Shortly after Prozac became the best-selling drug in the world in the early 1990s, I proposed that there was little or no evidence for efficacy, but considerable evidence that the drug would worsen depression and cause severe behavioral abnormalities. I attributed much of the problem to "compensatory changes" in neurotransmitters as the brain resists the drug effect. Since then, in a series of books and articles, I've documented antidepressant-induced clinical worsening and some of its underlying physical causes. Now the idea has gained ground in the broader research community and has recently been named "tardive dysphoria."

It has been apparent for many years that chronic exposure to SSRI antidepressants frequently makes people feel apathetic or less engaged in their lives, and ultimately more depressed. In my clinical experience, this is a frequent reason that family members encourage patients to seek help in reducing or stopping their medication. SSRI-induced apathy occurs in adults and includes cognitive and frontal lobe function losses. (See Barnhart et al., 2004; Deakin et al., 2004; Hoehn-Saric et al., 1990). It has also been identified in children. Adults with dementia are particularly susceptible to antidepressant-induced apathy.

Psychiatric Drug Use Spreads--Pharmacy Data Show a Big Rise in Antipsychotic and Adult ADHD Treatments

Wall Street Journal, November 16, 2011

The medicating of Americans for mental illnesses continued to grow over the past decade, with one in five adults now taking at least one psychiatric drug such as antidepressants, antipsychotics and anti-anxiety medications, according to an analysis of pharmacy-claims data.

Among the most striking findings was a big increase in the use of powerful antipsychotic drugs across all ages, as well as growth in adult use of drugs for attention-deficit hyperactivity disorder—a condition typically diagnosed in childhood. Use of ADHD drugs such as Concerta and Vyvanse tripled among those aged 20 to 44 between 2001 and 2010, and it doubled over that time among women in the 45-to-65 group, according to the report.

Overall use of psychiatric medications among adults grew 22% from 2001 to 2010. The new figures, released Wednesday, are based on prescription-drug pharmacy claims of two million U.S. insured adults and children reported by Medco Health Solutions Inc., a pharmacy-benefit manager.

Read more here.

For those of you who participate on Facebook or who want to keep closer track of the various news that we pass along throughout the month, I have created a 'public figure' Facebook page for Dr. Peter Breggin.  We use this page to announce various Empathic Therapy Center activities and projects as well as to pass along vital news that flows across our desks.  You can easily access our official Facebook page by signing in to Facebook and then clicking on this link.  Once on the page click on the 'Like' button at the top of the page.  Be sure you are signed in to Facebook to be able to interact fully with our page.  See you there!  

        

When I was a first-year graduate student in social work I had a placement in a general hospital's psychiatric outpatient unit.  A psychiatrist was brought in from California to provide inservice training to students and full-time staff.  He had a reputation as an excellent diagnostician.  I had already worked in the field before grad school, had been well-trained, and I looked forward to seeing the diagnostic "chops" of this psychiatrist.

He had us watch him through a one-way mirror as he interviewed a new patient.  After the patient left we gathered to discuss the interview and hear his diagnosis.

This patient was a 62 year old man who had been nationally recognized for his professional accomplishments as a high school educator until, at age 55, he suffered a complete mental breakdown.  He then lost his job, stopped working on a book about his work, became estranged from his wife, moved into an apartment alone, and saw his adult son hospitalized in a state mental hospital with a diagnosis of schizophrenia.  The patient had seen a psychiatrist for the past 7 years, was prescribed neuroleptics, and was now displaying the following symptoms; flat affect, drooling, unclear verbal articulation, bent-over posture, poor hygiene, delusions, unregulated emotional states ranging from nearly-catatonic to agitated and frenetic, chronic and severe constipation, no eye contact, an empty gaze, and an inability to relate to others. 

After describing the dynamics of the interview and the data gathered, the psychiatrist stated that this man was “Manic-depressive, psychotic”.  He went on to say "...of course this disorder is incurable..." and that he will require life-long medication with little hope of any improvement, only maintenance.  I, being a lot younger and possibly brasher than I am now, raised my hand and asked the psychiatrist how he could possibly reach the conclusion of incurability based on one interview of 45 minutes.  His response was that his experience and the literature both supported his position.  I had worked with autistic children, also called incurable, and knew that the ability to cure resided within the patient and required only a relationship with a person who was committed to and focused on that patient in order to engage their health.  I suggested to him that he was making a statement based not on data gleaned from the patient but taken instead from the opinions of other professionals in the field.  At that point he turned to the group and informed them that he would be returning in 6 months for a follow-up inservice training and that this patient will be assigned to me to treat, and I could report on it when the psychiatrist returned.  I accepted what was meant to be a challenge as simply a referral and thanked him.  I was introduced to the patient as his new therapist, and we set up our next meeting, our first full appointment, the following Tuesday morning at 10:00. 

