Looming Mental Health Collapse - U.S: 5% Of World Pop, 2/3rds Of All Psych Meds, 1 in 10 on Anti-Depressants

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Looming Mental Health Collapse - U.S: 5% Of World Pop, 2/3rds Of All Psych Meds, 1 in 10 on Anti-Depressants

One in 10 Americans takes anti-depressants (just one type of psychiatric medication). Others take other kinds. The U.S. population makes up 5% of the world population, yet are prescribed 2/3rds of all psychiatric drugs used worldwide.

People of all ages are affected, but the fastest growing group is young adults. Millennials are the most stressed demographic, according to "Stress in America", a study commissioned by the American Psychological Association.

According to 2002 and 2004 study data, inmates in federal, state, and local prisons and jails, 69.1%, 68.6%, and 45.5%, respectively, were placed on a psychiatric medication after admission into the system. At time of arrest, the numbers were 25.5%, 29.6%, and and 38.5%, respectively.

Sources:
http://www.npr.org/blogs/health/2011/10/20/141544135/look-around-1-in-10-americans-take-antidepressants
http://www.guardian.co.uk/commentisfree/cifamerica/2011/mar/15/psychology-healthcare
http://www.usatoday.com/story/news/nation/2013/02/06/stress-psychology-millennials-depression/1878295/
http://www.medscape.com/viewarticle/703701

So, what happens when medications become increasingly expensive, increasingly unavailable?

For people who may be depressed now (and more depressed as economic and social conditions worsen), holistic medicine, meditation, talk therapy/counseling, friend/family support, etc. may help. (Caution: St. John's Wort, an herb taken for depression also makes birth control less effective for women.) But what about psychosis and anger management and violence?

Recent Examples Of What I Am Concerned About:
Adam Lanza, the Newtown School shooter, was taking the antipsychotic Fanapt.
Ali Syed, who earlier this month went on a killing and carjacking rampage, was taking some kind of anti-psychotic.

How To Adapt And Cope?
I think things are going to get crazier, if you know what I mean. What can we do to adapt and cope? It's not just about ourselves and our children. (That's addressed here and elsewhere.). It's also about how deflect unwanted attention away from ourselves and our families and homes? To help friends and relatives who may have a hard time coping at exactly a time when medication becomes more expensive or difficult or impossible to obtain... Please share your thoughts.

Poet

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Symptoms, not the cause...

This approach is really alarming. 
What I read when I see studies and conclusions like this is:
1. Society is creating mentally unhealthy people with vast amounts of sensory deprivation, violent ideation and a truly insane pace of existence with little in the way of psycho-social harmony or satisfaction.

2. Society is unwilling to change the pace, scale back the violence, sex and ideation.

3. Money can be generated by maintaining this unhealthy lifestyle, and then selling snake oil to 'cure' the symptoms, while leaving the cause in tact to damage more generations of Americans.

4. Good business practice is unhealthy and unethical.

I hate to decry the business model of the U.S. because it's such an easy scapegoat for ideologically driven arguments, but this is one area where it's particularly devious. The health care that we receive is horrendously offset with the healthcare we're capable of providing. 

The main problem (isn't it always?) is that we can't provide quality to quantity
Now, I'm not a physician, but have a strong interest in medicine, and I must say that the ideal of altering neurochemistry on whim to satisfy complaints of symptoms that can be remedied by healthy, regular activity, and an gratifying social and family network seems painfully myopic and flawed.

The impacts of these drugs are well understood to be very harmful - especially to young men - and yet they continue to be prescribed without regard, as the long term health of the patient is thrown away for an easy, 'one size fits all' solution in pill form.

Sad.
Aaron

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As a Physician who prescribes

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.

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Wow

AndyG, wonderful post.

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Agree

Andy, 

Thank you for that... what a contribution.

