probably need some sort of chemical treatment involving powerful psychotropic drugs.
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior.[1] These substances may be used recreationally, to purposefully alter one's consciousness, as entheogens, for ritual, spiritual, and/or shamanic purposes, as a tool for studying or augmenting the mind, or therapeutically as medication.
Psychoactive drugs are divided into three groups according to their pharmacological effects:[13]
Stimulants ("uppers"). This category comprises substances that wake one up,....
Examples: coffee, tobacco, amphetamine, tea, cacao, guarana, mate, ephedra, khat, and coca.
Depressants ("downers"), including sedatives, hypnotics, and narcotics. This category includes all of the calmative, sleep-inducing, anxiety-reducing, anesthetizing substances, which sometimes induce perceptual changes, such as dream images, and also often evoke feelings of euphoria.
Examples: opioids, barbiturates, benzodiazepines, and alcohol. Hallucinogens, including psychedelics, dissociatives and deliriants. This category encompasses all those substances that produce distinct alterations in perception, sensation of space and time, and emotional states.
Examples: psilocybin, LSD, Salvia divinorum, marijuana and nitrous oxide.
: Psychiatric medications
Zoloft (sertraline) is an SSRI antidepressant.
Psychiatric medications are prescribed for the management of mental and emotional disorders. There are six major classes of psychiatric medications:
Antidepressants, which are used to treat disparate disorders such as clinical depression, dysthymia, anxiety, eating disorders and borderline personality disorder.[19]
Stimulants, which are used to treat disorders such as attention deficit disorder and narcolepsy and to suppress the appetite.
Antipsychotics, which are used to treat psychosis, schizophrenia and mania.
Mood stabilizers, which are used to treat bipolar disorder and schizoaffective disorder.
Anxiolytics, which are used to treat anxiety disorders.
Depressants, which are used as hypnotics, sedatives, and anesthetics
The history of sertraline dates back to the early 1970s, when Pfizer chemist Reinhard Sarges invented a novel series of psychoactive compounds based on the structures of neuroleptics chlorprothixene and thiothixene.[162][163] Further work on these compounds led to tametraline, a norepinephrine and weaker dopamine reuptake inhibitor. Development of tametraline was soon stopped because of undesired stimulant effects observed in animals.
Sertraline was approved by the U.S. Food and Drug Administration (FDA) in 1991 based on the recommendation of the Psychopharmacological Drugs Advisory Committee; it had already become available in the United Kingdom the previous year.[166] The FDA committee achieved a consensus that sertraline was safe and effective for the treatment of major depression. During the discussion, Paul Leber, Director of the FDA Division of Neuropharmacological Drug Products, noted that granting approval was a "tough decision", since the treatment effect on outpatients with depression had been "modest to minimal". Other experts emphasized that the drug's effect on inpatients had not differed from placebo and criticized poor design of the trials by Pfizer.[167] For example, 40% of participants dropped out of the trials, significantly decreasing their validity.[168]
Until 2002, sertraline was only approved for use in adults ages 18 and over; that year, it was approved by the FDA for use in treating children aged 6 or older with severe obsessive-compulsive disorder (OCD). In 2003, the UK Medicines and Healthcare products Regulatory Agency issued a guidance that, apart from fluoxetine (Prozac), SSRIs are not suitable for the treatment of depression in patients under 18.[174][
In 1999, Zoloft came under great public scrutiny after it was discovered that Eric Harris, one of the two shooters involved in the Columbine High School massacre, had been taking the drug before switching to Luvox. Many[who?] immediately pointed fingers at sertraline and fluvoxamine.
Zoloft, was advertised to consumers by Pfizer using the following wording: "While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance. You just shouldn't have to feel this way anymore." An essay published in the journal PLoS Medicine noted that there is no scientific support for the "serotonin imbalance" theory of depression, and criticized Pfizer and manufacturers of other SSRIs for using it. When asked to comment on this apparent breach of federal regulations, the FDA answered that such "reductionist statements" are acceptable to explain the neurochemistry of depression "to the fraction of the public that functions at no higher than a 6th-grade reading level."[179] However, the FDA reacted promptly with a Warning Letter when a Zoloft advertisement omitted information about the risk of suicidal behavior...
