This person doesn't "sound" very educated.

First of all, your grammar is horrible. It was almost impossible to tell whether you were complaining or agreeing or being sarcastic. Second of all, why can't pharma be allowed to continue, but under the pretense that they were no longer allowed to research psychoactive treatments, rather alternative therapies and treatments such as transcranial direct current stimulation, something that is absolutely exploding in the primary literature right now. Third of all, I liked how you went to the trouble to have 2 citations, and both citations were of your own papers. Just because pharmacy companies aren't allowed to run their business like a greedy monopoly anymore doesn't mean everyone with a mental illness is doomed, we just need to use different things.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

All ad hominem attacks aside, I found sarcasm in this post to be remarkably easy to detect - but I recognize the inherent challenges in the online medium for expressing such subtleties (one can only do so much with punctuation and emoticons.)

Still, I'm compelled to question the suggestion that the pharmaceutical industry is any kind of monopoly. Is it the suggestion that somehow, all the various competing firms are conspiring together and are therefore in violation of Sherman Antitrust legislation? Were that the case, I'm sure that the government's action against them would have been much more direct and definitive.

I wouldn't call Transcranial Direct Current Stimulation an "alternative therapy," and I certainly reject the implication that some "monopoly" on the part of "Big Pharma" is keeping it from reaching its potential - there is some science behind it and, when enough evidence exists for the FDA, no doubt it shall be brought into the mainstream, just as Transcranial Magnetic Stimulation was - and thank heavens, for that matter, that Neuronetics hasn't been punished in the way that some of the pharmaceutical companies have (at least not yet,) so that they remain motivated to do business and bring their product to as many communities as possible! Many have benefitted greatly already - what a tragedy it would be were this exciting and, as yet undeveloped, new treatment method to wither on the vine.

The saddest thing of all is that, while I do not trust the government to ever perform research and development at the level that can be achieved by an appropriately motivated private sector, now we are looking at a time when the government is the least able to undertake such a thing! (Somehow I doubt that the money saved by ending the Space Shuttle program is going to be funneled into mental health research. All while the private sector is now being called upon by the administration to pick up the slack on the Space Program!)

All that said, however - I am very excited to hear what other "different things" can be used once the "greedy monopoly" is finally out of the way?

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Dr. Stahl: Your rant is long on rhetoric but short on fact.

Your key argument appears to be that increasing regulations on pharmaceutical marketing techniques have led to the drying up of the CNS pipeline. While you provide no evidence to back up your argument, there are many reasons to question this.

1. Other fields of medicine have seen a boom in new agents--diabetes, oncology, and cardiology are examples. New rules in academic medical centers limiting participation in speaker’s bureaus, access to drug reps, and gifts from drug companies have applied in these fields as well as psychiatry--but appear not to be limiting innovation.

2. In psychiatry, many potentially novel agents have been developed and tested during the "pharma-scold" era but have failed in clinical trials because they have simply not worked, not because medical schools have told their faculty not to accept money to tout them. Examples are numerous, and include Substance P antagonist and mifeprestone for depression, J & J's anti-amyloid bapineuzumab for dementia (along with many other anti-amyloid agents from other companies), and Lilly's anti-glutamate agent mGlu2/3 for schizophrenia.

3. Drug companies have introduced many psychiatric medications over the last two decades, but they have made the business decision to invest heavily in me-too agents, some of which, such as Pristiq and Invega, are embarrassingly blatant patent-extenders with no clear advantages over existing agents. Perhaps if companies had invested more resources into developing truly novel compounds, they wouldn’t be in the pickle they are in.

The reason that some companies are pulling out of CNS drugs is not because of the Carlat Blog (though I’m flattered that you believe I have so much clout) but because the brain is incredibly complex mechanism and we yet to work out the basic neurobiology underlying mental illness. As a psychiatrist, I prescribe drugs all the time and I know both their promise and limitations. Far from being “anti-psychiatry,” I would welcome novel drugs to ease my patients’ suffering.

Please show us some evidence for your position. That would be better than more low blow ad hominem attacks on those of us who are trying to improve the pharmaceutical industry by making it more ethical.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I think it would be interesting to split the poll in two:
1. "How do you feel about Pharma's role in mental health research?"
2. "How do you feel about Pharma's role in mental health education?"
Some people might support Pharma's participation in mental health research, but not in the design of medical education programs (this is my position).

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

To me, it's pretty simple: the drug companies are pulling out of the psych market because they know that if they try to pull the slick BS they pulled for the last few decades (me-too drugs, patent extenders, rigged drug trials, ghost-written articles, etc) that this time there will be critics with knives sharpened. The drug companies will be under a microscope this time -- as they should have been all along. They'll have to have real scientific proof of their drugs' efficacy going forward -- not just marketing pseudoscience.

So what was their response to this bar-raising for results? They packed up and moved to greener pastures, to fields of medicine they can still exploit. Speaks volumes.

I think Stahl's logic is representative of how deeply corrupt the times we live in are. Pharmaceutical corruption is so well entrenched, and been around so long, that some physicians have professionally come of age under the veil of a bought-out profession, and think that pharmaceutical company tactics are just the way things are, because doctors don't know any better. Thus Stahl's misguided criticism that somehow the antipsychiatry crowd has effectively flushed pharmaceutical companies from psychiatry. Wrong: it is the result of the exposure of pharmaceutical corruption and is a much-needed correction against that corruption. What IS the point of continuing to release drugs that are the product of brazen corruption? We as a society can do much better.

