Dr. Joanna Moncrieff: O Desafio da Nova Onda dos Antidepressivos

De

-

19/04/2018

This week we interview Dr. Joanna Moncrieff. Dr. Moncrieff is a psychiatrist, academic and author. She has an interest in the history, philosophy and politics of psychiatry, and particularly in the use, misuse and misrepresentation of psychiatric drugs. As an author, Dr. Moncrieff has written extensively on psychiatric drugs and her books include The Myth of the Chemical Cure, A Straight Talking Introduction to Psychiatric Drugs and The Bitterest Pills: the troubling story of antipsychotic drugs.

She is one of the founding members of the Critical Psychiatry Network which consists of psychiatrists from around the world who are sceptical of the idea that mental disorders are simply brain diseases and of the dominance of the pharmaceutical industry.

We talk about the recent meta-analysis of the efficacy and tolerability of 21 antidepressant drugs, widely reported in the UK news media on February 22^nd.

In the episode we discuss:

The approach taken in the largest ever meta-analysis of efficacy and tolerability of 21 common antidepressant drugs.
The problems inherent in comparing antidepressants with each other, as opposed to trials that compare the active drug to a placebo.
That the main conclusion reached was that all the antidepressants studied were better than placebo at reducing depressive symptoms.
The limitations of the study, particularly how response rate was selected as the primary outcome measure.
That ‘response’ is mostly defined as a reduction in the Hamilton Depression Rating Scale (or other scale) rating of 50% or more during the study.
That the response rate can artificially inflate the difference between drug and placebo.
The problems with blinding in the supporting trials and the effects of including people who are already receiving antidepressant treatment.
That the study did not include adverse effects or withdrawal difficulties, only dropout rates which are not representative of the whole picture of taking the drugs.
The short-term nature of the supporting trials, mainly 8 weeks, with a range of 4 to 12 weeks, which cannot be easily compared with the real world experience of people taking the drugs for much longer periods.
That, when the primary data is analysed (the depression rating scale scores) the differences between placebo and antidepressants are very small and probably clinically insignificant.
The uncritical and sensational nature of the media reporting of the study and the link to the Science Media Centre.
The concerns about the reporting that depression is under-treated in the UK which is not supported by the results of the study.
That people should carefully consider the balance of benefit versus risk, taking into account the potential for adverse effects or difficulties stopping the drugs.

Relevant links:

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis

Challenging the New Hype About Antidepressants

The Hamilton Depression Scale

Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences

Efficacy of antidepressants in adults

The Science Media Centre

To get in touch with us email: [email protected]

Jim van Os: Repensando a Psiquiatria Biológica

De

James Moore

-

19/04/2018

0

This week on the Mad in America podcast we interview Professor Jim van Os.

Professor van Os is Chairman of the Department of Psychiatry and Psychology at Maastricht University Medical Centre, Maastricht, The Netherlands, and Visiting Professor of Psychiatric Epidemiology at King’s College, Institute of Psychiatry, London.

He trained in Psychiatry in Casablanca, Bordeaux and the Institute of Psychiatry and the Maudsley Royal Hospital in London.

In 2011, he was elected member of the Royal Netherlands Academy of Arts and Sciences (KNAW); he appears on the 2014 Thomson-Reuter Web of Science list of the world’s most influential scientific minds of our time.

He is Director of Psychiatric Services at Maastricht University Medical Centre and runs a service for treatment-resistant depression and first episode psychosis.

I was keen to ask Professor van Os about his views on biological psychiatry, why we should sometimes challenge schizophrenia, psychosis and other diagnostic terminology, and how he sees the future of mental healthcare.

