Evidence-biased Antidepressant Prescription

Evidence-biased Antidepressant Prescription

Author: Michael P. Hengartner

Publisher: Springer Nature

Published: 2021-12-09

Total Pages: 355

ISBN-13: 3030825876

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This book addresses the over-prescribing of antidepressants in people with mostly mild and subthreshold depression. It outlines the steep increase in antidepressant prescription and critically examines the current scientific evidence on the efficacy and safety of antidepressants in depression. The book is not only concerned with the conflicting views as to whether antidepressants are useful or ineffective in various forms of depression, but also aims at detailing how flaws in the conduct and reporting of antidepressant trials have led to an overestimation of benefits and underestimation of harms. The transformation of the diagnostic concept of depression from a rare but serious disorder to an over-inclusive, highly prevalent but predominantly mild and self-limiting disorder is central to the books argument. It maintains that biological reductionism in psychiatry and pharmaceutical marketing reframed depression as a brain disorder, corroborating the overemphasis on drug treatment in both research and practice. Finally, the author goes on to explore how pharmaceutical companies have distorted the scientific literature on the efficacy and safety of antidepressants and how patient advocacy groups, leading academics, and medical organisations with pervasive financial ties to the industry helped to promote systematically biased benefit-harm evaluations, affecting public attitudes towards antidepressants as well as medical education, training, and practice.


Fluoxetine

Fluoxetine

Author: Graziano Pinna

Publisher:

Published: 2015-04-01

Total Pages: 412

ISBN-13: 9781634820769

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Fluoxetine, best known by the trade name Prozac®, unlike other psychotropic drugs whose effects were serendipitously stumbled upon, was the first developed for a precise mechanism of action, that is, the ability to selectively inhibit serotonin reuptake, based upon the theory that increasing the availability of serotonin would treat major depression. Once approved by the FDA in 1987, fluoxetine quickly became the most prescribed psychotropic drug worldwide and its success in improving mood disorders has triggered the development of a large number of congener molecules, commonly known as SSRIs after their purported mechanism of action. However, a quarter of a century after its development, the idea that fluoxetine asserts its positive behavioral effect through inhibition of serotonergic reuptake is not firmly established. This book reviews several preclinical and clinical reports suggesting that the pharmacological effects of fluoxetine may be mediated by means other than the regulation of serotonin, including the regulation of gene expression, modifying epigenetic mechanisms as well as modifying microRNAs. One of the most prominent mechanisms for the therapeutic relevance of fluoxetine relates to influencing neuroplasticity by enhancing neurotropic factors, including BDNF signaling and altering adult neurogenesis. The ability of fluoxetine to rapidly increase neurosteroid levels accounts for the fast anxiolytic effects of this drug. Fluoxetine action at sigma-1 receptor or modulating glutamatergic neurotransmission as well as the combination of fluoxetine with other psychotropic drugs is discussed in relation to its therapeutic effects. While fluoxetine was primarily prescribed as an antidepressant, this drug currently represents a treatment of choice for a broad spectrum of psychiatric disorders, including post-traumatic stress disorder and a range of anxiety disorders. This drug even possesses analgesic actions and is a valuable therapy for stroke. This book also highlights emerging evidence on the gender-specific effects of fluoxetine, its potential adverse features, including its addiction liability in combination with psychostimulants, and the impact of perinatal fluoxetine exposure.


The Emperor's New Drugs

The Emperor's New Drugs

Author: Irving Kirsch

Publisher: Basic Books

Published: 2010-01-26

Total Pages: 242

ISBN-13: 0465021042

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Do antidepressants work? Of course -- everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch's research -- a thorough analysis of decades of Food and Drug Administration data -- has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we've been treating it with suggestion. The Emperor's New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.


Antidepressed

Antidepressed

Author: Beverley Thomson

Publisher: Hatherleigh Press

Published: 2022-01-04

Total Pages: 167

ISBN-13: 157826927X

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A COMPREHENSIVE WAKE-UP CALL FOR PATIENTS AND PROFESSIONALS Antidepressed breaks down the growing issue of antidepressant use, harm and dependence—how we got to this point, what’s happening worldwide every single day, and most importantly, where we go from here. Providing information that both patients and mental health professionals desperately need, Antidepressed exposes the holes in mental health systems and highlights the desperate need for reform. Featuring compelling accounts from real people whose lives have been irrevocably harmed by prescription antidepressants, Antidepressed provides proof that there is no such thing as a magic pill—and that pretending otherwise risks the lives and well-being of those who need help the most.


Unhinged

Unhinged

Author: Daniel Carlat

Publisher: Simon and Schuster

Published: 2010-05-18

Total Pages: 274

ISBN-13: 1416596356

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In this stirring and beautifully written wake-up call, psychiatrist Daniel Carlat writes with bracing honesty about how psychiatry has so largely forsaken the practice of talk therapy for the seductive—and more lucrative—practice of simply prescribing drugs, with a host of deeply troubling consequences. Psychiatrist Daniel Carlat has noticed a pattern plaguing his profession. Psychiatrists have settled for treating symptoms rather than causes, embracing the apparent medical rigor of DSM diagnoses and prescription in place of learning the more challenging craft of therapeutic counseling, gaining only limited understanding of their patients’ lives. Talk therapy takes time, whereas the fifteen-minute "med check" allows for more patients and more insurance company reimbursement. Yet, DSM diagnoses, he shows, are premised on a good deal less science than we would think. Writing from an insider’s perspective, with refreshing forthrightness about his own daily struggles as a practitioner, Dr. Carlat shares a wealth of stories from his own practice and those of others that demonstrate the glaring shortcomings of the standard fifteen-minute patient visit. He also reveals the dangers of rampant diagnoses of bipolar disorder, ADHD, and other "popular" psychiatric disorders, and exposes the risks of the cocktails of medications so many patients are put on. Especially disturbing are the terrible consequences of overprescription of drugs to children of ever younger ages. Taking us on a tour of the world of pharmaceutical marketing, he also reveals the inner workings of collusion between psychiatrists and drug companies. Concluding with a road map for exactly how the profession should be reformed, Unhinged is vital reading for all those in treatment or considering it, as well as a stirring call to action for the large community of psychiatrists themselves. As physicians and drug companies continue to work together in disquieting and harmful ways, and as diagnoses—and misdiagnoses—of mental disorders skyrocket, it’s essential that Dr. Carlat’s bold call for reform is heeded.


