Saturday, 18.09.2021

Jon David Healy, Joann Le Noury and Julie Wood: Children of the Cure

Missing Data, Lost Lives and antidepressants 

 

Hector Warnes’ comments

 

      There is no question that Healey, Le Noury and Wood have written a historical and veridical account of the history of psychopharmacology, with particular emphasis on its negative and most disturbing side as they write, “…around 200 (or more) non-psychotropic drugs have caused serious adverse side effects to countless patients.”

      Unfortunately, we must admit that in medicine as a whole there is no panacea (panakeia, a herb that would heal all illnesses or a universal remedy -- cure-all). The authors meticulously name every psychotropic compound that has been found either ineffective or that caused adverse reaction, some to the point of suicide. It is true that the benefit that we expect from a drug should be greater than the potential risks or harm.

      However, reading the book one cannot avoid feeling that the authors are throwing the baby out with the bath water, in other words, they are rejecting the favorable along with the unfavorable or just dismissing the positive results and the valuable achievements of neuropsychopharmacology since the decade of the 1950s and concentrating only on its failures.

      We all know that the specialty of medicine has its percentage of failures and tragic denouement not always attributed to drug treatment. I would further agree that judging by all the negativity noted in this book, we are in disarray. Perhaps we promised more than we can deliver but there is no question that neurosciences, pharmacogenetics and biology (a field hardly tackled in his book) are supporting continuing research in this field. Molecular analysis of brain receptors would eventually identify the biochemical molecules that act on specific cellular signaling or metabolic pathways.

      I often read the prospectus that the pharmaceutical companies are supposed to include when the drug is sold to the public. As far as concerns the selective serotonin re-uptake inhibitors, it is usually stated that in the first weeks of usage there may be states of excitement and/or suicidal tendencies. When psychopharmacological treatment is not given along with psychotherapy and minute consideration of environmental and background factors the results are not as promising. At times I had to treat patients who fell into despair because a son or a daughter was admitted to hospital for a minor illness but contracted an infection or did not come out of a lethal anesthesia. Nobody has questioned the fact that most anti-depressant medications help less than 60% of patients, depending on the type of depression, of course, and the type of doctor-patient relationship. The word “stress” has given rise to a new field that tries to encompass all the possible factors in any illness including cancer: psychoneuroimmunoendocrinology. I know many neurologists and endocrinologists who spent two or more years to get a master’s degree in this field.

      I tend to agree that pharmaceutical companies are prone to become marketing companies and that drugs are tested in Phase III too rapidly, without exhausting possible risks. It has often been the case that Phase III patients are recruited from developing poor countries and so on. In the past heroin, cocaine and barbiturates were the number one killers, but now drug overdoses have shifted and polypharmacy is on the rise.

      I would suggest that training in psychiatry is limited because of the many reasons the book  mentions and which would require at least two years training in pharmacology in view of drug interactions which are the rule more than the exception. In my experience pharmacovigilance is not practiced with the frequency and extension it should. Since there are so many schools of psychotherapy, to become an expert in just one school would suffice. Neurologists, our first cousins, stayed closer to medicine and learned their boundaries. Psychiatrists are likely to cross boundaries and to keep on distancing themselves from core medicine or neurology to the point that there are nowadays many kinds of psychiatrists.

      I have not seen for a long time the phrase "drug automatisms" which refers to elderly (or not so elderly) patients who forget that they already took a medication prescribed and take it again and perhaps again. There are two peak periods of suicide (statistically), during adolescence and in the elderly. I am inclined to think that there are several variables that enter into a "successful" suicide.

 

December 31, 2020