one way or another. And this fits the classic definition of fraud, on some level.

Prozac, the bestselling antidepressant taken by 40 million people worldwide, does not work and nor do similar drugs in the same class, according to a major review released today.

The study examined all available data on the drugs, including results from clinical trials that the manufacturers chose not to publish at the time. The trials compared the effect on patients taking the drugs with those given a placebo or sugar pill.

When all the data was pulled together, it appeared that patients had improved - but those on placebo improved just as much as those on the drugs.

The only exception is in the most severely depressed patients, according to the authors - Prof Irving Kirsch from the department of psychology at Hull University and colleagues in the US and Canada. But that is probably because the placebo stopped working so well, they say, rather than the drugs having worked better.

"Given these results, there seems little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed," says Kirsch. "This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported."

The paper, published today in the journal PLoS (Public Library of Science) Medicine, is likely to have a significant impact on the prescribing of the drugs. The National Institute for Health and Clinical Excellence (Nice) already recommends that counselling should be tried before doctors prescribe antidepressants. Kirsch, who was one of the consultants for the guidelines, says the new analysis "would suggest that the prescription of antidepressant medications might be restricted even more".

The review breaks new ground because Kirsch and his colleagues have obtained for the first time what they believe is a full set of trial data for four antidepressants.

They requested the full data under freedom of information rules from the Food and Drug Administration, which licenses medicines in the US and requires all data when it makes a decision.

The pattern they saw from the trial results of fluoxetine (Prozac), paroxetine (Seroxat), venlafaxine (Effexor) and nefazodone (Serzone) was consistent. "Using complete data sets (including unpublished data) and a substantially larger data set of this type than has been previously reported, we find the overall effect of new-generation antidepressant medication is below recommended criteria for clinical significance," they write.

Two more frequently prescribed antidepressants were omitted from the study because scientists were unable to obtain all the data.

Concerns have been raised in recent years about the side-effects of this class of antidepressant. Evidence that they could prompt some young people to consider suicide led to a warning to doctors not to prescribe them for the under-18s - with the exception of Prozac, which was considered more effective than the rest.

In adults, however, the depression-beating benefits were thought to outweigh the risks. Since its launch in the US in 1988, some 40 million people have taken Prozac, earning tens of billions of dollars for the manufacturer, Eli Lilly. Although the patent lapsed in 2001, fluoxetine continues to make the company money - it is now the active ingredient in Sarafem, a pill sold by Lilly for premenstrual syndrome.

Eli Lilly was defiant last night. "Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant," it said in a statement. "Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression."

A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the "very positive" benefits of the treatment and their conclusions were "at odds with what has been seen in actual clinical practice".

He added: "This analysis has only examined a small subset of the total data available while regulatory bodies around the world have conducted extensive reviews and evaluations of all the data available, and this one study should not be used to cause unnecessary alarm and concern for patients."

Here's a follow up link to another story on the study: Seems that Big Pharma is in a slight Panic

The Decline of Psychiatry, Part 2

Earlier we reported on the declining numbers of psychiatrists in Indiana. Now we have this report of a similar decline in Ohio:

[...]Trumbull is undergoing a psychiatrist shortage, according to those at Trumbull LifeLifes, the agency considering joining forces with Summa Health System in Akron.

‘‘It’s a perennial challenge here in Trumbull County, all over the state,’’ said James Sager, LifeLifes chief operating officer. ‘‘Finding and keeping psychiatrists is particularly a difficult challenge for us.’’[...]

According to the National Center for Health Workforce Analysis, Ohio had 1,019 psychiatrists six years ago, making 31st in the nation in the number of psychiatrists per capita. In comparison, Pennsylvania ranked 11th with 1,753.

[...]

Director of consultation liaison psychiatry at Summa, Tod Ivan, said he believes there is an overall shortage largely because of federal policy.