"Let's criminalize the marketing of psychiatric drugs, levy billions in fines to Pharma, force out their CEOs and even make them and their Pharma collaborators take the "perp walk" on their way to court in chains and orange jumpsuits and in front of the cameras! Get out of our professional societies! Get out of our journals! Get out of our medical centers! Good riddance!!!"
-->These all sound like great ideas to me. The same thing should be done to Wall Street CEOs and bankers.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

As a well trained dynamic psychotherapist, it would be great to all check our countertransference once in a while and try to get some insight into why we do the things we do. I read many of Dr Stahl's works and like many of his ideas- drug company issues aside. His book lays out a framework for performing medication management both on and off label... In performing CBT and IPT, each has a manual and a framework, the many schools of dynamic psychotherapy also have frameworks to perform by... I think some of you miss the point here in that regardless of Stahl's creds, we will have a lack of new meds. Some due to pharma's wanting to pull out due to the flack we give them now, some as they have not found a new blockbuster... Let's be real it is not a one sided story...it never is
Now for Dr Carlat.... I have read your work and admire that you fight against drug companies' negatives but cannot name one positive? I have read one of your works where you state you were at a big Wyeth meeting and you really over stated some of the themes and qualities of that meeting in a very sarcastic way... similar to the blog above by Dr STahl (I was at the Wyeth meeting too and didn't quite see it 100% hostile). I saw it 50/50 (actually at that meeting bumped into another random researcher who helped set my career in research in the right direction and he has been a mentor ever since...) There were some good things and some bad things. I like that Dr Carlat actually sometimes writes about how that some psychiatrists, just practice bad medicine- boy we focus on pharma but what about the glut of practitioners that do not even follow APA guidelines or even read package inserts, can't make DSM diagnoses? I sit as an expert witness sometimes and you would not believe the things that some of us do... Dr Carlat and Stahl- what can we do about this?
What about the HMOs? A post above said TMS is great? We will never know as HMOs rarely allow it... (also, its data is +/-). Dr Stahl/Carlat what can we do about this...?
I heard a rumor that our FDA felt that SeroquelXR/quetiapineXR had solid GAD treatment data but felt they could not trust the average US clinician to realize its risks (TD/EPS/Metabs) and use it for more resistant illness... Drs Stahl/Carlat, what can we do about this when our government doesn't trust us and dictates how we practice ( actually just remitted a treatment refractory anxious patient with that drug and i gave good informed consent and monitor for side effects.... I don;t care if it is brand name or generic, cost 5 cents or 5 dollars a day, but 15 other things failed and my patient is much much better... I don't care if a sales rep told me, a commercial told me, a colleague told me, or I personally read up on a few of the peer review trials, or If I flipped a coin that day as my patient is much better when 15 other things failed.)
I picked that drug as it has antihistamine properties which could help his anxiety like generic hydroxyzine, his sleep like generic diphenhydramine, calm his agitation like generic haloperidol (But with less TD and EPS) through some DA2 blockade, actually treat his anxiety with its norepinephrine reuptake properties like generic desipramine, treat his anxiety further with its serotonin 1a receptor agonism like generic buspirone, and promote better quality sleep with its serotonin-2 receptor blockade perhaps like generic, albeit off-label trazodone (As we do not have an FDA approve 5HT2 blocking hypnotic). So, this expensive advertised drug, took the place of 6 cheap generics... it was more expensive, a monotherapy, and it worked. I used stahl's ideas on the pharmacodynamics, the DSM, the drug. I used Carlat's ideas on knowing the data, cutting through the fluff of advertising, and being a good doctor who made an accurate diagnosis, tried safer things first, picked the right treatment for this patient at the right time while conveying and then monitoring my patient for good and negative effects. Isn't this what it is about..?

So- I know Dr Stahl may be biased towards meds, med discovery and some of the usefulness of pharma. I know that Dr Carlat wants us to practice good medicine but also may want to be the next Dr Szasz anti-psychiatrist (who I also know personally and admire) and is pretty vocal against pharma, the govt, public health law.... Dr Carlat is a practicing psychiatrist still, states he still uses meds to treat his patients.
Dr Carlat, I figure you can;t have it both ways and the truth is always in the middle. I'd love to ask what meds you use and what you refuse to use. I'd like to know what insurances you participate with and would like to know what you are paid to speak, write, blog and by what agencies? In the era of transparency this all makes sense-Dr STahl puts his info on his website I believe.
As far as biases, I have some colleagues here that refuse to use any brand name drugs and only speak in generic names. Others refuse to use anything addictive. Others who do dynamics refuse to use benzos... We all have our reasons for what we do. I see many of your claims hyped like Dr Stahl's in your writings too. I like your writings, they get me to think and have in some ways changed the way I practice (isn't that the goal of education?) I guess, it puts me in the position of who is right and who is wrong on this topic, which is all or none thinking and is an immature defense.

Finally- We all distort. Why not take the strengths in both areas and bolster them and try to minimize and mitigate the weaknesses (sorry about the supportive therapy innuendo) of both sides? You two both have a lot to offer- keep writing, blogging, opinionizing, arguing, truth telling, and distorting!

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Here's a "new model" for you, doc:

1. Talk to people, argue with them, solicit mercy and understanding, give honest advice, and bring effective justice to bear when it's finally necessary. STOP FORCIBLY DRUGGING PEOPLE, STOP RUINING BRAINS, UNDER A PRETENSE OF MEDICAL HELP.

2. Dismantle the coercion machine of state psychiatry. No more involuntary commitment, no more insanity defense, and no more state propaganda about "mental illness = brain disease".

