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Are antidepressants over-prescribed in Australia?

The British Medical Journal (BMJ) has just published two opposing views on the vexed question of whether antidepressants are being over-prescribed. The issues raised by debate are by no means unique to…

Antidepressant prescribing has been increasing in most developed countries since the the late 1980s and early 1990s. PrettyPills/Flickr

The British Medical Journal (BMJ) has just published two opposing views on the vexed question of whether antidepressants are being over-prescribed. The issues raised by debate are by no means unique to the United Kingdom; increasing rates of antidepressant prescribing are apparent in most developed countries, including Australia.

The BMJ discussion was precipitated by recent UK prescribing data, which reported a 9.6% increase in antidepressant prescriptions in 2011 – the largest increase in prescriptions of all medication classes for that year.

Arguing that the figures indicated over-prescribing, general practitioner Des Spence writes, “I think that we use antidepressants too easily, for too long, and that they are effective for few people (if at all)."

In the opposing camp, professor of psychiatry Ian Reid contends, “Given recent demonstrations that depression is still under-recognised and under-treated, the claim that antidepressants are over-prescribed needs careful consideration.”

Situation in Australia

A recent report on prescribing patterns of antidepressants and other psychotropic medications (drugs for mental illnesses) has aroused similar controversy in the local media. The study’s authors reported a 58.2% increase in the dispensing of psychotropic drugs over the period from 2000 to 2011, including a 95.3% increase in antidepressants.

Echoing the argument that antidepressants are being over-prescribed, the authors raised concern about “ … the dramatic increase in antidepressant prescriptions despite questions about the efficacy of these drugs in mild to moderate depression."

These recent UK and Australian data are not surprising; they are consistent with the major increase in antidepressant prescribing that’s been occurring in most developed countries since the introduction of the SSRI (selective serotonin reuptake inhibitor) antidepressants in the late 1980s and early 1990s.

An international trend

In 2000, my colleagues and I wrote one of the first major reports of this global trend. We found an approximately threefold increase in antidepressant prescribing in Australia from 1990 to 1998. The increase reflected what was occurring in most major Western countries and coincided with the widespread introduction of SSRI antidepressants such as Prozac, Zoloft, Aropax and Cipramil during that period.

In a another paper, we examined a longer timeframe (1975 to 2002) finding a 1.1% annual increase in antidepressant prescribing from 1975 to 1990, an acceleration to 29% in 1995, then a slowing down to 6.6% in 2002.

There’s no doubt there’s a continuing increase in the use of antidepressants in developed countries such as Australia and the UK, in the range of between 6% and 9% annually. The critical question, though, is whether this substantial increase in prescribing is justified at both a national public health and the individual clinical level.

Benefit or harm?

In Australia, we are able to look at the question of benefit or harm by examining national epidemiological and suicide data.

In terms of adequacy of depression treatment, a 2007 national survey found that 6.2% of individuals had experienced a mood disorder (mainly depression) over the prior 12 months, but over half (51.2%) did not access any services for mental health problems in that time. This indicates a substantial unmet treatment need for depression, rather than over-treatment.

It’s important to consider whether the increase in prescribing is justified at both a national public health and the individual clinical level. Erin DeMay

While it’s not possible to identify rates of antidepressant prescribing, as such, from the survey, the rate of use for psychological services was 23.2% for those with a mood disorder. This is a substantial increase from the 11.8% in an analogous 1997 survey, suggesting that doctors were readily utilising psychological services via Commonwealth-funded schemes such as Better Access.

Overall, these data do not indicate that there’s over-prescribing of antidepressants in Australia.

Antidepressants and suicide

A second potential measure of the value or otherwise of this increase in antidepressant use is its impact on suicide rates.

We examined this question in 2003, and found there was a significant correlation between changes in antidepressant prescribing rates from 1991 to 2000 and the rates of suicide. We also found that people in age and gender groups with increased rates of prescribing demonstrating lower suicide rates.

This same finding has also been reported in the United States and Scandinavia, indicating that greater rates of effective treatment for depression in a population have a significant impact on suicide.

We interpreted our findings broadly – that effective treatment of depression, whether by medication or psychological treatment can lead to a measurable benefit (here a fall in suicide rates), even at a whole population level.

Issues around effectiveness

Another issue raised in the BMJ debate is the current state of knowledge about the effectiveness of antidepressants for those with mild depression – the most common form in the community. Unfortunately, current evidence is inconsistent and dependent on the methodology used by researchers.

A highly publicised 2008 meta-analysis of published and unpublished antidepressant trials found that only those with severe levels of depression benefited more from antidepressants than a placebo.

But a recent report examining longitudinal data from individual patients in a series of large antidepressant trials found no relationship between likelihood of benefit from antidepressants and the initial severity of depression. In other words, patients benefited at similar rates independently of how severely depressed they were.

These inconsistent findings indicate the jury is still out on whether those with mild depression benefit from antidepressants.

What to make of it all?

So, where does this leave us in determining whether current rates of antidepressant prescribing are excessive? While rates of prescribing are undoubtedly increasing, data from national surveys suggest continuing high rates of untreated depression as well as increased use of psychological services. And, as discussed above, findings from a number of developed countries, including Australia, indicate the public health benefit of reduced suicide rates.

Still, we must remain vigilant in monitoring such prescribing and avoid mindless use of antidepressants, particularly for milder levels of depression where psychological treatments are probably more appropriate.

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner or in Australia, contact Lifeline 13 11 14 for support, beyondblue 1300 22 4636 or SANE Australia for information.

This is the sixth and final article in our short series on depression. Click on the links below to read the other articles:

Part one – Explainer: what is depression?

Part two – Treating depression ethically requires more than drugs

Part three – Predicting the risk of depressive disorder – promises and pitfalls

Part four - The science of interpreting common symbols in dreams

Part five – Genetic testing for depression creates an ethical minefield

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132 Comments sorted by

  1. phil k

    logged in via email @bigpond.com.au

    My local GP will try and get you on to anti-depressants for a whole range of issues ... from sports injuries , upset tummy, unhappy with your job, unhappy with your partner, being female... apparently there is nothing they can't fix.. and once your on them you have the perfect excuse for being narcissistic..and showing zero empathy to your family, friends and workmates.. and the best part is your workplace doesn't consider them to be a problem like other drugs .. they will happily let you carry on with your job.. and treat your workmates like crap.. and you can't be disciplined ..because your on the number one productivity enhancer for work place.. the HR nazis love them .. they mask people burning out.. and they stop them from showing any empathy for their fellow workers .. empathy that may be cultivated into some type of association for workers rights.. I wonder whether fighter pilots are allowed to fly armed missions while dosed up on anti- depressants ?

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    1. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to phil k

      This comment shows a severe misunderstanding of both mental health issues and anti-depressant medications.

      Perhaps you should do a little research before posting misinformed comments like this in future...

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    2. phil k

      logged in via email @bigpond.com.au

      In reply to William Bennett

      Thanks for the tip William.. You are correct , I am not a research fellow at a university, and I would really need to research anti depressants a lot more, before I would allow myself or any one I cared for to be weaned onto them. I attended university for 4 years, and carry my alumni card, if that somehow gives my "observations" some credibility. I can only "observe" my community turning into zombies, and ask individuals what medication they have been prescribed. Can I assume your judgement of my…

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    3. Tim Scanlon

      Debunker

      In reply to phil k

      So your defence for being bigoted toward those with mental illness is to say "well I do have a degree and I reckon they are all self absorbed idiots".

      The fact that you have completely dismissed a legitimate illness shows that you have no real "observations" to contribute as you have too many biases to be of any value. Thus you should spend more time understanding about mental illness and subsequent treatment methods and medications before commenting in public again.

