The drugs don’t work, and yet they do

I’ve been busy lately and not able to focus much on the blog. My OLF (old lady friend) who I wrote about two posts ago got out of the hospital after three days and is bouncing around like a someone half her age. She was telling everyone she knew that she didn’t need to go to the hospital and I did her no favor by taking her there. So, I read her the Riot Act, telling her that her symptoms were such that I would have been negligent if I didn’t take her to the hospital. What I was trying to impress on her was that at her age, not having regular, reliable medical care isn’t going to work for her much longer. She was having none of it.

This and pre-Christmas preparations have distracted me from being able to focus on cranking out a decent post. Here’s what I was working on before I got side-tracked.

The Drugs Don’t Work is the title of a 2009 article in Prospect magazine (“Good writing about things that matter”). I won’t bore you with summary of the article, except to say that it’s an in-depth review of “The Emperor’s New Drugs,” by Irving Kirsch, yet another book that claims that antidepressant SSRI’s are worse than useless. While many of us are heartened that we finally are getting to hear the bad news about antidepressants and neuroleptics, when it comes to antidepressants, we also know that these kinds of meds work for most people. David Nutt, of Imperial College, who heads one of the largest departments of psychopharmacology in Britain says “Antidepressants work in clinical practice, and everybody knows they work.”

We all know they work, due to something called the placebo effect, and we also know that while they in most cases are quick depression busters, they come with the price tag of side effects. (Peter Jones, psychiatry prof at Cambridge University, makes the astonishing claim in the article that no teenager ever committed suicide while in a clinical trial.) Kirsch’s contribution is to point out that there cannot possibly be blinded studies on this particular class of medications because the clinical trial participants will quickly figure out if they are on an SSRI because they will be experiencing side effects.

The key to the placebo effect in clinical trials is expectation. People who believe they are taking the real drug are more confident that they are improving, and improve they will, even if they are on the placebo. The article explains that research shows the worse your depression, the more you will improve on an SSRI. According to Kirsch, as dosages increase in response to increasing depression, the side effects increase, too, making it more obvious to the patient that they are taking the real drug. So much for double blind trials.

Today’s obituary

John E. du Pont

I’d like to see the autopsy report.

John E. du Pont, an heir to the du Pont chemical fortune whose benevolent support of Olympic athletes deteriorated into delusion and ended in the shooting death of a champion wrestler, died Thursday in a western Pennsylvania prison. He was 72.

Mr. du Pont was found unresponsive in his cell at Laurel Highlands State Prison near Somerset, Pa., a prison spokeswoman told The Associated Press.

“He had had some illnesses, so we are considering it natural,” Susan McNaughton, the spokeswoman, told The A.P., adding that the Somerset County coroner would make the final determination of the cause of death.

‘Tis the season to be jolly

I make a point on my blog not to enter the territory of Gloom because enough people get their fill of gloom from the professionals dealing with “serious mental illness.”

This week-end has been gloomy. The winter weather where I live would make even a cock-eyed optimist slit his wrists, but it’s actually loneliness I’m speaking of. I spent part of Saturday night in an ambulance accompanying an elderly friend to the hospital. On reflection and without knowing further medical details, I believe that her extreme loneliness caused neurological symptoms.  I found her sitting in a darkened apartment, her skin was flaming hot to the touch, and she had a look of shock on her face. She kept repeating that she didn’t feel well and that she was so sad. Well, she has every reason to be sad. Her beloved husband passed away three years ago last month, the Christmas season is fast approaching, and she lives completely alone.

This brings me to the next story. Chris visited a friend on Saturday night who he met at the day program he attended a few years ago. The friend is living with two cats in subsidized housing. I sent Chris off with a couple of good steaks to accompany their jamming session because his friend’s refrigerator is usually empty. Chris told me that his friend doesn’t understand why his family keeps him at a distance and that most people find him strange. He’s been living on an electrical apprentice stipend of $20 a day for the past five years. Since he lives far from the training site, occasionally he is forced to take a cab. The people who run this sheltered workshop type of arrangement criticize him for taking a cab when he’s paid so little. He’s thinking of quitting.

I suspect that this sheltered workshop arrangement is the final step of the program that they both attended. Chris was encouraged to try out furniture repair after the program ended. Chris never learned furniture repair. The whole experiment fizzled out through lack of interest on his part. Since he emerged from the “recovery” program in pretty marginal shape he didn’t enthusiastically embrace the work. He sat on a chair, sipping a coffee, watching the work, not doing it. The day program had the best of intentions, of course, but, as the saying goes, the road to Hell is paved with good intentions.

This sheltered workshop is a “good idea” that doesn’t work for a lot of people, maybe because it’s stigmatizing. It says to the individual that something isn’t right with him while perhaps punishing the individual for living marginally, as was the case with Chris’s friend. Recovery does take a while and one wonders where would the person be if these programs weren’t available. In the absence of an encouraging family that person may well be on the streets.

Being separated from the family can be an outgrowth of the “good intention” approach. I maintain that more families would nurture their relatives if they weren’t put off by the gloomy diagnosis in the first place. Families need to be told that complete recovery is indeed expected and here’s what they can do to help. Instead, the doctors tell us that our children have brain diseases and will have to take medications their entire lives. Maybe they can live productively, but don’t count on it. The medical model encourages sheltered workshops and subsidized housing. The individual becomes a problem from the families’ perspective. People like Chris’s friend are the biggest victims in this way of thinking.

Extending the hand of friendship is a powerful influence on outcomes in people’s lives. Words and gestures can turn lives around.