A Tale of Myths

Over the next few blog entries, I would like to tell you a tale about the little-known medical myths of Peter Breggin's 2001 book, The Anti-Depressant Fact Book.

Breggin begins his book by establishing some mechanisms by which the antidepressants he is convinced are harmful could be kept on the market. He points out that consumers are less likely to question an FDA-approved, doctor-endorsed pill than another consumer product. He reminds us that psychiatric drugs are sold for profit, which could result in less than honorable marketing.

Once Breggin is done discussing the evil of the drug companies (an argument I will return to when I review Talking Back to Prozac), he proceeds to list the myths he believes he must correct about antidepressants.

Survey (or in this case The Anti-Depressant Fact Book) says:
"'FDA approval means a drug is safe.'
'The FDA makes sure that a drug is tested on thousands of patients before it is approved.'
'Antidepressants are not mood-altering, they directly improve the disease of depression.'
'Antidepressants are like insulin for diabetes, they provide essential missing substances.'
'Antidepressants don't cause abnormalities in the brain, they correct biochemical imbalances.'
'Antidepressants aren't in any way similar to stimulants like amphetamine and cocaine.'
'Antidepressants don't cause cause withdrawal problems; you can stop them without any ill effects.'
'Antidepressants can't make you psychotic unless you have a preexisting mental illness'"

Let's start with the first two claims. What exactly does the Food and Drug Administration do to approve drugs? According to the FDA, the purpose of the FDA's Center for Drug Evaluation and Research "is to ensure that drugs marketed in this country are safe and effective." This may be the reason why many civilians believe that FDA approval indicates a level of safety. However, it is true that the FDA itself is not directly responsible for the testing of a drug. The drug is tested by the pharmaceutical company and then the data is compiled and sent to the FDA for something called an Investigational New Drug application. A month after that application is submitted the company is, unless put on hold by the FDA, allowed to begin clinical trials. The results of these along with pertinent marketing information are sent to the FDA in a New Drug Application. If the results of these two applications indicate that the drug is appropriate for use, then it is approved. Therefore, for Breggin's claim to be false, the FDA must be foregoing their responsibilities or the drug companies must be falsifying information. Either way, that would be an issue much larger than the efficacy of antidepressants.
 

Breggin, Peter Roger. The Antidepressant Fact Book: What Doctors Won't Tell You about Prozac, Zoloft, Paxil, Celexa, and Luvox. Cambridge, MA: Perseus Pub., 2001. Print.

"How Drugs Are Developed and Approved." FDA. Web. 27 Feb. 2012. <http://www.fda.gov/drugs/developmentapprovalprocess/howdrugsaredevelopedandapproved/default.htm>.

"The Conscience of Psychiatry"

This week I have begun reading some of the works of the well known psychiatry reform advocate, Peter Breggin, MD. Breggin is himself a psychiatrist. He has a private practice in New York. He attended Harvard College, Case Western Reserve Medical School, did his residency as a psychiatrist and had a teaching fellowship at Harvard Medical School. He also worked for the National Institute of Mental Health. Breggin is a very busy man. He's found an organization called the International Center for the Study of Psychiatry and Psychology. He's founded his own journal and he edits other journals. He also testifies as an express witness in a variety of psychiatry-related court cases. He also found time to write seventeen books and one film, often produced with the assistance of his wife.

 The film instructs psychiatrists beginning their careers to infuse empathy in their style of psychotherapy. He wrote three books to that end as well.  He also wrote a book on treating schizophrenic patients as well as a book on treating children. One of the books is a biographical tribute to Breggin's reform work.  One of them is a book discussing the connection between psychotherapy and peacemaking in any sort of conflict. Another one of his books, which I have acquired, is Medication Madness A Psychiatrist Exposes the Danger of Mood Altering Medications, which examines the possible connection between acts of violence and the psychiatric drugs the perpetrators were taking at the time. If this connection can be proven, this is a significant argument that psychiatric drugs are harmful to society. The argument of the book seems to be that the drugs can only mask a growing depression, psychosis or other state of instability. Breggin mentions common drugs like Prozac, Xanax and Ritalin in his accusations. Breggin also discusses the harmful nature of psychiatric drugs in a book discussing the way they, along with electroshock, can disable the brain. However, I am not reviewing that book due to it's apparent emphasis on electroconvulsive therapy.  Breggin has written two books discussing Ritalin, one a direct attack on the medication. He has written a book that disparages the supposed attack of psychiatry on inner city kids in an effort to reduce violence. He wrote one book discussing antidepressants and one book more specifically criticizing the antidepressant Prozac (seen in my slideshow as fluoxetine). I have acquired both of these works of Breggin. He also wrote a book instructing patients on when and how to stop taking medication. His 17th book comes out of left field and discusses what it is to be an American.