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    4. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Scanlon

      Ouch ..Big Tim.. I NEVER said their wasn't a legitimate illness called mental illness. Don't be putting words in my mouth. Here , I will type it out, just for you .. I believe there is a legitimate illness known as mental illness.. My mention of university education was purely to indicate to William that I am in fact ,capable of research. I work in the brave new world of EAP's and the removal of workplace chaplains ..and the replacement of "personnel officers " with HR behavioural experts... who care not for the mental health of the employee ..but are paid on their KPI's to squeeze more productivity out of burnt out souls.. I have attended my workmates funerals and seen the breakdowns of men in their FIFO camps .. my observations are real .. and I definitely have seen healthy "normal"people offered these drugs for illness that was definitely not "mental "

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    5. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Scanlon

      Is it" mental' illness, when your workmate wants to fight you, because he isn't "allowed" to work more than 72 hours each week, because of "fatigue policy", so he can send the extra money home to his wife , who is on SSRI's to cope with the burnt out man that comes home 1 week in 4 or 5 or 6 ? But the drug screening at the workplace is only interested in amphetamines, opiates and cannabinoids, so they can see who is using "drugs" to cope, so SSRI's must be the answer ..surely ? But please call the Employee Assistance Program for a confidential assessment on this 1800 number if you or your family aren't coping ... or you see a workmate trying to harm himself ..or try to injure another worker with no apparent sense of "empathy"

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    6. Sue Ieraci

      Public hospital clinician

      In reply to phil k

      OK - I think I have understood Phil's argument:

      1. Bad workplace conditions and lack of flexibility/control make workers and their families feel "depressed."

      2. SOme of these people are treated with antidepressants without necessarily correcting the workplace issues.

      3. Phil finds this ironic, because workers are drug-tested for illegal drugs, but not for prescribed ones.

      4. Because of 1 - 3, Phil thinks that GPs use antidepressants for everything.

      Phil also thinks that pilots should not fly on antidepressants (which ones? Any of them?), that antidepressants mask burn-out and make people lose empathy for their work colleagues.

      Finally, Phil thinks there is an illness called "mental illness" (in fact, there are a large group of mental illnesses).

      So, if the GPs can't help fix the workplace issues, and the people don't want to or can;t attend a psychologist, should they try SSRIs to help adjust the low mood?

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    7. phil k

      logged in via email @bigpond.com.au

      In reply to Sue Ieraci

      Thanks Sue .. Points 1 and 2 are some of my "observations" ... Point 3.. well.. no .. I don't consider it "irony" at all.. I consider it criminally negligent and a failure to show" duty of care" by the employer... now point 4 .. Points 1 to 3 are not the reasons I " think " some GP's prescribe anti depressants .. I have physically observed GP's prescribing anti depressants for the ailments I listed originally... next ..the fighter pilot question... I did ask the question whether fighter pilots…

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    8. phil k

      logged in via email @bigpond.com.au

      In reply to phil k

      a little bit of research ala google fighter pilot,

      What action does the FAA take when pilots either disclose they are being treated for depression or request treatment?

      A pilot will be grounded until all symptoms of the psychiatric condition being treated are improved by the single medication and the pilot is stable for 12 months. The FAA requires:

      A consultation status report (and follow-up reports as required) from a treating psychiatrist attesting to and describing the pilot's diagnosis…

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    9. Sue Ieraci

      Public hospital clinician

      In reply to phil k

      Phil - your mesothelioma straw man is an inappropriate distraction - it was the medical discovery of the nature and cause of asbestos-related disease that has led to the restriction in use.

      With that strange analogy, would you seriously hold GPs accountable for fixing shift patterns and staff relationships in the workplace?

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    10. Addy

      logged in via Twitter

      In reply to phil k

      The FAA is the Federal Aviation Administration, which is the national aviation administration of the United States. The FAA regulates and oversees all aspects of civil aviation, which is non-military aviation.

      You have quoted directly from the FAA website (http://www.faa.gov/licenses_certificates/medical_certification/specialissuance/antidepressants/) and thus your comment that these regulations apply to 'fighter pilots' is erroneous.

      Regardless, I fail to see how any of this has relevance to the question of whether anti-depressants are over-prescribed in Australia.

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    11. phil k

      logged in via email @bigpond.com.au

      In reply to Addy

      Addy.I do apologise for distracting the conversation. The reference to "fighter pilots" was purely an example of the possibility that a prescriber of anti depressants could be placing more than just the patient at risk, if they prescribed the drug as the answer to a problem, without considering " all" possible causes and effects. I was accused earlier of lacking research. So, I "googled"," fighter pilot" and "anti depressants", and the US FAA document was the first response from the search engine…

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    12. phil k

      logged in via email @bigpond.com.au

      In reply to Sue Ieraci

      It would appear that any observation or fact I present that may remotely support the claim of over prescription would be considered inappropriate by you or any prescriber Sue. Accountable ?, that is a concept that would ultimately be decided by a judge, when a loss of life or property is presented in a court of law. I am held accountable for risk analysis in my job, so, I find it reasonable that a prescriber of drugs should be held accountable for their actions. I am fully aware that reason and accountability…

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    13. Pamela H.

      logged in via email @hotmail.com

      In reply to phil k

      In Australia drs prescribe them for just about everything as well. They are a mask. I've been offered antidepressants from several drs for things from tummy pain to menopause. It doesn't fix the problem, it just messes with your head. They also don't tell you about the horrific side effects, one of them is zero sleep. One woman told me that when she was on them she couldn't cry. It also prevents orgasm in many women. What sort of life is that, where you walk around like a feelingless zombie?

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    14. Pamela H.

      logged in via email @hotmail.com

      In reply to phil k

      Drs tell us they're not addictive, but they absolutely are. So much so that there are psychologists who specialise in helping people come off them. I had to wean myself off them over many months, with terrible side effects. Drs 'research' is only what they're told by Big Pharma, the makers of antidepressants. These days Big Pharma funds the training of Drs and runs their seminars, giving nice little kickbacks for promoting their products. It's all big business and nothing more.

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    15. Pamela H.

      logged in via email @hotmail.com

      In reply to Sue Ieraci

      It's not up to GPs to fix workplace issues. A GP's job is to recognise the problem with their patients and guide them to the correct treatments, not just send them all down the same path with anti depressants. I sometimes wonder if antidepressants weren't designed to create a robotic, non-complaining workforce for the machine.

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    16. Pamela H.

      logged in via email @hotmail.com

      In reply to Sue Ieraci

      It's not productive to deliberately pretend to misunderstand the point a person is trying to make. That's simply being antagonistic.

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    17. phil k

      logged in via email @bigpond.com.au

      In reply to Pamela H.

      Don't be too harsh on Sue , Pamela.. Those public hospital clinicians are over worked and under payed .. I have observed.. they do the best they can under the circumstances.. but could antagonism be a sign of a mood disorder ?

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    18. phil k

      logged in via email @bigpond.com.au

      In reply to Pamela H.

      I hope you have found a health care professional who has the time to find the cause for what ails you Pamela and doesn't use drugs as the first line of treatment.

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    19. Pamela H.

      logged in via email @hotmail.com

      In reply to phil k

      They all seem to be clock-watchers. They stand and hold the door open after ten minutes while you're still asking questions. They don't like questions.

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    20. Tanya Clark

      logged in via email @hotmail.com

      In reply to Pamela H.