Aaron

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Anatomy of an Epidemic

Richard Whitaker's book "Anatomy o an Epidemic" is an eye opening look at the meteoric rise in neuroleptic prescriptions in the past 2 decades. Are there any doctors out there that might comment on his findings? It's scary!

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A Sample List...

The following list is taken from the Save Project web page:

http://www.thesaveproject.com/

  • Thirteen year-old Chris Fetters killed his favorite aunt while taking Prozac.
  • Twelve year-old Christopher Pittman murdered both his grandparents while taking Zoloft.
  • Thirteen year-old Mathew Miller hung himself in his bedroom closet after taking Zoloft for 6 days.
  • Fifteen year-old Jarred Viktor stabbed his grandmother 61 times after 5 days on Paxil.
  • Luke Woodham aged 16 (Prozac) killed his mother and then killed two students, wounding six others.
  • Boy in Pocatello, ID (Zoloft) in 1998 who in seizure activity from Zoloft had a stand off at the school.
  • Michael Carneal (Ritalin) a 14-year-old opened fire on students at a high school prayer meeting in West Paducah, Kentucky. Three teenagers were killed, five others were wounded, one of whom was paralyzed.
  • Andrew Golden, aged 11, (Ritalin) and Mitchell Johnson, aged 14, (Ritalin) shot 15 people killing four students, one teacher, and wounding 10 others.
  • TJ Solomon, aged 15, (Ritalin) high school student in Conyers, Georgia opened fire on and wounded six of his class mates.
  • Rod Mathews, aged 14, (Ritalin) beat a classmate to death with a bat.James Wilson, aged 19, (Psychiatric Drugs - various) Breenwood, South Carolina, took a .22 caliber revolver into an elementary school killing two young girls, and wounding seven other children and two teachers.
  • Elizabeth Bush aged 13 (Paxil) was responsible for a school shooting in Pennsylvania
  • Jason Hoffman (Effexor and Celexa) - school shooting in El Cajon, CaliforniaAnother boy in Pocatello, ID (Zoloft) had a stand off at the school.
  • Jarred Viktor aged 15 (Paxil), after five days on Paxil he stabbed his grandmother 61 times.Chris Shanahan aged 15 (Paxil) in Rigby, ID who out of the blue killed a woman.
  • Eric Harris aged 17 (Zoloft then Luvox) and Dylan Klebold aged 18 in Colombine school shooting in Littleton, Colorado, killed 12 students and 1 teacher, and injured 23 others, before killing themselves.
  • Jeff Franklin (Prozac and Ritalin), Huntsville, AL, killed his parents as they came home from work using a sledge hammer, hatchet, butcher knife and mechanic's file, then attacked his younger brothers and sister.
  • Neal Furrow, (Prozac) in LA Jewish school shooting reported to have been court-ordered to be on Prozac along with several other medications.
  • Cory Baadesgaard (Paxil then 300 mgs Effexor) in Matawa, WA school shooting. This was not long after being taken off Paxil cold turkey and changed over to Effexor.
  • Shawn Cooper of Notus, aged 15 (SSRI and Ritalin) took a 12 gauge shot gun to school and started firing, injuring one student and holding the school hostage for about 20 mins.
  • Jeff Weise, 16, (PROZAC) Minnesota School Shootings March 2005, killed his Grandfather and Grandmother, then went on a rampage at the school killing a teacher, a security officer, 5 students (and wounding 7 others, 2 critically), before exchanging gunfire with police and then shooting himself.
  • Christopher Pittman, aged 12, (Paxil then Zoloft). Known amongst family as 'pop-pops shadow', he had always been very close to his grandfather. Shortly after being prescribed Zoloft he shot both his grandparents dead and burned the house down.

     and etc...

Poet

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I suppose I cannot be fully

I suppose I cannot be fully objective on this issue as I work in the field but I do know some of the data. Truly, everyone's comments here are heartfelt and thoughtful. Aaron, I appreciate your perspective and as well as the others as they address the societal influences on individuals which is something mental health professionals cannot address so easily.

