In a move certain to create controversy, the American Psychiatric Association has voted to include bereavement in the definition of major depressive disorder, or MDD, that will be contained in the upcoming version of the Diagnostic and Statistical Manual of Mental Disorders, which will be known as the DSM-5, T
he Washington Post writes.
The decision is significant because the manual is widely considered to be a biblical-like reference tool for psychiatrists and by eliminating the so-called bereavement exclusion - which appeared in the last DSM that was published in 1994 - the APA may generate what some experts contend could be inappropriate diagnoses and treatment (back story).
When the possibility arose last year, The Lancet wrote an editorial noting this would mean "that feelings of deep sadness, loss, sleeplessness, crying, inability to concentrate, tiredness, and no appetite, which continue for more than two weeks after the death of a loved one, could be diagnosed as depression, rather than as a normal grief reaction."
Such diagnoses could also boost the sale of antidepressants and the Post points out that the upcoming change in the DSM-5 was developed, "in large part, by people affiliated with the pharmaceutical industry," which helps fund the APA. Moreover, most of the experts on the committee that drafted the new guideline have either ties to pharma.
Eight of 11 members of the APA committee reported financial connections to drugmakers, the Post reports, in the form of speaking or consulting fees, research grants or stock holdings, according to the disclosures filed with the APA. Six reported financial ties during the time that the committee met, and two more reported financial ties in the five years leading up to the committee assignment, according to APA records, the Post writes. In addition, the paper adds that Sidney Zisook, a psychiatrist at the University of California, San Diego, and a key adviser to the committee, was the lead author of a 2001 study that found the Wellbutrin antidepressant could be used to treat bereavement. Glaxo, which sponsored the study, markets the Wellbutrin and Paxil antidepressants (see this).
As noted last year, he has received honoraria from Glaxo (GSK) and AstraZeneca (AZN), which sells Seroquel, an antipsychotic that is approved for adjunctive treatment of MDD, although he tells the Post that work preceded his involvement in the DSM-5 guidelines.
Such conflicts are not surprising. A paper published last year in PLos Medicine noted that 69 percent of the DSM-5 task force members have ties to drugmakers, which is up from 57 percent of the DSM-IV task force members. The paper also found gaps in the APA disclosure policy of DSM committee members (back story).
As we wrote at the time, 67 percent of the panel for mood disorders, 83 percent of the panel for psychotic disorders and all of the panel for sleep and wake disorders have ties to drugmakers that sell meds for treating these disorders or companies that somehow service the industry.
“It’s not that this is a Machiavellian plot by the pharmaceutical industry,” Lisa Cosgrove, a research fellow at the Edmond J. Safra Center for Ethics at Harvard University and a psychology professor at the University of Massachusetts, tells the Post.
“But when you have so many of these industry relationships on a committee, it creates a pro-industry bias that compromises their ability to be objective,” she adds. Cosgrove was a co-author of the PLoS Medicine paper that last year criticized the APA.
APA ceo James Scully Jr. tells the Post that the organization took steps to reduce conflicts as part of its preparation for the DSM-5. The APA, for instance, required that panel members regularly file disclosures and placed limits on their financial connections to drugmakers, the Post writes.
Each committee member was allowed to receive up to a $10,000 in annual income from drugmakers, hold as much as $50,000 in stock and receive unlimited amounts of money to conduct research. He maintains that, if no financial ties were permitted, many qualified psychiatrists would be excluded because many university studies are funded by pharma, according to the Post.
However, the Post notes that a survey of academic researchers found that 36 percent of full professors at medical schools report no financial connections to pharma in the previous year.
unhappy pic thx to ron bennetts on flickr
80 Comments
How can a person heal from the loss of a loved one, except by going through a period of sadness? Medicating those in bereavement may mean these individuals never really heal from their loss.
How truly shameful.
The reality is that there is no shortage of other life experiences, transitions, etc. that may trigger (or seem to trigger) the same essential patterns. To isolate those _experiences_ in a diagnostic manual appears to serve treatment coverage more than anything else, although most shrinks would just use one of the depression codes anyway.
So I am still asking myself whom this really serves and what its function will be. Will be soon watch some version of the "low T" dude moping around, not because he's lost his cojanes, but because he's lost cousin John?
So, keep on writing those prescriptions, which for the most part, not long term effective. I have yet to see a psych. that runs out of one on one talk. If they are breathing, they will keep blabbering ad infinitum.