      You're right, Pamela. And there seems to be 2 themes going. The people who've personally experienced the very real, very negative side effects (and/or seen what the drugs have done to others close to them), and those who vehemently defend anti-d's and have clinical studies to back up their stance. One camp describes reality. The other defends a study. There aren't many reports from users on this page where anti-d's were a great solution - quite the opposite. Maths is a powerful tool; statistics…

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    21. Kim Darcy

      Analyst

      In reply to phil k

      Phil

      "My local GP will try and get you on to anti-depressants for a whole range of issues ... from sports injuries , upset tummy, unhappy with your job, unhappy with your partner, being female"

      There are SOME (probably a tiny minority) who think they are the candyman, but if s/he is telling you that the sorts of antidepressants discussed in this article that "once your on them you have the perfect excuse for being narcissistic..and showing zero empathy to your family, friends and workmates", then your GP is not trying to flog you antidepressants, but more likely a PCP/crystal-meth cocktail. ;)

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    22. phil k

      logged in via email @bigpond.com.au

      In reply to Kim Darcy

      Thanks Kim, my local GP isn't the type to discuss side effects. I find the local chemist is more concerned that I am aware of any "down side" of prescription medication. The narcissism and empathy effects were my own personal observations of some individuals who claimed to be on " anti depressants". I am unable to prove what they may have been on , but definitely not, cannabis, opiates or amphetamines, apparently, as they were randomly tested using the saliva test. I haven't any experience with PCP/crystal-meth, so I would have to take your word for it. ... thanks for the candyman reference.... I can't get Tony Barber out of my head now :) "the candy man can 'cause he mixes it with love and makes the world taste good " ;) First it was john mills and The Black Eyed Peas.. now it's "who can make the sunrise "

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    23. Kim Darcy

      Analyst

      In reply to Sue Ieraci

      Sue, that was a cracking response. Just of the right side of respecting your interlocutor's argument, without being snippy, did him the courtesy of breaking his own argument down into a neat point by point cause/effect dynamic, and then gave him a gift by incorporating the REAL depression issue going on here - a horrendous workplace. While we might all share varying degrees of cynicism towards BigPharma, I'd be very surprised if Wellcome, Eli-Lily, etc, ever claimed that SSRIs would turn a huge hole…

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    24. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to phil k

      Lol, :) Sry Phil, I dont know what it is, but that song always brings a tear to my eye, no other song does that to me, and how goods the message, it should be the mental health theme song, great to write to whilst listening, so is the Maryanne Faithful one, but is a bit rude, http://www.youtube.com/watch?v=3mvAMEaWgTQ-- still it might get that other candy man out of your brain, heavy swear words warning, warning warning, ok, your call, emotion adrenalin, pump it up.

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    25. phil k

      logged in via email @bigpond.com.au

      In reply to john mills

      Yep .. Tony B has left the building .. thanks mate .. made me think about Marianne and Bowie and Mick and Keef.. and what they could add to this conversation.. they'd probably have a few " real" life observations to contribute ..

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    26. phil k

      logged in via email @bigpond.com.au

      In reply to Kim Darcy

      Thanks Kim,
      Indeed, the candyman (or woman) certainly has a lot of different lollies to hand out these days, food for thought, no doubt.
      The Hippocratic oath, now there is a blast from the past, does the candyman still need to swear that one these days, and to what "higher" authority ? Who is the god of the multinationals ? Mammon possibly ?
      It has been a very long time since the individuals I have observed, have shone a ray of sunshine ,sadly, but you would hope that at some time in their life the light was strong within them, but long before my association, I must say.
      I am familiar with the "fat drugs", so I don't believe that they alone, are the cause, but there is always the possibility of a cocktail.

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    27. Sue Ieraci

      Public hospital clinician

      In reply to Kim Darcy

      Kim Darcy - it's highly unlikely that GPs are treating psychotic illness or bipolar disorder without reference to a psychiatrist.

      "One behaviour that might lead a GP to reach for anti psychotic script pad is patient aggressiveness. " Again - this is highly unlikely - antipsychotics are not prescribed by GPs in the manner you suggest (except sometimes to help control the behaviour of aggressive old people with dementia).

      Have you ever had to manage a patient with severe psychotic illness? How did you make the diagnosis, and how did you decide on the best therapy?

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  2. Tim Outhred
    Tim Outhred is a Friend of The Conversation.

    PhD Candidate at University of Sydney

    Though we do not understand the mechanisms involved, the question whether antidepressants decrease suicidality seems to be associated with age.

    Another paper authored by Gibbons and colleagues (2012; http://archpsyc.jamanetwork.com/article.aspx?articleid=1151018#qundefined) reports that younger patients (under the age of 25) treated with antidepressants respond in terms of their depressive symptoms but not in terms of suicidality. Others (e.g., Stone et al., 2009; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725270

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  3. William Bennett

    Lecturer in Environmental Chemistry at Griffith University

    I think a really important issue being missed here is the prescription of SSRI anti-depressants for the treatment of anxiety disorders. Generalised anxiety disorder, panic disorders, OCD, PTSD etc can have severe impacts on a person's life and SSRI medications have been shown to be very effective in treating these conditions.

    Is the usage of these drugs for anxiety disorders taken into account in the analyses discussed in this article?

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    1. Sue Ieraci

      Public hospital clinician

      In reply to William Bennett

      Good point, William. We also know that many people with mild to moderate depression have anxiety as a prominent symptom, and that SSRIs are effective in treating this mix of symptoms. These people are unlikely to turn up in suicide statistics, but they have symptoms as part of an illness that can be helped by a relatively safe medication.

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    2. Pamela H.

      logged in via email @hotmail.com

      In reply to William Bennett

      I can tell you right here and now, that antidepressants do NOT work for anxiety disorders. I've had a lifetime of this and have been prescribed many different antidepressants and NONE of them helped at all. I suffered all the many side effects and NONE of the so-called benefits. They disrupted the quality of my life incredibly. All through that time I was studying at university, I suffered vertigo, sleeplessness, constant dry coughing, further anxiety, itchy skin rashes, panic attacks, headaches, shortness of breath, the list is endless. These things have more 'impact on a person's life' than the anxiety itself. I'm not just going by what some pharmaceutical company told me, I'm going by decades of personal experience.

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    3. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Pamela H.

      Unfortunately, there is a lot of clinical data that disagrees with you, Pamela.

      I am sorry that the medications did not work for you, but there are many people for whom they do work. Did you combine medication with psychotherapy? How long ago were you prescribed anti depressants? The newer generation drugs are, from what I understand, a vast improvement on the older ones...

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  4. Sue Ieraci

    Public hospital clinician

    Thank you for the article.

    I see our society grappling with a big paradox. On the one hand, we have spent the last couple of decades trying to de-mystify and de-stigmatise mental illness, having more people feel comfortable to recognise it for what it is, declare it and visit their GP. Like any other illness, one should not be embarrassed or made to feel personally responsible.

    As a result, we have higher rates of diagnosis and treatment - both medication and psychological. In both the anti-depressants…

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    1. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Sue Ieraci

      I couldn't agree with you more, Sue.

      It has been a massive struggle for our society to begin to accept mental illness as they do physical illness - as something that can and should be treated.

      I wonder if any of these ideologues who are opposed to anti-depressant medications, would argue that one shouldn't take statins for controlling cholesterol or calcium channel blockers for managing hypertension? Of course they wouldn't!

      In fact, I'm not sure they fully realise how these drugs actually…

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    2. Tim Outhred
      Tim Outhred is a Friend of The Conversation.

      PhD Candidate at University of Sydney

      In reply to William Bennett

      You raise an important point about how we do not yet know how antidepressants work. We know that they do work and are one of the most commonly prescribed medications in the world, but the science is currently behind.

      Researchers are yet to understand the mechanism of antidepressant treatment due to the challenges of examining the multiple interactions between complex systems that need to be analysed together at different levels, over time, from the cellular level to the behavioural level. We know what happens to the cell and behaviour, but how the changes at cell causes changes in behaviour is currently speculative.

      I have written about this issue on The Conversation, if you are interested. https://theconversation.edu.au/proof-of-the-pill-cutting-out-the-guesswork-in-prescribing-antidepressants-2962

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Tim Outhred

      Hi, Tim

      While it's true that we don't fully understand by what mechanism antidepressants actually influence mood, readers should be aware that they are well-studied substances, whose pharmacology is well-known. We also know that serotonin has a role in mood, but also in many other conditions from gut function to migraine.