He said the government — through Medicare — has restricted funding for specialty care, like psychiatry, in favor or primary care. Also, Ivan said, policy regarding managed care makes it hard for psychiatrists to make a living, like for example, a 50 percent co-payment on mental health services through Medicare.

‘‘Nationally, for about 20 years, the numbers have remained flat,’’ he said.

Of course, they try to put a positive face on the report, citing partnership efforts with other population centers. We suspect that there is a larger long term trend that they are not at alll happy about, and that this report is just another pin in the Voodoo Doll of Psychiatry.

Complaints on the rise against psychiatrists and other doctors

We would like to see a breakdown of the complaint statistics by specialty. There is evidence supporting the notion that there are more sexual misconduct complaints against psychiatrists, for example. A report from Victoria, Australia

Formal complaints about Victorian doctors have jumped significantly, and the number deemed unfit to practice due to serious health issues has also risen, a report has revealed.

A psychiatrist who had sex with two vulnerable patients and a doctor who prescribed illegal levels of morphine were among those to be struck off for serious misconduct.

Figures tabled in State Parliament show there was a 9% jump in professional conduct complaints to the Medical Practitioners Board — from 582 in 2006 to 633 last year.

And 70 doctors were investigated over serious health concerns such as psychiatric illness or drug and alcohol abuse — up from 59 the previous year.

A doctor who made sexual advances to a teenage patient he was counselling for a serious eating disorder was allowed to keep his licence. And a GP who sexually harassed a staff member, putting his hand down her jumper to touch her breast, also escaped with a reprimand.

In a tragic case at the Royal Children's Hospital, a trainee doctor gave a four-week old baby 10 times the appropriate concentration of glucose in a drip, causing irreversible brain damage. The board allowed her to continue practising and ordered her to undergo counselling, feeling she was "genuinely remorseful."

In 16 cases finalised at formal hearings, 15 doctors were found to have engaged in serious professional misconduct. Four were struck off, one had their licence suspended and 10 were either cautioned, reprimanded or ordered to undergo counselling.

The board president, Dr Joanna Flynn, said the rise in complaints was consistent with national and international trends. "It is not unexpected and may reflect gradual awareness within the community of the board and its role in protecting the public," she said.

Brain scans, the new snake oil

A reaction to an OpEd piece from the LA times

In an Op-Ed piece in the Dec. 5 L.A. Times, self-proclaimed "neuropsychiatrist and brain-imaging expert" Daniel G. Amen attempts to convince us that "three of the last four presidents have shown clear brain pathology." Starting with Ronald Reagan's Alzheimer's disease, which was never in dispute, he proceeds to Bill Clinton's moral lapses as indicating "problems in the prefrontal cortex" and Bush's emotional rigidity as a symptom of temporal lobe pathology.

Even the non-medical reader will have a sense of sweeping generalization in these pronouncements. If every moral lapse indicated "problems in the prefrontal cortex," most of mankind could be said to have disordered frontal lobes. And, if all the emotionally rigid people in this world were tallied, a large proportion of mankind would have disordered temporal lobes. Disconnects in Amen's logic include: first, there is no agreed-upon standard for evaluating moral lapses and emotional rigidity; second, brain imaging cannot detect attributes of individual personality; and third, there is no direct correspondence between obvious frontal or temporal lobe brain disease, including Alzheimer's, and the behavior Amen would attribute to these brain areas.

On his website, Amen lists "14 reasons to get your brain scanned at Amen clinics." One particularly outrageous claim is, "Even if you are not having trouble, SPECT scans can help check the health of your individual brain." Implicit in this claim is that Single Photon Emission Computed Tomography, which requires an intravenous injection of radioactive material and very expensive imaging equipment (and therefore high cost to the patient), will be correct every time. Nothing could be further from the truth.