The sanctimony coming off this Industry's 'Ethics' is already enough to gag a goat off a garbage truck.
http://psychroaches.blogspot.com/2012/07/hospitals-report-only-1-of-patient-harm.html
http://psychroaches.blogspot.com/search/label/Medical%20Ethics (25 Ethical posts so far and counting)
An acquaintance of mine who stands five foot even and has been repeatedly poisoned by Psychiatrists for 30 of their 50 years now weighs 245lbs. Their kidneys have shut down twice and come within a hairsbreadth of killing them, twice. ER, life support, touch and go. Every time they’ve cleaned the filth out of their system some Quack has ordered them back onto it at home or be forced back onto it in another State Psychiatric Snake Pit.
My acquaintance just had a temporary Quack assigned them for a month, between regular Quacks.
And the new Quack told them in all candor, that the Quack wanted them back on the drugs even though the Quack Knew of the certainty of kidney failure and death, BECAUSE, my acquaintance just didn’t seem to be improving in life, and it would be better if they had one good year instead.
This is what 'Ethically' happens when Govt. empowers a Humanist POE with an MD in Collectivist Politics to do other people’s thinking for them.
“Look, you’re already used up and I need fresh, physically resilient/undamaged meat to research, so hurry up, die and get off my case load.”
And I wish we could could All get past the malaprop of referring to Psychiatric Neurotoxins as 'medications'. At best, they're drugs that cure Nothing, and can't even legally Claim to actually Cure anything, because in this instance the consumer might suffer a 'Relapse' of their Bereavement if they Ever chance to remember the 50 or 60 years they shared with their spouse and get misty eyed over it.
In the hundred of brand team meetings that I've attended at scores of pharma companies, the marketing people array themselves in fairly typical fashion along the ethical behavior spectrum. I believe they've actually been a bit better within the past two or three years, not because they're more principled, but because circumstances have made them more cautious. The numerous fines sustained by companies in recent years for off-label marketing, bribery and similar transgressions have also required them to enter into consent decrees and retain compliance officers. Then too, personnel downsizing in the last few years have made most of them more cautious.
During the same time I've seen that on many brand teams for psychiatric products, the overzealous plans will offer come from MDs in Medical Affairs and other functions that disdain marketing as something anyone can do. All the dysfunctional personal characteristics of MDs -- spoiled "my son the doctor" types who were never slapped down -- start to emerge.
Funny how the psych. docs remain silent as to the risk of suicide/homicide in the wake of the heart-wrenching Connecticut shooting of 20 little children - a risk seldom mentioned in the so-called "mainstream media."
Except mostly for JiM, the arguments here are divorced from the reality of how most cases of bereavement unwind. It may come as a surprise that shrinks will not be masquerading as grave diggers hoping to slip a few Prozacs in your purse on your way to the wake. In fact the vast majority of those who go through the normal self-limiting process of bereavement won't even think about seeing a shrink because they will get better on their own.
GET IT BUNKY?
It will only be the small minority of those with unresolved grief that will even think about seeking out a professional, and most of those can be helped with counseling and not drugs. Only a fraction of this small minority will go on to develop Major Depression and require drugs.
Time to get your panties out of a twist, ladies.
But I'm still left with the question of how to understand the benefit (to pharma or anyone else) of this DSM change. Given that shrinks can already code for major depression, and would likely do so in such cases anyway, who is actually profiting from this? Will it likely play out in DTC? "Consultancies"? Whispers in the wind? Primary care docs with too little time to actually listen to anyone? Or what?
How low does pharma have to go before you morons give your sophistry a rest?
#3 actually seems most likely to me--facilitating the already largely corrupt be more so.
Now, start lining up below and identify all of you that took the time to publically voice your concerns rather than in your usual overweening ex post facto mode.
I will be truly surprised if even one of you shows up.
Curious...
What I didn't quite get was that the guideline folks managed to remove the part of DSM that specifically emphasized an exception for bereavement reactions. Obviously, docs can still rx as they choose, but this was intended to provide at least a more differentiated understanding.
So the result of these changes is, I believe, a dumbing down of medical knowledge, and potential diagnosis and treatment. I believe it will negatively impact patient care, especially among the less experienced.
No, I was not aware of my chance to comment on the DSM V. But the article also makes clear that there was not trivial disagreement among those who created the guidelies, significantly associated with industry ties.
My revised Dx: It's a bad, bad thing.
Therefore the big payday will come when big pharma can milk the cow from underneath the PCP's rather than the shrinks, but how to do it?
