SAMHSA has another one of those votes going, this time for the most important achievements in mental health in the last 20 years.

The Treatment Advocacy Center has ensured that assisted outpatient commitment is one of the top vote getters.

If you would like to see peer services, recovery and consumer-driven care rank higher than outpatient commitment then visit and vote for at least the two below and pass this on.

Then people still have 4 votes more for their individual choice.

Recovery model and consumer-driven care:

http://feedback.samhsa.gov/forums/148531-help-samhsa-highlight-advances-of-the-behavioral-h/suggestions/2583877-the-focus-on-the-recovery-model-and-consumer-drive#comments

2.1. 10 peer programs that promote complete mental health recovery by ISEPP Member Corinna West

http://feedback.samhsa.gov/forums/148531-help-samhsa-highlight-advances-of-the-behavioral-h/suggestions/2589278-10-types-of-peer-programs-that-promote-complete-me

ISEPP members are available as media commentors regarding assisted outpatient commitment and consumer-driven mental health care.  Click here for ISEPP Contact Information.

Uploaded by CCHRfloridaon Feb 22, 2012

It is a relief to read stories, find others who know what is happening, have the same concerns and can talk about it.

I have been alone (some connections online) but mostly I am around people who do not understand the deep concerns and insights I have.

I come at this issue of human wellbeing from being the eldest sister, a daughter and then mother whose been living in the trenches, taking care of the well-being of those around me.  I particularly want to find a way to be more active for those in need, especially children, but I’m not an official, credentialed ‘mental health professional’. Actually, in truth, I have 40 years of experience taking care of the overall health of people which does make me a professional, but the work of mothers still goes uncounted and unrecognized for what it is and how important it is.

I especially understand how different what is learned from mothers whose job of well-being spans a 24 hour period daily versus people who seek to help well-being through employment that limits contacts to usually 1 hour at a time and weeks in between. The same information does not apply to the care and well-being of people in these different situations.

I have wondered if there a support group for mothers on this issue?

Is there a network of mothers within? Someone to call and talk to about the personal aspects of it?

I am in need of some emotional support.

If you have any recommendations on how I might get some emotional support for my work, let me know.

I’m new to ISEPP.

I have a one and 1/2-year-old grandson whose mother, my daughter-in-law had been diagnosed as depressed and given medications since she was 9.  She’s now 27.  She went off meds for her pregnancy.

At the moment, I watch my grandson while she works. She has a strong relationship of trust with her doctors so even though she’s heard a few things from me she seems too afraid to be open to alternatives. While I’ve been observing and dealing with the issues she has as a mother and the impact on the baby, my biggest fear is that because of her lack of emotional skills and her own experience, that she will end up medicating my grandson at some point simply because of her over reliance on doctors and lack of skill, knowledge and experience as mother…… as she already relies on medications, in my view, inappropriately.

Book review by Adina Lambert, MA

Dr. Philip Sinaikin has taken a frightening and often misunderstood subject and written a book that is not only clear, concise, and easily understood, but at times even humorous.   He has given practicing psychologists, therapists, social workers, psychiatrists and the lay public the opportunity to understand a shocking and bizarre trend in the field of psychiatry that is spiraling out of control.

First,Dr. Sinaikin “deconstructs” the Diagnostic and Statistical Manuel (DSM) and the plethora of false, psychiatric, diagnostic labels that are given to innocent, unsuspecting patients/victims.  Second, Dr. Sinaikin  “deconstructs” the drugs that are given to these people to treat these imaginary illnesses, and then by “deconstructing” big business – inthe form of both the pharmaceutical giants and the advertisers, who are only too happy to take their ill begotten money, Dr. Sinaikan is able to present a strong case for how the public is being duped and manipulated into believing falsehoods about human suffering that is as much a fantasy as Disneyland – hence title of his book, Psychiatryland.

Dr. Sinaikin explains that the American Psychiatric Association (AMA) and the pharmaceutical giants have been able to perpetrate a lie on the American people like no other.  Through the use of power and money they have been able to market and advertise not only pills to cure-all our ills, but they have marketed the made up bio-psychiatric labels that need to be “treated”with all their wonder drugs.  They have been able to perpetuate this myth, which is sheer fantasy, and the pharmaceutical companies and the psychiatrists have put us in Psychiatryland.  We are like Alice in Wonderland; it is as if we have fallen down a rabbit hole and we are struggling to understand where we are and how we got here. We find ourselves in a world of ridiculous diagnostic labels and a public that is all to ready to believe that Attention Deficit Disorder is a real medical illness that needs to be treated with cocaine-like drugs.  Dr. Sinaikin describes how we are going from bad to worse, now diagnosing children as young as two years old with Bi-Polar Disorder. He explains the ridiculous, and arbitrary differences, between Bipolar I and Bipolar II and, some what disappointingly, he seems to accept the Bipolar I diagnosis as something that needs to be “treated”.