This kind of hucksterism is not new to psychiatry. In 1964, psychiatrists responding to a poll attempted to "diagnose" presidential candidate Barry Goldwater by his political pronouncements as clinically paranoid. Charles Krauthammer, a psychiatrist himself, rightfully characterized this as a "shameful ... misuse of medical authority." Because of this episode, the American Psychiatric Assn. developed an ethical principle, the "Goldwater rule," which states that, "On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination [emphasis added] and has been granted proper authorization for such a statement." Clearly, violations of this ethical principle continue.

There are further instances. The medical profession, psychiatrists included, is coming under increasing scrutiny for excessive promotion of new drugs and medical devices. For example, in an August 2002 Stanford University news release, Dr. Alan Schatzberg, chair of Stanford's Psychiatry Department, stated that treatment of psychotically depressed patients with the abortion drug, RU-486, "may be the equivalent of shock treatments in a pill.…" Given that electroconvulsive therapy is the most effective treatment for such patients, this was a hugely exaggerated claim, particularly because there was no significant evidence for effectiveness of the drug at that time. (Indeed, later FDA-monitored clinical trials also have been uniformly negative.) The possible commercial connection? Schatzberg is a co-founder and major shareholder of the company established to market RU-486 as a treatment for psychotic depression, and in 2002 the company was preparing for an initial public stock offering.

A very recent example is the Nov. 11 New York Times Op-Ed, "This Is Your Brain on Politics," written by seven research scientists, including three from FKF Applied Research (on its website, the company calls itself "The Leader in NeuroMarketing"). The article describes the functional MRI brain scans of swing voters who were shown political pictures while in the scanner. Based on which areas of the brain were activated by particular pictures, the authors offered conclusions such as "Hillary Clinton and Rudy Giuliani are on opposite sides of the gender divide," "Mitt Romney shows potential," "Fred Thompson ... evokes more empathy (than Rudy Giuliani)" and "John Edwards has promise — and a problem." One presumes this is saleable information to political campaigns. In swift reaction, a Nov. 22 editorial in the scientific journal Nature harshly criticized this "questionable scientific research," calling it "a great disservice to science" and "a great deal for the company."

So, what to make of all this? The adage, caveat lector et emptor, applies well here — let the reader and buyer beware. Ask trusted professionals for their perspective and advice. Hype, if not outright hucksterism, unfortunately is all too frequent in medicine, whether it is the latest expensive drug, or technology such as brain scanning. But, considering the snake oil of old, hasn't it always been so?

Robert T. Rubin, a board-certified psychiatrist, is professor and vice chair of the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, and chief of psychiatry and mental health at the VA Greater Los Angeles Healthcare System.

The inherent unreliability of psychological tests - Misdiagnosis likely

A recent study raises serious questions about the validity of current psychological testing methods, and demonstrates how much is not known. The author offers several possible explanations for the results, which are basically filler substituting for a generic "I don't know what is going on" answer.

This has profound implications for many other psychiatric and psychological diagnostic "tests", such as for ADHD, etc., which involve questionable diseases to begin with.

Left unsaid is the profound danger of misdiagnosis, horrific because of the toxic side effects of many psychiatric medications prevalent on the market.

From Science Daily.

The study is published in the July issue of Neuropsychology, which is published by the American Psychological Association (APA).

Salthouse gave 16 common cognitive and neuropsychological tests to evenly divided participants (90 in the first, 1600 in the second) into groups of ages 18-39, 50-59 and 60-97 years old. In both studies, the variation between someone's scores on the same test given three times over two weeks was as big as the variation between the scores of people in different age groups. It's as if on the same test, someone acted like a 20-year-old on a Monday, a 45-year-old the following Friday, and a 32-year-old the following Wednesday. This major inconsistency raises questions about the worth of single, one-time test scores.

"I don't think many people would have expected that the variability would be this large, and apparent in a wide variety of cognitive tests -- not simply tests of speed or alertness," says Salthouse.

[...]

