Saturday, July 31, 2010

The obvious effects of antidepressants

Edward Shorter, in his book, Before Prozac, rues the fact that there has been no progress in the pharmacological treatment of mood disorders, since imipramine was introduced in the 1950s. He quotes from Ronald Kuhn, who discovered imipramine, and who "never used 'controlled double-blind studies' with 'placebo', 'standardised rating scales' or the statistical treatment of large numbers of patients". Instead, what Kuhn noticed was an "obvious effect" in improving vital depression in psychiatric patients that he tried it on. To use a quote, again from Kuhn in Shorter (2009), "The patients become generally livelier, their depressive whisper voices become louder, the patients appear more social, the yammering and crying come to an end."

As I pointed out in a previous post, how do we know that antidepressants aren't just placebos with side effects? What Kuhn may have "discovered" was merely the placebo effect.

Shorter thinks we may have "lost something" because today "Kuhn would be kicked out of the door at the FDA", by which he means imipramine would never have come onto the market without controlled trials to support it. As he says, what we've got at the moment is a "mesh of patent-protected remedies". I agree this isn't progress, but Kuhn may have merely sent us down the route of the wish-fullfilling phantasy of the chemical cure of depression.

Tuesday, July 20, 2010

Academic freedom for critical psychiatry

As a follow-up to my post on Why haven't professors of psychiatry used their tenure to go up against the system that we’re in?, I suppose Thomas Szasz is the exception that makes the rule. There's a tweet that agrees with me. I guess Szasz has been lucky to have tenure.

The best article that explained what happened to Szasz when his tenure was threatened is by Ronald Leifer. Perhaps I'm just jealous that I've had to carry on in the real world of psychiatric practice and not had the freedom of tenure like Szasz, still going aged 90.

Am I a bromide?

Now Nassir Ghaemi has called me a "bromidic anti-biological critic". I have reviewed his book The rise and fall of the biopsychosocial model, which I mentioned in a previous post. He has replied to my review and I have responded to his comments.

I can understand him being upset about my views about his book. But I have gone on at length about the misunderstanding of saying that critical psychiatry is anti-biological (eg. see another previous post). By the way, bromides were used as sedatives in psychiatric hospitals in the past.

And I don't think critical psychiatry is bromidic in the sense of being conformist to majority opinion. Maybe I should be happy to be bromidic in the adapted words of the song from South Pacific:-

Wonderful critical psychiatry

I expect everyone
of my crowd to make fun
of my proud protestations for critical psychiatry.
And they'll say I'm naive
as a babe to believe
that the fables of psychiatry will be exposed.
Fearlessly, I'll face them and argue their doubts away.
Loudly, I'll sing about flowers in spring.
Flatly, I'll stand on my little flat feet and say....
Critical psychiatry... is a grand and a beautiful thing.
I'm not ashamed to reveal,
the world famous feeling I feel.
I'm as corny as Kansas in August,
I'm as normal as blueberry pie,
no more a smart little guy with no heart,
I have found me a wonderful cause.
I am in a conventional dither,
with a conventional star in my eye.
And you will note there's a lump in my throat,
when I speak of that wonderful cause.
I'm as trite and as gay as a daisy in May
a cliché coming true,
I'm bromidic and bright as a moon
happy night pouring light on the dew.
I'm as corny as Kansas in August,
high as the flag on the 4th of July.
If you'll excuse an expression I use...
I'm committed, I'm committed, I'm committed,
I'm committed, I'm committed, I'm committed to a wonderful cause!
(interlude)
I'm as trite and gay as a daisy in May
a cliche' coming true.
I'm bromidic and bright as a moon
happy night pouring light on the dew.
I'm as corny as Kansas in August,
high as the flag on the 4th of July.
If you'll excuse an expression I use...
I'm committed (13x) to a wonderful cause!

(To the music of "A wonderful guy" from South Pacific)