Dr. Sinaikin explains how everyone now believes that Depression is a “serious medial condition”.  Why?  Because the advertisers have told us this over and over again.  Dr. Sinaikin takes the pharmaceutical companies and the drafters of the DSM to task for all of thenonsense fed to the unsuspecting public, through direct to consumer advertising on TV and in print advertisements. Dr. Sinaikin makes the interesting observation that the USA is the ONLYcountry in the world that allows direct to consumer advertising.  This has created a climate in which people believe what they are being told and they are eager for the next“miracle” cure and a “quick fix” for what is really everyday, normal, humansuffering.   And if Prozac helped your Aunt Sally you are only too eager to ask your doctor to prescribe it for you, too.  It has been said that Depression is spread more by word of mouth rather than any scientific proof of a “chemical imbalance” or any other medical malady.  There is no scientific evidence to the“chemical imbalance” theory and no medical or biological test to support this claim.  Depression is an emotional state that has deep psycho/social/spiritual implications, and cannot be curedor even treated with biological or medical treatments.  Dr. Sinaikin believes that the way to stop this dangerous practice of over diagnosing and over medicating is to change the discourse in the public market place.  He feels strongly that a new message must be given to people so they can make informed decisions. It is through books such as his very readable Psychiatryland that just such a message can begin to make a big difference.  Dr. Sinaikin’s book could not come at abetter time. More and more people are beginning to question what they are being told by psychiatrists and Big Pharma.

Dr. Sinaikin would like Primary Care Physicians to refer to psychologists, therapists, social workers, etc.before recommending drugs for emotional and psychological distress.   The last chapter offers much needed information about some of the therapeutic approaches that Dr. Sinaikinfeels are the most helpful for alleviating human suffering.  Dr. Sinaikin recommends several contemporary therapy methods and is in favor of the use of support groups like Alcoholic Anonymous – particularly Emotions Anonymous.  He feels their greatest value is that not only are these support groups FREE, but they also offer one of the fundamentals of all therapies – a human connection.  Please read this book, share it with your friends, talk about it with your family, your clients/patients and let’s help Dr. Sinaikin change the public discourse.

Click here to visit PSYCHIATRYLAND.com

NARPA AT 30:  Celebrating Our Past, Creating Our Future

September 5-8, 2012

The Millennium Hotel 

Cincinnati, OH   

For 30 years, NARPA has provided an educational conference with inspiring keynoters and  outstanding workshops. We learn from each other and come together as a community committed to social justice for people with psychiatric labels & developmental disabilities.

Workshop RFP on our website – Submission deadline April 1!

Limited scholarships available – Application on website soon. 

Check www.narpa.org or e-mail narpa@aol.com for updates.   

========================================================================================

CALL FOR PRESENTATIONS

The National Association

for Rights Protection and Advocacy

2012 Annual Rights Conference

  NARPA AT 30:

Celebrating Our Past, Creating Our Future  

The National Association for Rights Protection and Advocacy (NARPA) is seeking proposals which address strategies, ideas, programs, and emerging practices that support and promote NARPA’s mission and commitment to individual rights, liberty, freedom and dignity.

NARPA‘s mission is to promote policies and pursue strategies that result in individuals with psychiatric diagnoses making their own choices regarding treatment. We educate and mentor those individuals to enable them to exercise their legal and human rights with a goal of abolition of all forced treatment.

NARPA is an independent organization, solely supported by its members. It is a unique mix of people who have experienced psychiatric intervention, advocates, civil rights activists, mental health workers, and lawyers — with many people whose roles overlap. NARPA exists to protect people’s right to choice and to be free from coercion, and to promote alternatives so that the right to choice can be meaningful. Read about NARPA’s history of human rights advocacy, check out the ADA Case of the Week archives, and more.

If you are a journalist seeking mental health professionals or legal experts for news commentators on issues related to human rights violations affecting  individuals with psychiatric diagnoses, please contact ISEPP’s Executive Director Dr. Al Galves:

Albert Galves, Ph.D.

agalves2003@comcast.net

575-522-8371 (home)

575-571-3105 (cell)

575-635-4331 (fax)

Posted by Maria Mangicaro

Boston, MA.:  Investigative reporter Mike Beaudet from Boston’s FOX 25 resently presented a powerful undercover report on the  Judge Rotenberg Center claiming a controversial video of a disabled teen tied down and given  painful electric shocks for seven hours should be made public.

Cheryl McCollins gave a horrific account about the treatment of her disabled son, Andre stating:  “It is horrific. And poor  Andre, who had to suffer through this, and not know why.”    FOX News reports the ordeal  began after Andre hit a staff member and gave this account:

Inside a classroom, as a camera was  recording, he was tied to a restraint board, face down, a helmet over his head. He stayed like that for seven hours without a break, no food, no water,  or trips to the bathroom. Each time he screamed or tensed up, he was shocked, 31  times in all. His mother called the next day to check on him.

He stayed like that for seven hours without a break, no food, no water,  or trips to the bathroom. Each time he screamed or tensed up, he was shocked, 31  times in all. His mother called the next day to check on him. “I said,  ‘Andre.’ I said, ‘Hello.’ And so he said, ‘Help me,’” McCollins said.

After spending three days in a comatose state, not eating or drinking, Andre  was taken to Children’s Hospital, where he was diagnosed with “acute stress  response” caused by the shocks. “The doctors took all the shackles and  all those things off of him. Andre’s not talking to me. I’m just holding him and  telling him how much I love him, and asking him please to talk to me, just tell  me what happened,” McCollins said.