American Psychological Association (2007, July 3). Cognitive Scores Vary As Much Within Test Takers As Between Age Groups Making Testing Less Valid. ScienceDaily. Retrieved December 3, 2007, from http://www.sciencedaily.com­ /releases/2007/07/070702084329.htm

Ritalin prescribed twice as often for children in divorced families

A study published in the Canadian Medical Association Journal back in June, 2007 found that Ritalin, which is prescribed for ADHD, is dished out to kids from divorced families almost twice as often as to kids from normal families. So much for biological causes.

The study was conducted by Lisa Strohschein, a sociologist at the University of Alberta in Edmonton. Strohschein gives no reason for why this happens. It reminds me of the story of a guy named Howard Dully whose step-mother had him lobotomized and managed to get his Father to go along with it. When the lobotomy didn’t work to her satisfaction she had him committed for the remainder of his childhood.

Here are some snippets from the story:

Ritalin use is almost twice as high among children whose parents divorce compared with those who continue to live with two biological parents, a Canadian study suggests.

Ritalin, or methylphenidate, is commonly prescribed for attention deficit hyperactivity disorder, or ADHD, in children.

Use of the drug has increased rapidly over the past few decades in Canada, the U.S., the Netherlands, Israel and Australia, raising questions about whether it is overprescribed or prescribed inappropriately in children.

The study in Tuesday's issue of the Canadian Medical Association Journal attempted to tease apart whether family structure makes a difference in the higher prescription rate, but the findings do not explain why the prescription rates are higher, said the study's author, Lisa Strohschein.

"I've got the what, but not the why," said Strohschein, a sociologist at the University of Alberta in Edmonton.

Stress of divorce?

Previous studies suggest children who live with a single parent or a parent and step-parent were more likely to be prescribed Ritalin.

But a child could be living in a single-parent household because of several reasons — divorce, loss of parent to death or because they were born to a single parent. The earlier research was not clear about whether divorce itself makes a difference in Ritalin prescription rates.

When Strohschein looked at prescription rates between 1994 and 2000 among 4,151 children whose parents hadn't divorced and 633 children whose parents had, she found Ritalin use was significantly higher among children whose parents divorced.

In two-parent families, 3.3 per cent of children were prescribed the drug, which rose to 6.1 per cent among the children whose parents had divorced.

[...]

The Statistics Canada survey results on which the study was based did not include questions to test whether Ritalin is prescribed inappropriately to children of divorce.

Be cautious in prescribing

Nonetheless, the findings should serve as a reminder to doctors to be cautious in prescribing drugs for ADHD to children after a divorce, said Dr. Abel Ickowicz, the psychiatrist-in-chief at the Hospital for Sick Children in Toronto.

"Because … if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing."

[...]

How Often Are Patients Misdiagnosed?

While this article has to do with standard medicine, we must ask the question as it relates to the field of psychiatry, where there is no objective test for mental illness. While modern medicine has the option of at least being able to check their diagnosis, even if via the autopsy table, psychiatry does not. Psychiatrists do not order objective tests when diagnosing their diseases. From the New York Times:

The only sure way to study the extent of misdiagnosis is to compare autopsy results to a patient's final diagnosis. When researchers have done this, they have generally found a contradiction between the two in about 40 percent of cases. Roughly half of these misdiagnoses prevented the patient from getting treatment that could have made a difference.

A good summary of the research appeared in a 1998 article in The Journal of the American Medical Association, by George D. Lundberg, then the publication's editor. He said recently that it still reflected his views.

The paper can be seen here:

Low-Tech Autopsies in the Era of High-Tech Medicine by George D. Lundberg, JAMA, Oct. 14, 1998 (pdf)

It is our opinion that misdiagnoses in the field of psychiatry will be much higher than in standard medicine precisely because there are no standardized objective tests. Further, if the diseases diagnosed are based on other considerations besides objective tests, then the misdiagnosis rate will trend off the chart.