3. Start practicing psychiatry as contractual, fee-for-service medicine. See if you can earn an honest living.

Response to Tom Schwartz

Hi Tom—I agree that it would be better to work together for the benefit of patients rather than squabbling about political issues.

Dr. Stahl and I actually agree on most important things. We believe that psychiatric meds are effective, that off-label use is important and valuable, that doctors should be able to decide what medications to use, regardless of whether they are formally “approved” for a particular indication. We believe that pharma should continue to fund psychopharm research and that academic psychiatrists should be able to accept money from drug companies to conduct this research. Most importantly, we agree that, in the end, what’s best for our patients trumps everything else.

We disagree on some points. Dr. Stahl believes that academics should be involved in marketing drugs and in accepting money from companies to education doctors about their drugs. I believe doctors should get out of the marketing business and stick to research and patient care.

Both Dr. Stahl and Dr. Tom Stossel (a prominent Harvard doctor who coined the term “pharma-scolds”) believe that the more contact between doctors and drug companies, the better educated we will be about effective treatments. They see essentially no downsides to such relationships, only upsides. It’s not an unreasonable point of view, but they are swimming against the tide of ethical opinion in medicine. Most doctors have had too many bad experiences with industry funded talks that gloss over side effects and encourage the use of overly expensive agents that have few if any benefits over existing drugs. We are beginning to realize that taking money from drug companies to push their drugs yields minimal benefits for the profession or patients, and is besmirching the reputations of otherwise great and ethical doctors who participate in such ad campaigns.

As far as disclosures, I’m happy to disclose anything you’d like. My main source of income is from Carlat Publishing, which publishes The Carlat Psychiatry Report and The Carlat Child Psychiatry Report.

Here is my personal income breakdown from 2010:
--Carlat Publishing (profits from sales of subscriptions to newsletters and from joint sponsorships to provide CME credit for other non-industry funded CME organizations): $190,000
--Private Practice (about 5 hours/week, I take all insurances except Medicaid): $25,000
--Royalties from various books (Unhinged, The Psychiatric Interview), and honoraria for occasional speeches: $20,000

As you probably know, standard disclosures (such as Dr. Stahl’s) do not include dollar amounts, and I think that’s too bad. I think it is important to know exactly how much money doctors are accepting from drug companies to give promotional talks, to do marketing consultation, and to participate in industry funded CME. When it comes to money, size matters--$100,000 from a company is intuitively more likely to lead to a biased presentation than $5000. I would be astonished if Dr. Stahl would reveal how much money he makes from each company to do what, but would be impressed if he does so.

You asked about what meds I use or refuse to use. I use just about every medication in the psychiatric pharmacopeia. I rarely use the newest antipsychotics unless there’s some truly compelling clinical reason. I did prescribe Latuda to one patient recently, but only because a former psychiatrist had started it in a different city and I continued it. Now she wants to taper off of it because it is causing insomnia.

I have never prescribed certain newer antidepressants, such as Pristiq or Oleptra. I have never prescribed Silenor because Doxepin works just fine.

I'm not anti-psychiatry and I am in complete in disagreement with Dr. Szasz's opinions that mental illness is a societal construct. Like you, however, I respect his intellect and his chutzpah for standing up and sharing opinions that are extremely unpopular with his colleagues.

What else? Interesting that you were at the Wyeth meeting and that you saw it more positively. I viewed it as a fairly blatant indoctrination into a way of tweaking information for promotional value--but I acknowledge that there was some good solid information at the meeting if you worked to separate the wheat from the chaff!

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

As Dr. Carlat pointed out, pharma has glossed over side effects and adverse events from psychiatric drugs for many years. This has led to prescribing practices based on inadequate risk-benefit assessments, and inadequate post-marketing reporting.

If you don't know what the risks are, how can you responsibly evaluate the risk-benefit profile for any individual patient?

This has led to vast overprescribing of, for example, newer antipsychotics, for conditions far removed from psychosis. Somehow someone has communicated to psychiatrists and primary care physicians alike that there is little downside to chronically prescribed psychiatric drugs. Who could that be?

Just, for example, in terms of diabetes risk, unnecessarily chronically prescribed antipsychotics AND antidepressants clearly add to a public health epidemic. Which would you rather have, occasional insomnia or diabetes? Moderate depression or diabetes? Especially when there are other treatment options for insomnia and moderate depression?

Let us also remember it's not just bad form to allow oneself to be influenced by pharma company misrepresentation of risks and benefits. It's not just a breach of a gentleman's agreement. It doesn't merely look bad ethically. It's not just an embarrassment. It's not just a shaking of doctorly egos.

Underestimate of risks for any individual patient results in patient harm, sometimes long-lasting. The reason there are so many pharma-scolds and antimedication patients is because, at the absurdly high rate of chronically prescribed psychiatric medications, there are a lot of dissatisfied customers out there, and they're not keeping quiet.

This is something medicine and psychiatry needs to come to grips with. Your activities are no longer being carried on in private in hushed sacrosanct environments. This is the age of information-sharing, and flaws in psychiatric practice are coming to light in very public ways. Time to man up and own your responsibilities to patients, and stop whining about the criticism. The days of the Wild West in psychiatry are over, and you are now accountable.

Do pharmaceutical companies allow their employees to accept gifts? Of course not!

Dr. Stahl decries stopping “giving legal freebies (no coffee or bottled water even allowed in Massachusetts let alone a book” to physicians.

Two points:

First, what are the policies that gift-giving pharmaceutical companies have about their own employees’ receiving gifts?