What happened that morning in  October 2002 became clear after the Rotenberg Center showed her the video of  Andre’s ordeal, recorded by the classroom camera. “When I viewed the  tape, I saw Andre walking into a room, someone asking him to take off his coat.  Andre said no, they shocked him, he went underneath the table trying to get away  from them. They pulled him out, tied him up and they continued to shock him,”

McCollins said. “When you look at that videotape, what was the purpose  of all those shocks?” asked FOX Undercover reporter Mike Beaudet. “I  have no idea,” McCollins replied. “Did you get an apology?” Beaudet  asked. “No, they felt what they did was therapy,” McCollins replied. “Does that look like therapy to you?” Beaudet asked. “No, it  was torture,” McCollins said.

For now, the public can’t see for  themselves what Andre’s treatment looks like because the Rotenberg Center asked  a Norfolk Superior Court judge to seal the video tape, saying it would be  unsettling for viewers who didn’t understand the context.

The judge agreed, and  the video remains under a protective order. “This is video they fought  vehemently not to release, fought vehemently to keep quiet and I think now are  very concerned that this tape is out there,” said attorney Andrew Meyer, who  represents Andre McCollins in a lawsuit against the Rotenberg Center. “The Judge Rotenberg Center has consistently gotten away with being able to  soft sell their treatment, to whitewash what they’ve done about it being  therapeutic: ‘It’s not so bad, it helps these children.’

 But the eyewitness  accounts that we now have about what actually goes on at this center puts to lie  everything they’ve been saying,” Meyer said. But not everyone agrees.  When asked about the perception that electric shock therapy is torture, school  attorney Michael Flammia said, “Absolutely wrong.” Flammia would not  talk about Andre McCollins. “But I can tell you I’m familiar with every  kid who has been at the school, who have been at the school over 20 years and I  can promise you the treatment here is safe, it’s effective, it’s administered  properly and every kid has benefited enormously from it,” Flammia said. “We talked with a parent who says, ‘Put that video out there, let the public  see what happened to my son here.

Let them see what she calls torture,’” asked  FOX Undercover’s Beaudet. “The matter is in the hands of the courts and  we have complete confidence in the court system on that particular matter,”  Flammia replied. “So you don’t want us to see that video?” Beaudet  asked. “It’s in the hands of the court,” Flammia replied. But  McCollins says the public needs to see the video of what happened to her son. “I hope this stops it. I hope this tape being exposed puts an end to  this torture.

Click here to visit MyFOXBoston for the full story.

Click here to read:  Shock treatment at Judge Rotenberg Center debated

Child advocates outraged at this and similar cases are asking that concerned citizens contact their Senators today to Co-Sponser S.2020 to outlaw the use of seclusion rooms and restraints on challenging kids, claiming schools need to use Collaborative Problem SolvingSkills a’ la Dr. Ross Greene and learn to implement Plan B.

PLEASE EMAIL YOUR  SENATORS AND ASK THEM TO COSPONSOR THE KEEPING ALL STUDENTS SAFE ACT (S.2020).  This bill will protect children nationwide from restraint and seclusion in schools.  Click here for more information.

Members of the International Society for Ethical Psychology and Psychiatry are available as media commentators on the use of restrains on children with disabilities.

http://cdnapi.kaltura.com/index.php/kwidget/wid/1_zrl5dh8j/uiconf_id/6501241

Read On ABC News Radio: http://abcnewsradioonline.com/national-news/jury-selection-begins-in-tyler-clementi-cyberbullying-trial.html#ixzz1n4tEfoPx

New Brunswick, N.J.:  ABC News reports jury selection is underway for the trial of Rutgers University student Dharun Ravi.

Ravi is accused of personal attacks through cyber-bullying and charged with multiple counts of invasion of privacy, witness tampering, hindering prosecution and bias intimidation.  The trial will be broadcast live across the country and abroad.  A guilty verdict means Ravi could faces up to 10 years in state prison.

On Jan. 6, 2011, New Jersey Governor Chris Christie signed into law the Anti-Bullying Bill of Rights, believed to be the toughest state law regulating student-related bullying, harassment and intimidation in the nation.

The new law focuses on bullying, harassment and intimidation in kindergarten through 12th grade, as well as in the state’s public colleges and universities.

Although it had been in the works for more than a year, the Anti-Bullying Bill of Rights moved quickly through the Legislature after 18-year-old Rutgers University student Tyler Clementi committed suicide by jumping from the George Washington Bridge on Sept. 22, 2010, following an Internet video broadcast by his roommate focusing on Clementi’s sexual orientation. The bill was drafted and passed in the Senate 38-0 and in the Assembly 73-1 just two months after Clementi’s death.  Click here to read more.

Bullying prevention in America is becoming a blog-driven lightening rod for enacting legislation and public policy to protect victims and potential victims, many of them are children with special needs.

Bullying certainly isn’t a new problem; it has existed for generations. Historically, many have seen it as a rite of passage, a type of de facto hazing. According to Dr. Peter Raffalli, a pediatric neurologist at the Children’s Hospital in Boston, Mass., this attitude is, in many cases, more dangerous than the bullies themselves. “No matter how you look at it, bullying is a form of abuse victimization, plain and simple,” said Dr.Raffailli. “It’s a case of the strong – or at least the stronger – preying on the weak. It says volumes about where we are as a culture and race.” Click here to read more.