It may even approach 100% when the understanding of the condition is fundamentally wrong.

Antidepressants Now No. 1 Drug Prescribed For Women 18-44 - High Number Of Prescriptions Worrying Some Experts

Snippets from a report on MSNBC

Studies are showing that for every 100 American women, 37 have been prescribed an antidepressant, which is now the No. 1 drug prescribed to women ages 18 to 44.

Some experts said they're worried.

"Some of the women are not really depressed," said Diana Zuckerman, president of the National Research Center for Women and Families.

She said these numbers are too high. A big issue for her is that too often a medical doctor like a gynecologist or general practitioner is prescribing the antidepressant rather than a psychiatrist trained to treat mental health issues. As a result, many patients on mood meds are not getting the follow-up care they need. One study suggests that just 20 percent of adults on these drugs are getting follow-ups.

"But realistically, you want somebody who's keeping an eye on that patient and a lot of doctors are just not going to do that," Zuckerman said.

[...]

In fact, about two-thirds of people on these drugs experience side effects, which can be severe and devastating.

Internet bloggers are even sharing their experiences with antidepressants online. They descibe these effects as a "nightmare" and like "torture." Common reactions include "weight gain, decreased sex drive and severe stomach cramping."

"Something is going on with these drugs," Zuckerman said. "Not everybody metabolizes them the same way. It doesn't have the same effect on every person and some people are harmed by them."

Of course, we remain skeptical about the psychiatrists.

Has Psychiatry Earned Its Unpopularity?

As seen on the Huffington Post

While psychiatry--similar to the Bush administration -- may want to blame its current unpopularity on the press, the corporate media is generally reluctant to challenge a powerful institution until it is already out of favor. Thus, the unpopularity of a powerful institution is usually well-earned through undeniable deceit, incompetence, corruption and failure.

Just how unpopular is psychiatry? A December 2006 Gallup poll on the "honesty and ethical standards" of different professions reported the following: 84 percent of Americans have a positive opinion of nurses, while only 38 percent have a positive opinion of psychiatrists--much lower than the 69 percent positive rating for other medical doctors.

Until recently, most journalists have been extremely timid about confronting Big Pharma's hijacking of psychiatry. One exception is Robert Whitaker, winner of the George Polk award for medical writing. Whitaker, in his book Mad in America (2002), summarizes the beginnings of the corruption of America's psychiatrists and their professional organization, the American Psychiatric Association (APA): "By the early 1970s, all of psychiatry was in the process of being transformed by the influence of drug money." Whitaker reported, "The APA, had become even more fiscally dependent on drug companies. Thirty percent of the APA's annual budget came from drug advertisements to its journals."

The APA, for quite some time, has seen no conflict of interest in its collaboration with drug companies. In 1992, after Upjohn, makers of the tranquilizer Halcion, had given an unrestricted gift of $1.5 million to the APA, the APA medical director claimed that the Upjohn-APA relationship was a "responsible, ethical partnership that uses the no-strings resources of one partner and the experts of the other." This sort of partnering has continued. In the first quarter of 2007, Eli Lilly, makers of the antidepressant Prozac and the antipsychotic Zyprexa, provided grants of over $412,000 for two APA programs: "Improving Depression Treatments" and "Understanding the Complexity of Bipolar Mixed Episodes."

Is the partnership between the APA and Big Pharma a "no-strings" relationship? The American Journal of Psychiatry is published by the APA. In September 2007, attempting to reverse declining antidepressant prescriptions in young people, an American Journal of Psychiatry study unjustifiably concluded that increased suicide was caused by decreased antidepressant use. This time The New York Times and others nailed APA's journal for its data dishonesty; and The Boston Globe reported that Pfizer, makers of the antidepressant Zoloft, had contributed $30,000 to that American Journal of Psychiatry study. This is only the tip of the iceberg.

