Monday, April 9, 2012

Why the Market Can't Keep You Safe From Harmful Drugs (Unless You Have a Clue)

I would like to return to the question of why psychiatrists are increasingly leaving talk therapy in the hands of psychologists. However, I am waiting on a source that I think would illuminate the matter. For this reason, I will break the promise I made in my last post. Instead, I would like to discuss why my question is important and elaborate on the manner in which I asked it. Why do I feel it is important to consider the efficacy of antidepressants? What does that "efficacy" mean?


When I first began this project, I did not want to simply compare a bunch of studies. My goal is to determine the worthiness of antidepressants from a diagnostic perspective. I feel as if lately I may seem to be getting off topic to those who do not have the same picture of a finished project in mind that I have envisioned. My result can't be a catalog of statistics because when prescribing a medicine to the individual there is so much more to consider than how often it is successful statistically. In fact, so long as it is successful at all, there is a chance that it will help the patient. From that point, part of the problem is a subjective balancing of side effects. Is being less depressed worth it if you suddenly find it extremely difficult to sleep? Consider that possibility in the long run. Consider the side effects based on how they might be affected by age. Consider the side effects versus the severity of the depression. Every case of depression is unique. I have taken to finding out as much as I can about this type of medications and the way they are used and from that,  I will draw my own conclusions about how they should be handled to improve the success of depression treatment (with medication) and minimize severe adverse reactions. At the end of this project, all I will be able to offer is an opinion. I have not performed my own study in the traditional sense. I have no original data to present to you. I am examining the various stages of antidepressant distribution and making a value judgment on how things should occur.

The first stage is production. The drugs are produced for a profit by a pharmaceutical company. The FDA regulates this to a certain extent but I have already discussed that they do not have to preform their own studies on the drug. They review studies provided by the company. They provide the public with the facts through labeling and pamphlets. As a secondary function, they consider the safety of the drugs. How can an ineffective or harmful drug slip through this process? Either the studies were flawed or not representative enough or the studies were misrepresented to benefit the company.

Then, the drugs meet the psychiatrist, who reviews the information provided by the FDA and the drug company and decides in what situations he thinks it is worth prescribing. This cannot help being a subjective decision. How can an ineffective or harmful drug be readily prescribed? The psychiatrist, much like I must, must evaluate the risks, the side effects, the potential benefits, how these all interact with the situation of the patient.  They cannot have an infallible rule for prescription.

Finally, the drug reaches the consumer. Here, one might argue, the statistics are finally enough. If the consumer finds the side effects to overwhelm the effects, they will stop taking the drug. If the people who consume the drug are harmed, the drug will be taken off the market either due to regulation or lack of demand (from either psychiatrists or patients). Antidepressants are not a drug that people take for recreation. There is no apparent reason for the patient to keep taking the drug if they find it unpleasant, seriously harmful, or completely ineffective to their depression. So why do I insist upon reviewing the worthiness of these drugs? Would not the market determine their worthlessness and insist upon their removal naturally? I think not. I do not trust the producer to be honest or all-knowing about the product. I do not trust the doctor to always prescribe the drugs without making a mistake even if he has the best intentions. I do not trust the consumer to know that they are not being helped. It is possible for harmful drugs to reach the market. Anyone who has ever seen a class action lawsuit commercial could tell you that. People are given new drugs and later, it is discovered that they produce serious health problems. Legal action is taken and perhaps they're taken off the market. But these lawsuits are not only strategically avoided by drug companies, they are also much more likely to start in a drug that is producing obvious harmful effects like heart failure. Antidepressants may not have these drastic effects but does that mean that they are 100% safe? From my research up to this point, I have determined that antidepressants can have serious side effects and are not always effective or perhaps enough to alleviate depression. It's important to remember that our attitude towards the medicine can affect the safety of it's prescription. Without greater regulation, consumers must consider the risks of accepting the drug company at it's word (without reliable independent studies) and taking a drug from a doctor that they do not even sometimes partially understand. They must think for themselves. It is important to trust your doctor's knowledge of medicine but it is also important to understand your treatment and it's possible side effects to the best of your ability.  

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