Easy enough. Coincident with development of DSM V was development of ICD 11, which is much more widely used as a coding manual than the DSM, although the DSM gets all the press. If all goes according to our dastardly little plan pretty soon the all of the PCP's in America will be getting reimbursed for treating bereaved patients with antidepressants, all kosher under the heading of Prolonged Grief Disorder, courtesy of the friendly folks at the ICD 11 below.
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000121
If you want to engage in a shouting match, My caps keys works just fine too.
What part of Humanist POE don't You and your Ben Franklin Cohiba get?
My acquaintance would be LESS WORK AND BETTER OFF DEAD at age 51 thanks to YOUR industry's pushers, than if they just left my acquaintance alone, but unfortunately, after being Robbed of 20-30 IQ Points by YOUR industry's glib, fork tongued, "I have a State Mandated Check List I must follow to keep My butt from being Sued or Incarcerated" street runners, My acquaintance has to keep placing their Life in the hands of YOUR industry's Constitutional, and entry level research easily checkable facts impaired, Uber Scholars, . . . to remain qualified for a disability check, or Starve to death on the street to fire up Your Cohiba.
http://1boringoldman.com/index.php/2012/12/18/speaking-of-infringement/
I have tried to verify the identity of the Final commenter who told me I was way over the top today, just before the site's owner shut off the comments, but to no avail.
You're welcome to pick all the nits you want over How your Street Runners wind up bloodsucking the Bereaved and everybody else, but None of Your Industry's Psychiatric Poisons would ever have become the multi Billion Dollar Blockbusters they became without subterfuge, misdirection, and outright coercion.
And BTW, IF, that commenter wants their question Actually Answered:
http://www.federalobserver.com/wp-content/uploads/2012/12/121214.Israeli.school.kids_.jpg
8 children shot at school in 10 years in Israel, as opposed to almost 350 here in the US in 10 years.
That, is their purpose, Dr. Commenter, and Dr. Site Owner.
But YOUR Industry, OII, doesn't have Any Blame at all for these atrocities.
SSRISTORIES.com
66 School Shootings/Incidents Involving SSRIs
Most of the stories on this site describe events that occurred after the year 2000. The increase in online news material and the efficiency of search engines has greatly increased the ability to track stories. Even these 4,800+ documented stories only represent the tip of an iceberg since most stories do not make it into the media. There are 115 cases of bizarre behavior, 66 school shootings/incidents, 68 road rage tragedies, 19 air rage incidents, 101 arson cases, 70 postpartum depression cases, over 1,000 murders (homicides) or murder attempts, over 300 murder-suicides (30% committed by women) and other acts of violence including workplace violence on this site. There are also over 100 Journal Articles and FDA reports listed in the Index. They are at the top of the Index immediately below the 66 school shootings/incidents and the 29 "won" criminal cases.
But that’s OK, because the benefits outweigh the risks.
http://www.mirecc.va.gov/visn3/education.asp "Algorithms:
A review of existing algorithms, including VA National Guidelines, APA, the Texas Medication Algorithm Project (TMAP), and PORT was conducted. After careful consideration, a modified version of TMAP was selected, and named the New Jersey Algorithm.
The sequence includes two trials of atypical antipsychotics followed by a Clozaril trial. If no favorable response is observed, a third atypical neuroleptic is tried, followed by a typical neuroleptic, followed by a combination of antipsychotic medications. The consensus of the internal advisory committee was to provide a flexible algorithm that will allow for minor modifications as new research is disseminated. Though a positive outcome has not been observed with the NJ Algorithm to date, researchers suspect that a larger sample size might generate significant findings in the future."
Well, It appears that the drugs really Are garbage and YOUR Industry's Street Runners Know it.
Hospitals Report less than 1% of Patient Harm Events.
That’s kind of a steep hill to defend when the issue is medical ethics.
'Grief' as a mental illness... Sick Joke.
"PCPS have traditionally not treated this patient.....We can change their paradigm."
Viva Zyprexa, baby!
(p.s. I'm sure doctoring people in mourning must be a major bummer. All that somatizing, interrupted sleep, distractedness, unsmiley faces....Pill 'em up, move 'em out!)
Prozac, Paxil, Effexor, Celexa, Zoloft, Wellbutrin - Care to estimate total pharma revenues? Hint - its pretty similar to what you will find in your couch cushions, as these are all generic drugs. The only antidepressants still generating significant amounts of revenue are Cymbalta, whose patent expires in 2013, and to a lesser extent Pristiq, which has already been the subject of a Paragraph IV filing. Total antidepressant sales currently amount to about 1% of industry revenues, and will fall much further in the coming year.
Zyprexa has been generic since 2011.
But where's the fun in ranting about psychiatrists?