Vermont’s Prescribed Product Disclosure Law requires pharmaceutical manufacturers to disclose gifts to physicians and other health care professionals. Although Vermont’s gift-giving ban now includes food, during both fiscal year 2008 (July 1, 2007, to June 30, 2008) and fiscal year 2009 (July 1, 2008, to June 30, 2009), food accounted for about $800,000 in expenditures. (Source: Prescribed Product Disclosures: Report of Vermont Attorney General William H. Sorrell for Fiscal Year 2010. April 1, 2011; tinyurl.com/3gnno73).

The top five spenders for marketing in Vermont during FY 2009 were Lilly, Pfizer, Forest, Merck, and GSK. Source: Pharmaceutical Marketing Disclosures: Report of Vermont Attorney General William H. Sorrell. April 1, 2010 (tinyurl.com/3jmnha5).

Here is the policy of one of these top five spenders about its employees receiving gifts:

Pfizer
The Blue Book: Summary of Pfizer Policies on Business Conduct (tinyurl.com/25ufurl), p. 27
Giving and Accepting Gifts, Entertainment, Loans, or Other Favors
The Company prohibits you — or someone from your immediate family — from giving and receiving gifts, services, perks, entertainment, or other items of more than token or nominal monetary value to or from the Company’s suppliers, customers, or other third parties. Moreover, gifts of nominal value are permitted only if they are not given or received on a regular or frequent basis.

The policies of the other four top spenders are similar.

The unblinking hypocrisy is galling.

Second, who really pays for the “legal freebies” that Dr. Stahl wants pharmaceutical companies to be allowed to continue? Grandma does, and the rest of us, and Medicare and Medicaid in the form of higher drug prices. There’s no such thing as a free lunch.

Relation of Psychiatry to the Pharmaceutical Industry--1957 style

Kline NS. Relation of psychiatry to the pharmaceutical industry [editorial]. AMA Arch Neurol Psychiatry. 1957 Jun;77(6):611-615.

My personal familiarity with the men who serve in the pharmaceutical industry in both professional and administrative capacities is reasonably extensive, and, with few exceptions, I know them to be men of good will, whose interest extends beyond the purely financial to a strong desire to be of service not only to the medical profession but to mankind in general. Unless we bring attention of this ethical and well-intentioned group the rare exceptions, it will be impossible for the necessary moral suasion to be exerted, and they, to, may find themselves debased by attempting “to meet competition.”

That negative criticisms which I have had to offer are few compared with the multiple benefits, but I believe action must be taken promptly and effectively in order to maintain that which is begun so promisingly.

Nathan S. Kline, M.D.
Rockland State Hospital
Orangeburg, N.Y.

Would that Dr. Kline’s suggested action had been taken promptly and effectively!

Sorry about duplicated post.

Sorry the the post was duplicated. I do not know how that occurred.

what about the criminal corporations?

Steve,

You say the pharmascolds want to say Get out of our professional societies! to the drug companies. Well, I am not a pharmascold but I have been leaning on one of our esteemed professional societies (the one that touts itself as premier in our field) to do something about the corporate members who have pled guilty to criminal behavior and paid hundreds of millions of dollars in fines.

When I joined said esteemed group many years ago they had a provision in the Bylaws for any member convicted of a felony to be expelled. Several corporate members (corporations) have now crossed that threshold but the organization continues to tolerate them. When I urge Council to grasp the nettle they plainly don’t want to hear about the issue. I am not even urging expulsion – I think a 5-year suspension of corporate membership and denial of access to our annual meeting would get the attention of these criminal corporations.

I have no problem welcoming real scientists who work in corporations into our professional societies, but I am seriously turned off by the legions of corporate executives who hang around our scientific meetings with commercial rather than scientific intent. I wish you and others would join me in raising this issue of criminal corporate members with Council.

Barney Carroll.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

"Two of the biggest defectors are the two British companies Astra Zeneca and GSK, who have shuttered all their laboratories for mental health research for good, closing facilities all over the world including those the US, UK and Italy and elsewhere..."

The premise that AstraZeneca and GSK are leaving the scene because of misguided "pharmascold" zealots is hardly a defensible analysis of what's happening in the world of psychiatry and psychopharmacology currently. Both companies arrived late with "me too" drugs - Seroquel and Paxil - and turned them into "blockbusters" with aggressive and stealth advertising. Both companies have paid heavily in the courts but still ended up with a net profit measured in billions. The internal documents from the legal discovery process reveal marketing strategies formerly reserved for summer beach novels about corporate greed. And neither company has any new drugs in the "pipeline" that might be used for another run on the pharmaceutical dollar. Their exit from the CNS market is consistent with the way they've behaved while in it - a "business decision." They see the Gold Rush is ending and they are moving on. Attributing their exit to self-righteous "pharmascolds" is simply naive. If re-establishing an ethical base to academic medicine, medical "societies," medical education, and our psychiatric literature costs us the good graces of the likes of AstraZeneca and GSK, little is lost in the process. And anyway, their wonder drugs will still be around for us to use. If they're as good as they told us they were, why would we even need any replacements?

