http://groups.msn.com/psychbusters
Decoding Psychiatric Propaganda

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Jagged little pills

Robin Harvey
TORONTO STAR

7 June 2003

Studies show antidepressants help only 20 per cent of people who take
them. That's based on controlled, double-blind trials which show that
although 60 per cent of people respond to antidepressants, 40 per cent
respond to a sugar pill, Cooke says.

http://groups.msn.com/psychbusters
Decoding Psychiatric Propaganda

* * *

Jagged little pills

Robin Harvey
TORONTO STAR

7 June 2003

Treating depression is an inexact balance of art and science.

Since you can't study live brains to see how any treatment really
works, tackling the disease is somewhat like nailing jelly to the
wall, says a leading expert.

Add that to the fact that more than half of depressive episodes
eventually go away without treatment, and it's even harder to
understand the disease, says Dr. Robert Cooke, of the mood disorders
clinic at the Centre for Addiction and Mental Health in Toronto.

The resulting reality is that each day, millions of North Americans
take pills to fight depression even though no one really knows exactly
how they work.

"The brain is incredibly complicated (and) the mind is incredibly
complicated," Cooke says. "There are still no simple answers or magic
cures. We have treatments worked out on a trial-and-error basis and
they are imperfect."

A mainstay of treatment has been antidepressant medication. But the
earliest pills developed in the 1950s had significant side effects and
could be highly toxic. By the late 1980s, with the advent of the new
"designer" antidepressants, doctors thought they'd found a better
answer.

The new drugs specifically target and change levels of the brain's
chemical messengers — neurotransmitters. They were touted as
"cleaner" drugs with fewer side effects and less toxic if taken in
overdose.

They became so popular that sales of the drug Prozac — the first
of the new class — hit $2.81 billion (U.S.) worldwide in 1998,
and it became the fourth pharmaceutical product ever to eclipse $2.5
billion (U.S.) in global sales.

In Canada, from 1993 until 2002 the number of prescriptions for this
class of drugs increased 768 per cent to 13.8 million, according to
IMS Health Canada, a medical research firm.

Yet today, though millions of people are prescribed the new class of
drugs, the new pills have not lived up to initial expectations.

"We need a major breakthrough in medications," Cooke says. "Most (used
today) are copycats of older ones changed somewhat so they have fewer
side effects. But the fact is, when it comes to effectiveness, the new
drugs are no more effective than the ones we used in 1950s."

There is no doubt that changing neurotransmitter levels can affect
mood, easing depression and mood swings, Cooke says.

Toronto's Glenn Hardcastle who has had bouts of depression all his
adult life says he could never have fought the "molasses on the mind"
without medication.

"It would be cruel to expect people to talk their way out when they
are really down," he says. "For me, it was just not possible."

And Phil Upshall, spokesperson for the Mood Disorders Society of
Canada, says the drugs help people out of their immediate crises so
they can engage in talk therapy. Upshall, who has bipolar disorder,
says medication was key to his getting his life back on track.

Though people on the medicine paint a glowing portrait of the drugs'
benefits, the scientific evidence is not as clear-cut.

Studies show antidepressants help only 20 per cent of people who take
them. That's based on controlled, double-blind trials which show that
although 60 per cent of people respond to antidepressants, 40 per cent
respond to a sugar pill, Cooke says.

But Dr. Barry Martin, another expert at the centre who runs its
electro-convulsive therapy service, says that picture is incomplete
because it only deals with patients who report improvement.

If you look at the number of people who completely recover on
medication and compare it to people who take a sugar pill who report
the same recovery, both are equally effective — about 40 per
cent, he says.

However, Dr. Anthony Levitt, psychiatrist-in-chief at Sunnybrook and
Women's Health Sciences Centre, says neither statistic is relevant. He
says if you just look at depressed people left on waiting lists who
are not involved in any studies, only 20 per cent improve on their
own.

Besides the hazy picture of the drugs' effectiveness, other problems
have emerged over the past 15 years as the newer medications have
grown more popular.

Their side effects can be significant. The major ones are weight gain,
sleep disturbance and sexual dysfunction, Cooke says.

Up to 30 per cent of patients using the neurotransmitter reuptake
inhibitors report some sexual problem — either loss of desire,
inability to have an orgasm, impotence or delayed orgasm. Hardcastle
says he has experienced headaches, sexual dysfunction, agitation,
sleeplessness and frequent urination as side effects in his search for
a suitable medication.

Another concern has been the reports of physical withdrawal when
people stop taking antidepressants — a problem Cooke says was
"really underestimated."

In April, Health Canada warned doctors that "withdrawal reactions or
discontinuation symptoms" occur with all the newer antidepressant
drugs. It "may be misdiagnosed, leading to inappropriate treatment."

Cooke says people who stop antidepressants don't crave them for a
high. But they can experience nausea and diarrhea. They may also have
nightmares and can get a disturbing feeling like electrical sparks
shooting through parts of their body, he says.

Bonnie North says she went through "agonizing withdrawal" when she
tried to stop an antidepressant in 2001.

She had been on the treatment for three years to fend off depression
after childbirth.

North suffered headaches, extreme nausea, vomiting and diarrhea. Most
maddening, she says, was a constant sense of an electrical "zap" in
her head that lasted for months. She has launched a lawsuit against
the drug manufacturer.

The manufacturer will not comment on the court case but says its drug
is safe and causes no severe withdrawal symptoms if discontinued
properly under a doctor's supervision.

North also worries because there have been no studies of long-term
side effects.

People like herself, who are put on the drugs for years, are "guinea
pigs" she says.

Most of the pre-market studies of the drugs before they were approved
for sale lasted six weeks. But many patients stay on the drugs much
longer. That's because, unless the drugs are taken for a year, a
patient is likely to have a relapse, Cooke says.

He acknowledges that information about long-term side effects is not
available. But since the drugs are monitored after they hit the
market, serious adverse reactions would be reported, he says.

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http://groups.msn.com/psychbusters
Decoding Psychiatric Propaganda