Examining his body of work, it is clear that Breggin takes a very humanistic, empathetic and hands on approach to psychiatry. However, I still find myself wondering if psychiatric drugs could possibly be on the market today if they were as dangerous as he implies. Hopefully, reading Medication Madness A Psychiatrist Exposes the Danger of Mood Altering Medications, The Antidepressant Fact Book:What Your Doctor Won't Tell You About Prozac, Zoloft, Paxil, Celexa and Luvox, and Talking Back to Prozac:What Doctors Aren't Telling You About Prozac and the Newer Antidepressants will give me insight into his apparently radical point of view as well as general knowledge about antidepressants and some anti-anxiety medication.

Breggin, Peter, and Ginger Breggin. "Books." Psychiatric Drug Facts with Dr. Peter Breggin. Web. 24 Feb. 2012. <http://breggin.com/index.php?option=com_content>.


"About Peter Breggin - HOME." Psychiatric Drug Facts with Dr. Peter Breggin. Web. 24 Feb. 2012. <http://www.breggin.com/>. 

Peter Breggin. Digital image. Web. 24 Feb. 2012. <http://www.breggin.com/prbconscience.jpg>.

"About Peter Breggin." Psychiatric Drug Facts with Dr. Peter Breggin. Web. 24 Feb. 2012. <http://www.breggin.com/prbbio.html>.

Bupropion, an Atypical Antidepressant?

Last week, I added a slideshow to my blog, consisting of all the antidepressants, their generic names, and a photo example. Of all the antidepressants pictured, only one of them was described with a caption that I had not mentioned in my first post. While I classified sertraline with the SSRIs and phenelzine with the MAOIs, I found that bupropion (commonly known by the brand name Wellbutrin) was merely described as an atypical antidepressant. Apparently, it is unique.

What is different about Bupropion? The first major difference is the way it works. Bupropion is a NDRI, or norepinephrine and dopamine reputake inhibitor. It uses the same reuptake process I explained previously but works on different neurotransmitters.

Bupropion is the only medicine of it's kind approved for use. It is used to treat major depressive disorder (clinical depression), seasonal affective disorder, and also to help people quit smoking (under the brand name Zyban) in some cases. The mechanism behind it's use against smoking is unknown but it has been shown to reduce cravings, even in those that are not depressed, without any replacement nicotine. Nicotine replacement therapy is the common method of smoking cessation today.

But disregarding it's smoking cessation options, what sets this medication apart from the others in practice? One major factor is that it is less likely to develop sexual side effects while on Wellbutrin than it is with many other antidepressants. For many people, the risk of sexual dysfunction is an important part of their antidepressant prescription. Though even with Wellbutrin, sexual side effects remain a possibility. In fact, there are many side effects including "agitation, weight loss, dry mouth, constipation, headaches, nausea or vomiting, dizziness, increased sweating, tremors, insomnia, and appetite loss." Those beginning to take Wellbutrin are also advised to be aware that it is possible for suicidal thoughts to increase at the start of the prescription taking.  Burpropion has interactions with MAOIs that can be very serious. This medicine is not right for everyone, and those with a history of seizures, eating disorders, brain injuries, manic depressive disorder, heart disease, liver problems,  kidney disease, or suffer from certain allergies. It is also important to be weary of pregnancy, future pregnancy, breastfeeding, or regular alcohol consumption while taking Wellbutrin. After all this, I sound much like one of those slightly terrifying commericals about an antidepressant.

With all the things that could go wrong, why would someone take this drug? Could it really help him or her? Many patients that find success with Wellbutrin and other bupropion brand names praise the way the medicine did not dull their emotions like other antidepressants they had tried in the past had done. Some say they were affected by very few side effects and often those who were affected, said they were minor, went away over time, and were worth waiting out. With even a handful of people who claim their lives to be truly turned around by a drug like Wellbutrin, it seems difficult to claim that antidepressants do not function as they are meant to.


"Wellbutrin Success Stories." Depression Forums. Web. 22 Feb. 2012. <http://www.depressionforums.org/forums/topic/1881-positive-stories-about-wellbutrin/>.

"Bupropion Hydrochloride (Zyban) for Quitting Smoking." WebMD. WebMD, 22 July 2009. Web. 22 Feb. 2012. <http://www.webmd.com/smoking-cessation/bupropion-hydrochloride-zyban-for-quitting-smoking>.

 

"Once-Daily WELLBUTRIN XL®." Once-Daily WELLBUTRIN XL®. Web. 22 Feb. 2012. <http://www.wellbutrinxl.com/>.

 

"Wellbutrin." Depression Home Page. Web. 22 Feb. 2012. <http://depression.emedtv.com/wellbutrin/wellbutrin.html>.

Understanding the Mental Illness of Depression

The discussion of what antidepressants are leads to an inevitable question: how do psychiatrists know that an increase in these particular chemicals will cure depression? The answer is, they do not. Currently, there is no cure for depression. In fact, depression is such a complicated disorder with so many possible contributing factors that modern medicine can only hope to treat the apparent chemical imbalance correlated with depression, alleviating some symptoms. This is the current medication treatment model for all of psychiatry: to produce a drug that treats what is currently believed to be the primary physical aspect of the disease (chemical imbalances in the brain). This is known as a disease-centered model of treatment and it explains why the psychiatric drugs are named things like antidepressants and antipsychotics. They are grouped by the chemical imbalances they are supposed to help. However, these drugs do not always result in an alleviation of symptoms for all patients. Like with any incurable disease, to help the patient, the doctors must focus on treating symptoms.