      The older antidepressants - such as tricyclics and MAOI inhibitors, had a lot of side effects and long-term effects due to pharmacologic mechanisms that were well-understood…

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    4. Tim Outhred
      Tim Outhred is a Friend of The Conversation.

      PhD Candidate at University of Sydney

      In reply to Sue Ieraci

      Yes, the pharmacological mechanisms are well understood, but the connection between these and psychological and behavioural changes are not so well understood.

      I agree that pharmacological solutions are not inherently bad; however, they could be better understood and thus used in a manner to maximise benefit, perhaps in conjunction with psychotherapy as you suggest. A patients treatment might also be improved if the psychotherapy also taps into processes that the pharmacological solutions modulate, thereby maximising the effects.

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    5. Tim Scanlon

      Debunker

      In reply to Sue Ieraci

      My analogy for mental illness is breaking an arm.

      You can get by with one arm, that broken one will eventually heal and might heal properly, or it may continue to cause pain the rest of your life. But with modern medicine we really should be going to a doctor and getting the broken arm fixed (meds) and then having physio to rehabilitate (psychological counselling) so that you not only fix the problem but are less likely to have any future problems relating to it.

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    6. jamie jardine

      Acupuncturist

      In reply to William Bennett

      "In fact, I'm not sure they fully realise how these drugs actually work. They are not happy pills, nor do they turn you into someone devoid of empathy. Just like medicines for physical diseases, there will be people who respond well and others who don't, to these drugs. Some people will need to have dosages titrated up to an effective level, and some will need to change to a different drug within the class of SSRI's."

      Hi William have you read the study done by Kirsch et al? The result of this meta-analysis suggests that at least for cases of mild to moderate depression the mechanism involved is the placebo effect. http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050045

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    7. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      Hi Jamie,

      Irving Kirsch's research is controversial at best, and very unscientific at worst. Much criticism has been levelled at him for cherry-picking the data sources for his meta-analyses - favouring short-term data sets over the larger, more reliable data sets that are available.

      I would take any of his conclusions with a grain of salt. Here's an interesting opinion piece by Dr Peter Kramer, who elaborates on this issue.

      http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html?pagewanted=all&_r=0

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    8. jamie jardine

      Acupuncturist

      In reply to William Bennett

      "Kramer's most notable book is Listening to Prozac (1993). This work was grounded in the observation that, treated with antidepressants, some patients reported feeling "better than well." This result led Kramer to consider the feasibility of "cosmetic psychopharmacology," the use of medication in healthy people to induce personality traits that are desired or socially rewarded." http://en.wikipedia.org/wiki/Peter_D._Kramer

      Hardly an unbiased review wouldn't you say? The science behind the use of these types of medication is based on the theory of a "chemical imbalance" has never been proven and is now suggested by many in the field to be incorrect. If this is so then these drugs are useless, here is another psychiatrist Dr. Walter Brown http://www.cbsnews.com/video/watch/?id=7399368n

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    9. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Outhred

      Hi Tim, thanks for the link. I have done a little more research as suggested by William. I find it interesting that we are prescribing these drugs in increasing levels because we believe they " work" without understanding the " mechanism ". Is this the way "modern" medical science operates ?

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    10. Tim Scanlon

      Debunker

      In reply to phil k

      Phil, feel free to stop using your phone until we fully understand how quantum mechanics works.

      Unless you have some ethical way of doing human trials that will require slaughter of the participants afterwards to see what affect the drugs have had, or at least require invasive brain probes, then I doubt we'll be allowed to find out exactly how they work.

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    11. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Scanlon

      Hey .. thanks big tim, I left the door open for you on that one and you barrelled through, as expected ... Actually , I know a fair bit about the technology behind phones, what do you need to know ? Now.. how about bringing some of your special wisdom to those who have commented here on their personal stories of the failure of anti depressants to make their life a chemical enhanced utopia ? Maybe they are human trial ?

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    12. Tim Scanlon

      Debunker

      In reply to phil k

      So you'll be able to explain the quantum phenomenon behind signal transmission then.

      The phenomenon that can't be explained adequately as quantum mechanics isn't understood well enough.

      This was my point. But good luck Phil, you clearly know so much that we are all blind and ignorant in comparison.

      Also, you reference "failure of antidepressants" as though that means something. There are a range of different problems that fall under the depression banner, there are a range of possible drugs interventions, those drugs will react differently with individual biochemistry, doses will vary by individual; such that it is no wonder that drugs treatments need to be worked out. This takes time and effort and persistence. But of course, you don't understand what depression is, you have already labelled it as an annoyance in your workplace and don't really care about mental illness, as displayed in your ignorant postings here.

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    13. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Scanlon

      Hey big tim. The article here is asking whether anti depressants are over prescribed ? Quantum mechanics is a great subject too. I have looked into it a bit. I love physics and I find Stephen Hawking's mind amazing, but we probably should wait until that is the actual topic of discussion. Now, on to your reply to me. I was hoping you would bring your wisdom on the failure of antidepressants to those who have posted a negative experience here. I notice you are using " we ". What is that all about…

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    14. Tim Scanlon

      Debunker

      In reply to phil k

      And you failed to address any of the arguments presented and instead used the fallacy Tu Quoque.

      As to my statements about what you have said here, did you or did you not state "and once your on them you have the perfect excuse for being narcissistic..and showing zero empathy to your family, friends and workmates.."? Because this statement shows that you hold people being treated for mental illnesses as lesser people than the rest of society. Didn't you also say "Some of my colleagues are on drugs…

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    15. phil k

      logged in via email @bigpond.com.au

      In reply to Tim Scanlon

      Wrong again tim .. I don't hold people being treated for mental illness as lesser people than the rest of society . I do have time for people with mental illness in the workplace . I have not attempted to describe mental illness. However, I have witnessed individuals who have been prescribed anti depressants claiming the effects of the medication as an excuse for their behaviours. I have witnessed individuals who have been prescribed anti depressants exhibiting life threatening behaviours that…

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    16. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      I get the impression that arguing with you about the evidence for the use of anti depressants will be like bashing my head against a brick wall.

      Given that you are a practitioner of alternative medicine, i doubt any amount of evidence would sway your strongly held convictions.

      Thankfully, most healthcare professionals do practice evidence-based medicine, so patients will receive effective treatments like anti depressants regardless of the fact that you disagree with their usage.

      That's the beauty of science, you see - it's true whether you believe in it or not! (can't remember who said this but I've always loved it!)

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    17. jamie jardine

      Acupuncturist

      In reply to William Bennett

      Considering that I am the only one who has supplied any evidence so far I find your reply especially ironic. Besides, I wasn't looking for an argument, but merely putting forth a POV that had yet to be expressed for the consideration of others reading this..

      Cheers

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    18. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      By 'evidence', do you mean cherry-picked examples that support your view?

      You say that you wanted to put forth "a POV that had yet to be expressed for the consideration of others reading this". But if you had bothered to read this article we are commenting on, you would realise that the author included a section that discussed questions surrounding the effectiveness of antidepressants, and infact, included a balanced viewpoint with multiple references to evidence.

      Is there a reason why you refer to yourself as a "student", rather than a practitioner of alternative medicine? In the spirit of full disclosure that this website prides itself on, it seems a little dishonest...

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    19. jamie jardine

      Acupuncturist

      In reply to William Bennett

      Incidentally William, I'm not suggesting that these drugs don't work, it is obvious that they do help many people cope with there depression. It is just that we are now beginning to better understand the power that the placebo response has in healing. What we are arguing here may just be a matter of degree, I think it is mostly if not all placebo, even the most favourable studies only demonstrate a minor statistical difference over placebo for most cases. And that small difference may be attributable to the fact that the real drug has side-effects thus increasing its placebo effect.

