As a Physician who prescribes these medications [in the UK] we have a similar but less significant trend in prescribing over here.

I think there's quite a few things going on. Including, but not exclusively:

1. Breakdown in relationships, family and community support structures

2. Uncertainty about jobs and the future

but an attitude I see more and more is people's expectations to always be 'happy'. I call it the 'McMedicine' syndrome. [TM pending!] Depression - remembering there are various types with some definitely benefitting from medication - is natures way of telling you something isn't right. It should cause you to stop and reflect if some change is necessary. It's the medicalisation [and medications = $ to companies] of normal human experience that is seen to need 'curing'.

Early on in my training I was given Ivan Illich's book [1975] Limits to Medicine. To quote Wikipedia:  Illich subjected contemporary Western medicine to detailed attack. He argued that the medicalization in recent decades of so many of life's vicissitudes—birth and death, for example—frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society.

Primum non nocere - "first, do no harm", from the Hippocratic Corpus. However, to 'do nothing' seems not to be acceptable to many patient's theses days. 'Do something doctor!' is the plea. Add in defensive medicine to the profit motive [Doctors and big Pharmacy] and the scene is set for over perscribing.

Question - What is the most sensitive organ in your body?

Answer - your Brain. Bear this in mind when you put chemicals in your body.

Having lived for a few years in Africa, and comparing cultures, they have a richness we so often surrender on other altars. I visited with some University students [age 19/20] and had them ask their Africa peers this questions:

Q. If you had no money, and needed to borrow some, how many people could you turn to who would instantly lend some to you?

How would you answer that question?

Africa student = around 90 people

UK student = 3

It is true African's [generalising for a continent aside - the part I was in anyway] are more 'time rich but cash poor'. Their 'treasure' and investment is in people. They live with scarcity all the time, and day to day. They maintain relationships in ways we are having to re learn here in the West. We have lost it. They still have it. In one sense I hope a 'slow descent' will enable our communities to become more 'healthy' in so many ways. Those who manage to do so with thrive in proper human like ways.

Andy, 

Thank you for that... what a contribution.

Aaron

By bringing up the extreme and provocative case of the psychotic cannablistic antisocial Jeffrey Dahmer in no way did I mean to imply that patients with psychotic disorders are routinely violent. Statistics show (IMHO)most are quite isolated and not at all violent. My apologies for a seemingly biased example.

Violence is associated with personality disorders, substance abuse and the manic phase of manic depression but I apologize I do not have time to provide sources. However, you can google it and find the information pretty easily by using keywords "psychiatric correlates violence" I suspect.

Regards, I have to drive home now

Denise

I have long suspected our American diet is making us sick. Here is another nail in its coffin. OUr diet is high in gluten, and, well, read on.

I had a low level of chronic depression all my life, which was kicked into a major depressive episode when my ex left us, 24 years ago. Prozac and then Zoloft saved my ability to function for about 7 years. Then I went on a low carb diet, and the Zoloft was actually making me sick I had to stop taking it. I was suddenly well and have continued to be well since.

Recent studies indicate that what I was suffering from was depression brought on by gluten intolerance.

A few articles, srating with this one:

“In my experience, the most common causes behind depression are gluten intolerance, poor nutrition, adrenal exhaustion, and hormonal imbalance. At HealthNOW Medical Center, we thoroughly test each patient to find the root cause of their depression and, invariably, there is a real solution – one that gets rid of the depression while improving the person’s health, and without the need for dangerous drugs that do nothing more than attempt to relieve the symptoms.”

How does gluten intolerance cause depression?

According to Dr. Petersen, the nervous system is more commonly affected by gluten intolerance than any part of the body other than the digestive system. In a gluten intolerant person, the body reacts to the gluten protein as if it were a toxin: the immune system attacks the affected area of the body in an attempt to get rid of the protein or reduce its effect. However, the protein to which those with gluten intolerance are reacting is very similar to other proteins found in the body, including those in the brain. When the body confuses these proteins, the immune system attacks the brain and nervous system. This results in inflammation and irritation that, in turn, causes depression and anxiety.

Here's an article from Psychology Today:

Is Gluten Making You Depressed?

Celiac disease, commonly thought of as only a GI disorder, can cause profound psychological symptoms. One of which is depression.

