Linda Comac's Blog: When the Mental Health System Fails

Confirming what I wrote in my post of December 16th, a study published in the "Annals of Internal Medicine" On Nov. 24, 2020, reveals that physicians' prescribing practices are influenced by pharmaceutical companies payments. The study is discussed in today's "Mad in America" weekly newsletter --"Pharmaceutical Industry Payments Influence Physician Prescribing Decisions, Study Finds" Here's a link to the article
https://www.madinamerica.com/2020/12/...

The number of prescriptions for antidepressants keeps increasing--36 million prescriptions for antidepressants were written in in 2008 and 70.9 million in 2018. Are these drugs always written with no other thought than the interests of the patient? Maybe not.

It all started with chlorpromazine (widely known as Thorazine), synthesized in December 1951 in laboratories in France. In 1952, Smith Kline purchased the rights to chlorpromazine and began marketing it as an anti-vomiting treatment while the company attempted to convince psychology departments and medical schools to test the drug as a treatment for mental illness. Eventually, Smith Kline convinced state governments that use of the drug would save them money since administering it would decrease the number of patients in mental institutions. In 1954, Thorazine received FDA approval and psychopharmacology was born.

The pharmaceutical industry soon recognized that psychiatry could be the goose that lay the golden egg and began to court psychiatrists and their professional organizations. In addition to a stream of free gifts and meals, drug companies offered hefty pay to psychiatrists to be consultants and speakers, and subsidized various professional conferences. More money was spent on psychiatrists than on physicians in any other specialty.

According to Dr. Robert Whitaker, author of three books on the practice of modern psychiatry, the psychiatric establishment has been selling “a false story.” It has promoted the notion that psychiatric medications fix chemical imbalances in the brain, “even though decades of research failed to corroborate this.” In fact, in 2019 a study published in BMJ Open reported that approximately 80% of the symptom improvement experienced in clinical trials of antidepressants is also observed in the placebo comparison group. Yet antidepressants are the most commonly prescribed form of drug with approximately one in ten Americans taking them.

Pharmaceutical companies’ antidepressant advertising campaign is helping to drive the increase in sales. Since patients can’t buy these drugs over the counter, it is obvious that the purpose of the ads is to initiate patient conversations with physicians. Is it, therefore, just coincidence that the proportion of the U.S. population receiving outpatient treatment for depression increased by more than 300 percent between 1987 and 1997? In 2005, the National Institutes of Health reported that “SSRI advertising has expanded the size of the antidepressant market, and SSRIs are now among the best-selling drugs in medical practice.” In the same year, an article in the Journal of the American Medical Association (JAMA) reported that “Patients' requests have a profound effect on physician prescribing in major depression” and “the medical marketplace is being shaped in a way that is advantageous to the pharmaceutical companies.”

Caveat emptor—“let the buyer beware.” Don’t take antidepressants just because a doctor prescribes them. Do the research. Make your own decision. Medication isn’t the only way to fight depressi

I’ve been unable to post for several months because of a bad arm injury that required surgery. Now that I can finally type with two hands…

My younger son suffered from depression and anxiety and was treated with one drug after another. Nothing helped. When he died from an accidental overdose of prescription drugs, I was not only devastated, but also furious at the mental health system that had relied on drugs to help him. In order to move on with life, I decided to write a book about my son’s experiences ("Broken: How the Broken Mental Health System Leads to Broken Lives and Broken Hearts," Amazon 2019). The research I did for the book taught me that dependence on antidepressants is misguided if not downright dangerous.
Evidence continues to mount that antidepressants are not an effective treatment, may increase the severity of the condition, and may even prove fatal.

The ineffectiveness of antidepressants is well documented. “Over a third of patients with major depressive disorder (MDD) do not have an adequate response to first-line antidepressant treatments,” as reported in the MDPI journal in June 2020. Similarly, the journal of the British Pharmacological Society reports, “…in the real‐world, antidepressants are only efficacious in 30%‐40% of depressed patients.” With this information in hand, it is not at all surprising that Joanna Moncrieff, MD, writes, “People should be informed that the story they have been told, implicitly or explicitly, about having an underlying chemical imbalance that drugs can correct is just that—a story—with very little evidence to back it up.” ("Mad in America," October 2020)

And when antidepressants do work, they are no more effective than a placebo. According to NIH, approximately 40 to 60 out of 100 people taking antidepressants notice an improvement in six to eight weeks. However, in that same time period, 20 to 40 of every 100 people taking a placebo also notice an improvement in symptoms. Further evidence of this phenomenon was reported in the journal "Frontiers in Psychiatry" in June 2019 “… data are consistent in showing that most (if not all) of the benefits of antidepressants in the treatment of depression and anxiety are due to the placebo response.”