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    20. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to William Bennett

      Thankfully, most healthcare professionals do practice evidence-based medicine,((( "so patients will receive effective treatments" )))) achtung, like anti depressants """regardless of the fact that you disagree with their usage""". ---- more achtung--- Not very nice Billy boy-- is that you in a white coat with a couple of gorillas beside you, is that really you, I mean really really you. `|_ _I` there's a puzzle for you mate , see if you can put that together. And again Billy--- That's the beauty…

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    21. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      And here is a study that disagrees with the findings of Kirsch:

      http://www.ncbi.nlm.nih.gov/pubmed/22393205

      and another one:

      http://archpsyc.jamanetwork.com/article.aspx?articleid=1107437#qundefined

      The point is, just as the author of this Conversation article said in his piece, there are inconsistencies in the literature associated with the methodology used to analyse the data. Which means, depending on the literature source and the analysis used, you can provide evidence for one side…

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    22. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to john mills

      That statement is neither arrogant or narcissistic. Facts are facts, regardless who "believes" in them or not.

      You can not like it, disagree with it and argue against it all you like John, but it won't change the facts. Evidence doesn't belong to anyone - evidence is independent.

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    23. jamie jardine

      Acupuncturist

      In reply to William Bennett

      So what is your background in health and healing William? You seem to understand a little about research methodology, but judging by your posts appear to possess few interpersonal skills. For your information I can say what I like, if YOU are genuinely interested in expanding YOUR knowledge of the placebo effect then may I humbly suggest a visit to Ted Kaptchuk's site, very informative with some good research on the topic.. http://tedkaptchuk.com/

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    24. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      Let's skip the ad hominem attacks and get to the point of your comment, shall we?

      Of course you can say what you like - but it won't change the facts. Once again, the beauty of science is that the truth is true, regardless of whether YOU believe it or not.

      One interesting fact you should consider is that Ted Kaptchuk, who claims to be a Doctor in Chinese Medicine, never actually received a Doctorate. He has a Diploma in Chinese Medicine from an uncertified organisation in Macao. The difference between a Doctorate, and a Diploma, is quite significant!

      See: http://www.sciencebasedmedicine.org/wp-content/uploads/2011/11/K-diploma-transl-0001.jpg

      So, basically, he's a fraud.

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    25. Roger Crook

      Retired agribusiness manager & farmer

      In reply to William Bennett

      'Science is a way of understanding the world, not a mountain of facts. Before anyone can truly understand scientific information, they must know how science works. Science does not prove anything absolutely -- all scientific ideas are open to revision in the light of new evidence. The process of science, therefore, involves making educated guesses (hypotheses) that are then rigorously and repeatedly tested.'

      So then William, with respect, we come down to the definition of the truth as it applies to science, do we not? Sorry to be pedantic, but so often what we know to be 'true' (in science) turns out to be the opposite.

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    26. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Roger Crook

      Roger, you have misinterpreted my point.

      Of course science does not prove anything absolutely - I wasn't saying this. My point was that something shown to be a "fact", in the scientific sense of the term, is still a "fact" regardless of what people believe or not.

      As a scientist myself, commenting on an article about science, I simply assumed most readers would understand what the words "fact" and "truth" means in a scientific context.

      And I'm not sure that your last statement is correct: "so often what we know to be true turns out to be the opposite". When has this really happened in modern times? Sure, we are constantly revising our knowledge of the world around us, and mistakes are made and corrected. But it is not often that something with a large quantity of good quality evidence ends up being completely false.

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    27. phil k

      logged in via email @bigpond.com.au

      In reply to William Bennett

      William, I realise you have little respect for my observations in regard to the issue above. So, if we are able to put that aside for a moment, I may be able to provide you with some valuable insight into those most valuable commodities, being Truth, Fact and Evidence. I would be interested to know if you have ever had the opportunity to serve on a jury ? I would be interested to know if you have ever had the chance to present any of these three gems in a court of law ? I would be interested to know…

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    28. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to William Bennett

      Can you do this before you read it billy----
      Try the music message maybe :) http://www.youtube.com/watch?v=WpYeekQkAdc
      Nothing better at times like this.
      To me you've answered yourself, your in denial of other peoples feelings that are their "real", their pain and their despair, you've got some anosognosia Billy, you know the one they call all their opposition victims, unisightfull, -and then,- if theyre still challenging them,-say that theyre also suffering with, "anasognosia", thats when their…

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    29. jamie jardine

      Acupuncturist

      In reply to William Bennett

      What truth are you referring too? I entered this conversation because you made a point that the mechanism of these drugs is unknown yet apparently the science is incontrovertible, it is true whether I believe it or not. What am I supposed to believe? At best the efficacy of these drugs is controversial, what are these facts you keep referring too?

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    30. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to jamie jardine

      From the comments you have posted, it is obvious that you believe anti-depressants are no better than placebo. You even say that "...these drugs are useless".

      This is simply not true. You cannot base your entire opinion on a few meta-analyses!

      You have ignored much of the positive evidence presented, and refused to address the concerns raised about the way in which Kirsch et al. conducted their studies.

      I have two questions for you:

      1. If a family member of yours was diagnosed with depression and they asked you for advice on whether or not they should try anti-depressant medication, what would you recommend and why?

      2. If you were diagnosed with depression and your doctor prescribed anti-depressants, would you take them and why/why not?

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    31. Sue Ieraci

      Public hospital clinician

      In reply to jamie jardine

      Jamie Jardine - the placebo effect is not only well-recognised it testing pharmaceuticals, but is specifically accounted for in placebo-controlled trials.

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    32. Tanya Clark

      logged in via email @hotmail.com

      In reply to William Bennett

      I know your questions were to Jamie, but I'd like to answer them too, if I may.

      If a family member of mine was diagosed with depression I would recommend they stay as far away from ADM's as possible. They need a clear mind to full analyse why they're depressed, to fully vocalise what's behind it, and most importantly, to make sure they get LISTENED to and helped effectively. Medicating them to a fogginess is equivalent to fobbing them off. Would you like to feel fobbed off, William? Wouldn't…

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    33. jamie jardine

      Acupuncturist

      In reply to William Bennett

      Placebo's are not useless William, they do indeed work well for a large percentage of the population. In answer to your question though I don't believe that depression is caused by a deficiency of serotonin or even an excess (see SSRE's), or by an imbalance of any other neurotransmitter therefore I would not recommend to anyone I know to take them. There are many other therapies available that are at least equally effective (and safer) than taking these pills. And as you noted I am a (studying) natural…

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    34. jamie jardine

      Acupuncturist

      In reply to Sue Ieraci

      Hi Sue, placebo is well recognized I do know that, what I am saying is that is still not well understood and is underplayed as a potential therapeutic. In fact the pharmaceutical companies would rather it didn't exist, they don't like it because it skews their results. Ted Kaptchuk has done some awesome studies on this and the therapeutic encounter, really worth checking out. In one study treating patients with IBS he achieved good results with a placebo, even after disclosing to the participants that a placebo was to be used in the trial. I find it fascinating anyway..

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    35. jamie jardine

      Acupuncturist

      In reply to Tanya Clark

      Hi Tanyia, I just want to acknowledge your posts, thank you for taking the time to share your experiences here :)

      Jamie

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    36. Tanya Clark

      logged in via email @hotmail.com

      In reply to jamie jardine

      Thanks, Jamie. I'm glad other people have shared as well, but it saddens me that, although they haven't been in the majority, there's a few who strongly advocate the use of drugs because of the so called evidence they have, yet they know nothing of the heart wrenching first hand experiences real people have; nor do they seem to have the emotional intelligence to appreciate that most of those people just have a basic human need to be listened to, to feel validated, to have their frustrations alleviated or removed, not to be medicated off their eye balls and told to go away. I hope those waiving manipulated clinical studies never become a GP; perhaps torturing lab rats, or even drug company rep is more up their alley! lol

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    37. phil k

      logged in via email @bigpond.com.au

      In reply to jamie jardine

      I have a strong " feeling " that you know this jamie ... but I will say it justin case ...some of those that received the requisite OP 1... can be just a little bit "precious"... when they are forced to listen to the " other" life forms on the planet... the multinationals seek them out... massage their egos... tell them what they "want" to hear ... they have been "corrupted"... . they become blissfully ignorant of their affliction ...and defend the hive vigorously... the only ones worth listening to ..are the ones who have "volunteered" their services ..in some desperate role or place.. that really needed their "gifts".. the rest become mere "script " writers.. Keep up the good work jamie... Please.. don't look for praise from above... the ones who have been laid low... trying to "live" their lives... will give you all the praise you will ever need.. "real " humans are amazing creatures.. with amazing stories of survival .. if one takes the time to listen

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    38. Sue Ieraci

      Public hospital clinician

      In reply to jamie jardine

      "I think it is mostly if not all placebo, even the most favourable studies only demonstrate a minor statistical difference over placebo for most cases."