In this episode we discuss:

How Jim became interested in Psychology and Psychiatry, partly because of the experiences of family members
That Jim felt that training in many parts of the world allowed him to see variations in psychiatric models and this led to him questioning the biological model
That Jim also saw how dominant the prescribing of medication but noticed the wide variation in practices
How Jim observed in France a willingness by the treating doctors to accept that they didn’t know what the root cause of a mental health difficulty
That some of the diagnoses that psychiatrists rely on are actually cultural agreements between professionals and that if a patient accepts the idea that they have a diseased brain, it can be limiting for that patient
That we should be able to admit that we don’t know causes but we can still help and support people who struggle with their mental health
That there is a 25% yearly prevalence of mental disorders, but many nations have a capacity for only 4% to 6% of the general population
That selection criteria to get help and support with their mental health just don’t work because we cannot precept outcomes for people
That there are interesting developments in eCommunities where people can participate in online communities to share experiences, for example ‘Proud to be Me’ in the Netherlands.
That diagnoses are starting to function as an economic measurement of mental illness and treatment and some cannot access treatment without a diagnosis, which perpetuate the diagnostic paradigm
That there were attempts in the most recent Diagnostic and Statistical Manual (DSM V) discussions to adopt ranges or dimensions of disorders, but the proposal was shot down
That it would have been historic if dimensions were adopted in the DSM because then the discussion between the clinician and the patient would have had to change
That there is some dimensionality in DSM V, represented as ‘spectrum disorders’ which are the first step towards acknowledging the variations inherent in human experiences
That Jim saw in his own family that the initial ‘relief’ of receiving a diagnosis was undone when more and more diagnoses were added
That a label of Schizophrenia can mean that other people do not know what to expect and find it difficult to relate psychologically to that person and their experiences
That the Maastricht User Research Centre has been discussing the language used in psychiatry, in particular the terms psychosis and schizophrenia and trying to find more helpful terms, for example hyper-meaning
That sometimes terms such as ‘susceptibility’ and ‘syndrome’ are far more helpful than giving someone the message that they have a brain disease
That biological psychiatry has been trying to reverse engineer and validate the concept of schizophrenia by investigating case control differences
That there is more awareness developing about the critical appraisal of diagnostic terminology
That the mental health sector should not be viewed as a separate entity, but should reinvent itself as an inclusive local community that is there to connect with people and their range of experiences
That patients often indicate that what got them better was community and connection and meaning and empowerment
That the User Research Centre, led by Dr. Peter Groot, have developed a solution to help patients withdraw slowly and gradually from their psychiatric medications
That when prescribing medication, we should encourage people to monitor their experiences to allow a better discussion about treatment continuing or stopping based on evidence
That if we suppress difficulties with medication, it can make it more difficult for the person to build up coping mechanisms

Relevant Links:

Professor Jim van Os

Tedx: Maastricht, Connecting to Madness

Jim van Os interview on Mad in America

Schizophrenia does not exist

Tapering Strips

How to Listen:

To listen in iTunes, click here

To listen on YouTube, click here

To get in touch with us email: [email protected]

Johann Hari: Conexões Perdidas

De

James Moore

-

19/04/2018

0

This week we interview journalist and author Johann Hari. Johann is one of our foremost social science thinkers and writers. In addition to writing regularly for the New York Times and Independent newspapers, he has written extensively on social science and human rights issues. His 2015 book Chasing the Scream: The First and Last Days of the War on Drugs, challenges what we believe about addiction, and his TED talk on our response to addiction has been viewed over 20 million times.

Johann was twice named ‘National Newspaper Journalist of the Year’ by Amnesty International. And he has been named ‘Cultural Commentator of the Year’ and ‘Environmental Commentator of the Year’ at the Comment Awards.

In this interview, we talk about Johann’s latest book, Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions, which has been called a ‘game changer’ and received plaudits for its explanation of the social and cultural issues leading to depression and anxiety.

In the episode we discuss:

How Johann became interested in journalism and began writing about social justice and human rights issues.
What led to wanting to write a book that was partly based on his own experiences with depression and anxiety, but also that provided the evidence for social and cultural issues that may underlie the dramatic increase in the number of people seeking support for emotional distress.
The facts behind the chemical imbalance theory of mental illness.
The role of the bio-psycho-social model of mental distress and why we may have focussed predominantly on biological interventions.
Social prescribing as a means to enable connection between people who struggle with depression and anxiety.
The Hamilton Depression scale and how it shows us that the effect of antidepressant drugs is small when compared to the improvements that can be achieved without drug therapy.
How Johann would like to widen the definition of what may be considered an ‘antidepressant’.
How disempowerment often lies at the heart of poor health.
How stigma relates to our perceptions of an individual who is labelled mentally ill and how it changes if we think someone has a biological problem.
Johann’s experiences in the Berlin district of Kotti.
That people can hear audio of the many of the interviews held for the book at https://thelostconnections.com