The popular TV sho Glee has also taken on the topic of bullying and in last night’s episode one of the characters attempted suicide after being harassed about his sexual orientation.  The who featured a premier of the Trevor Projects PSA with featuring actor Daniel Radcliffe.

In an attempt to expand awareness of bullying prevention, a new website was recently launched by several Key West residents after an incident of gay bullying in local schools.  The website “One Human Family considers Bullying Prevention” hopes to illustrate how the global community spirit of Key West supports the   dynamics of collective consciousness and promotes views of humanity in which peace is possible.

Members of the International Society for Ethical Psychology and Psychiatry are available as media commentators on bullying and cyberbullying issues.

By consensual agreement within the American Psychiatric Association psychiatric diagnoses are descriptive labels only for phenomenology, not etiological or mechanistic explanation for syndromes. Thus, a psychiatric diagnosis labels a pattern of signs and symptoms, but offers no hypothesis concerning the mechanism(s) of the clinical phenomena. (Davidoff et al.,1991).

Click here to read ISEPP’s press release on the DSM-V

Members of the International Society for Ethical Psychology and Psychiatry are available as media commentators on mental health related issues.

Our varied membership includes psychiatrists, forensic psychologists, professional clinical counselors, academic researchers, educators, lawyers, psychiatric survivors, concerned family members, other mental health professionals, and advocates from around the world.  ISEPP is an independent organization which currently takes no monies from external sources and is run completely by volunteer members.

Click here for ISEPP contact information.

On February 19, 2012, Lesley Stahl’s “Treating depression:  is there a placebo effect?” aired on CBS 60 Minutes.  Stahl is to be commended for doing an excellent job.  During the broadcast, Stahl interviewed Irving Kirsch, Michael Brown, and Michael Thase as well as providing information on new government policies in the UK on treating persons experiencing mild and moderate levels of depression.

However, the program was marred by a significant omission.  In it, Stahl failed to tell the audience that non-drug psychotherapy has proven to be just as effective as antidepressant drugs without the damaging side effects and high relapse rate that is associated with the drug use.

During the program, Dr. Irving Kirsch provided the bottom line finding from his analyses of FDA data documenting that antidepressants are not effective in treating persons scoring in the mild and moderate ranges of depression assessed by the Hamilton Rating Scale.  Kirsch indicated that antidepressants are effective for persons scoring in the severe ranges of depression.  What Kirsch could have said, which he said in his book, is that even for the severe depressed, there is only a 4 point (out of 51) difference between the placebo and the drug treated.  Moreover, comparing those who are mildly depressed with those scoring in the severe range, the same level of improvement occurs for the mildly depressed and those scoring in the severely depressed range.  The reason for the finding of better performance for the drug in the severely depressed group is that the severely depressed don’t exhibit much change in response to placebo.

Ironically, Michael Thase, the exponent for antidepressants, has admitted that, on drugs, only 47% are in remission.  By the way, the program could have discussed spontaneous remission, but did not.  Even the severely depressed do recover.  Before drugs, the average duration of an episode of depression was 6 months.  Over a two year period, 80% of persons on drugs or without drugs will recover.

In the broadcast, the focus of the discussion was on the short term outcomes from the studies evaluating treatment for eight weeks.  The outcomes for drugs appear even worse if one examines long term.  For example in a study by Maj et al (1992), during a five-year follow-up 72 persons with 76.3% remaining on drug, 75% have relapsed.  In a meta-analysis, Williams et al. (2009) reports that for those who fully recover on drug and remain on drug, 45% will relapse during a three year period.  Fava and Offindani (2011) and Andrews et al. (2011) have compared relapse rates among those on drug versus those not on drugs.  Those on drugs have higher rates of relapse.

Lesley Stahl correctly cautioned that people should not discontinue taking their drugs abruptly.  Stahl did not detail the very dramatic drug withdrawal effects.  In his book, Kirsch indicates that 20% of persons experience withdrawal symptoms when drugs are discontinued.  In fact, in 1994, I argued that the very high rates of depression relapse (around 75% of persons randomized to placebo maintenance) within the 6 months after switch to placebo probably reflects drug withdrawal.    The withdrawal symptoms noted in the literature include mania, motor problems in the jaw, nausea, abdominal cramping, headaches, sleep disruption, blurred vision, numbness, twitches and tremors.  What is even more disturbing, although Stahl advises supervision from the doctor during withdrawal, request for assistance in drug discontinuation will find the doctor unprepared.  There is a literature on how to detox from heroin, alcohol, benzodiazepines.  Similar literatures are unavailable for detox from antidepressants.

There was reference to the side effects in the program, but no specification of what the side effects entail.  Side effects are not trivial.  Most people are aware of the diminished libido and sexual dysfunction.  They may not be aware of the association with suicidal ideation, for which there is a black box warning for young people and children.  Long term, people lose the ability to respond emotionally both to positive and negative stimuli.  (This has been verified with brain imagery.) SSRIs are associated with bone loss.  (Cells in bone express the protein on which Prozac operates).  SSRIs are associated with bleeding problems.  (Platelets also express the protein on which Prozac operates.)  SSRIs are associated with weight gain, metabolic syndrome, loss of vagal tone, an increase in inflammatory markers, and an increased risk for diabetes.

