Ssris - Is Continuing To Prescribe Them A Contravention Of "do No Harm"?

[Anarchy]

A massive, peer reviewed study, published in the Journal of the American Medical Association, back in January 2010, Dead Link Removed found that except for "major depression" SSRIs were no more effective than placebos. Their effectiveness in "major depression" is not exactly breath taking either, as virtually any psycho stimulant will show an effect.

I gather that since that study, freedom of information requests have brought to light clinical trials which had failed to show any statistically significant difference to placebos, that the drugs companies had hidden away.

Having been in long term intimate relationships with people who were taking SSRIs, I have close knowledge of the downsides of something that was no more effective than a sugar pill.

High money price, six weeks of feeling crap before even the placebo effect began to take hold, suicidality, Hideous withdrawal (far worse than heroine - but given a different name). Weight gain, permanently trashed sexual function...
and problems for babies born to mothers who were on SSRIs http://jama.jamanetwork.com/article.aspx?articleid=1555130

In the light of those findings, is a doctor who now prescribes SSRIs for anything other than a "Major Depression" in contravention of the first part of their Hippocratic Oath; "Do no harm"?

and are they opening themselves up to potential compensation claim?
____________________________
One of the users here recently started SSRIs then stopped them, on the basis that unless they were experiencing the difficulties that the SSRIs were meant to mask / suppress, they could not learn to cope with those (very significant) difficulties.
anyone have thoughts on this?

 

[anthony]

I've never been a fan of them, to be honest... and I pretty much come across that way personally about them, though I do accept they work for a minority, so if they do good, then maybe let it ride. Saying that, I am totally in agreement about the "do no harm" aspect of doctors, as psychiatrists are doctors, and is prescribing them for PTSD really the best option they can come to? There are lots of medications known to work far better than SSRI's, yet there are always givings between any medication... one comes with this side effect, another that one, so forth--then all tossed into whether an individual will get x, y or z side effect. Maybe all of them!

I don't know what the solution is, as its obviously above my head, though I think far more information should be given to any patient prior to prescribing, with a whole bunch of discussion about the pro's and con's of the medication, then the patient decides whether to give them a try or go for something more robust and proven, if anything at all.

I guess this is the current argument for marijuana. Medical marijuana has most of the nasties removed from it, thus its less dangerous, yet still mind altering and if someone drives after taking it, well... however; if someone loads up on valium and then drives in a zoned out state... again... accident, death, destruction, mayhem.

Above my pay grade... though it pisses me off personally that such misinformation exists about these pills, as though they have some profound benefit and majority positive impact. Doctors just keep dishing them out... kickbacks must be good.

 

[Sandstone]

Doctors just keep dishing them out... kickbacks must be good.

Or, less cynically, doctors feel helpless in the face of complex mental health problems, limited appointment times and limited therapy resources, so reach for the one thing they CAN do.

 

[moonbeam]

I stopped taking mine and noticed that I am better able to cope and haven't SH since the withdrawals ended. I suppose that's the only good effect I have had is that I am now more proud of myself for my ability to function without them.

I know in my experience that I definitely wasn't given enough info from the psych. When I went back armed with information I was told to just stick with it and it will work. I still don't fully understand why they thought that giving a suicidal person meds that say they increase suicidal thoughts or behaviours was supposed to be a good idea.

I think the issue with my doc (who isn't my doc anymore) was that he genuinely thought that it was better than nothing. Prescribing psych meds is often a gamble, cross your fingers and hope it works. But I was already in talking therapy so they didn't really know what else to do.

 

[Queen Boudica]

Interesting. Thanks for this link.

 

[Queen Boudica]

unless they were experiencing the difficulties that the SSRIs were meant to mask / suppress, they could not learn to cope with those (very significant) difficulties.

Precisely. Exactly how I feel about it. I'd rather go through the pain and learn to manage now I know what I'm dealing with. How do you ever learn to ride a bike if you've got training wheels on all time? (Probably not the best analogy)

 

[joeylittle]

I gather that since that study, freedom of information requests have brought to light clinical trials which had failed to show any statistically significant difference to placebos, that the drugs companies had hidden away.

I think this is unfounded. You don't need to file a FOIA to access trials done in the public sector, and I've read many studies showing that various individual SSRIs are not effective, even for MDD. Myself, I was only ever on one SSRI specifically, and it didn't put a dent in my depression - so I got to go back to the other SNRI that clearly did.

If you are talking about the closed trials that drug companies conduct for themselves, those records are, yes, requestable after a drug has been approved (in the US). But honestly, the field at large jumps all over these things the moment they come out. Look, if it made it to the public it got through the FDA, which stands for nearly nothing. But in order to get to that phase, it has had public, accessible trials. The research is all out there. It can be overwhelming for an individual to find it or know how to read it, but that doesn't mean Pfizer (or whoever) is hiding it, it means you need a little more patience and access to some good medical dictionaries.

For PTSD, the standard prescribing protocol still starts with SSRIs, and it's just shameful. People with PTSD don't have depression. They have PTSD, of which depressed mood is a symptom, but not necessarily the lead symptom. I'd guess (total guess) that a lot of the depression people deal with is situational to their PTSD diagnosis. What I mean is, they have this cluster of symptoms and this trauma event and it's all falling down on their heads. Yes, situational depression makes sense.

(If you went to a psych for medication for situational depression, they would (if they were a good doctor) send you to therapy and give you something to help with whatever end of the sleep stick you are struggling with.)

But the arousal, the intense sleep disturbances, the mental pain of it all - SSRIs just aren't chemically suitable.