When the serotonin-enhancer Prozac first hit the market in the late 1980s, Americans heard from the APA and psychiatry officialdom that depression is caused by a deficiency of serotonin. There was no proof of this, and by the mid-1990s the serotonin-deficiency theory of depression had been scientifically tested and rejected. But antidepressant manufactures knew that more people would take Prozac, Paxil, Zoloft and other antidepressants if they believed these drugs worked by correcting a deficiency (analogous to insulin) rather than by "taking the edge off" (analogous to alcohol and illegal drugs). So drug companies and their partners in psychiatry kept quiet. Psychiatry also kept quiet about antidepressant tolerance (the need for an increasingly higher dosage), dependency, and nightmarish withdrawal--all of which was well-known in the scientific community several years before word got out to the general public.

In the past, those who have confronted Big Pharma's corruption of psychiatry have been accused by psychiatry apologists of belittling emotional suffering. But Americans increasingly understand that such smearing is as ridiculous as accusing critics of the Bush administration's invasion and occupation of Iraq of disloyalty to American soldiers.

Raids Highlight Prescription Drug Debate

From this report

California authorities who raided the homes and offices of two of Anna Nicole Smith's doctors last week made the highest-profile use yet of a controversial state database that can detect suspicious patterns of prescriptions.

But the raids also reignited debate about the technology. Law enforcement officials say it's a useful tool for fighting prescription drug abuse. Many doctors and privacy advocates say patients are suffering because the government crackdown invades people's privacy and interferes with the doctor-patient relationship.

"What we have going on right now is a society wide witch hunt," said Dr. Frank Fisher, who was recently exonerated following a seven-year court battle that included murder charges, malpractice suits and a medical board investigation into the deaths of several patients for whom he prescribed painkillers.

Some patient advocates believe that allowing investigators to track physicians' prescribing habits risks hurting patients who genuinely need the drugs.

"These databases chill prescribing," said Siobhan Reynolds, who founded the New Mexico-based nonprofit Pain Relief Network after her terminally ill husband was denied large doses of pain killers in the days before his death. "If we had the resources, we would try to shut down every one."

California Attorney General Jerry Brown and other law enforcement officials dismiss such claims and contend the system is needed to curb prescription drug abuse.

"There is no evidence that legitimate treatment is being suppressed or being discouraged," Brown said in an interview. "I think there are more cases out there than are being prosecuted."

The number of Americans who abuse prescription drugs nearly doubled, from 7.8 million in 1992 to 15.1 million in 2003, according to the U.N.-affiliated International Narcotics Control Board in its 2006 annual report, issued in February.

Investigators use the database to look for patients who have received prescription narcotics from several doctors. They are also searching for physicians who authorize higher-than-expected amounts of drugs.

California authorities conducted the raids Friday at the office of Smith's psychiatrist, Dr. Khristine Eroshevich, and the home and office of Dr. Sandeep Kapoor, who prescribed the painkiller methadone to Smith shortly before her February death from an overdose. She was 39.

Brown said his office began investigating Kapoor and Eroshevich after he discovered the two combined to prescribe more than a dozen drugs in the days before Smith's death at a Florida hotel. He has declined to speculate on what charges the doctors might face if it is determined they improperly prescribed drugs.

The Medical Board of California is also investigating Eroshevich, who, according to documents, authorized all 11 prescription medications found in Smith's hotel room the day she died.

Agents have so far reviewed more than 100,000 computer images and files, analyzed patient profiles and pharmacy logs, and interviewed witnesses in the U.S. and abroad, Brown said.

Authorities are also mining the massive database kept by the California Department of Justice called the Controlled Substance Utilization Review and Evaluation System, or CURES.

The database has long been a useful tool for doctors wanting to check patient backgrounds before writing a new prescription. It details the 20 million narcotic prescriptions written each year in the state.

Nearly three dozen states have similar databases, but California's, created in 1996, is the oldest and largest.