As I have said before, in addition to medication abuse, alcohol use is still known to increase risk of suicide and homicide in all age groups (per the
CDC) and should not be ignored in any discussion of violence.

http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm
http://www.cdc.gov/alcohol/faqs.htm

Antidepressant and amphetamine use in youth can lead to manic episodes and worsening of psychosis in individuals predisposed to these problems.  A good child psychiatrist knows this. But there are very few child psychiatrists.  Most of these meds are prescribed by primary care doctors who cannot do therapy. That is not an indictment but a byproduct of pharmaceutical marketing to OB/GYN, surgeons, primary care doctors, pediatricians and internists coupled with a shortage in mental health professionals outside of big urban areas. This leads to some inappropriate prescribing as much as my treating someone's hypertension will lead to more mistakes, it is just not my area.

However-I have never seen medications restrain someone who was intent on harming themselves or others-I mean completely intent on harm. Medications don't stop a predator for very long.Even physical restraints won't keep someone down if they are inventive.

So we have a population of people who are isolated, stressed, on psych meds that are inadequately monitored by well meaning doctors who are overworked (most psych meds in the country are NOT prescribed by psychiatrists). The family unit and society supports are disintegrating. Parents are overworked, absent or having their own problems. No question the suicide rates and substance abuse rates are increasing.

What a great time to cut mental health funding.

St. John's Wort is studied in the US literature and found to be effective for mild-moderate depression but it is an MAOI and can interact with other medications. Sam-E also can be helpful. Nurses and PA and NP specialists may be available to monitor peopleon medication. Exercise is helpful. Meditation is helpful.

However, if someone is psychotic, with predatory impulses and paranoid delusions (like heaven forbid a Jeffrey Dahmer) http://en.wikipedia.org/wiki/Jeffrey_Dahmer what do you do???  Who wouldn't recommend medications? and incarceration.  Whitaker makes some good points but some people are truly dangerous and psychotic and need help. I still believe there is a place for psych meds.

As things deteriorate I think the NP's, PA's and nurses are going to be called upon, along with herbalists and alternative providers, to help out. And the cheapest medications will become the ones everyone will have to take if needed. I apologize for my unusually long winded post.

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clarification

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

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an herbal guide

was on sale at the last Massachusett General Psychopharmacology Course, seems pretty good regarding effects, side effects and interactions:

http://www.amazon.com/Mosbys-Handbook-Herbs-Natural-Supplements/dp/03230...

I think cannabis use has to be looked at very carefully to see if it is friend or foe, speaking of herbs. It is a different drug from back in the day.

Enough of me, again apologies for my rants. I hope to compose my thoughts as time goes on. Violent behavior is a topic I deal with every day in my work and I still don't have many answers. Hopefully others will.

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gluten intolerance & depression

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.

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TV Ontario's (Canada) The

TV Ontario's (Canada) The Agenda hosted a week long series recently called Mental Health Matters.

The main guest on the first program was Iain McGilchrist. He is a British Phychiatist and the author of The Master and His Emmissary. In the video he discusses what he believes to be the origins of our current mental health crises. He says that the our left brain dominant, and increasingly mechanistic modern Western societies lack the social cohesion that is necessary for our mental health.

And that autism spectrum disorders and schizophrenia are more common now because of disorders of the domination of left brain hemiphere over the right. It seems that our dominant left hemiphere is creating a world that is making us ill. And that the modern Wesern society is very bad for our mental health. 

This link will also take you to the site of The Agena with Steve Paiken where you can find a whole series of videos about mental health issues and medications. BTW The Agenda is a great program that deals with a wide range of important topics. And the guests are most often extemely bright, interesting and well informed. Many fans of TVO including myself wish that Steve Paiken would run for the leadership of this country. 

http://theagenda.tvo.org/story/origins-our-mental-malaise

A couple of things that stood out in Poet's list: almost every person here is a male. And also that many had only been taking medication for a short period of time before they committed the offence. I thought that these medications take several weeks to have an effect. And I also thought that with Paxil that the difficulty is that people have a hard time and sometimes become very unstable when they attempt to stop taking it.