Studies also demonstrate that antidepressants can actually worsen the symptoms they are designed to eradicate. John Horgan, director of the Center for Science Writings at the Stevens Institute of Technology, considered this issue in “Are Psychiatric Medications Making Us Sicker.” “A multi-nation report by the World Health Organization in 1998 associated long-term antidepressant usage with a higher rather than a lower risk of long-term depression.” In September 2017, a study conducted by Jeffrey Vittengl at Truman University and published in "Psychotherapy and Psychosomatics" indicated that patients who had taken antidepressants for nine years displayed more severe depression symptoms. According to the 2020 book "Advances in Neuropharmacology Drugs and Therapeutics," “The use of antidepressant drugs for the period greater than 3 years increased the risk of suicidality in the prescribed patients.” No wonder the "Journal of Clinical Psychiatry" has published at least four studies that looked at worsening suicidal ideation during antidepressant treatment (https://www.psychiatrist.com/JCP/arti...).

The dangers of worsening symptoms may not be the worst outcome of antidepressant use. In 2017, researchers at a public research university in Canada reviewed studies involving hundreds of thousands of people and reported that antidepressant users have a 14 percent higher risk of cardiovascular events such as strokes and heart attacks and a 33 percent higher chance of death than non-users. A 2018 study published in "BMC Medicine" looked at 238,963 patients aged 20–64 being treated with a variety of antidepressant medications. It was reported that mortality rates were significantly increased with all classes of antidepressants compared with non-use.

This information is all readily available, and yet In 2019, antidepressant drug sales amounted to $14.3 billion. Have pharmaceutical companies purposely misleading the public? To be continued...

My book "Broken: How the broken mental health care system leads to broken lives and broken hearts" was motivated by my younger son's accidental prescription drug overdose. Both anecdotal and research data on mental health practitioners' overdependance on drugs are presented. Additional data reveals how Big Pharma often "fudges" test results to make the drugs appear more efficacious and less dangerous than they are. The falsification of mental health research doesn't stop there.
A research study in the August 20 edition of the "Journal of Clinical Epidemiology" analyzed clinical trials of psychotherapy. The journal article reveals that a staggering 94% of the clinical trials studied "spun" the results, making the treatments appear more helpful than they were.
Remember these words: “Parents, families, and caregivers are a 'minority' group in the mental health system. This population is hungry for knowledge, direction, and peace of mind. The first step toward these things is embracing truth about our 'fallen' mental health system” ― Tamara Hill, MS,

Although this is not directly a mental health issue, it is certainly an issue that is causing me (and I suspect many of you) deep distress. The current controversy over taking down statues of Confederate heroes and images of the Confederate flag has now turned to the old TV show Dukes of Hazzard"--odd to begin with since reruns were already removed from the air back in 215.
Are we to delete (or even burn) any and all period pieces because they include practices we now find abhorrent? In June, HBO Max temporarily removed from its collection the 1939 movie ‘Gone with the Wind’." Will the book be removed from libraries? An awful lot of films/books about the Holocaust would fall into the same category. The value of such pieces is to teach/show behaviors that are wrong and should not be permitted. Perhaps adding disclaimers would be helpful if the objectionable behavior is not clearly rejected in the story.
George Orwell, of course, said it better in "1984"-- “Every record has been destroyed or falsified, every book rewritten, every picture has been repainted, every statue and street building has been renamed, every date has been altered. And the process is continuing day by day and minute by minute. History has stopped, it ceases to exist. Nothing exists except an endless present in which the Party is always right and there are no exceptions.”