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

As a former sales representative for a major international pharma company, I learned firsthand clinician and patient attitudes toward the pharma companies. Patients eyed pharma reps suspiciously in waiting rooms, the front-desk staff treated us miserably, and the doctors refused time with us. Even my acquaintences, some of whom owed their lives to modern pharmaceuticals, could not understand why pharmaceutical companies promote their products or sell them at any significant price. All education efforts, sales efforts, or marketing was considered questionable. As sales representatives, we had a hard time recruiting attendance for educational events because by this time, we were prohibited from providing lunch to go with the presentation. Soon, sales reps were banned from most clinics in the area, and we could no nothing more than drop off copies of clinical studies with scowling front-desk staff. It wasn't long before my entire sales team was laid off due to shrinking sales budgets. Any luxury item is heavily promoted and nobody complains. But a drug that saves lives is expected to be available for free and without sales or marketing behind it. I feel that the clinics in my sales territory did get what they asked for. The absence of up-to-date drug information and education from live representatives.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Dr. Stahl characterizes (or, rather, mis-characterizes) the skeptics as being a bunch of know-nothing zealots and religious cultists. Nothing could be further from the truth. A comprehensive rebuttal of Dr. Stahl's article is beyond the scope of this comment. What I would suggest is that interested people start by reading a truly outstanding book called, "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America", by Robert Whitaker. The book's Amazon page is here:

www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-Astonishing/dp/0307452417

Whitaker carefully lays out the clinical and scientific evidence against psychiatric drugs. He is an award-winning investigative reporter, not a Scientologist, alternative medicine freak, or someone with an ax to grind. Check out the book.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Gee....Am I being a pharmascold if I point out the following disclosure from Dr. Stahl's website?

Individual Disclosure Statements:
Author/Presenter
Stephen M. Stahl, MD, PhD, is an adjunct professor of psychiatry at the University of California, San Diego School of Medicine in San Diego, CA. Grant/Research: Forest; Johnson & Johnson; Novartis; Organon; Pamlab; Pfizer; Sepracor; Shire; Takeda; Vanda; Wyeth Consultant/Advisor: Arena; Azur; Bionevia; Bristol-Myers Squibb; CeNeRx; Eli Lilly; Endo; Forest; Janssen; Jazz; Johnson & Johnson; Labopharm; Lundbeck; Marinus; Neuronetics; Novartis; Noven; Pamlab; Pfizer; Pierre Fabre; Sanofi-Synthélabo; Sepracor; Servier; Shire; SK; Solvay; Somaxon; Tetragenix; Vanda
Speakers Bureau: Pfizer; Wyeth
www.neiglobal.com/Default.aspx?tabid=146&menuId=_ctl0__ctl2__ctl0_lMenu_Menu2-menuItem000

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I am a depression patient. My depression was so bad that I could not take proper care of my young children. I would cry in front of them and they would ask me why I was sad. My husband was scared and had to take time off of work. I could not sleep for days and I couldn't eat. The anxiety was unbearable and nobody understood why I was anxious. I felt terrible for at least six months straight and my hair was falling out, making my anxiety worse. I considered suicide but I didn't want to leave my kids without a mom. I was terrified of taking any drugs because I thought I would have side affects or my hair would fall out more. When I finally went to my doctor, he gave me an anti-anxiety medication that worked right away, and a prescription for Zoloft. That afternoon, I slept for the first time in days. Within five or six weeks I was back to my usual happy self. I was able to get a job and work part-time. I was interested in friends and hobbies again. Thank God for the companies that develop these life-saving drugs. I hope that these companies can keep making medicine that helps patients like me.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Are the chinese really taken over drug companies? criticalpsychiatry.blogspot.com/2011/08/are-chinese-taking-over-drug-companies.html

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

@Allen Jones -- good call. Here's another book that I heartily recommend: "Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts", by Carol Tavris and Elliot Aronson. The authors argue that you don't have to be OVERTLY corrupt to be biased by personal gain. Excellent book -- here's the Amazon page:

www.amazon.com/Mistakes-Were-Made-But-Not/dp/0156033909/

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Stahl's commentary is really neither here nor there. No one is asking pharmaceutical companies to exit the business. Their involvement in education about newer drugs is welcomed. But if pharmaceutical companies are solely interested in educating physicians, why can't they just put their money into a joint 'escrow' with the ultimate allocation of marketing expenditures determined by someone with no ties to industry? Problem solved.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

FACT CHECK - KEEPING THEM HONEST

Dr. Carlat posted the following comment but fact checking shows that he has his facts wrong. See fact checking in CAPS below his various assertions:August 27 comment:

Dr. Stahl: Your rant is long on rhetoric but short on fact. Your key argument appears to be that increasing regulations on pharmaceutical marketing techniques have led to the drying up of the CNS pipeline. While you provide no evidence to back up your argument, there are many reasons to question this.

CARLAT ASSERTION:1. Other fields of medicine have seen a boom in new agents--diabetes, oncology, and cardiology are examples. New rules in academic medical centers limiting participation in speaker’s bureaus, access to drug reps, and gifts from drug companies have applied in these fields as well as psychiatry--but appear not to be limiting innovation.

FACT: ALL FIELDS OF MEDICINE HAVE SEEN A DECLINE. 50% FEWER NEW MOLECULAR ENTITIES (NMEs) WERE APPROVED IN ALL THERAPEUTIC AREAS IN THE LAST 5 YEARS COMPARED TO THE PREVIOUS 5 YEARS (PAUL S ET AL). In 2007, for example, only 19 NMEs (including biologics) were approved by the FDA, the fewest number of NMEs approved since 1983, and the number rose only slightly to 21 in 2008. 21 new drugs were approved by the FDA in 2008, and 24 in 2009 (Paul S, et al, Nature Reviews Drug Discovery 2010, 9:203-214)

CARLAT ASSERTION:2. In psychiatry, many potentially novel agents have been developed and tested during the "pharma-scold" era but have failed in clinical trials because they have simply not worked, not because medical schools have told their faculty not to accept money to tout them. Examples are numerous, and include Substance P antagonist and mifeprestone for depression, J & J's anti-amyloid bapineuzumab for dementia (along with many other anti-amyloid agents from other companies), and Lilly's anti-glutamate agent mGlu2/3 for schizophrenia.