Have you read the comments by Windbag and Jana earlier in this thread?
Zyprexa was very far from generic when Lilly worked to position it to replace their Prozac market. And they were very successful with that, even after being busted by DOJ for fraud and misrepresentation.
Also agree that motive is hard to track on this one, other than that it's a battle that has apparently been going on for a while. Are there no new antidepressants in the pipeline? Of course, we know that a range of other brand drugs--e.g., Abilify--are also used for depressed pts.
http://www.prweb.com/releases/2018-antidepressant-drugs/market-mdd-ocd-gad-pd/prweb10034006.htm
The headline, though is free: projected $13+B in sales by 2018 (up from 11B in 2011), with hope to expand indications, etc. Probably not chump change, even if spread around several companies.
According to the APA, there are 48,000 practicing psychiatrists in the US. At $175K per year, the aggregate income of these physicians, who are paid almost exclusively to prescribe psychotropic drugs (and are mostly not paid if they don't), is $8.4B.
Business owners in this $8.4B industry write treatment guidelines that are used to determine when their primary business activity, the prescribing of psychotropic drugs, will be reimbursed. Seems like an extraordinary conflict of interest to me, but all anyone on this thread seems to be able to do is wring their hands about how this wonderful system is being corrupted by the pharmaceutical industry.
The system was corrupt long before the pharmaceutical industry arrived on the scene, and will remain so as the most commonly used drugs go generic and pharma continues to de-emphasize psychiatric drugs.
Given the justifiable outrage against pharma among experienced people who work in the industry, I would ask what can be done to curb this organized crime that jeopardizes public health? Not a week goes by without several stories about routine violations such as off-label marketing, bribery (of prescribers, investigators or public officials), hiding/shading data and similar practices. Clearly pharma and the various medical specialties have relinquished all vestiges of the integrity needed for capitalism to work. This trend has continued during both Republican and Democratic administrations. I would like to see some suggestions from informed people whose bitterness reflects their disappointment with an industry they once respected.
"Take the gun leave the canoles".
Distributing blame in this case only serves to divert attention away from those who are overwhelmingly responsible for the situation, and to promote the myth that every problem in the practice of medicine in this country is traceable to pharma.
@ OII: Masters of brevity ehh?
After 9 Million pages of Pharma $COI-ed 'Research Must Continue' skewed, and misrepresented hogwash?
Here's your Brevity OII.
http://www.forteantimes.com/features/articles/3847/the_occult_world_of_cg_jung.html
The Apex of Psychiatric Sigh-entific Diagnosing acumen.
A Hitler Worshipping, Anti-Semite.
http://psychroaches.blogspot.com/2008/02/carl-jung-and-friends.html
Or maybe you'd prefer This self deluded idiot who thought that Socialism's desired outcome was great, but it's methods weren't.
http://www.lifecourseinstitute.com/Adler.htm
"Here we find reflections of Adler’s later concepts of Early Recollections, Fictional Final Goal, Compensation, Ideal Image, Inferiority, and Courage in Striving. But one of Adler’s childhood memories was not what it seemed to be. Sperber says:
As a six-year-old boy, [Adler] was gripped with a horrible fear on the way to and from school because he could not avoid going past a cemetery. This fear became more unbearable when he saw that other children who took the same route remained fearless and uninhibited. One day he decided to come earlier than usual and forced himself to climb back and forth over the cemetery wall, and so rid himself of his fear. Years later he met an old schoolmate who had lived in the neighborhood and taken the same path. Adler reminded him of the cemetery and spoke of his own fear of it. However, the schoolmate, a perfectly reliable witness, informed him that the cemetery had never existed and that the memory...was based on an occurrence which Adler had fabricated, not experienced. Adler returned to the spot and was forced to concede that his heroic deed had indeed been a fantasy. [Adler] continued to relate this story to his students in order to append the instructive epilogue. For from this self-deception he had drawn a multitude of conclusions. (Sperber, 1974, pp.14-15)"
Or maybe This coke fried atheist would be more to your ideations?
http://psychroaches.blogspot.com/2011/08/is-freud-really-dead.html
These are the Big 3 whose gibberish is what every other school of Super Sigh-ence is built on.
Atheists, Nazis and Communists.
It's unfortunate that Your Industry can't be more the 'Masters of Brevity' you've alluded to, but if they Did boil all of their intentionally misleading 'Safe and Effective' down into offhand one-liners, to sell their garbage, they'd be wearing handcuffs and orange jump-suits in a heartbeat.