I do know that sometimes anti -depressants cause unstable behavior. But I think that what is happening here has a lot more to do with a combination of many other factors than it does with anti-depressant medications. And I agree with Denise that alchohol is a huge contributor to violent behaviour in many situations. 

I think that this is a very important topic and something that deserves much more attention. I have know many young men that have become mentally ill and have taken their own lives. The last one was my neighbour who was only 18 years old (he used his father's gun to kill himself). He was a kind, intellegent and very decent person and he had great parents and a many people that cared about him. Several weeks later another neighbours son did the same thing.

But although these cases are very tragic and mental illness is certainly on the rise,  we are not seeing an increase in gun and other types of violence here in Canada.

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Gluten and Brain Inflammation

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. 

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Knock on effects for everything downstream....

Nice to see this thread!

Aaron, that was a really great post. We will do just about anything to maintain our illusions and almost nothing that requires really changing our lives (guilty as charged in my case).

Very nice too to see input from several medically trained members. I imagine that it is an ethical quagmire trying to determine who needs/should have potentially helpful medications. What gets me is that there does not seem to be any incentive to ever wean anyone off of these meds once they have begun taking them.

Poet, as an academic, let me just say that lists of horrible actions by people taking these meds does not show causality by and of itself no matter how long and grisly. It certainly shows that medications are not a panacea though. Presumably these people are on medications because they are having psychological problems to begin with, the question is whether the meds are in any way reducing the liklihood that they do harm to themselves or others? The meds might help, do nothing, or even make matters worse. Note, I lost my best friend to suicide after having taken such medications.

That said, what goes in must come out and our industrial scale use of antidepressants is literally leaking out into the rest of the outside world. From us to our sewage treatment systems to the water in streams and everything that drinks from them and the fish that reside within them.

Average concentrations of antidepressants in water, sediment, and fish neural tissue from Boulder Creek just below the point where wastewater from a sewage treatment plant is discharged (USGS Site ID 400305105103901). Since concentration units differed for each sample type, the concentrations were normalized to the highest single antidepressant concentration in each sample type (highest concentration was set to equal one). The graph shows that fish selectively absorb some antidepressants more than others.
(Larger Version)

Mark

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Go Suck a Lemon.

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?

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goodbye, lemonade

Arthur, you know the answer to that one. We'd be paying impossibly high  fees for deisgner scurvy drugs.

And our Congress would, under pressure from lobbyists, make lemons illegal.

What to do about the situation is a big, awful die-lemma.

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Ivan Illich and "Limits to Medicine"

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

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Causual relations

Mark,

While I tend to agree with you that there's nothing in the empiricals that show a causual relationship between violent activity and these drugs, what we can say for certain is that they are *not* acting effectively as anti-psychotics.

I wish I was able to establish this in a more official capacity, but here's my thinking on why we're seeing this:
1. These drugs are shown to produce results in patients with severe, chronic depression.
2. Most people who are prescribed SSRI's and other anti-depressant/anti-psychotic medications are not experiencing abnormal amounts of depression. They are depressed because of external influences, not internal imbalances.
3. Drugs designed to correct those imbalances have unpredictable effects on patients who are not experiencing neurochemical abnormalities. These effects are well known to include heightened levels of violent ideation and increased aggression, disorientation and a host of other problems.

So why are they still being prescribed?
Because they're the lemon, to borrow Arthur's analogy.

In any case, this is an opinion piece, as I have no solid academic studies to show the effects, but the impetus for these observations are readily available at the end of any commercial, from your medical provider and from a gamut of scholarly articles that show a clearly detrimental relationship between the interaction of psychotropics and a healthy brain. 