Stahl did report that the British health system is training more psychotherapists.  In the studies evaluating drugs, many have included a psychotherapy control group.   Psychotherapy consistently proves as effective as drugs, although drugs sometimes achieve remission more rapidly by several weeks.  Moreover, persons treated with psychotherapy, in various studies, are less likely to relapse than those treated and continued on drug.  As Kirsch argues in his book, psychotherapy is more cost effective as well.

Stahl also reported that the British are encouraging exercise, which has shown to be effective in preventing and treating depression.  While the 15 minute segment was insufficient time to detail other alternatives, there is an emerging literature on dietary interventions (curcumin, omega-3s, Mediterranean diet) which prevent and ameliorate depression.  Dietary interventions and exercise, unlike antidepressants which increases risk for diabetes and heart disease, will prevent heart disease and diabetes.

Hopefully America can learn from the British.  As Americans move into universal health care coverage, we need to learn from those across the pond how to do it better and more cheaply.

Members of the International Society for Ethical Psychology and Psychiatry are available as media commentators on mental health related issues.

Our varied membership includes psychiatrists, psychologists, professional clinical counselors, academic researchers, educators, lawyers, psychiatric survivors, concerned family members, other mental health professionals, and advocates from around the world.  ISEPP is an independent organization which currently takes no monies from external sources and is run completely by volunteer members.

Click here for ISEPP contact information.

Annotated Bibliography on Outcomes for Treated and Untreated

Andrews, P. W., Kornstein, S. G., Halberstadt, L. J., Gardner, C. O., & Neale, M. C.  (2011).  Blue again;  perturbational effects of antidepressants suggest monoaminergic homeostasis in major depression.  Frontiers in Psychology, 2, Article 159, 1-24.  Analysis suggests greater relapse in those being treated with antidepressants

Beck, A. T.  (1967).  Depression:  Causes and treatment.  Philadelphia:  University of Pennsylvania Press. Comments that in the more refined studies estimate is episode of untreated depression lasts about 6-8 months p. 51

Fava, G. A.  (2003).  Can long-term treatment with antidepressant drugs worsen the course of depression?  Journal of Clinical Psychiatry, 64, 123-133.  Fava reviewed literature on the increased frequency of episodes and shorter remission periods reported in the new literature compared to older literature.  He reviewed studies finding emergence of depressive symptoms in groups who were treated with SSRIs for conditions such as panic disorder but were not depressed.  He also reviewed the literature considering the precipitation of mania in individuals taking an antidepressant.  He advanced the hypothesis that antidepressants may impair whatever switch mechanism the body has for maintaining equilibrium.  He also considered the possibility that people may just become tolerant to antidepressants, which might be a permanent condition.  He acknowledged the similarity of his hypothesis to the possibility introduced earlier (1989) by Fredrick Goodwin that drugs will accelerate a natural cycle of mood fluctuation.

Fava, G. A. (2003). Can long-term treatment with antidepressant drugs worsen the course of

depression? J Clin Psychiatry, 64(2), 123-133.  Speculates on reasons for worse relapse on drugs

Fava, G. A., & Offidani, E. (2011). The mechanisms of tolerance in antidepressant action. Prog Neuropsychopharmacol Biol Psychiatry. doi: S0278-5846(10)00292-7 [pii] speculates on why high relapse rates on medications

Gueorguieva, R., Mallinckrodt, C., & Krystal, J. H. (2011).  Trajectories of depression severity in clinical trials of duloxetine:  insights into antidepressants and placebo responses.  Archives of General Psychiatry, 66 (12), 1227-1237.  This study identified the curves in depression scores in those treated with placebo and drug over the 8 weeks of the trial.  Both the placebo and drug responders showed a decrease in symptoms of depression over time.  (About 76.3% of those receiving drug were responders).  However, for the 23.7% of those on drug who were non-responders, the trajectories was either flat or with a positive slope.  The authors questioned whether there is subgroup of depressed persons who are worse off on drug.

Kirsch, I.  (2010).  The emperor’s new drugs:  exploding the antidepressant myth.  New York:  Basic Books.

Klein, D. F., Gittelman, R., Quitkin, F., & Rifkin, A.  (1980).  Diagnosis and drug treatment of psychiatric disorders:  adults and children (2^nd ed.)  Baltimore:  Williams and Wilkins.  See page 410-says 8 months average duration of untreated depression

Lehmann, H. E.  (1983).  Clinical evaluation and natural course of depression.  Journal of Clinical Psychiatry, 44, 5-10.  Summary statement:  “Without antidepressant therapy, episodes of clinical depression last from 2 months to several years, with average around 5 to 6 months.  One-third of the patients recover within a year; probably one out of four untreated episodes last more than 2 years.  Depressive episodes occur, on the average, every 2  to 3 years.”

Posternak, M.A., Solomon, D. A., Leon, A. C., Shea, M. T., Endicott, J., & Keller, M. B.  (2006).  The naturalistic course of unipolar depression in the absence of somatic therapy.  Journal of Nervous and Mental Disorders, 194 (5), 324-329.  Median time to recovery was 13 months for those who did not seek treatment; was 6 months for those who sought treatment

Spijker, J., De Graaf, R., Bijl, R. V., Beekman, A. T. F., Ormel, J., & Nolen, W. A.  (2002).  Duration of major depressive episodes in the general population:  results from The Netherlands Mental Health Survey and Incidence Study.  British Journal of Psychiatry, 181, 208-213.  20% of the subjects had not recovered after 24 months-level of treatment did not alter result.