Making Medicines Affordable

Making Medicines Affordable

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2018-03-01

Total Pages: 235

ISBN-13: 0309468086

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Thanks to remarkable advances in modern health care attributable to science, engineering, and medicine, it is now possible to cure or manage illnesses that were long deemed untreatable. At the same time, however, the United States is facing the vexing challenge of a seemingly uncontrolled rise in the cost of health care. Total medical expenditures are rapidly approaching 20 percent of the gross domestic product and are crowding out other priorities of national importance. The use of increasingly expensive prescription drugs is a significant part of this problem, making the cost of biopharmaceuticals a serious national concern with broad political implications. Especially with the highly visible and very large price increases for prescription drugs that have occurred in recent years, finding a way to make prescription medicinesâ€"and health care at largeâ€"more affordable for everyone has become a socioeconomic imperative. Affordability is a complex function of factors, including not just the prices of the drugs themselves, but also the details of an individual's insurance coverage and the number of medical conditions that an individual or family confronts. Therefore, any solution to the affordability issue will require considering all of these factors together. The current high and increasing costs of prescription drugsâ€"coupled with the broader trends in overall health care costsâ€"is unsustainable to society as a whole. Making Medicines Affordable examines patient access to affordable and effective therapies, with emphasis on drug pricing, inflation in the cost of drugs, and insurance design. This report explores structural and policy factors influencing drug pricing, drug access programs, the emerging role of comparative effectiveness assessments in payment policies, changing finances of medical practice with regard to drug costs and reimbursement, and measures to prevent drug shortages and foster continued innovation in drug development. It makes recommendations for policy actions that could address drug price trends, improve patient access to affordable and effective treatments, and encourage innovations that address significant needs in health care.


Discontinuing Antidepressant Medications

Discontinuing Antidepressant Medications

Author: Giovanni A. Fava

Publisher: Oxford University Press

Published: 2021-10-21

Total Pages: 200

ISBN-13: 0192651315

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One in six people in the US are currently taking psychotropic drugs. In 80% of cases, the medication is taken for long-term use and predominantly involves new-generation antidepressants, such as SSRIs (e.g. paroxetine) and SNRIs (e.g. venlafaxine). When patients want to stop taking these drugs and/or their physicians decide it is time for them to stop, substantial problems often can ensue. About 50% of patients experience withdrawal symptoms that do not necessarily subside after a few days or weeks and may be severe and debilitating. Physicians often do not know what to do in these situations. As a result, patients experiencing the anguish and mental pain of withdrawal syndromes are unlikely to receive appropriate medical attention. Discontinuing antidepressants is a highly technical challenge that requires specific strategies. This handbook guides clinicians through each clinical step (assessment; what the counter-indications would be for stopping or continuing; and how discontinuation can best be achieved). It provides a detailed account of the assessment and management strategies, with many case illustrations and clinical examples, drawing from the literature that is available and the extensive personal experience of the author.


Lost Connections

Lost Connections

Author: Johann Hari

Publisher: Bloomsbury Publishing

Published: 2020-11-12

Total Pages: 417

ISBN-13: 1526634082

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THE INTERNATIONAL BESTSELLER: A radically new way of thinking about depression and anxiety 'A book that could actually make us happy' SIMON AMSTELL 'This amazing book will change your life' ELTON JOHN 'One of the most important texts of recent years' BRITISH JOURNAL OF GENERAL PRACTICE 'Brilliant, stimulating, radical' MATT HAIG 'The more people read this book, the better off the world will be' NAOMI KLEIN 'Wonderful' HILLARY CLINTON 'Eye-opening' GUARDIAN 'Brilliant for anyone wanting a better understanding of mental health' ZOE BALL 'A game-changer' DAVINA MCCALL 'Extraordinary' DR MAX PEMBERTON Depression and anxiety are now at epidemic levels. Why? Across the world, scientists have uncovered evidence for nine different causes. Some are in our biology, but most are in the way we are living today. Lost Connections offers a radical new way of thinking about this crisis. It shows that once we understand the real causes, we can begin to turn to pioneering new solutions – ones that offer real hope.


Suicide in Children and Adolescents

Suicide in Children and Adolescents

Author: Robert A. King

Publisher: Cambridge University Press

Published: 2003-08-28

Total Pages: 340

ISBN-13: 9780521622264

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In an epoch when rates of death and illness among the young have steadily decreased in the face of medical progress, the persistently high rates of youth suicide and suicide attempts around the world remain a tragic irony and a challenge to both our clinical practice and theoretical understanding. How can these deaths be prevented? Can they be anticipated? Are there perceptible patterns of risk and vulnerability? What role do families, gender, culture, and biology play? What are the treatments for and outcomes of suicide attempters? To address these questions, experts from around the world in all areas of psychiatry, from epidemiology, neurobiology, genetics and psychotherapy, have brought together their current findings in Suicide in Children and Adolescents.