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. 

With plenty of opportunity for both isolation and violent ideation, it's easy for young men especially to sit in the basement, playing obscene amounts of violent games and have a PCP tell them that they're just depressed and there's a drug that should help.

Terrible idea! If they're depressed, get them out!
Plant something. Go climbing. Hike. Find a waterfall. Play a sport.
Get active. Interact with people. 
Sadness is a part of life, and a necessary one at that, and beating it is well worth the effort.

Cheers,

Aaron

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Medical ruminations - post peak

Mots wrote:

1) I would like to  pursue  this  very important topic of how institutionalized  (collectivized) medicine is wrong and how to develop a better health system.

2) 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?

3)  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

Mots's picture
Mots
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Medicine after a collapse

Thank you AndyG
Regarding: "why do you think collectivized medicine is wrong" I dont mean nationalized medicine.  I have much experience  in Japan and am convinced that their nationalized health care is much better than the US private monopoly systems.  I was surprised to  see  much more competition  in Japan despite their national health plan.  (for example, service is  not split up  into pieces  carried out by separate financial entities all owned by the same doctor or doctor's group to jack up bills, but lab tests etc sent out to a low cost provider from a hotly contested  market)  As a result I pay the same or  less cash out of pocket for service in Japan (outside the national insurance plan as a  cash paying outsider) than I do as copay with insurance in the US.   There is much more competition and also  less focus  on unnecessary but lucrative damaging invasive procedures  than in the US.  

No, "collectivized" in my sense means "instititionalized" in the sense discussed by Ivan Illich. Private independent care givers  giving up their independence to a "collective" that creates monopolies, hides prices (until after the service is done or started), raises prices, sets fees  and promotes/pushes questionable practices that do not  overall  improve health  for the people, but do create vast wealth  gathering for the  collective.  Surgury to remove prostate based on prostate antigen blood test results, blood vessel stent heart operations, drugs  to lower cholesterol  or blood pressure  instead  of at least trying diet, etc.

I would like to see an overall summary of what medical service/biological problems are encountered by a population and the spectrum  of resources for addressing those.  An overview.  I am sure that this info is in several places and I would like to consider what would a brand new formed community develop as an ideal.   I  dont have time at the  moment  to clarify.............

best wishes

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Mark Cochrane
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Aaron, I think that we

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

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A. M.
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Ailments, con't

Hey Mark,

I realized too late I sounded really preachy, and I meant to edit that comment to make a clear deliniation between where I was addressing your comment, and my prosthelytizing!
Either way, I think we are very much on the same page, and thank you for the kind words - I do intend to make medicine/science my career once I finish my degree. It's not easy going back after so many years, though, that's for sure!

As far as the 'divide and conquer' strategy, I have no doubt you're right. It might be motivated by some sort of sociological aim, but I think it's far more likely that it creates a dependant class, which is what our debt based money system requires to expand exponentially. Without it, people can't be counted on to take risky loans, or be foolish with their earnings in general. An entitlement class ensures that state governments are standing in front of the federal appropriations agents with their hands out. It doesn't pay to have people healthy, active and enjoying the fruits of life that are Donum Deus.

Breaking that cycle is going to take a fundemental shift in our society. I just can't imagine that it will happen without some sort of collapse. It's far too easy to 'plug in, tune out' with the amount of information we're inundated with on a daily basis. It's hard to care what your neighbors think, or what's going on in their lives when you only see them when you leave for work. It's not easy to plan a trip to the mountains when you can sit on your duff and watch TV. Apathy is easy. Until it's as easy to be involved (as it was in the past), people will continue to bury themselves in their digital caves and hibernate, becoming less attached and mentally involved with society.

At any rate, I'd sure like to see some critical thought given to these problems in the academic world, but I've been terribly disappointed with the strong emphasis on rote learning and little attention given to training our future scientists in the macro-scale critical thinking it takes to truly understand cause and effect. 