Thase, M. E., Haight, B. R., Richard, N., Rockett, C. B., Mitton, M., Modell, J. G., VanMeter, S., Harriett, A.E., & Wang, Y.  (2005).  Remission rates following antidepressant therapy with bupropion or selective serotonin reuptake inhibitors:  a meta-analysis of original data from 7 randomized controlled trials.  Journal of Clinical Psychiatry, 66 (8), 974-981.  After 8 weeks for all but one study which followed for 16 weeks, response rates across drugs range from 62% to 63% and for remission 47%, which is better than placebo with 51% response and 36% remission.  Authors estimate that placebo effect may account for 75% of the efficacy in response to an antidepressant drug.

Williams, N., Sampson, A. N., Simpson, K., & Nahas, Z.  (2009).  Relapse rates with long term-antidepressant drug therapy:  a meta-analysis.  Human Psychopharmacology, 24, 401-408. Continuation on antidepressant, risk of relapse is 23% in one year, 34% in two years; 45% in 3 years

Zis, A. P., & Goodwin, F. K.  (1979).  Major affective disorder as a recurrent illness.  Archives of General Psychiatry, 36, 835-639.  A literature of studies before drug therapy.  Those who never experience a second episode:  Kraepelin 60%; Pollock 57%; Rennie, 21%, Lundquist, 66%, Stenstedt, 62%

Annotated Bibliography on withdrawal symptoms

Ceccherini-Nelli, A., Bardelllini, L., Cur, A., Guazzelli, M., Maggini, C., & Dilsaver, S. C.  (1993).  Anti-depressant withdrawal:  prospective findings.  American Journal of Psychiatry, 150, 165.  Examined 10 individuals withdrawn from various antidepressants.  Seven exhibited withdrawal symptoms which included cardiac arrhythmia, resting tremor of the jaw, tongue, and upper extremities, insomnia, chills, sweating, nausea, headache.

Haddad, P.  (1997).  New antidepressants and the discontinuation syndrome.  Journal of Clinical Psychiatry, 58, Supplement 7, 17-21.  Indicates that patients need to be on SSRIs for 8 weeks before a discontinuation syndrome will be observed;  indicates that 20-86% of sample report symptoms; symptoms include dizziness, nausea, lethargy, headache, anxiety, tingling and burning sensations, confusion, tremor, sweating, insomnia, irritability, memory problems, anorexia

Lejoyeux, M., & Adés, J.  (1997).  Antidepressant discontinuation: a review of the literature.  Journal of Clinical Psychiatry, 58 (Supplement 7), 11-15. Mentions:  gastrointestinal distress, arrhythmias, anxiety, sleep disturbance, movement disorder, panic attacks, mania or hypomania, delirium, mood changes, dizziness, sensations of tingling and burning in limbs

Littrell, J.  (1994).  Relationship between time since reuptake-blocker antidepressant discontinuation and relapse.  Experimental and Clinical Psychopharmacology, 2 (1), 82-94.  This article analyzed results from 11 studies in which persons who had fully recovered from an episode of major depression had their medication discontinued.   All studies found high rates of relapse (57% to 100%) within the six months following drug discontinuation. The paper argues that the high relapse rates represented drug withdrawal rather than a reemergence of major depression.

McGrath, P. J., Stewart, J. W., Tricamo, E., Nunes, E. N., & Quitkin, F. M.  (1993).   Paradoxical mood shifts to euthytmia or hypomania upon withdrawal of antidepressant agents.  Journal of Clinical Psychopharmacology, 13(3), 224-225. Report emergence of mania/hypomania in 2% following antidepressant withdrawal in persons without a history of mania/hypomania.

Stoukides, J.A.,  & Stoukides, C. A.  (1991).  Extrapyramidal symptoms upon discontinuation of fluoxetine.  American Journal of  Psychiatry, 148, 1263. Report of man who had taken Prozac for 6 months, upon discontinuation was experiencing muscle spasms and exhibiting protruding tongue movements

Annotated Bibliography on Drug Side Effects

Andersohn, F., Schade, R., Suissa, S., & Garbe, E. (2009). Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. American Journal of Psychiatry, 166(5), 591-598.  Increase in diabetes

Bliziotes, M.  (2010).  Update on serotonin and bone.  Journal  of Clinical Endocrinology and Metabolism, 95 (9), 2124-4132.  Recognizes that there are serotonin transporter  on the membranes of  cells involved in bone turn over.  Indicates that SSRIs are associated with decreased bone mass, increased bone loss, and increased fractures.

Csoka, A. B., Bahrick, A., Mehtonen, O. P.  (2008).  Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors.  Journal of Sexual Medicine, 5 (1), 227-233.  Discusses case reports of persons experiencing persistent genital anesthesia, loss of libido, and erectile dysfunction following discontinuation of an SSRI.

Fava, M. (2000). Weight gain and antidepressants. Journal of Clinical Psychiatry, 61 (Suppl. 11), 37-41.