      Jamie - can you show us some evidence for that?

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    39. Sue Ieraci

      Public hospital clinician

      In reply to Roger Crook

      The case of Helicobacter is often misused by the anti-scientists.

      The proponents of the infection theory of peptic ulcer disease were able to convince their colleagues by producing high quality research, which was replicated by others. As a result, the medical professional adopted the new knowledge, and acted on it.

      It has not negated all the previous knowledge on peptic ulcer disease, but added to it.

      Does that mean that everything before was wrong? NO - we still know how gastric acid is secreted. We still know that aspirin and other NSAID use, cigarette smoking and prolonged steroid use increase the rate of peptic ulceration. H pylori infection is only one factor.

      That's how scientific knowledge develops - incrementally.

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    40. Mia Masters

      pensioner

      In reply to Sue Ieraci

      "The anti-scientists"? I would say that people who have objections to lack of evidence and adverse outcomes from drugs and when they voice those objections (often based on personal experience) they are labelled anti-scientists!!!!

      Quite the contrary Ms Ieraci! I want science-based medicine and treatment. And if I point out (or anyone else points out) that the 'evidence' is wonky or non-existent, I do not want to be labelled anti-scientist, because that is akin to kindergarten bully-tactics and nothing more.

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    41. Tanya Clark

      logged in via email @hotmail.com

      In reply to Mia Masters

      Well said, Mia.

      I've enjoyed reading this page. It helps me understand why mental health care is so inadequate and in need of major change in style and attitude. I read peoples' real accounts of the very negative effects drugs have had on them (the real life patients) and I've also read many views that virtually dismiss every word of those stories because the person has science to "proove" what the patient says cannot possibly be correct. There haven't been many drugs saved my life stories. I would have thought the proportion of negative outcomes would have caused those waiving science and clinical studies to at least start to question the validity of such information, not produce such a non-emotional, dogmatic, I am right approach. I wouldn't want any of my loved ones to end up in their consulting rooms, that's for sure.

      I'm not anti-science, and I'm glad I've got the foresight to challenge what I read, not take it all as gospel.

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  5. Richard Hockey

    logged in via Facebook

    Something that is never mentioned about the new generation of anti-depressive drugs is the severe withdrawal side effects some people experience when they discontinue treatment. Product information sheets for these drugs seldom mention this and I doubt prescribing doctors ever mention this.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Richard Hockey

      Here is an excerpt from the product information for Escitalopram:

      "Discontinuation
      Discontinuation symptoms when stopping treatment are common, particularly if discontinuation is abrupt.

      The risk of discontinuation symptoms may be dependent on several factors including the duration and dose of therapy and the rate of dose reduction. Dizziness, sensory disturbances (including
      paraesthesia and electric shock sensations), sleep disturbances (including insomnia and intense dreams), agitation…

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    2. Richard Hockey

      logged in via Facebook

      In reply to Sue Ieraci

      I love the way they euphemistically call withdrawal 'discontinuation"!
      R

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Richard Hockey

      Euphemistically? I thought discontinuation was just another word for "stopping".

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    4. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Richard Hockey

      Stopping many drugs suddenly will lead to bad consequences. Slowly tapering the dosage appears to avoid these issues, and it is a common recommendation in the product info sheets, as Sue has shown with an example from a modern SSRI.

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    5. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to Sue Ieraci

      Hi Sue, nice post, i especially liked this line-- My understanding is that it is standard practice to withdraw any psychotropic medication gradually and with caution.
      your exactly right
      but sadly that's not what's happening, in practice, advice wise, there is no withdrawal clinic or facility for people who want to get off, (their choice) let alone those caught /trapped debilitated, or a prisoner of psychiatry on psychotropics, (not their choice) there is also no honesty about it , the condition…

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  6. Sue Ieraci

    Public hospital clinician

    Another thought about this topic: the question "are antidepressants overused?" is a bit like "do we do too many cesareans?"

    To make good public policy, we need to remove the ideology, or any guess at an ideal rate, and instead ask "Is the way we currently use antidepressants (or cesareans) achieving the best balance of effect, adverse events, cost-effectiveness, access and patient satisfaction?"

    Any proposed change of practice would be assessed against the same criteria. It's not about whether we like talking therapies more than medications, it's about how to achieve the best outcomes for the time and money spent, reaching the most people, with minimal risk.

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  7. Dr Ben Mullings

    logged in via Twitter

    Psychological therapy is important, but equally so, is the need to support people with a mental health condition who seek psychological treatment. The article above credits programs like the Better Access initiative to improving access to psychological treatment, but since the beginning of this year access to psychological treatment was cut down to 10 sessions, with no exceptions. This falls below minimum levels of recommended treatment for mental health disorders. At just ten appointments, we know…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Dr Ben Mullings

      And, since the Better Access initiative, with its medicare-covered access to psychological services, is accessed via one's GP - this rather suggests that GPs are not blind to the need to balance different types of therapy.

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    2. Dr Ben Mullings

      logged in via Twitter

      In reply to Dr Ben Mullings

      Just a small correction to my above post - I should have said 'dispensing' rather the 'prescribing'. Factoring that in, we have a situations where one set of data tells us that people are being given antidepressants more often, while another set of data tells us that patients report using antidepressants less often. If people are not inclined to use the medication that they are given, then we probably need to look at whether they might use psychological treatment. Otherwise they probably aren't getting any help, at a time when they reached out and their GP/psychiatrist came to the view that they needed treatment.

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    3. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Dr Ben Mullings

      This was such a stupid decision by the Government. Of all health services that they could have cut back on, mental health was not one of them. Clinical psychologists are very expensive (~$160 per hour I think) and many people can't afford to attend the required number of sessions to see an improvement.

      The Better Access scheme is essential in facilitating the treatment of people suffering with mental illness. The Government has done thousands of people a great disservice by cutting back funding for this essential health service.

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    4. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to Dr Ben Mullings

      Good point Ben, it seems as though people would rather put up with their concerns, hurdles, than feel what the drugs make them feel, just a little bit of mathematics, and horses for courses, I guess. But are the GPs actually suggesting or offering alternatives, such as cognitive, psychological, counselling, or have they got their hand in the till with the drug companies and the psyches. and pushing meds.

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  8. Doug Rankin

    Plasterer

    As a somewhat knowedgeable person about psch drugs from a real-life perspective - and not from studies which when translated to real-life mean little. I mean lets face it the DSM is the most useless book every written.
    Firstly I have to say that the best psch drugs are:
    Tricyclics.
    Lithium.
    Chorpromazine.
    Valium.
    The problem with them is is all have all have horrible side-effects up to and including death.
    In my experience (and apparently suicide rates) SNRIs and SSRIs are pretty useless…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Doug Rankin

      Doug - just like any other illness and its treatment, individual patients with individual diagnoses need individual treatments. That's where the DSM comes in.

      Tricyclics are antidepressants with several adverse effects and very dangerous in significant overdose - therefore not commonly used except in severe or difficult-to-treat depression.

