Tag Archives: psychiatric drugs

Drugs and Violence

By Dr David Laing Dawson

In medicine, when we find something that works we overuse it. That is as true of antibiotics, anti-inflammatories, and blood pressure drugs as it is for psychiatric drugs.

And this means that some people who really didn’t need the drug in the first place may be suffering unnecessary side-effects. Over time medicine usually corrects with broad studies and new guidelines.

(Although it is as difficult for doctors to convince a patient that he needs to exercise rather than take Prozac, as it is to convince a mother that her child’s cold and earache will run its course with or without antibiotics.)

But to blame psychiatric drugs for violence and murder is patently ridiculous.

In fact, if one extrapolates from the murder rate trends around the world, or just within large Canadian cities, one could make a case for the wide prescription of anti-depressant and anti-psychotic medication being the source of less violence in our societies.

Murder rates in the middle ages were shockingly high by all estimates. Similarly throughout the 1800’s.

In Toronto and Montreal the murder rates climbed from 1900 into the 1960’s, peaking in the mid 70’s and then declining ever since.

The powerful psychiatric drugs were introduced in the 60’s but mostly used within hospitals and outpatient clinics of hospitals. Wider use developed in line with the reduction of psychiatric hospital beds and the introduction of newer drugs in the 1970’s and 1980’s: the so-called atypical anti-psychotics (Risperdal, Seroquel eg) and the SSRI’s for anxiety and depression (Prozac onward).

The increasing use of these drugs within the community and less ill population, when charted, is a reverse image of the declining murder/homicide rates.

Many other factors are at play as well, of course, so I cannot make a case for these drugs specifically being responsible for the declining rate of homicides, but I can from this data be confident that wide-spread use of these medications is NOT increasing the homicide rate.

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The first group of antidepressants were introduced in the 1950’s, again primarily in hospitals, outpatient clinics and for severe depression. (Imipramine, Amitriptyline)

Prozac, the first SSRI antidepressant was introduced in 1989. Currently 86 people per 1000 in Canada take an antidepressant, usually an SSRI or NSRI medication.

(note both the highest suicide rate and the lowest consumption of antidepressants falls to South Korea)

Similarly the first antipsychotics (Chlorpromazine etc.) were introduced in the late 1950’s/early 60’s and were used primarily within the mental hospital population. The second generation only became available in the 1980’s. Currently a little over 1% of the American population takes anti-psychotic medication.

If one considers the percentage of the population that suffers from severe mood disorders it is reasonable to say that the antidepressants are being somewhat over prescribed.

On the other hand if one considers the percentage of the population suffering from a psychotic disorder (schizophrenia, bipolar disorder, psychotic depression, autism with psychosis) the anti-psychotic medications are being underutilized.

But, either way, to blame these medications for violence or homicide in 2018 is ridiculous, as the data clearly demonstrate.

 

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Blue Dreams – the Story of Psychiatric Drugs

By Marvin Ross

I’ve just finished reading Blue Dreams The Science and the Story of the Drugs That Changed Our Minds and it is the most balanced accounting of psychiatric meds that I’ve ever read. Lauren Slater is a psychologist and someone who has taken psychotropic medication for bipolar depression for most of her life. She has been in and out of hospitals many times so she speaks from both experience and academic awareness.

She starts out with a very detailed account of how chlorpromazine, the first anti-psychotic, came to be and gradually made inroads against the psychoanalysis that was prevalent at the time. What surprised me was that there were psychoanalytic neurologists who considered Parkinson’s to be the result of psychology and not brain chemistry. She then moves on to give the history of the first anti-depressant, imipramine.

As a political aside, both of those drugs were first used in North America by Dr Heinz Lehmann in Quebec. He came to Canada as a refugee fleeing Hitler. His colleagues arranged a ski vacation for him to Quebec as a ruse so he left Germany with his skis and all his luggage. A lesson for the Donald on the value of refugees.

Her discussion of lithium is quite interesting as its use goes back many years for all manner of ailments but it was slow to be accepted by medicine for psychiatry because there cannot be a patent on a naturally occurring substance. No money can be made and so, to this day, no one has ever bothered to try to find out what it does to the brain or how it works. A sad condemnation of science and of the profit motive in drug development.

Ms Slater began suffering depression at quite a young age and was eventually sent to see a psychiatrist in her early teens. She saw the doctor three times per week. After about 6 years of no progress, her doctor put her on imipramine which had recently become available but it did not help and gave her terrible side effects. When Prozac became available, she was switched to that and she spent 17 years taking it.

This is what she had to say:

“Both before and while I was on imipramine, my emotions were wild and I was whipped between states of utter despair, whirling anxiety and unstable ecstacy that allowed me to pull all-nighters writing lengthy tomes that later, in the sober light of another day, lacked what I felt at the time of composition had been a poetic essence. I was also a revolving-door mental patient in and out of the hospital admitted and discharged five times between the ages of thirteen and twenty-four, with not much hope for a full future……”

“Prozac turned my life around and did it fast, one two.”

“On SSRIs, however, I have been able to stay out of mental hospitals, to write nine books, to bear two babies who are now adolescents with their own keen interests and proclivities to manage with their own interests, to manage a marriage and then a divorce, and, just as important, to nurture a circle of friends.”

Unfortunately, over the years she has had to increase the dose until Prozac became ineffective and she had to switch to other medications. And, the drugs had a severe impact on her health causing her to gain weight and to develop diabetes. But, she said, that was the price she had to pay for sanity.

While she has been helped by pharmaceuticals as have many people, she is very critical of psychiatry and its theories which are quite simplistic. I was surprised to learn that despite the dopamine theory of schizophrenia, it turns out that those with this disease can have a wide range of dopamine levels and the levels are not related to the presence of the disease or its severity. The same applies to serotonin in the case of those with depression. Prescribing is a guessing game and there are doctors who prefer certain drugs and that is what they prescribe based simply on their preferences and not the science of why a certain drug works. However, drugs that dampen or increase levels of these neurotansmitters do help with the symptoms but psychiatry still has no clue about etiology.

This ideological adherence to certain drugs is one that I encountered a number of years ago. I pitched a story to a psychiatry/neurology newspaper on research done comparing the side effect profile of the older anti-psychotics with the new atypicals. The pitch was accepted and I submitted the story which showed that the newer drugs had just as many side effects as the older ones. The editor called and told me the research was preposterous and should never have been accepted as a presentation at a psychiatry conference. They refused to run the story but paid me anyway because they had accepted my pitch (in error I was told).

Of course, we all now know that the research was correct.

One interesting fact she mentions is that even with drugs like Prozac, the rates of depression are increasing. The reported incidences of depression have increased a thousandfold since the introduction of anti-depressants. She suggests that this might be the result of an American society that emphasizes individualism and has very few safety nets like universal health care. Sociological studies have shown that depression increases with isolative societies.

It would be interesting to compare rates of depression over time between the US and other western countries that are less individualistic like Canada and Western Europe.

I was pleased to see that while she references my old opponent, Robert Whitaker, she discounts his views. Yes, anti-depressants do cause changes in the brain as he points out but then, untreated depression (and schizophrenia) cause changes in the brain and the patient when untreated, is not able to manage.

Psychiatry and our knowledge of the brain is still in its infancy and we can only hope that greater progress is coming.