There is also a mad utopian strain in psychiatry that it can use drugs to eradicate the scourges of unhappiness and trauma from human experience.
This is a purely biopsychiatric approach that does not appreciate the value of learning from even painful experience or existential angst.
Grief, in particular, is an emotional reorganization process where the individual prepares to let go in order to start anew.
original industry insider, if "depression" is increasing -- a highly debatable factoid -- it's in tandem with the expansion of its definition driven by pharma-sponsored psychiatry research and enshrined by the profession in DSM and other publications with an unfortunate influence on non-psychiatrist prescribers.
The propaganda was originally fueled by pharma money but is now its own industry -- the sorcerer's apprentice effect.
You'll do well to scrub the tautologies from your reasoning when it comes to defending overprescription of psychiatric drugs.
Altostrata I have also read my Anthony Burgess, and your delusions are taken straight from "A Clockwork Orange", where this very approach is used to "cure" Alex of his evil ways. Some lines below"
"In a few minutes you'll be meeting Dr Brodsky and you'll begin your treatment. You're a very lucky boy to have been chosen.
She inserts a needle into a medicine vial. "What's the hypo for then? Going to send me to sleep? Something like that, after each meal you'll get a shot."
"What is the treatment here going to be then? It's quite simple really. We're just going to show you some films."
"And viddy films I would. I was bound up in a straightjacket and my guliver was strapped to a headrest with like wires running away from it. Then they clamped like lidlocks on my eyes so that I could not shut them no matter how hard I tried."
At the back of the auditorium are ten or fifteen solemn medical professionals in white coats occasionally taking notes.
VIOLENCE FILM IS SHOWED TO ALEC
Man being beaten by four toughs. Punches, kicks, groans, blood, screams. The sounds were real horroshow. Girl being beaten, raped by six toughs.
"When it cae to the sixth or seventh malachick, leering and smacking I began to feel really sick. But I could not shut my glazzies and could not get out of the line of this picture"
Dr Brodsky: "very soon the drug will cause the subject to experience a death like paralysis together with deep feelings of terror and helplessness...being like death, a sense of stifling and drowning, and it is during this period that the subject will make his most rewarding associations between his catastrophic experience and the violence he sees.
Alec: "Let me be sick.. I want to get up. get me something to be sick in.. STOP THE FILM... Please stop it! I can't stand it anymore. Stop it please...please".
Yes, Altostrata, just another example of modern day psychiatry turning a dystopian society into its own archetype.
And the "ism" that pulls them all together?
“When plunder becomes a way of life for a group of men,living together in society,they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it.”Frederic Bastiat, (1801-1850)
http://rt.com/news/oliver-stone-us-orwellian-022/
And another day without a "giant leap for mankind" from the legaltainment complex of The Patriot Act. And the crazies always go over the cliff - hoping for an "Adam Lanza Gun Control Law"?
Coping with the BOTTOM LINE - death - is definitely a CULTURAL affair so it becomes completely impossible to "classify" it into a system that is nothing if not utterly without "culture"?
"DEATH IS NOTHING AT ALL...
Death is nothing at all, I have only slipped away to the next room. I am I and you are you. Whatever we were to each other, We still are.
Call me by my old familiar name. Speak to me in the easy way you always used. Put no difference into your tone. Wear no forced air of solemnity or sorrow.
Laugh as we always laughed at the little jokes we enjoyed together. Let my name be the household word that it always was. Let it be spoken without the shadow of a ghost.
Life means all that it ever meant. All is well, nothing is lost, One brief moment and all will be as before.
How we shall laugh at the trouble of parting..... When we meet again."
Is everything a "anger" issue? If so, then give everybody the same medication. I think it is more complicated than that.
Make no mistake about it JiM, that is EXACTLY the accusation some of the above posters are leveling at this entire enterprise.
I think it is hard to untangle the motives from the system - meaning that the business model is totalitarian, it is ABSOLUTE, so even if there is "good faith", there is no way to deliver it.
Let me put it in another way, biopsychopharmacology is practiced in a culture of "greed is good" and/or used as a potential weapon, mano et mano. How can we be sure that the thought - "give everyone the same drug to *subdue* their anger" - is not going to be turned into action by idea-logs? History is replete with examples of nman's inhumanity against man - century after century.
However, it would NOT be that hard to PROVE that there is no such *plan*, would it?
And why is the *illegal* drug consumption so massively profitable? People self-medicating their way out of righteous *anger* because there is nothing that one person can do? Go catatonic or go masochist? Blue or red pill?
This whole field of neurobiology "science" has gone way beyond finding a "cure" for epilepsy.
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