Pfizer, Inc. (NYSE: PFE) (English pronunciation: /'fa?z?r/) is an American multinational pharmaceutical corporation. The company is based in New York City, New York with its research headquarters in Groton, Connecticut, United States.
Pfizer pleaded guilty in 2009 to the largest health care fraud in U.S. history and received the largest criminal penalty ever levied for illegal marketing of four of its drugs. Called a repeat offender, this was Pfizer's fourth such settlement with the U.S. Department of Justice in the previous ten years.[4][5] On January 26, 2009, Pfizer agreed to buy pharmaceutical giant Wyeth for US$68 billion, a deal financed with cash, shares and loans.[6] The deal was completed on October 15, 2009.[7]
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Economic influences on psychiatric practice
American Psychiatric Association president Steven S. Sharfstein has stated that when the profit motive of pharmaceutical companies and human good are aligned, that the results are mutually beneficial and that "Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists."
However, too often "[t]he practice of psychiatry and the pharmaceutical industry have different goals and abide by different ethics." He states a number of concerns exascerbating this situation which he suggests require remedying, including:[21]
that the psychiatric profession has allowed the biopsychosocial model to become entirely dominated by biological factors;
a "broken health care system" that allows "many patients [to be] prescribed the wrong drugs or drugs they don't need";
"medical education opportunities sponsored by pharmaceutical companies [that] are often biased toward one product or another";
"[d]irect marketing to consumers [that] also leads to increased demand for medications and inflates expectations about the benefits of medications";
drug company gifts to doctors, that have become sufficiently problematical as to warrant legislative constraints; and
"drug companies [paying] physicians to allow company reps to sit in on patient sessions allegedly to learn more about care for patients and then advise the doctor on appropriate prescribing."
Nevertheless, Sharfstein concluded that "[a]s psychiatrists, we should all be grateful for the modern pharmacopia and the promise of even more improvements in the future."[21]
Economic motives are not necessarily limited to pharmaceutical treatments; those providing other forms of treatment may also have economic motives.
[edit] Pharmaceutical industry influence on the psychiatric profession
Studies have shown that medical students and residents are susceptible to undue influence from pharmaceutical companies due to the companies involvement in medical school programs.[22]
Antidepressants have been shown to have only a minimal effect, over that of a placebo, on patients. In an analysis of the efficacy data submitted to the U.S. Food and Drug Administration for approval of the six most widely prescribed antidepressants approved between 1987 and 1999, it was found that
Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale. Improvement at the highest doses of medication was not different from improvement at the lowest doses. The proportion of the drug response duplicated by placebo was significantly greater with observed cases (OC) data than with last observation carried forward (LOCF) data. If drug and placebo effects are additive, the pharmacological effects of antidepressants are clinically negligible. If they are not additive, alternative experimental designs are needed for the evaluation of antidepressants.[23]
In an essay on advertisements for anti-depressants published in PLoS Medicine, social work academic Jeffrey Lacasse and neuroanatomist Jonathan Leo state that, despite this, the chemical imbalance theory is promoted by the medical industry as an explanation to depression and that their medicines correct the chemical imbalance. They also state that there is some evidence that both patients and professionals are influenced by the advertisements and patients may get prescribed medicines when other interventions are more suitable.[24]
In a further article they state that chemical imbalance has also been cited in media as an important cause of depression despite a lack of scientific literature that shows this causality.[25]
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Big Pharma and American Psychiatry: The Good, the Bad, and the Ugly
APA's annual meeting is one of the largest medical meetings in the United States and the largest psychiatric meeting in the world. There is something for everyone at our wonderful meeting, but many have commented to me on the extraordinary presence of the pharmaceutical industry throughout the scientific programs and on the exhibit floor.
The U.S. pharmaceutical industry is one of the most profitable industries in the history of the world, averaging a return of 17 percent on revenue over the last quarter century. Drug costs have been the most rapidly rising element in health care spending in recent years. Antidepressant medications rank third in pharmaceutical sales worldwide, with $13.4 billion in sales last year alone. This represents 4.2 percent of all pharmaceutical sales globally. Antipsychotic medications generated $6.5 billion in revenue.