FACT: ALTHOUGH SEVERAL SUBSTANCE P ANTAGONISTS HAVE BEEN DROPPED FROM DEVELOPMENT, CONTACTING THE COMPANIES DIRECTLY REVEALS THAT MIFIPRISTONE IS STILL IN PHASE III; THAT BAPINEUZAMAB IS VERY MUCH ALIVE AN MOVING AHEAD IN MANY LARGE TRIALS WITH WYETH/PFIZER/ELAN/JNJ, AND THAT THE LILLY mGLUR 2/3 IS VERY MUCH ALIVE IN PHASE III

CARLAT ASSERTION:3. Drug companies have introduced many psychiatric medications over the last two decades, but they have made the business decision to invest heavily in me-too agents, some of which, such as Pristiq and Invega, are embarrassingly blatant patent-extenders with no clear advantages over existing agents. Perhaps if companies had invested more resources into developing truly novel compounds, they wouldn’t be in the pickle they are in.

FACT: THE SUBSTANCE P ANTAGONISTS WERE NOVEL, AS WERE THE CRF1 ANTAGONISTS, NEUROKININ 2, NEUROKININ 3, BETA 3 AGONISTS, AND MANY OTHERS THAT FAILED TO SHOW CONSISTENT EFFICACY. AGOMELATINE IS NOVEL AND FACES AN UNCERTAIN FUTURE IN THE US BECAUSE OF POTENTIAL HEPATOTOXICITY. OVER A DOZEN NOVEL MECHANISMS WERE ADDED ON TO ANTIPSYCHOTICS TO TEST COGNITIVE IMPROVEMENT, FROM 5HT6, TO NICOTINIC AGONISTS, AMPAKINES, MANY MORE. THE FACT IS THAT INDUSTRY IS PUNISHED FOR PURSUSING TRULY NOVEL COMPOUNDS AND REWARDED FOR ME TOOS.

The reason that some companies are pulling out of CNS drugs is not because of the Carlat Blog (though I’m flattered that you believe I have so much clout) but because the brain is incredibly complex mechanism and we yet to work out the basic neurobiology underlying mental illness. As a psychiatrist, I prescribe drugs all the time and I know both their promise and limitations. Far from being “anti-psychiatry,” I would welcome novel drugs to ease my patients’ suffering. Please show us some evidence for your position. That would be better than more low blow ad hominem attacks on those of us who are trying to improve the pharmaceutical industry by making it more ethical. By Daniel Carlat on Saturday, August 27, 2011

THIS MAY BE A BIT THIN SKINNED ON DR. CARLAT'S PART AND IS FACTUALLY INCORRECT. DR. STAHL'S POST STATED THAT THE SITUATION DELIGHTED ANTIPSYCHIATRY AND PHARMASCOLD BLOGS BUT HE DID NOT MENTION ANY PERSON, AND STATING THAT THOSE BLOGS (AS WELL AS SOME OF THE COMMENTS ABOVE ON THIS BLOG) HAVE ANTIPSYCHIATRY, ANTIMEDICATION AND ANTI-PHARMA COMMENTS IS SELF EVIDENT, AND DOES NOT COMPRISE AN AD HOMINEM ATTACK. ALSO, CORRECTING ERRORS HERE BY DR. CARLAT IS NOT AN AD HOMINEM ATTACK. ON THE OTHER HAND, CALLING DR. STAHL THE ENEMY, ACCUSING HIM OF GOING OFF THE DEEP END, HAVING BLOGGERS ACCUSE HIM OF BEING MENTALLY ILL, SAYING THAT HE HARMS PATIENTS BY DIAGNOSING MENTAL ILLNESS AND TREATING WITH MEDICATION ON THE OTHER HAND, ARE AD HOMINEM. I WILL TRY TO POST THIS SET OF FACT CHECKS ON THE CARLAT BLOG, BUT MOST COMMENTS THAT ARE NOT "ANTI-PHARMA" ARE CENSORED THERE AND NOT POSTED WHEN SUBMITTED, SO IT PROBABLY WILL NOT BE SEEN THERE.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Dr Morrisette in the previous posting could not have said it better. I suspect that the reason that Dr Carlat is so out of touch with the facts, particularly those concerning CNS drug development, is that he cannot or will not communicate with the pharmaceutical industry. His positions have probably alienated himself from industry, and one of the consequences is to be clueless about what is actually going on in the area of innovations for our patients. Perhaps Dr Carlat should limit his "expert" punditry on his blog to commentary about marketing practices. Leave progress in drug development to the experts (like Steve Stahl). While he's at it, leave commentary about "me too's" like Pristiq and Invega to those who are knowledgable about psychopharmacology (like Steve Stahl). I shudder to think what our world of psychopharmacology would be like without a healthy relationship with Pharma - would we be left with "teachers" like Dr Carlat.

Re: Dr. Morrissette's comments

Hi Dr. Morrissette--I never censor any viewpoints on my blog, but to save you the trouble of posting your comment there, I have posted it myself: carlatpsychiatry.blogspot.com/2011/08/dr-stahls-medical-writer-fights-back.html

Thanks for joining the debate!

Dr. Stahl's stalking horse

Dr. Stahl should apologize for this intemperate comment posted on his behalf by Dr. Morrissette, especially the smear concerning Dr. Carlat: CALLING DR. STAHL THE ENEMY. He didn’t.