      Lithium is a mood stabiliser - generally used in conjunction with other medications (for example, in biploar affective disorder). It also has adverse effects…

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    2. William Bennett

      Lecturer in Environmental Chemistry at Griffith University

      In reply to Sue Ieraci

      Sue, can I just say that it is great having you regularly commenting here on The Conversation. You are a constant source of accurate and highly relevant information for health-based issues, and your contribution is very much appreciated!

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    3. Sue Ieraci

      Public hospital clinician

      In reply to William Bennett

      Thanks, William.

      You won't find my comments very often in the areas of economics or sport, but I like to think that giving some background from the health sciences helps to clarify issues related to health care.

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  9. Roger Crook

    Retired agribusiness manager & farmer

    I wrote the following for the first in this series of articles. Maybe here is a better place for it?:

    The answer to the headline is nobody knows.
    Having been the keeper of the 'black dog' for many years (now only occasionally) and having been subjected to (I am sure) every drug, which is available for 'depression', and having been told 'these may take a couple of weeks to kick in'.
    Then the waiting for them to 'kick in' and feeling no worse or feeling even worse when they did 'kick in' but certainly…

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    1. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to Roger Crook

      I think you've made the best point here Roger, learning how to cope isn't in a pill, its in a life, its learning, finding out, maturing, evolving, there is only so much we can teach ourselves, the rest is in the world and the other people around us, people who have learnt things that can help us, we've all learnt things that can help others too, even if we might be a bit lost, in the fog, or overwhelmed in our thinking and feeling at a particular stage in our lives, here take a pill and vegetate, practice sick, pop that pill, or here take some advice and grow, learn how to cope, its what you have to do bottom line, what the pill does is entirely up to the chemicals in it and how it makes the person feel, if the chemicals in the drug, and its effect make you feel bad, then bad on bad equals really bad, what part about that dont these people get ?.

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    2. Roger Crook

      Retired agribusiness manager & farmer

      In reply to john mills

      It's interesting, isn't it, John? It's such a big industry with so many vested interests, and I don't mean that in any sinister way.

      We, my therapist and I, spent many hours discussing one word, 'transition' - just that one word and how it applies to our everyday perspective on life, of others, of the past and the future.

      Once I accepted 'transition' - the inevitable journey if you like - slowly the cogs started to mesh again.

      That is not to say I am 'cured', because when it comes to depression, I don't believe there is such a condition.

      The 'black dog' will always come back, the trick is in learning not to feed it.

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    3. Tanya Clark

      logged in via email @hotmail.com

      In reply to Roger Crook

      You're so right, Roger. Sounds like the wise words of experience. What's your best tip for learning how not to feed the dog?

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    4. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to Roger Crook

      Not Feeding it, That's the trick we all need to learn. Your not wrong there Roger, that's where we've all got to be our own doctor, learn to not beat up on ourselves with our thinking, be kind to ourselves with our thinking and feeling, take lessons, prescribe good to us, for us, etc etc. Good on ya Roger, thanks again,for your words of your experience, your truth, and your care. Good Man.

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  10. Michael Tam

    Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

    The important thing to recognise is that a global question like "are antidepressants over-prescribed?" is not in itself very illuminating. The better question to ask is "are antidepressants prescribed for the individuals who will benefit from them?"

    Without framing it in this manner, it is easy for people holding the affirmative and negative positions to be actually arguing past each other. Simply, it is possible, indeed, LIKELY, that antidepressants are both over-prescribed and under-prescribed simultaneously. It is over-prescribed in individuals who have mild, reactive types of depression that respond minimally to these type of drugs. On the other hand, it is likely under-prescribed in individuals who suffer from the more severe spectrum of major depressive disorder.

    The focus then is not arguing on "we should be prescribing less" or "we should be prescribing more", but rather, "for whom should we prescribe and are we meeting patient health care needs?"

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    1. Tanya Clark

      logged in via email @hotmail.com

      In reply to Michael Tam

      I appreciate your comment, Michael: The focus then is not arguing on "we should be prescribing less" or "we should be prescribing more", but rather, "for whom should we prescribe and are we meeting patient health care needs?"

      Just as a single example of a group that is targetted for anti-d's, pls refer to my just posted short story outlining the classic scenario of a new mother and the PND over/mis-diagnosis. For years it has seemed that as soon as a woman gives birth, a prescription is put in her hand, and therefore your question about meeting patient health care needs is very relevant, because the negative consequences of the drug then involves the care of a small child or family as well.

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    2. Kim Darcy

      Analyst

      In reply to Michael Tam

      Excellent Michael. Now, what I am about to say will piss of a lot medico-types, but please understand, I am not being dismissive. On the contrary, I am highlighting just how mind-blowingly hard mental health is. I don't consider Psychiatry to be "science". Sure, Psychiatry draws on scientific knowledge, and in practice tries very hard to mimic actual Science, but it has a long way to go.

      What we are dealing with is a human being suddenly/slowly change substantially in their approach to life…

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    3. Richard Hockey

      logged in via Facebook

      In reply to Kim Darcy

      Hi do you have any references for this or did you just make it up!

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    4. phil k

      logged in via email @bigpond.com.au

      In reply to Kim Darcy

      Who was it that said " I'd rather a bottle in front of me than a frontal lobotomy "? Is it unreasonable that some one who administers these treatments should take the journey themselves. A 3 month holiday on anti depressants for a healthy physician should give a reasonable understanding of the side effects. It would be much more realistic than asking a doctor to experience a lobotomy before prescribing one for a patient.

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    5. Kim Darcy

      Analyst

      In reply to Richard Hockey

      Richard,a few words might be negligible through typos, or me not checking back to everything. But I've seen this develop over a few years now, so do it off my head. But if there are any particular bits you'd like references for, just ask.

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    6. Michael Tam

      Conjoint Senior Lecturer, and Staff Specialist in General Practice at UNSW Australia

      In reply to Kim Darcy

      Dear Kim,

      Thank you for your post. I agree with you on some of the broad historical elements in your post, but not necessarily the details.

      If you look a little bit further into the past of Western Medicine (by a few centuries), mental illness was not perceived as categorically different to "physical" disease. The rise of the concept of mind-body dualism by Descartes is perhaps the progenitor of the modern division between "mental" (i.e., mind) and "physical" (i.e., body) diseases. This has…

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    7. Sue Ieraci

      Public hospital clinician

      In reply to Kim Darcy

      Kim Darcy - if your dissertation annoys anyone, it will most likely be because you are talking off the top of your head, without ever have been responsible for treating anyone with psychiatric illness. You are talking about the market for psychiatric drugs, but where are the patients in all this?

      My first contact with psychiatry was thirty years ago, when the best available antidepressants were tricyclics, and antipsychotics were phenothiazines. These drugs had complex pharmacology with side-effects…

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  11. Tanya Clark

    logged in via email @hotmail.com

    I've speed read most of the conversation. It's interesting to note how adamant some become on the topic, even if they haven't experienced the black dog, or experienced the disillusionment of encountering our lack of mental health support, let alone the very negative side effects of anti-d’s. From many years of personal experience, and witnessing the experiences of many close friends after they, too, were prescribed anti-d's, I'm convinced we're playing with fire; we don't know enough about the…

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    1. phil k

      logged in via email @bigpond.com.au

      In reply to Tanya Clark

      Apparently, stories that don't show positive outcomes for anti-depressants, have a way of upsetting some of the folk in this conversation, Tanya. My experience of those individuals prescribed anti depressants, outside the workplace, tallies with your experience. I apologise for my fellow Australians on the lack of support for new mothers in this country. I am raising two kids on my own , so I claim to be aware of at least some of the prejudices involved. Australia will no doubt reap what it sows in relation to the treatment of those who take on, what I consider to be, the important role of parent, with very little support from the community. Luckily, my employers have all been very supportive of my task, but this support appears to be the exception to the rule, from what I hear from some other parents I mix with.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Tanya Clark

      Hi, Tanya,

      I've also seen the other side of the story - mothers who suffered through PND with no identification or treatment, and many who have benefited from a combination of medication and psychotherapy.