When the profit motive and human good are aligned, it is a“ win-win” situation. Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients. The proven effectiveness of antidepressant, mood-stabilizing, and antipsychotic medications has helped sensitize the public to the reality of mental illness and taught them that treatment works. In this way, Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists. My comments that follow on the pharmaceutical industry and its relationship to psychiatry bear this in mind.
The interests of Big Pharma and psychiatry, however, are often not aligned. The practice of psychiatry and the pharmaceutical industry have different goals and abide by different ethics. Big Pharma is a business, governed by the motive of selling products and making money. The profession of psychiatry aims to provide the highest quality of psychiatric care to persons who suffer from psychiatric conditions. There is widespread concern of the over-medicalization of mental disorders and the overuse of medications. Financial incentives and managed care have contributed to the notion of a “quick fix” by taking a pill and reducing the emphasis on psychotherapy and psychosocial treatments. There is much evidence that there is less psychotherapy provided by psychiatrists than 10 years ago. This is true despite the strong evidence base that many psychotherapies are effective used alone or in combination with medications.
In my last column, I shared with you my experience, and APA's, in responding to the antipsychiatry remarks that Tom Cruise made earlier this summer as he publicized his new movie in a succession of media interviews. One of the charges against psychiatry that was discussed in the resultant media coverage is that many patients are being prescribed the wrong drugs or drugs they don't need. These charges are true, but it is not psychiatry's fault—it is the fault of the broken health care system that the United States appears to be willing to endure. As we address these Big Pharma issues, we must examine the fact that as a profession, we have allowed the biopsychosocial model to become the bio-bio-bio model. In a time of economic constraint, a “pill and an appointment” has dominated treatment. We must work hard to end this situation and get involved in advocacy to reform our health care system from the bottom up.
Furthermore, continuing medical education opportunities sponsored by pharmaceutical companies are often biased toward one product or another, and they are more akin to marketing than CME. APA has strict guidelines for the industry-sponsored symposia presented at our annual meetings; sanctions are applied when our rules are broken. Our guidelines have been held up as a standard for medical meetings in other specialties throughout the country. But there are many grand rounds, evening dinners, and lectures where such standards do not prevail.
Direct marketing to consumers also leads to increased demand for medications and inflates expectations about the benefits of medications. As a profession, we need to be concerned about advertising and the impact it has on the over-medicalization of our field. Of course, what is marketed to consumers are the highest-cost, on-patent products, and the cost of medications is something rarely considered by prescribing clinicians. When doctors don't prescribe cheaper but equally effective drugs, it consumes money that could have been used to provide other psychiatric or medical services.
There are examples of the “ugly” practices that undermine the credibility of our profession. Drug company representatives will be the first to say that it is the doctors who request the fancy dinners, cruises, tickets to athletic events, and so on. But can we really be surprised that several states have passed laws to force disclosure of these gifts? So-called“ preceptorships” are another example of the “ugly”; that is, drug companies who pay physicians to allow company reps to sit in on patient sessions allegedly to learn more about care for patients and then advise the doctor on appropriate prescribing.
Drug company representatives bearing gifts are frequent visitors to psychiatrists' offices and consulting rooms. We should have the wisdom and distance to call these gifts what they are—kickbacks and bribes. (For more thoughts on this topic, see Viewpoints on page 33.) If we are seen as mere pill pushers and employees of the pharmaceutical industry, our credibility as a profession is compromised.
Here are several suggestions for remedies in our relationship with the industry.
•
We need to embrace a new professional ethic. The doctor-patient relationship should not be a market-driven phenomenon.
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Preceptorships should be considered unethical.
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Enticements, gifts, parties, and so on should be reined in because patients must believe that their doctor has their best interests in mind when a prescription is handed to them.
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We must re-evaluate single-sponsored medical education events and phase them out in favor of more general support for CME along with a careful policing of these events for bias.
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The amount and support received by individual clinicians and researchers from industry should be transparent and the information readily available.
•
When we attend lectures at annual meetings and other educational events, and read journals and textbooks, we should know very clearly about the industry support given to presenters and authors.
As psychiatrists, we should all be grateful for the modern pharmacopia and the promise of even more improvements in the future. At the same time, however, we must be very mindful that we cannot accept gratuities in the new medical marketplace. ?
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