Crime victims like Bob Pack insist the state's prescription database needs a technological update to catch more people who seek drugs from multiple doctors. A drugged-up motorist ran over Pack's two young children in 2003 as they walked to get ice cream on a Sunday evening.

The foundation Pack launched with his wife in honor of their children is now the driving force behind an effort to make the database instantaneously accessible.

Currently, only Justice Department officials can directly access the CURES database. Doctors and pharmacists must fax patient background requests to the agency, a process Pack argues is too time-consuming to catch drug abuses who obtain multiple prescriptions from different doctors.

Jimena Barreto, the professional nanny who killed Pack's children, had six prescriptions for the pain killer Vicodin from six different doctors at the same HMO in the weeks before the crash.

"When my children were killed, I naively thought doctors and pharmacies had this information at their fingertips," Pack said. "They don't."

Exercise on par with drugs for aiding depression

It seems that the big drug companies have something to fear from the fitness craze. After all, all these people running around being healthy or getting healthy won't need the drugs to control the depression they won't have. As seen in this Reuters news report.

Regular exercise may work as well as medication in improving symptoms of major depression, researchers have found.

In a study of 202 depressed adults, investigators found that those who went through group-based exercise therapy did as well as those treated with an antidepressant drug. A third group that performed home-based exercise also improved, though to a lesser degree.

Importantly, the researchers found, all three groups did better than a fourth group given a placebo -- an inactive pill identical to the antidepressant.

While past studies have suggested that exercise can ease depression symptoms, a criticism has been that the research failed to compare exercise with a placebo. This leaves a question as to whether the therapy, per se, was responsible for the benefit.

The new findings bolster evidence that exercise does have a real effect on depression, according to the researchers.

Doctors may not start widely prescribing exercise as a depression treatment just yet. But for patients who are motivated to try exercise, it could be a reasonable option, the study authors say.

"If exercise were a drug, I'm not sure that it would receive FDA approval at this time," noted study author Dr. James A. Blumenthal, a professor of medical psychology at Duke University Medical Center in Durham, North Carolina.

"But," he told Reuters Health, "there is certainly growing evidence that exercise may be a viable alternative to medication, at least among those patients who are receptive to exercise as a potential treatment for their depression."

The study, published in the journal Psychosomatic Medicine, included 202 men and women age 40 and older who were diagnosed with major depression. They were randomly assigned to one of four groups: one that worked out in a supervised, group setting three times per week; one that exercised at home; one that took the antidepressant sertraline (Zoloft); and one that took placebo pills.

After 16 weeks, the patients completed standard measures of depression symptoms.

By the end of the study, Blumenthal's team found, 47 percent of patients on the antidepressant no longer met the criteria for major depression. The same was true of 45 percent of those in the supervised exercise group.

In the home-based exercise group, 40 percent had their symptoms go into remission. That compared with 31 percent of the placebo group.

There are several theories on why exercise might improve depression. For example, physical activity seems to affect some key nervous system chemicals -- norepinephrine and serotonin -- that are targets of antidepressant drugs, as well as brain neurotrophins, which help protect nerve cells from injury and transmit signals in brain regions related to mood.

Exercise may also boost people's feelings of self-efficacy and promote positive thinking. Some experts speculate that group exercise, with its social aspect, may have added benefits.

Though the home exercise group in this study did better than the placebo group, it's not clear whether it's as good as supervised classes, according to Blumenthal. "Home exercise may be more convenient," he noted, "but patients not push themselves as hard on their own."

He added that supervised exercise may also be safer for some people, such as those with heart disease.

SOURCE: Psychosomatic Medicine, September 2007.

The Hand Seen Behind Alarmist Suicide Statistics

A column by Martha Rosenberg

Long before the New York Times reported this month that youth suicides were up 8% from 2003 to 2004 and experts blamed an "antidepressant deficiency" big pharma was trying to plant the story.