Hamer, M., Batty, G. D., Marmot, M. G., Singh-Manoux, A., & Kivimaki, M. (2011). Anti-depressant medication use and C-reactive protein: results from two population-based studies. Brain, Behavior, and Immunity, 25(1), 168-173.  Higher C-reactive protein, risk factor for cardiovascular disease

See Kawail, M., & Rosen, C. J.  (2010).  Minireview:  a skeleton in serotonin’s closet?  Endocrinology, 151(9), 4103-4108.  Contains list of studies finding bone loss with SSRIs

Kivimaki, M., Hamer, M., Batty, G. D., Geddes, J. R., Tabak, A. G., Pentti, J., et al. (2010). Antidepressant medication use, weight gain, and risk of type 2 diabetes: a population-based study. Diabetes Care, 33(12), 2611-2616.  Both weight gain and diabetes increase

Laje, G., Paddock, S., Manji, H., Rush, A. J., Wilson, A. F., Charney,
D., & McMahon, F. J.  (2007).  Genetic marker of suicidal ideation emerging during citalopram treatment of major depression.  American Journal of Psychiatry, 164, 1530-1538. 6%  (120/1862) of their sample developed suicidal ideation early in treatment.  Laje et al.  were able to identify alleles for genes associated with the emergence of suicidal ideation

Licht, C. M., de Geus, E. J., Zitman, F. G., Hoogendijk, W. J., van Dyck, R., & Penninx, B. W. (2008). Association between major depressive disorder and heart rate variability in the Netherlands Study of Depression and Anxiety (NESDA). Archives of General Psychiatry, 65(12), 1358-1367.

Loke, Y. K., Trivedi, A. N., Singh, S.  (2008).  Meta-analysis:  gastrointestinal bleeding due to interaction between selective serotonin uptake inhibitors and non-steroidal anti-inflammatory drugs.  Alimentary Pharmacology & Therapeutics, 27, 31-40.  A meta-analysis finding that SSRIs doubles risk for upper gastrointestinal haemorrhage and when combined with aspirin raises risk to 500%.  It should be recognized that there are serotonin transporters on platelets and thus SSRI use can be expected to affect blood clotting.

McCabe, C.,Mishor, Z., Cowen, P. J., & Harmer, C. J.  (2010).  Diminished neural processing of aversive and rewarding stimuli during selective serotonin reuptake inhibitor treatment.  Biological Psychiatry, 67 (5), 439-445. Cites anecdotal reports of emotional numbing to aversive and positive experiences in people taking SSRIs.  Conducted f functional MRI observing the response to positive and negative stimuli in areas of the brain that are known to be activated by emotional stimuli.   Healthy individuals who had taken citalopram for 7 days were less responsive to both positive and negative stimuli.

Moore, T. J., Glenmullen, J., & Furberg, C. D.  (2010).  Prescription drugs associated with reports of violence towards others.  PloS ONE, 5 (12), ep. 15337.  Analyzes the relative risk of increase in report in violence among those taking various drugs.  Risk is elevated for those taking antidepressants and chantix for nicotine withdrawal.

Raeder, M. B., Bjelland, I., Emil Vollset, S., & Steen, V. M. (2006). Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland Health Study. Journal of Clinical Psychiatry, 67(12), 1974-1982.

Rosen, R. C., Lane, R. M., & Menza, M.  (1999).  Effects of SSRIs on sexual function:  a critical review.  Journal of Clinical Psychopharmacology, 19 (1), 67-85.  Reports that as much as 80% may experience sexual dysfunction when taking SSRIs.  Symptoms include anorgasmia, erectile dysfunction, diminished libido, and genital anesthesia.

Rubin, R. R., Ma, Y., Peyrot, M., Marrero, D. G., Price, D.W., Barrett-Connor, E., Knowler, W. C.  (2010).   Antidepressant medicine use and risk of developing diabetes during the diabetes prevention program and diabetes prevention program outcome study.  Diabetes Care, 33 (12), 2549-2551. SSRIs doubled the risk of development of Type II diabetes unless an individual was also taking metformin (a drug used to treat diabetes)

Serebruany, V. L., (2006).  Selective serotonin reuptake inhibitors and increased bleeding risk:  are we missing something?  American Journal of Medicine, 119 (2), 113-116. Indicates there are 120 cited peer reviewed articles documenting risk of platelet malfunction in persons on SSRIs.

Shah, A. (2011). Antidepressant use linked to thicker arteries. Emory University. Atlanta, GA.  Retrieved 12/12/11 from http:shared.web.emory.edu/whsc/news/release/2011/04/antidepressants-linked-to-thicker-arteries.html.

Annotated Bibliography on Psychotherapy versus Drugs

Blackburn, I. M., & Moore, R. G.  (1997).  Controlled acute and follow-up trial of cognitive therapy and pharmacotherapy inn out-patients with recurrent depression.  British Journal of Psychiatry, 171 (10), 328-334.  Compared 16 weeks of acute treatment with drugs followed by two years of drug maintenance to acute cognitive therapy and maintenance cognitive therapy.  The subjects were selected for having at least one other episode of depression prior to the index episode.  At 16 weeks, all groups had improved and there were not significant differences across drug treated versus CBT treated, although more remitted in the CBT group (33%) versus drug treated (24%).  For the severely depressed, all treatments were equally effective.  During the two year follow-up, subjects continued to improve, although there was a trend for more improvement among those receiving CBT.