My younger son died in January 2015 following a lifelong battle with depression and anxiety. Twenty-five months later, the love of my life died from metastatic kidney cancer. So many of us have lost loved ones to cancer, heart disease, and diabetes. Fewer people have lost loved ones to mental health issues. We may, therefore wonder how important it is to use limited resources to provide good mental health care. We should be aware that mental health issues and substance use disorders are actually the leading cause of disability in the world. The most recent study of the global burden of disease was conducted in 2013 and revealed that the total number of years lost to illness, disability, or premature death (DALYs) due to mental and behavioral disorders was even larger than the disease burden caused by cancer and tumors. In addition, in 2018, suicide was the 10th leading cause of death in the U.S.: 48,344 died by suicide and there were 1.4 million suicide attempts. And yet, an estimated 56% of Americans don’t get the help they need for a variety of reasons:

• Shame and the fear of stigma prevent many from seeking treatment. As one researcher put it, patients may “attempt to distance themselves from the labels that mark them for social exclusion.”
• There is a woeful lack of trained mental health professionals. More than 115 million Americans live in areas that have been designated “Health Professional Shortage Areas,” areas having fewer than 1 mental health professional per 30,000 people.
• Treatment is exceedingly expensive. The average cost of treatment for depression is $6,990 for 8.4 days; for drug use disorder treatment, $4,591 for 5.2 days; for alcohol use disorder treatment, $5,908 for 6.2 days. No wonder 50 percent of those surveyed said they couldn’t afford mental health care, and an additional 15 percent said that their health insurance didn’t cover it or didn’t cover enough.
• People insured by Medicaid are often not insured for in-patient treatment. If the in-patient facility has more than 16 beds, patients under the age of 65 and not covered by Medicaid.

Does any of this matter to you if no one you care about is affected by a mental health disorder? Indeed it does. The personal, social and economic costs to all of us are enormous:

• Untreated mental illnesses in the U.S. costs more than $100 billion a year in lost productivity
• Those who cannot afford treatment often go to emergency rooms when they are in crisis. Emergency room care of the mentally ill causes backups that mean other patients have long waits.
• Domestic problems result from untreated mental health issues. Family members suffer severe emotional distress which can lead to physical and/or emotional abuse. Schools need more special education classes. Courts and jails must deal with an increased number of offenders.

Once we understand the problem, how can be a force for change?

• Advocate to extend Medicaid coverage for in-patient treatment, to increase the number of trained professionals and for government negotiation of prescription drug prices as in other countries
• Work to eliminate the stigma associated with mental illnesses, including substance abuse
• Be sure to listen to those who are experiencing difficulties. Empathetic listening is considered one of the most effective tools in a mental health crisis.

The purpose of this blog is to discuss mental health issues. Discussing the current state of race relations in the USA may seem unrelated to mental health, but it is definitely an issue affecting my mental health. The protests, riots, discussions and reactions have left me feeling depressed and very anxious about the future of the USA.

I keep asking how it is possible for fear and hatred of a person’s skin color to exist in the modern world. How is it possible that thousands upon thousands of Americans have begun their lives in the care of black women—nurses, nannies, babysitters—yet so many of us remain silent (or worse) as black women and their families lose their lives to poverty, disease and murder. How is it possible that thousands upon thousands of Americans have entrusted the care of their frail and aging parents to black caregivers, yet fail to protect the families of those black women?

Black women usher us into this life and out of it, yet thousands of Americans fail to offer them the respect, dignity and security they deserve and are entitled to. We trust them to care for our babies, parents, and grandparents but fail to pay them a living wage to do so. They are, indeed essential workers who must be recognized for the critical role they play in American society.

Black women labor to keep our babies safe, to keep our old people comfortable, to keep our homes livable. Meanwhile legions of black men fight our fires, protect our streets, drive our buses, deliver our packages and mail. Yet these essential men are murdered in the streets.

I am saddened and depressed over the senseless loss of life. I am anxious because it’s hard to know what I can do to help. I know what I plan to do and I entreat others to join me:
• Listen to what members of the black community say they need. Speak to anyone you can reach who can help accomplish those things.
• Speak up and out against anyone who promotes bigotry—even in jokes
• Advocate in your community for a policy against excessive of force by police, for the mandatory use of body cameras when police accost citizens, and for independent review boards comprised of police and citizens from diverse backgrounds
• Work to ensure that black and other minority educators are included in the staff of schools that minority children attend.
• Donate to groups that are working to ensure voting rights for black citizens.
• Become active in groups that lobby for racial justice.
Let’s start right now:
Smile on your brother
Everybody get together
Try to love one another
Right now

As Mental Health Awareness Month ends, we should remember how important it is to raise awareness:
• 48,344 Americans died by suicide in 2020
• 50% of all lifetime cases of mental illness begin by age 15
• Approximately 1 in 5 adults (20%) experience a mental health issue each year
• Suicide deaths and attempts cost approximately $69 billion in combined work-loss and medical costs
• Because of stigma related to mental problems, many people avoid obtaining treatment

Learn about mental illness, and look around you; if you see something that concerns you, reach out. Talk. Listen.