Neuro-psychiatry is finally catching up, research-wise, but many doctors are still way behind the curve. I personally think whether it's kickbacks or stupidity is just a distraction. Sadly, it is 100% incumbent on the patient to do their own research and (in the US) find a doctor that is up-to-date and conservative in their approach to medicating for PTSD symptoms. I say sadly, because when a person needs to be able to do this, they are usually having a really shitty time of it.

I think a good doc will prescribe specifically for whatever symptom set is interfering most with functioning during recovery. So if that's sleep, or nightmares, or panic - give something targeted for those issues. And make sure the patient is enrolled in actual trauma therapy.

That, in my opinion, would be to do no harm.

 

[Queen Boudica]

It is quite terrifying how proactive you have to be and how knowledgeable about diagnosis and treatments when you have mental health conditions. And this is exactly when you are at your most vulnerable. Very useful to be able to read this stuff here.

 

[theshadowoftheliving]

My experience with this was being force-medicated as a teenager. Te psychoactive drugs reduced me to a shaking, suicidal mess and as I got worse from the side effects, they upped my dose, therefore making the side effects worse .... When I turned 18, I stopped all meds. Suddenly I wasn't as anxious and I wasnt suicidal anymore.

I'm still a mess. But atleast I'm working with the baseline and I know that when I get better or worse that's it's related to me, not the medication. I can't speak for everyone's exoeriences, but dealing with the side effects was, for me, significantly worse than dealing with the actual problem.

Plus, I know now that SSRIs are linked to suicidity in teenagers. I'm forever rageful at the psychiatrist who didn't do his research on what he was prescribing me. (Sorry, end rant.)

 

[Queen Boudica]

Good on you @theshadowoftheliving Amazing insight at 18.

 

[shimmerz]

proactive you have to be and how knowledgeable about diagnosis and treatments when you have mental health conditions. A

Yes, and also how doctors damned me when I was pro-active. I was like the whipping girl when I told them I wouldn't take a drug unless I, myself, the person who was going to be affected by the drug, did my research as to what the side effects were. Jeeeeezzzus. I got a reputation as being 'difficult'. On the upside I am still alive.

One of the users here recently started SSRIs then stopped them, on the basis that unless they were experiencing the difficulties that the SSRIs were meant to mask / suppress, they could not learn to cope with those (very significant) difficulties.
anyone have thoughts on this?

Everyone is different so I am not professing to know what is right or wrong for anyone else. After I went suicidal one one of my meds I decided to stop my relationship with SSRI's. My experience with any of them was one of a 'stepford wife' persona. I am certain that the pills are what had me unable to perform and ultimately lose my business. *heavy sigh* But that is conjecture. I believe it to be true but can't prove it. Oh, and when I asked the doctor about it he said 'You've only been on the drug for a week, we need to keep you on it for five more weeks so we can see how it does.' WTF???? I am suicidal! I have never EVER been suicidal before.

My experience didn't go into a database so I am guessing it is not a statistic. Why not? He dismissed this very real experience right from the get-go.

Here's the rub....when being assessed at a renowned trauma treatment program here, I was diagnosed as bi-polar because the SSRI's didn't agree with me (suicidal, zombie, unable to think at all). A cute little brand new doctor, in 1.5 hours deemed that I was bi-polar because I didn't do well on SSRI's. Treatment? Anti-psychotics and a new diagnosis. Problem is, I didn't fit the criteria nor the symptomology for bi-polar at all but she stressed that ANYONE having an issue with SSRI's (who suffers PTSD) must have bi-polar. Now, don't get me wrong. I don't mind a diagnosis of bi-polar - if I show the signs and symptoms but I simply did not. I found it interesting that because I didn't conform to the SSRI treatment path it was time to throw me on more powerful (and not at all appropriate) drugs and a bigger diagnosis.

After trying and trying and trying to deal with the conventional health care system here who makes it a prerequisite that first line treatment is drugs and then wait for 6 weeks to 'see how they work', while life may be falling apart around oneself, I dropped out of the health care system. Sorry, this is a hot button topic for me. I lost everything .... everything and was damned for attempting to say that the SSRI's were doing more harm than good.

 

[ihateusernames]

SSRIs terrify me and I have not and almost definitely will not ever take one. But I do currently take wellbutrin, I went to my regular doctor (who is actually a nurse practitioner) planning to ask for it, but it was her first suggestion anyway, and the majority of information I find on it boils down to "we don't know exactly how it works" so, probably not much better. But it has worked for me. However, I was also told that antidepressants plus therapy is a much more effective combination and that sometimes therapy on it's own is just as good or better particularly if there are underlying issues, or if it's a situational depression. I consider that pretty good disclosure and was genuinely impressed- I don't normally trust doctors at all.

That said, our actual family doctor who is in the same practice recently wrote my husband a prescription for an SSRI for cold urticaria. Seriously, an allergy... just "in case" it's stress related. We didn't even know what the drug was until we picked up the prescription and googled it. I honestly don't know what to say about that. I know my husband was pissed, he's had bad reactions to them in the past and prescribing it for this, absurd. The doctor also got mad at him for refusing to take it. It's just all around stupid. I don't know whether the doctor genuinely thinks he's helping and is poorly misguided, whether he's being lazy, whether he's used to patients demanding meds... But I can't see that as anything other than harmful. That's a general physician, not a psychiatrist prescribing them willy nilly. You would expect a mental health professional to be better informed about psychotropic drugs, but I guess they're not.

I know I'm rambling here, it's because I don't know what the answer is. Or who is to blame, and the frequency and carelessness with which sometimes scary drugs are prescribed makes me really sad.