Elkin, I., Shea, T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., Fiester, S. J., & Parloff, M. B.  (1989).  National Institute of Mental Health treatment of depression collaborative research program.  Archives of General Psychiatry, 46, 971-982.  Found no difference between medications and talk therapy for the entire sample.  For those entering with severe depression, drugs were superior to CBT but equal to Interpersonal Therapy.

Evans, M. D., Hollon, S. D., DeRubeis, R. J., Piasecki, J. M., Grove, W. M., Garvey, M. J., & Tuason, V. B.  (1992).  Differential relapse following cognitive therapy and pharmacotherapy for depression.  Archives of General Psychiatry, 49, 802-808.  Followed up on persons responding to their treatment to determine risk of reemergence of depression.  CBT had lower rate of relapse.  During the active arm of treatment , (reported in same issue of Archives by Shea et al.), recovery rates were 30% of cognitive therapy; 26% for interpersonal therapy, 19% for active drug; 20% for placebo-differences were not statistically significant.  For relapse after treatment discontinuation:   36% for CBT; 33% of interpersonal therapy; 50% for drug; 33% for placebo

Keller, M. B., McCullough, J. P., Klein, D. N., Arnown, B., Dunner, D. L., Gelenberg, A. J., Markowitz, J. C., Nemeroff, C. B., Russell, J. M., Thase, M. E., Trivedi, M. H., & Zajecka, J.  (2000).  A comparison of nefazadone, the cognitive-behavioral analysis system of psychotherapy, and their combination for the treatment of chronic depression.  New England Journal of Medicine, 342 (20), 1462-1470.  Found that drugs and CBT were equally effective but the combination was superior to either treatment alone

Simons, A. D., Murphy, G. E., Levine, J. L., & Wetzel, R. D.  (1986).  Cognitive therapy and pharmacotherapy for depression.  Archives of General Psychiatry, 43, 43-48.  Compared those treated with cognitive therapy alone, those treated with antidepressants, those treated with both for 12 weeks.  No difference in response rate at end of 12 weeks across the treatments.  Followed up on persons responding to their treatment to determine risk of reemergence of depression after treatments were discontinued.  Twenty percent relapsed

in the Cognitive therapy group; 66% relapsed in the drug treatment group; 43% relapsed in the combination group.

Annotated Bibliography on Curcumin, Omega-3s, Exercise

Blumenthal, J., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P. Waugh, R., Napolitano, M.A., Forman, L. M., Appelbaum, M., Doraiswamy, P. M., & Krishnan, K.R.  (1999).  Effects of exercise training on older patients with major depression.  Archives of Internal Medicine, 159, 2349-2356.  Exercise is efficacious

Greenwood BN,& Fleshner M.  (2011).  Exercise, Stress Resistance, and Central Serotonergic Systems. Exercise and Sports Science Review, 38 (3), 140-149.  Reviews animal and human literature on exercise increasing stress resistance

Greenwood B.N. & Fleshner, M.  (2008).   Exercise, learned helplessness, and the stress-resistant brain. Neuromolecular Medicine, 10, 81-98. Shows that exercise precludes learned helplessness in animals

Hamer M., & Steptoe,  A.  (2007).   Association between physical fitness, parasympathetic control, and proinflammatory responses to mental stress. Psychosomatic Medicine,  69, 660-666.  Exercise decreases stress response

Hoffman, B. M., Babyak, M. A., Craighead, W.E., et al (2011).  Exercise and pharmacotherapy in patients with major depression: one-year follow-up of the SMILE study. Psychosomatic Medicine, 73, 127-133.  At one year follow-up, exercise was related to remission although medcations were not

Kiecolt-Glaser, J.K.  (2010).  Stress, food, and inflammation: psychoneuroimmunology and nutrition at the cutting edge. Psychosomatic Medicine , 72,365-369.  Literature review documenting omega-3s salubrious effects

Sanchez-Villegas, A., Delgado-Rodriguez, M. , Alonso A, et al (2009).  Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Archives of General Psychiatry, 66, 1090-1098.  Lowers levels of depression in those eating Mediterranean diet

Wang R., Xu Y., Wu, H.L., et al (2008).   The antidepressant effects of curcumin in the forced swimming test involve 5-HT1 and 5-HT2 receptors. European Journal of  Pharmacology, 578, 43-50.  Curcumin just as effective as antidepressant in reducing depressive behaviors in animals

Hello,

I would like to share a link to this documentary as one of the few sane and doable solutions to the problems faced by psychiatry and health care in general.

Again most of the problems discussed and lamented but never actually addressed by this and other groups are being addressed in these models which could easily be instated by doctors concerned about the state of medicine in the “mental health” arena.

It is one thing to point out problems and another to build a system that doesn’t allow for and in fact blocks the very travesties that occur on a daily basis to psychiatry endless victims.

The models outlined in this documentary put the missing ethical control that must be assumed by ethical leaders in Medicine back into the doctors control.

Click here to view the PBS video U.S. Health Care: The Good News.

It works if there is a:

commitment to public health verses personal greed for the doctors personal enrichment to give health care providers more time with patients;

doctors to be willing to give patients a real voice in treatment decision-making

and local hospitals and local doctors to perform at high levels.

This comment was recently shared by a member of ISEPP’s free Yahoo Discussion Group.  The group has members from around the world who participate in various topics about mental health concerns.

Click here to join the ISEPP Yahoo Discussion Group.

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