So what are the symptoms of depression?

According to the National Alliance on Mental Illness, 
"Little interest or pleasure in doing things
Feeling down, depressed or hopeless
Trouble falling or staying asleep or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself, that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed or the opposite in that you are so fidgety or restless that you have been moving around a lot more than usual
and
Thoughts that you would be better off dead or of hurting yourself in some way"

Firstly, I would like to say, many people suffer from depression and if you find yourself relating to these symptoms for a period of more than two weeks, you should consult a doctor.

Next, I would like to reiterate that there is no question of depression being a real illness. Major depression is not simply someone being sad for a long period of time. It can affect anyone and has even been shown to be genetically predisposed in some cases. Unfortunately, modern medicine cannot provide a comprehensive cause of depression. For this reason, it is important to examine whether the current method of treating chemical imbalances is the ideal treatment method. Even the societal implications of that method are important. Just as some people believe that depression is not a "real" illness, other people believe that suffering from a chemical balance in the mind shows that something is inherently wrong with the depressed. This point of view is unfair. Mental illness is not as simple as a chemical imbalance, even if our medicinal tools are not yet complex enough to treat it any better. All mental illnesses are complex disorders that derive from a variety of causes that medicine does not yet even fully understand. It is important that the minority of those who suffer from mental illnesses are not isolated as they may have been in the past with the system of institutional psychiatry and asylums. As a society, we must be mindful of the risk of alienating those who suffer from mental illnesses. 


Moncrieff, Joanna, and David Cohen. "Psychiatric Drugs: Magic Bullets or Psychological Sledgehammers." The Critical Psychiatry Website. Web. 17 Feb. 2012. <http://www.critpsynet.freeuk.com/models0904.htm>.


 "Depression Symptoms, Causes, and Diagnosis." National Alliance on Mental Illness. Web. 17 Feb. 2012. <http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=89096>.

Antidepressants: How Do They Function to Help People Function?

The first step to understanding the value of antidepressants is to understand what they are. Antidepressants are believed to increase the concentration of certain neurotransmitters in the brain in a way beneficial to those suffering from depression. There are four major types of antidepressants and they are all distinguished by the neurotransmitter effects that they produce.

The oldest type of antidepressant is the monoamine oxidase inhibitor, abbreviated MAOI. The inhibition of monoamine oxidase keeps the oxidase enzyme from breaking down norepinephrine, serotonin and dopamine, which are believed to elevate mood. 

Another type of antidepressant is the TCA, or tricyclic antidepressant. Tricyclic antidepressants increase the levels of norepinephrine in the brain and slightly increase the levels of serotonin as well. They are called tricyclic because of their chemical structure, but there are some tetracyclic antidepressants looped into the same group. TCAs work by blocking the reuptake of the two neurotransmitters they affect, resulting in an increased concentration of them in the synapse, which seems to ease depression symptoms.
Then there are selective serotonin reuptake inhibitors (SSRIs) which solely increase the levels of serotonin in the brain. They are the most popular antidepressant because they have the least side effects and drug interactions. The newest antidepressants are the serotonin norepinephrine reuptake inhibitors, which increase both serotonin and norepinephrine levels and are abbreviated SNRIs.

If monoamine oxidase inhibitors work by stopping the enzyme monoamine oxidase from breaking down the important neurotransmitters, how do all these reuptake inhibitors work? After a neuron (brain cell) releases neurotransmitters into the space between the original neuron and another neuron, that original neuron attempts to restore it's stock of that neurotransmitter by re-uptaking some of the neurotransmitters it released. Depressed patients often do not have enough serotonin to go around so, for example, SSRIs prevent the original neuron from taking back the neurotransmitters it released so that the other neuron can detect the chemical signal.

These medicines have revolutionized the treatment of antidepressants since they first came onto the market, but are their effects overwhelmingly good or possibly somewhat negative?

Ogbro, Omudhome. "Antidepressants Drug Class Information by Medicinenet.com." Ed. Jay W. Marks. Web. 15 Feb. 2012. <http://www.medicinenet.com/antidepressants/article.htm>.

 "Tricyclic Antidepressants (TCA's)." PSYweb Complete Mental Health Site. Web. 15 Feb. 2012. <http://www.psyweb.com/Glossary/tca.jsp>.

 "Spotlight SSRI." Office of History, National Institutes of Health. Web. 15 Feb. 2012. <http://history.nih.gov/exhibits/bowman/SSssri.htm>.

 Chemical Structures of Tricyclic Antidepressants. Digital image. MedScape. Web. 15 Feb. 2012. <http://img.medscape.com/slide/migrated/editorial/cmecircle/2001/220/slide09.gif>.

 SSRI. Digital image. Toxipedia. Web. 15 Feb. 2012. <http://toxipedia.org/download/attachments/7143805/SSRI-picture.jpg?version=1&modificationDate=1316517397000>.