In celiac disease the body's immune system mistakenly attacks a protein called gluten, which is found in wheat, rye, and barley. In its attack on gluten, the immune system damages the small intestine, producing intestinal symptoms such as abdominal cramps and swelling, pain, gas, vomiting, diarrhea, and constipation. Once damaged the small intestine may not absorb essential vitamins, minerals, and proteins as well as it should.

The health consequences of celiac disease, however, extend beyond gastrointestinal issues. . .

And then this one which was a finding about neurotransmitters when dealing with celiac disease (more scholarly):

Abstract

Many cases of coeliac disease, a gastrointestinal autoimmune disorder caused by sensitivity to gluten, can remain in a subclinical stage or undiagnosed. In a significant proportion of cases (10–15%) gluten intolerance can be associated with central or peripheral nervous system and psychiatric disorders.

And yet, I have 5-gallon pails of red hard wheat *sigh*.  I guess, since I only have a gluten sensitivity, I can make sour dough bread as long as I limit my portions.

This post is an addendum to Wendy's excellent post above about gluten being one of the dietary triggers of diverse symptoms throughout the entire body including depression and anxiety.  

And it does my heart good to hear so many people here at PP who are interested in really being healthy!

If anyone is interested in learning about the mechanism by which gluten is thought to trigger immune system inflammation, Scientific American carried an article in August 2011, with a wonderful explanation of this new line of research written for lay people with great pictures.  The author is Alessio Fasano, who has written quite a bit about the mechanism by which gluten can activate the immune system producing dysfunction in body parts far removed from the intestines.  (Full blown autoimmune reaction to gluten is called "Celiac Disease" and some articles on this topic use that term.)  But many lower grade versions of gluten triggered auto-immune inflammation exist too.  High blood pressure, osteoarthritis, migraines and chronic fatigue, for example, will sometimes improve with a 6 week trial of a gluten free diet. Other food antigens can trigger a similar process.

Here is the Fasano article:  http://www.scientificamerican.com/article.cfm?id=celiac-disease-insights  (Unfortunately, you have to pay to get it.....   I would be happy to email a pdf version of this article if you want to PM me and send me your email.)

There are many other molecules besides gluten that can set off auto-immune inflammation, too, but gluten is the biggest offender.   This process seems to happen when 3 factors come together:  1.  a triggering molecule in the intestines (such as a food like gluten) 2. a "leaky gut" that permits large (undigested) molecules to leak across the intestinal barrier where they MEET THE WHITE BLOOD CELLS of the immune system which live just under the intestinal barrier, and 3) a genetic pattern in the antigen recognition portions of the white blood cells that mistakenly recognizes the molecule as "some kind of invader."   Multiple immune mechanisms are then set off that can inflame distant body parts, like the brain.  Neurotransmitter balances are altered affecting thinking and mood.

[Disclaimer--I am a traditionally trained doctor who is specialized in emergency medicine.  I became interested in what it takes to become truly healthy just about 4 years ago when I began reading and attending courses in what is being called "functional medicine" and "science based naturopathy."  FM is focused on promoting healthy physiology, not on diseases.  FM rarely uses western drugs, often uses some herbs, probiotics, vitamins and minerals, diet, exercise, fresh air, yoga, meditation. But, I am not an expert at this point.  I am also not an academic.]

By the way, the podcast by Mark Sisson a few weeks ago was a wonderful implementation of many of the major principles at the core of functional medicine. 

Here is a question that exercises my mind.

Pretend that we don't know what causes scurvy and we asked Big Pharma to come up with a solution.

Would they sell us very expensive symptomatic relief or would they be honest and tell us to go suck a lemon?

AndyG
:Thank you for mentioning Ivan Illich's  observations about medicine.  I would like to  pursue  this  very important topic of how institutionalized  (collectivized) medicine is wrong and how to develop a better health system.   I was so surprised to live in Japan some years and see a much better approach where  "do no harm" was followed so much more than in the US.  Much progress for an improved life can result (and  much better economy) by focusing  on this area.  Is anyone out there interested  in a review of medical procedures or at least discuss Ivan Illich's observations about how improved  diet and sanitation (and not modern pill medicine) is basically responsible for improved  health  of modern societies?

With a real collapse (either slow motion, or quick) we have the opportunity to build a much healthier and much less costly way of maintaining health and dealing with disease and  other medical needs.  I am interested in reviewing the factors, and eventually preparing a plan / guideline suitable for a small island (my situation) or new  small  community (a shared goal of many).  My perspective is: what are the REAL medical needs and how are they best addressed. There are a lot of good idease for specific areas bantered  about here.   I would like  to review all of  them from the perspective of how to live in the new paradigm that will follow...............