Cheers,

Aaron

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sand_puppy
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Lemon troubles

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!”

robie robinson's picture
robie robinson
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Sand Puppy

It would be funny if it weren't true.

But Alas,Robie

MarkM's picture
MarkM
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Priceless...

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

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AndyG
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Conflict of interest

Mots wrote:

...There is much more competition and also  less focus  on unnecessary but lucrative damaging invasive procedures than in the US...

...promotes/pushes questionable practices that do not  overall  improve health  for the people, but do create vast wealth  gathering for the  collective.  Surgury to remove prostate based on prostate antigen blood test results, blood vessel stent heart operations, drugs  to lower cholesterol  or blood pressure  instead  of at least trying diet, etc...

...I would like to see an overall summary of what medical service/biological problems are encountered by a population and the spectrum  of resources for addressing those.  An overview...

Thanks for clarifying, Mots. I clearly miss read you regarding 'collectivized' and what you meant. I agree with you comments [some quoted above]. The difficulty with medicine is that there is infinite demand. It's also a service where the 'consumer' has to rely on the 'salesman' to act in their best interests to a large extent...an interesting concept!

The problems occur when you have a conflict of interest: the doctor having a financial interest in how you are treated, rather than truly you 'advocate'. [We see the pernicious effects of that conflict in other walks of life - banking anyone?]. I think that is currently one of the strengths of the NHS I work for - I have no financial reward for suggesting one course of action over another to my patients. I sit and help them navigate the choices and system, with its strengths and many weaknesses. What they don't currently doubt is my motives!

You are right to highlight prostate tests as one area where there is room for over treatment, and thus do harm. For instance: if you take 80 yr old men who have died from other causes and check their prostate glands, 50% will have cancer of the prostate, which never did them any harm. Only around 10% of men who develop prostate cancer died from the disease. Surgery/radiotherapy isn't without risks: death; incontinence; loss of sexual function etc.

Its difficult to give a 'summary of what medical service/biological problems are encountered by a population and the spectrum  of resources for addressing those.' As with the Lemon Chronicles above, we are all to often 'sold' medicines [and other products] which we don't really need and are harmful if for no other reason than the opportunity costs involved. I have no doubts Big Pharma is really just a business like anyother - there to make a profit for the shareholders. Pushing the boundaries where necessary [or going beyond if they think they can get away with it]. I am far more cynical than I was 20 years ago...

This means conditions which are chronic are often most profitable, and 'cures' less profitable. Conditions in the poorer parts of the world [thus can't afford expensive treatments] are neglected, such a malaria, filariasis, schistosomiasis etc. Time and time again it is shown that they only report 'positive' trials, rather than negative ones, which skew the data and evidence in their medications favour. There is a big drive over here to enasure all trials of any medication be logged on a database so all results are known, not just the ones they want you to see.

I do have some sympathy with Pharmacy companies though. It costs a few hundred million now to take a new medications from lab to patients and profits. Many fall at the last hurdle. I remember [no reference sorry] reading about the production of penicillin in America and the President of the time asking why they were being charged so much for something that cost only 6 cents to produce. 'well, Mr President, the first tablet cost $1million'. We do want Pharmacy companies to be viable... I think.

Nervous Nelly's picture
Nervous Nelly
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Lemons?

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

Arthur Robey's picture
Arthur Robey
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Hi NN.

Youv'e lost the thread. You need to back to my comment.

Nervous Nelly's picture
Nervous Nelly
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I'd like to add my two cents on mental heath.

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.

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VeganD
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Nelly I agree with

Nelly

I agree with you-mindfulness practice through Cheri Huber has been so important to me I am starting to buy my patients her meditation books. I have a tough time explaining this to tough guys but I am more capable of sharing this wisdom with women for some reason.

VeganD's picture
VeganD
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Two more titles on mindfulness

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

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