I met the patient in the waiting room and invited him into my office.  After sitting down, the gentleman asked me, with slow and slurred speech and a great deal of drooling, if he could phone me in the interval between our sessions.  I asked him to tell me what made this request so important that he wanted to begin our first full session with it.  He told me that his psychiatrist of seven years always allowed these calls.  I suggested to him that if his current condition was the result of treatment which included these calls, then the answer seemed to present itself within the context of his question.    I then answered “No” because it seemed to me the urgency of his request suggested that this was a very important issue, and that we would need to further explore its meanings and implications before any decision to bridge the time between appointments could be made.

That one word, “No”, seemed to change everything.  The patient’s head snapped up, he locked eyes with mine as I finished speaking and then said “What?” in a rather louder and clearer voice than before.  I explained that there were two reasons for my answer:  first, that the option of calling between sessions didn’t seem to have had a beneficial effect on him over the previous 7 years and second, that our work together could best be accomplished within the context of the face-to-face meetings between him and me.

The man stood up, rather straighter than before, and said he was leaving.  Though I was surprised, (which I now understand as an empathic response to the patient’s own surprise at my answer), I told him that it was always alright to leave when he wanted, and that I would see him at his next appointment the following Tuesday at 10:00.  Without verbal response he opened the door and stepped out, slamming the door behind him.  My note for the session was “Beginning to address the depression as evidenced by the patient expressing anger, verbally and behaviorally.”

About 5 minutes later there was a loud knocking at my door, I opened it, and there was the same gentleman.  He pointed down the hall and said “I just left a big turd for you in the toilet.” I responded by gently reminding him that we would talk again next Tuesday at 10:00, at which point he walked away.  I returned to my notes on the session and added, “Beginning to address the constipation.”

I treated him for four months, during which he was taken off his neuroleptic medication by his family doctor.  I asked my clinical supervisor, Cordill Wood, to join the final few sessions in order to confirm the growth and cure I was seeing in the patient.  Over those months he had physically and psychologically transformed from a broken man to a distinguished, erudite individual who had been rehired to his position in the high school, had reunited with his wife, had brought his son home to get outpatient treatment, and had resumed writing his book.  All of his physical symptoms were gone, and in the discharge session, he told me that he was tempted to thank me for my help, but realized that it was he who had done the work, and then told me, with a warm smile I had come to know, that if I ever say “No” to another patient as angry as he was, that I’d better make sure I have good hospitalization insurance.  I told him that I could sense his intense anger when we began, and was offering myself as a safe target for that anger, and that I would not have let him hurt himself or me.  We shook hands, while my eyes moistened with respect, and he then left, ready to get on with his life.

Two months after discharge, the psychiatrist returned and asked me to give a report on the "incurable" patient.  With my veteran supervisor confirming every detail of my report, I concluded with the statement that the patient was now cured of the disorder.  The psychiatrist leaned back in his leather office chair; there was silence in the room.  Slowly, he put his hands behind his head, then sat forward and announced "Well, this is the first time this has ever happened."  At that moment, pictures of me getting published and receiving awards flashed uncontrollably through my head.  For the first time, with evidence corroborated by another professional, a manic-depressive, psychotic patient had been cured.  I saw parades down 5th Avenue, possibly tickertape.  I bathed in the light of my fantasized professional recognition.

Then the psychiatrist continued, with a statement I have never forgotten.  "This is the first time I've ever been so wrong in my diagnosis.  Obviously the man did not have manic-depression psychosis because it is incurable and this man is cured.  I will have to amend his record."  Which he did.

I have worked in the field for 39 years since that day and I continue to treat people based on the experience of the relationship, to which I attempt to respond therapeutically.  I get out of the person’s way and move along with her or him on their inexorable journey toward health.

Richard F. Gottlieb, MSW
233 East Fulton, Suite 214
Grand Rapids, MI  49503
tel.  616.774.9000

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