Marvin

Hi Marvin,

You raise some interesting questions [I've numbered above] and I think discussing health issues and future changes is important. I liked the article a couple of weeks ago about keeping fit, and how important a part of resilience that is. Let me give you my thoughts on your questions:

1) I have worked in private and socialised medical systems. I am aware of the USA system to a degree and your culture [if that is the right word] of emphasing individual responsibility as a primary good. You may be aware the UK culture is another extreme with the NHS [national health service] and socialised care free at the point of need [paid from general taxation]. I could write a 10,000 word essay and leave many gaps in comparing the 2 systems! However, health is a 'group' dynamic - ie your behaviour affects my health, and vice versa. So much of good health is a social phenomenon. I would like to ask you, why do you think collectivized medicine is wrong? [I am genuinely interested]

2) I agree with Illich regarding health in a society [body health that is - since 'health' also encompasses mental, social and spiritual dimensions] being primarily a function of clean water, good sanitiation, quality food and shelter. I don't think you will find many doctors arguing otherwise. One of my first assignments as a medical student was to research John Snow and a cholera outbreak in London in 1854. Using good epidemiology he proved it was a certain Well causing the outbreak, and the need for clean water. This started legislation that exists in the UK today. We doctors today mostly fiddle at the edges. The health gains we provide are marginal to a society, although can be impressive and important to an individual. But most health care gains are from the 4 above factors. There is a huge body of evidence to support this, and we neglect these at our cost. From a peakprosperity perspective this is what developing resilience is all about, I think - ensuring we can feed, shelter, have sanitation and clean water post 'whatever' comes our way.

3) What about medicine 'post peak'? I have a few concerns: I think governments in extremis will 'cut' all too often the wrong things - reduce public health surveillance and spending on 'prevention', as its not sexy or obviously important until it's gone! 'Prevention is better than cure'. I think vaccination is critical, and without it our infant and child mortality rates will accelerate hugely. I dread a collapse where children can't get vaccinated and we see measles, German measles, Whooping cough, all making a come back. We have forgotten the death and morbidity such diseases wrought on our children until only a few decades ago. As an aside, I hope Bill Gates [et al] succeed very soon in eradicating Polio as they are so close to doing so. Antibiotics will also be a great loss and women will fear once again child birth. 1 in 25 women used to died when giving birth and still do in some cultures today. Puerperal sepsis [infection when having a baby or miscarriage] was also common before modern hygiene was understood. So if I had a 'wish list' the 2 items I'd want to be available post peak collapse would be vaccinations and antibiotics. These don't store for long, and production would need to be still continuing. Next, I'd go for pain medications - aspirin/morphine - aspirin [originally from Willow tree bark]. Mainly because I'm a wimp.

I am starting to locate and look at old medical equipment from 50-100 yrs ago and learn about them. An example [forgive the medical grossness] is catheters - tubes for draining your bladder. I often catheterise men with 'acute retention of urine'. This is one of the most distressing conditions where your bladder fills up but you can't pass urine. You bladder keeps filling up - and the pain keeps getting worse. Next time you want a pee, hold it for as long as you can. Currently we can get rubber/synthetic catheters to pass, but what happens when they are no longer available, say? Well, before rubber they used metal tubes [curved]. Now that has got to hurt, BUT it would work in an emergency.

I also think that with modern medicine many people are kept alive who would have died years ago. An example would be insulin dependent diabetics, women who's pelvises are too small and would have died in childbirth. I think with the loss of modern medicine, within a few years the population would have been 'culled' significantly, and a more Darwinian element of 'survival of the fittest' would reassert itself. We talk about sustainability, but how much of our medicine is 'sustainable'?

Arrrgh. This is all sounding so negative. I do think there could be many positives. Obesity would be for the few, not the many. Our Western diets are determined by profit making corporations and our health suffers as we succumb to advertising. Will Macdonalds* be there post peak? [* please substitute your fast food outlet of choice here]. We will be so much more active physically though necessity, and that will be fantastic from all sort of health points of view.

This is too long, sorry. But hope the banter is interesting!

