Four psychiatric horror stories

It’s very sad watching a young relative start a lifelong journey into schizophrenia (see the previous post).  The only consolation is thinking how much worse things would have been in the early 60s when I started medical school.

Horror story #1:  In addition to what his very devoted parents are about to go through, back then they would have been blamed for his condition.  They would be told how they put their son in a variety of double binds, where whatever choice he made was the wrong one.  While some psychiatrists promoting this view (Wiki R. D. Laing) led fairly chaotic lives and were regarded as fringe, my brother bought the idea that his wife’s parents had a lot to do with his brother-in-law’s illness.  Where did he get these ideas?  From a psychiatry professor where he went to medical school in the 60s (Yale — certainly not a fringe institution).  

Horror story #2:  He might have been exposed to electroconvulsive therapy (ECT) given as follows.  20 or so patients lying in an open ward watched while had a machine brought to the bedside, the wires attached, the patient convulsed, the wires removed, the machine moved to the next patient, etc. etc.  This happened in Warm Springs, Montana (the state mental institution) at some time before the 70s (as related to me by a patient).   

ECT is no longer used as a therapy for psychosis as it was then.  Because of barbarity like this there are those who want to ban it permanently.  However, for some unfortunates with depression, it is the only therapy that helps.  Kitty Dukakis (the wife of the former Governor and presidential candidate) is on a speaking tour about it being the only thing that has helped her.   Which brings us to

Horror Story #3 Depression is a serious illness, with a mortality as well as a morbidity.  David Foster Wallace fought it as long as he could and then took his own life.  Those who argue against any therapy used in depression  must be prepared to accept the risk of increased death from suicide.

Following a thorough and comprehensive review of all the available published and unpublished controlled clinical trials of antidepressants in children and adolescents, the U.S. Food and Drug Administration (FDA) issued a public warning in October 2004 about an increased risk of suicidal thoughts or behavior (suicidality) in children and adolescents treated with SSRI antidepressant medications. In 2006, an advisory committee to the FDA recommended that the agency extend the warning to include young adults up to age 25.

More recently, results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders. The study, partially funded by NIMH, was published in the April 18, 2007, issue of the Journal of the American Medical Association.1

What Did the FDA Review Find?

In the FDA review, no completed suicides occurred among nearly 2,200 children treated with SSRI medications. However, about 4 percent of those taking SSRI medications experienced suicidal thinking or behavior, including actual suicide attempts—twice the rate of those taking placebo, or sugar pills.

In response, the FDA adopted a “black box” label warning indicating that antidepressants may increase the risk of suicidal thinking and behavior in some children and adolescents with MDD. A black-box warning is the most serious type of warning in prescription drug labeling.

Horror story #3a:  In the year after the warning SSRI prescriptions to adolescents dropped around 25% and the number of adolescent suicides INcreased by the same amount.  I think the number of adolescent suicides increased in the second year after the warning. Does anyone know what the latest data shows?  Here’s a link to some older work

Horror story #4:  As a neurologist I saw a woman e for evaluation who’d been living in the Montana institution for the mentally retarded for decades.  She was terribly regressed having had no mental stimulation or need to develop any social skills since adolescence.  Her intelligence was normal however.  Eventually it turned out that her father (a powerful rancher) had her committed because she was promiscuous.  Hard to believe. 

The next few posts will involve  Clayden (to p. 1000) a possible book review, and responses to criticisms of what I think about protein structure in future posts (if nothing else happens).  These are far less disturbing than thinking about what the young man has ahead of him.

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