Meanwhile, please don’t try to create the appearance that mifepristone is going anywhere for treatment of psychiatric disorders – that is farcical and Dr. Morrissette should know better.

As long as Dr. Morrissette has the ear of Dr. Stahl, perhaps she can persuade him to respond to the comment I posted here concerning criminal convictions of pharmaceutical companies.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Perhaps Dr. Carroll should also get his facts straight before he demands an apology from Dr. Morrissette. Dr. Carlat has slammed Dr. Stahl many times in his posts and in fact his May 8, 2008 post shows a picture of Dr. Stahl and is entitled "More APA Notes: Conversations with the "Enemy." Maybe it is Dr. Carroll who should now apologize to Dr. Morrissette for HIS intemperate comments.

Dr. Stahl's stalking horse #2

Get a life, anonymous. Take the time to actually read the May 8, 2008 post by Dr. Carlat. His use of the term enemy there was ironic and self deprecatory, and he had several gracious compliments for Dr. Stahl. And while I think on it, why do you need to be anonymous? Barney Carroll.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

You cannot call somebody a name and then take it back and say you haven't said it, which is what Carlat did in his earlier post and what he does to try and appear to be clever while really being ad hominem and malicious. You should also get your other facts correct, too, Dr. Carroll, which is that no drug companies have been convicted of felonies as you state in your comment above. They have plead guilty to a single misdemeanor. Like jaywalking. Maybe they should have been convicted of a felony, but they have not. Get your facts straight before you go sounding off.

Staying anonymous keeps from getting slammed personally by all these pharmascolds including you, who don't even have their facts right.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Suggesting that pharma companies are leaving the CNS business simply because they've been "held accountable" or a sudden inability to hand out pens is of course somewhat naive and silly. But it seems easy to forget that they, like all businesses, are motivated by profit - and the implicit message they've been sent is that they are not wanted, and that there is no more profit in CNS - only risk.

No giant hammer has come down on them, but Death By A Thousand Paper Cuts is ultimately a worse fate. Instead of simply doing away with promotional dinners, instead it was decided that ONLY medical people could come. Most guys I know with a significant other at home will tend to go home in that case, since going to some dinner program (none of us really NEEDS a "free" steak,) and forgo the company of family/loved ones to listen to some FDA sanitized fluff about a drug is too much like work. So that promotional avenue is effectively dead.

Some seemed to think it was a major victory to stop the handing out of swag - indeed, many reps played martyrs over that - but how much did that really change anyone's bottom line? Other than to perhaps save the pharma companies a few bucks that they could put into DTC advertising instead?

It also, of course, costs real money to develop a drug (particularly a novel one) in the first place - more money than it takes to make a movie, all on some little compound that might turn out to be completely worthless - and then you get less than 10 years on patent to try to make your money back?

So, A. Tsai ... of course no one is ASKING pharma to leave the CNS business (I don't think the players are honest enough or have the guts ...) instead it is the typical, insidious, passive aggressive approach - "we won't ask you to leave, but we're just going to keep making it incrementally harder and harder to do business until you get the picture."

Dr. Stahl's stalking horses #3

Anonymous wants to say that no drug companies were hit with felony convictions. Anonymous needs to get his/her facts straight. Here is a rundown on the history of Pharma criminal prosecutions up to late 2009. It’s a main stream media piece, not a rant from some bunch of pharmascolds.
www.bloomberg.com/apps/news?pid=newsarchive&sid=a4yV1nYxCGoA

Here are some highlights. You will see here that, in addition to dozens of technical, plea bargained misdemeanor convictions, a Pfizer unit (Warner Lambert) pled guilty in 2004 to two felony counts of marketing a drug for unapproved uses, and Pfizer agreed to pay $430 million in criminal fines and civil penalties.
Moving right along, on September. 2, 2009, another Pfizer unit, Pharmacia & Upjohn, agreed to plead guilty to the same crime. For this new felony, Pfizer paid the largest criminal fine in U.S. history: $1.19 billion. On the same day, it paid $1 billion to settle civil cases involving the off-label promotion of Bextra and three other drugs with the U.S. and 49 states.
In April 2007, the same Pfizer unit, Pharmacia and Upjohn, pleaded guilty to a felony charge of offering a $12 million kickback to a pharmacy benefit manager. Meanwhile, as Ed Silverman on the Pharmalot blog tells it (April 18, 2011), Johnson & Johnson was charged in April 2011 by the U.S. Securities and Exchange Commission with violating the Foreign Corrupt Practices Act by bribing public doctors in several European countries - and paying kickbacks to Iraq - to illegally obtain business. As part of this mess, a former exec at J&J’s DePuy unit last year pleaded guilty for his role in paying $7 million in bribes to Greek doctors and was sentenced to 12 months in jail in the U.K.
This is not an exhaustive sampling of Pharma felony convictions. And keep in mind, as anonymous acknowledged, many of the misdemeanor settlements warranted felony status. I will end with a quote from Jerry Avorn at Harvard: “Marketing departments of many drug companies don’t respect any boundaries of professionalism or the law.”
Anonymous, you cannot expect to be taken seriously if you refuse to come out in the open, all the more so when you don’t seem to be able to get your facts straight.
Barney Carroll.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I think that it is important to point out that although Dr. Stahl is a champion for new drugs, he is also a champion for old drugs with no Pharma support that many are not taught how to use, like MAO inhibitors and lithium, and he has some of the most comprehensive educational materials available for these older agents. What may surprise the anti-medication and antipharma/Pharmascold crowds above and over on the carlat blog, is that Dr. Stahl actually is a champion as well for psychotherapy. I know this because I sat in on his private practice for 6 months during my fellowship from Chile where I am back. He did individual, couples and family therapy, to some patients given no drugs, as well as complex psychopharm consults. Also, you may want to check out his current education efforts, most now without Pharma support, including new programs on a new type of cognitive behavioral therapy - trial based as in Kafka, the trial. He found this during a trip to Brazil (where he gives away many free books and internet programs including in my country Chile especially to trainees), from the translator of his textbook Dr, Irismar Reis de Oliveira, and it is a big hit. In fact the next courses are online, free, no Pharma support, are over-booked and closed out now due to popularity among psychopharmacologists from NEI!! and so you will have to wait until more can be scheduled (see www.neiglobal.com/Default.aspx?tabid=929). He is writing two books, one with Dr. Oliveira and another with a psychologist, on how to integrate psychotherapy and psychopharmacology, out next year. He has also written books on medical education and given free books to every training director in the US and many other countries at his own cost. All of this matters nothing to antipsychiatrists and Pharmascolds, but needed to be said.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