Andy

Aaron,

I think that we basically agree but I am just pointing out what logic dictates can be concluded from a given set of observations. Note, even if you cannot definitively conclude the existence of something, you can certainly collect enough information to suspect that deeper studies are needed. Things like smoking-cancer and CO2-climate change linkages come to mind.

In this case, I think that there is more than enough evidence to suspect that either the anti-psychotics or the way that they are being prescribed/used (or both) is failing to achieve acceptable results. In a world (or country) where human health was truly the objective and most medical research and lobbying wasn't funded by Big Pharma you would expect better oversight.

Your three points outlining your thinking are perfectly reasoned and would make an excellent working hypothesis for a scientific investigation (would you like to be an academic?). As for why they are still being prescribed? It basically comes down to someone's cost benefit analysis. Ideally there is some quantitative probability analysis showing that the net body count would be higher without these drugs than with them. I do not know the medical literature so I have no idea of what the actual studies/evidence indicate.

That said, I think that your general prescription for treating depression would be effective in a functional society but not exactly easy to accomplish. Antidepressants are not meant to be a cure and should be just one (hopefully temporary) part of an overall treatment plan. Sadness and pain are part of life but I wonder how much of the rash of depression is explained by individual avoidance (give me a pill to make me happy) versus simply being an overall symptom of our disfunctional culture?

Your statement (below) really strikes a chord:

What I think we're seeing is this self-developing cycle of isolation, depression, sensory deprivation, social deprivation, heightened depression which leads to increased isolation. This is a cycle that can be broken without medication, and indeed, would be through the course of normal interaction.

At the risk of sounding paranoid, this sounds like a classic divide and conquer strategy. Isolating individuals breaks down communities and makes everyone more vulnerable. Whether by design or chance, the process you outline is powerful and destructive to healthy human societies. How do we break out of this depression-isolation cycle? Many if not most of us on this thread can remember a time when social interactions were very different than they are now. I'd like to find the balance between the positive aspects of both then and now....

Mark

The lemon saga, began here on this thread yesterday, continues with the following new items:

PharmaNews—Astra-Zeneca, the pharmaceutical giant, recently announce patent protection on its new product, Lemonite, used to prevent scurvy.  “We are proud to announce the release of Lemonite to the world and feel that it will provide a tremendous benefit to the people of all nations for the eradication of this deadly condition.”  When questioned about the high price of this proprietary product he quickly countered, “What is the price of health?  We must decide where our values lie.”  The composition of Lemonite is a closely guarded trade secret, but the literature describes it as “a proprietary blend of ascorbic acid and citrus bioflavonoids designed to replicate and improve upon the ratio found in nature.”

Reuters—Paul Brighttooth, DDS, leapt from an obscure small town dental practice to national prominence with his interview on 60 Minutes on the dangers of lemon juice on tooth enamel.  “I have been in practice for 25 years and have literally seen, 8, maybe 9 cases where the tooth enamel of children was eroded by habitual sucking on lemons.  I could no longer remain quiet.  I have to speak out….”  Follow up interviews on Good Morning America  and The View have made Dr Brighttooth a household name…   The segment “The Dangers of Fruit:  Are Your Children at Risk?” has been described as both “gripping and eye opening” by parent education groups.

AP—The University of Maryland College of dentistry is pleased to announce the appointment of Paul Brighttooth to the newly formed Department of Preventive Dentistry.  “We are pleased to add to our faculty such up and coming stars in the field of preventive dentistry.  We aim to have the University of Maryland become a world leader in this field.”

AP—Astra-Zeneca, announced its “Save the Children” campaign.  Its first public grant has gone to build the University of Maryland’s College of Dentistry’s new preventive dentistry facility.  “This gorgeous 22 million dollar facility is our way of giving back to the world that has supported Astra-Zeneca so generously through the years.  All of our children deserve the benefits of preventive dentistry being pioneered in this innovative program.”

AJD--The American Journal of Dentistry issued its new 2103 guidelines today urging all dentists to routinely question parents on the practice of sucking on lemons and to question whether lemons are kept in the home in unsecured containers.  “Some children will suck on lemons without the awareness of their parents.  A concerned parent will need to question children, especially adolescents, closely on this dangerous habit.”  Now that sale of lemons is illegal, the risk is reduced.  But occasionally a child will find a back yard lemon tree and be tempted by peers to experiment with this juice. 