      Child and family services are now better at identifying PND - women who are struggling are much better screened than they previously were. Mild cases may not be given antidepressants, but may benefit from psychotherapy. More severe cases may be too unwell to participate in psychotherapy until…

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    3. phil k

      logged in via email @bigpond.com.au

      In reply to Sue Ieraci

      " We have heard and acknowledged your story ". I thought only the queen used "we " . Who do you claim to represent using " we", Sue ?

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    4. Tanya Clark

      logged in via email @hotmail.com

      In reply to Sue Ieraci

      http://www.peh-med.com/content/3/1/14

      The link Roger provided shows how clincial data can be manipulated by inclusions and exclusions, the very short duration of some positive outcome studies, the small ratio of participants vs users, the many variables that are not considered, and the long term follow up that doesn't come into play at all, and a whole range of other factors that mean many of the clinical studies are not a true reflection of the supposed success of the drugs, and it seems the damaging side effects don't get factored into a spreadsheet either, neither does whether the participant ended up suiciding. Stats can be manipulated any way you want. We could produce statistical evidence to say the sky is orange if we wanted to, simply by manipulating the input criteria.

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    5. Tanya Clark

      logged in via email @hotmail.com

      In reply to phil k

      It's interesting to see how the camps have divided. Those with a clinical study result are basically invalidating what they're being told by people with real life experiences ... just because they've got a paper in their hand that says there's evidence of positive outcomes, we don't know what we're talking about. As I've just said somewhere else, you can manipulate stats to proove the sky is orange if you want; it depends on the study critieria.

      Neither of us is basing our conclusion on just our own personal experience, but those of many others around us as well. The same goes for many other people reporting negative experiences on the page. None of the outcomes I've seen has been positive. They may not have committed suicide, but they all lost parts of their life or quality of life in other ways. What would we know though, eh, Phil, we've just used the drugs, not written the prescription?!

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    6. john mills
      john mills is a Friend of The Conversation.

      artist

      In reply to Tanya Clark

      Your so on the ball Tanya, what a great writer , I so went on the journey with you in your story, so real, so sad, so amazing. so well done, cant wait for the book :). one day maybe ?.

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    7. Tanya Clark

      logged in via email @hotmail.com

      In reply to john mills

      Thanks, John. Perhaps I should write a book. I've heard that comment before. I managed to crack my doc up with a written description of a 'funny turn' a while back and she's still waiting for the book, too! lol

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  12. Mia Masters

    pensioner

    "In the published data, reboxetine was a safe and effective drug. In reality, it was no better than a sugar pill, and worse, it does more harm than good. As a doctor I ddi something which, on the balance of all the evidence, harmed my patients, simply because unflattering data was left unpublished."

    "In 2008 a group of researchers decided to check for publication of every trial that had ever been reported to the US Food and Drug Administration for all antidepressants that came onto the market…

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    1. Mia Masters

      pensioner

      In reply to Mia Masters

      "In February 2003, GSK spontaneously sent the MHRA a package of information on the risk of suicide on paroxetine, containing some analyses done in 2002 from adverse-event data in trials the company had held, going back a decade. This analysis showed that there was no increased risk of suicide. But it was misleading: although it was unclear at the time, data from trials in children had been mixed in with data from trials in adults, which had vastly greater number of participants. As a result, any sign of increased suicide risk among children on paroxetine had been completely diluted away."
      Ben Goldacre: Bad Pharma
      How drug companies mislead doctors and harm patients

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    2. Mia Masters

      pensioner

      In reply to Mia Masters

      "For example: duloxetine is another SSRI drug in fairly widespread use, which is usually given as an antidepressant. During a trial on its use for a completely different purpose - treating incontinence - there were apparently several suicides. This is important and interesting information, and the FDA hold the relevant data: it conducted a review on this issue, and came to a view on whether the risk was significant. But you cannot see any of that on the FDA website, because duloxetine never got a…

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    3. Tanya Clark

      logged in via email @hotmail.com

      In reply to Mia Masters

      I wonder who sponsors the studies? Would it be too cynical of us to think it'd be the pharmaceutical companies, and wouldn't the sponsor get to pick and choose which results get published? We're all being manipulated, doctors and patients alike; ADM's are a big money maker. I wonder if the GP still gets a case of Jamo's from the company rep at the end of the financial year if they make their prescription quota - that's how it used to work, didn't it? Forgive my cynicism, but I'd just like to see some greater acknowledgement that these drugs are not the be all and end all solution to depression, that they are being over prescribed, that they do have very nasty side effects, and doctors should be way more cautious in their approach to handing them out. I'm sure I'm not alone.

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    4. phil k

      logged in via email @bigpond.com.au

      In reply to Tanya Clark

      Hi Tanya, I will probably pick up a "WE are not amused " for this one from the other team.. but.. check out a book by Jamie Reidy.. called ...HARD SELL... The movie, " Love and Other drugs " was loosely based on it... It has a bit of an insight into what is going on here..

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    5. Tanya Clark

      logged in via email @hotmail.com

      In reply to phil k

      Good tip, Phil, thanks. Like you, I'm totally aware what's going on. I've already shown my cynicism by asking who funds the selectively published positive clinical research that the over-prescribing doctors declare to be evidence to justify their habit of issuing ADM's to all and sundry. I've also dared to ask if the doc still gets a case of Jamo's from the drug company rep if they reach a prescription quota for the financial year. I'm sure glad I'm not consulting with a couple of the loud, argumentative…

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    6. Mia Masters

      pensioner

      In reply to Tanya Clark

      An important element of this 'conversation' is missing: Are the people who are prescribed antidepressants doing better (any better) than those who get other kind of treatments/therapies or no treatment in the long term? What is the recurrence rate for depression for those who are given antidepressants and those who choose other treatments? Without this the question primary question of this article is meaningless.

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    7. Tanya Clark

      logged in via email @hotmail.com

      In reply to Mia Masters

      You're so right, Mia. And making assessments about outcomes of either treatment course is so so difficult seeing the variables are immense; the person, the causes, the duration, etc etc. We can't put a number value on any of it, it's emotional and all very subjective. I think the primary question can be answered in the affirmative, but just posing that question has exposed some other pretty urgent questions about how we deal with mental health, that's for sure.

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  13. Roger Crook

    Retired agribusiness manager & farmer

    May I suggest everyone involved in this discussion have a read of the research that can be found at: http://www.peh-med.com/content/3/1/14 It may help to give all of us, even those with a penchant for trying to blow up underground fortifications without a knowledge of explosives, some common ground on which to continue this discussion.

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    1. phil k

      logged in via email @bigpond.com.au

      In reply to Geoff Taylor

      Thanks for the link Geoff .. must have come from the French side of the Canadian brain :)

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  14. john mills
    john mills is a Friend of The Conversation.

    artist

    Not only are antidepressants over prescribed, but so are all the psychotropics, but its the anti depressants and psychotropics "forced" down throats, that we really have to worry about, and stop them making most of us sick with them, The government, the drug companies and the psychiatrists are poisoning the people, us, and they wont let us prove it, that's the truth. The truth that cant be denied, until the victims can have the test that either proves or disproves their truth, our despair, our truth.

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  15. Darren Parker

    logged in via Facebook

    I don't know much about psychiatry or psychiatric medication, but I do know that Tom Cruise think it's wrong - and that's good enough for me.

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  16. john mills
    john mills is a Friend of The Conversation.

    artist

    Green is sick, and people are yellow, psychotropics, like all mind altering substances, are blue, sure fight fire with fire, or poison with poison, we know, that sometime works, but dont just keep adding it, managing a blue and yellow--green sick, for the rest of a life, is simply wrong, and its bound to make some/ most, people worse, has to, greens sick remember. What dont these sick prolonger's get, what DON'T they SEE, that's the question, not what do they see, anyone knows that an anti depression…

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