There's too much money in diagnosing children with major psychiatric illnesses and keeping them on psychotropic drugs their whole lives to let a little thing like the black box warnings the FDA imposed on antidepressants for children in 2004 ruin sales.

After all this is a nation that believes that children are born with a Ritalin deficiency, insomnia is Ambien deficiency and old age is hormone deficiency. Why shouldn't pharmacology trump biology with suicide statistics as well?

Last year an article in the June issue of PLoS Medicine set the stage.

Lead author Dr. Julio Licinio, a consultant to Prozac-maker Eli Lilly, found the U.S. suicide rate "dropped steadily over 14 years as sales of the antidepressant [Prozac] rose."

It was followed by an article in April in the Archives of General Psychiatry by four representatives of a private "drug development services" company called Quintiles Transnational and four other authors expressing concerns that "the number of children and teenagers who were prescribed antidepressants has decreased significantly" underlining "the importance of presenting a fair balance within the media." ("Impact of Publicity Concerning Pediatric Suicidality Data on Physician Practice Patterns in the United States")

And in February a MedPage Today article actually scooped the New York Times with the headline, "Teen Suicide Spike Linked to SSRI Black Box."

Black box warnings create a barrier to treatment "by scaring young people and parents away from care," said David Shern, Ph.D., president of Mental Health America, reported to have accepted $3.8 million from pharmaceutical companies in 2005, in a statement when the article broke.

Charles Nemeroff, M.D., Ph.D., of Emory University School of Medicine took it a step further.

"The concerns about antidepressant use in children and adolescents have paradoxically resulted in a reduction in their use, and this has contributed to increased suicide rates," he told reporters. Dr. Nemeroff has links to Eli Lilly, Pfizer, Wyeth-Ayerst, Pharmacia-Upjohn and five other drug makers according to published reports.

Unfortunately for pharma, when the New York Times broke the story it had a short shelf life.

The rise in suicides among ages 10 to 24 in 2003 to 2004 stood. But the charge that the rise was due to a drop-off in antidepressant prescriptions, especially selective serotonin reuptake inhibitors (SSRIs) like Prozac, which came from an article in the September American Journal of Psychiatry, promptly fell on its head.

It turned out the drop in SSRI prescriptions that "caused" the suicide rise occurred the following year. In most of the year cited, SSRI prescriptions actually "rose an average of just over 10 percent" for those 18 and under according to Psychiatric News and "the number of prescriptions peaked in March 2004."

Meanwhile preliminary Centers for Disease Control and Prevention statistics from the year that would have been influenced by a drop in SSRI prescription that occurred--2005--do not show deaths up, though they have not been broken into category. See what others are saying and join the discussion at our Forum

Asked about the 180% turnaround in facts which meant the suicide rise was not caused by SSRI prescription drop-offs and possibly caused by SSRIs themselves, vindicating the FDA's black boxes, the article's lead author Robert D. Gibbons, Ph.D., a professor of biostatistics and psychiatry at the University of Illinois at Chicago, did not sound the statistician.

"This study was suggestive, that's what we're saying," Dr. Gibbons told the Times in a follow-up story--"Early Evidence on the Effects of Regulators’ Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents" is suggestive? try conclusive--and should piggyback off previous studies that showed the links… better.

Then why publish it?

There were other question marks about the American Journal of Psychiatry article too--not counting Pfizer's financial contribution and Dr. Gibbons link to Wyeth Pharmaceuticals.

What if the suicides aren't about SSRIs at all but the growing popularity of treating children with antipsychotic drugs?

"I would be absolutely certain that the increase is not because kids are not being treated," says David Healy, M.D., a psychiatrist at the University of Cardiff and early critic of SSRIs. "They may not be getting SSRIs, but they are getting psychotropics," he says and, "the antipsychotic 'mood stabilizers' have just as great an increase in suicide risk as antidepressants--if not greater."

Pharma is probably working on a new round of articles on the topic right now.