Medicaid Bulletin to Practitioners—The issue of coverage for new and expensive preventive products such as Lemonite under current Medicaid law is still under review.  “It is the current position of this office that only children with clearly established, symptomatic scurvy, including bleeding gums, bruises that cover more than 50% of the body surface area or ruptured aortic aneurysms qualify for coverage of this medication.  As with our other special case medicines, practitioners will need to fill out the prior-authorization paperwork completely and then contact our office by phone.  Wait times in the phone cue are generally less than 30 minutes.”

Boston Star—Crime Watch.  A combined task force of 12 agents from DOJ, HSD, DOA and the FDA raided a fruit stand today that was suspected of selling lemons.  Officers entered the fruit stand with weapons drawn after setting up a perimeter of sniper coverage on the surrounding buildings.  The owner was placed face down on the cement floor and handcuffed while shoppers were held at gunpoint for questioning.  A small bin of lemons was located in the facility and destroyed.  Other inventory was searched, destroyed and discarded in a dumpster as a precaution against the possibility that lemons might have been hidden in with the apples and guavas.  The personal computers and cash registers were confiscated and taken back to headquarters as a part of the ongoing investigation which will take most of the year.  The fruit stand owner was devastated financially and emotionally, but voiced his relief that he was not incarcerated under the newly expanded anti-terrorist legislation that now cover crimes against teeth enamel in children.

Milwaukee Herald—Family Life Section.   Parents are giving up seeing their long-time family practitioners saying that the small offices don’t seem to be able to do the paperwork required to obtain optimum care.  “We hate to do this to Dr Brown.  He is very kind and has cared for our family for 2 generations.  But his office staff just is not equipped to obtain approval for the newer drugs like Lemonite that our children need.  We are shifting over to a large group in town that has a secretary dedicated to obtaining these approvals.  We really don’t want our children to get scurvy!”

sandpuppy. Unforutnately for all of us, robie is correct.

Am I reading this right Sand Puppy?  Lemon substitute? It is absolutely insane what Big Pharm will invent to sell successfully at a ignorant , illetirate, boob tube brain washed public. It never fails to amaze me.

Sonya

Right on. Thanks AndyG. 

think there's quite a few things going on. Including, but not exclusively:

1. Breakdown in relationships, family and community support structures

2. Uncertainty about jobs and the future

but an attitude I see more and more is people's expectations to always be 'happy'. I call it the 'McMedicine' syndrome. [TM pending!] Depression - remembering there are various types with some definitely benefitting from medication - is natures way of telling you something isn't right. It should cause you to stop and reflect if some change is necessary. It's the medicalisation [and medications = $ to companies] of normal human experience that is seen to need 'curing'.

Question - What is the most sensitive organ in your body?

Answer - your Brain. Bear this in mind when you put chemicals in your body.

I do not want to  preach either but I'll write how I got out of this unhappiness state without medication.  I ve had off and on mild depression that I realised I picked up from my mother. Victim type personality ( no control over her life). I couldn't understand why other people seemed to be happy most of the time and I wasn't. I went to a psycologist etc etc..  I  read a lot of self help books but that still didn't fix what I felt was wrong with me.

What I finally found was Buddhist teachings and meditation. I was in a Sangha for 4 years. I took what I needed and I pratice at home now. I will  forever grateful because now I understand how my mind ,my emotions and my body are all interlinked. I can fix myself with out pills. Please don't get me wrong some people are truelly sick and need life long medication.

With pratice I realised that meditation slowed down my obsessive thoughts and because they were fewer fewer in between I could see the repeated negative pattern that I had picked up from Mom. Each thought has to do with the past or the future and they make you react emotionally. If the thoughts are mostly in the negative basket of emotions , anxiety, fear etc you'll become depressed.  How do you break a cycle that you're not even conscience of ?  The  key becoming conscience of yourself .......to stop.  Society keeps us running around like chickens with no heads. 

The mind, body connection is very complex, and most of the Docs try fix the brain with a pill. It's easier and more profitable. Here is a link to a physicist that decided to reaseach the effects of meditation.

Mental health practitioners have adopted some Zen principles in Dialectical Behavioral Therapy (DBT) but it is not the same.  Too expensive for some and perhaps overdone but useful for some.

I find books easier and these practices can be done on or off meds or any other therapies. Cheri Huber has a kind simple way of writing and explaining that I relate to:

The Fear Book

The Depression Book