Relevant links:

Lost Connections: Uncovering the Real causes of Depression and the Unexpected Solutions

Johann Hari talk at the Royal Society for the encouragement of Arts, Manufacturers and Commerce (RSA)

Chasing the Scream: The First and Last Days of the War on Drugs

TED Talk, Everything you think you know about addition is wrong

To get in touch with us email: [email protected]

Kermit Cole: Abordagens Dialógicas para Estados Extremos

De

James Moore

-

19/04/2018

0

This week, we interview Kermit Cole.

Kermit’s first career was in film and television, directing, amongst others, Living Proof: HIV and the Pursuit of Happiness in 1994.

Kermit has undergraduate and master’s degrees in psychology from Harvard and he has over two decades experience working with people in extreme states. He likes to say that he likes to work with trauma, especially when it’s being called something else – such as “psychosis”. Together with his partner Louisa Putnam, he works with couples and families with members who have been labeled as having a mental illness, seeking other ways to understand their struggles – ways that often lead to better outcomes.

Kermit has been part of the team at Mad in America since it was founded in January 2012.

I was keen to ask Kermit about what led to his interest in therapeutic work, his experiences of supporting those in extreme states and his thoughts on Open Dialogue and dialogical approaches in general.

In this episode, we discuss:

How Kermit came to be involved with a photo project that aimed to change the dominant image usually portrayed for those with HIV or AIDS and how that led to his 1994 film: Living Proof: HIV and the Pursuit of Happiness
How Kermit came to feel that a persons life should not be appraised based on its duration
How he went on to make the transition from filmmaker to supporting others with their mental health and wellbeing
That Kermit came to feel that having a camera got in the way of the connection that he wanted to make with people
How he went back to study and developed an interest in trauma and its impact on people and came to develop the skills necessary to be comfortable dealing with extreme states
His experiences working on a helpline for people experiencing suicidal thoughts and in a group home setting
How it felt to support those in distress without judgement or control, but just being with them and how not being alone sometimes makes a big difference
How sometimes supporting someone means not judging but also not colluding with beliefs that may come across as delusional, and how this is different to the approach of trying to medicate away behaviour that has been classified as aberrant
That Kermit feels blessed that he could choose between schooling and study or the risk of depression, diagnosis and hospital, but that many are not so fortunate
How Kermit and Louisa work together to support people struggling with their mental health through a family therapeutic approach and based on Open Dialog principles
That it is important to respond to a network that is in crisis, such as the family unit, rather than a single individual
That this approach used in Tornio, Finland resulted in excellent outcomes for patients and a lowering of municipal expenditure on mental health crises
How Louisa and Kermit approach working together in an open dialog model
How, if you can find a way for people to safely do what they would naturally want to do, then it can be helpful
How Kermit became involved with Mad in America after reading Robert Whitaker’s books
That taking medication could almost be viewed as an act of communion
That life, being human, hurts, but by learning to connect we can ameliorate the trauma

Relevant Links:

Kermit Cole, family therapist

From film director to group home director

Living Proof: HIV and the Pursuit of Happiness

Kermit and Louisa on the Dr. Peter Breggin hour podcast

Soteria Network UK

Open Dialogue

How to Listen:

To listen in iTunes, click here

To listen on YouTube, click here

To get in touch with us email: [email protected]

Olga Runciman: Moving Beyond Psychiatry

De

James Moore

-

18/04/2018

0

This week we interview Olga Runciman. Olga is an international trainer and speaker, writer, campaigner, and artist. She co-founded the Danish Hearing Voices Network and sees the role of the Hearing Voices Movement as post-psychiatric, working towards the recognition of human rights while offering hope, empowerment, and access to making sense of individual experiences.

Olga was a psychiatric nurse working in social psychiatry but today she is a psychologist and since 2013 she has had her own private practice in Denmark, working with people who have been labelled schizophrenic or psychotic. Olga is herself a psychiatric survivor and a voice hearer too.

In this interview, we discuss Olga’s professional and personal experiences of the psychiatric system and how she now helps and supports healing and recovery in others.