This Carlat guy reminds me of somebody who thinks he is a comic book hero. By day, the bespectacled mild mannered reporter, toiling in the fields of legitimate psychiatry and psychopharmacology making most money off of writing; but at night, and after emerging from phone booths, look, up in the sky, a bird, a plane, its Super-Blog-Man, fighting for truth, justice and the American way, without whom evil would triumph and ethics would disappear. Thank god for carlat to save the world.

In truth, he plays both ends against the middle, giving a forum to antipsychiatrists and pharmascolds and just because he hides behind them it is not convincing that he doesn't believe them, just that he doesn't have the courage to say so.

I need some comic relief occasionally, so reading about the pettiness and nastiness here is somewhat entertaining. Soon, we all have to get back to important things like what is best for patients from mainstream legitimate psychiatry and its promise of improved therapies in the future emerging from neuroscience not polemics.

Re: Dr. Morrissette's comments

Hi Dr. Morrissette--I never censor any viewpoints on my blog, but to save you the trouble of posting your comment there, I have posted it myself: carlatpsychiatry.blogspot.com/2011/08/dr-stahls-medical-writer-fights-back.html

Thanks for joining the debate!

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I agree with Dr. Carroll that people who are going to state strong positions or be critical should not be anonymous, includes those posts above here and on the carlat blog where people use screen names and not their real names. Thomas Friedman, famous NY TImes columnist and award winning technology writer (The World is Flat) has said this in writing and on TV about two laws of the internet and they apply to a lot of the statements above on this matter:

1. internet + anonymity = assho___
2. The internet is a vast sewer of information that must be filtered before consumed.

Re: Dr. Morrissette's comments

Hi Dr. Morrissette--I never censor any viewpoints on my blog, but to save you the trouble of posting your comment there, I have posted it myself: carlatpsychiatry.blogspot.com/2011/08/dr-stahls-medical-writer-fights-back.html

Thanks for joining the debate!

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I'm not an antipsychiatrist, but I do believe that psychiatry (and in particular psychopharmacology, which is pretty much the same thing these days) has gotten WAY ahead of itself. When I see a patient I have to remind myself that I'm dealing with a thinking, feeling human with a rich, complex history and an almost endless array of potential routes to recovery. Dr Stahl's explanations of pathways and drug mechanisms are beautiful and elegant, but when medications don't work the way he says they should (which is often), I wonder whether Dr Stahl's paradigms have anything to do with the patient in front of me.

Ultimately, I believe that the departure of pharmaceutical companies from CNS research could be a good thing. Their expert salesmanship-- and, unfortunately, the tendency of modern psychiatrists and patients to pathologize everyday life-- has made us all dependent (literally or figuratively) on drugs that are too often ineffective or cause further pathology. In my opinion, we need to rethink this whole enterprise and see our patients with a fresh perspective, not the pharma-tainted lenses that the current generation of psychiatrists, including myself, have inherited.

One other thing: In response to Dr Morrissette's assertion that Dr Carlat implied that Dr Stahl "HARMS PATIENTS BY DIAGNOSING MENTAL ILLNESS AND TREATING WITH MEDICATION," I can't say whether Dr Stahl has ever done such a thing, but I WILL say that I have seen plenty of psychiatrists HARM patients by doing precisely this. I'd be happy to explain.

Re: Dr. Morrissette's comments

Hi Dr. Morrissette--I never censor any viewpoints on my blog, but to save you the trouble of posting your comment there, I have posted it myself: carlatpsychiatry.blogspot.com/2011/08/dr-stahls-medical-writer-fights-back.html

Thanks for joining the debate!

Re: Dr. Morrissette's comments

Hi Dr. Morrissette--I never censor any viewpoints on my blog, but to save you the trouble of posting your comment there, I have posted it myself: carlatpsychiatry.blogspot.com/2011/08/dr-stahls-medical-writer-fights-back.html

Thanks for joining the debate!

Quote of Dr. Stahl Contradicting the Point of his Post

The fur is flying here and on my blog in part because everybody loves a good battle--but certainly the trigger is Dr. Stahl's incomprehensible statement that drug companies are puling resources out of psychiatric R&D because of a growing ethical movement to limit deceptive marketing techniques. But just last fall, he was singing a very different tune. I came across the following quote from a Lilly-supported lecture Dr. Stahl gave in November 2010 (you can read the full transcript at www.medscape.org/viewarticle/735992_transcript, but I believe you have to be a member of NEI--you can register for free.) Here, Dr. Stahl is explaining that drug companies are spending less money on psychiatry because of a series of scientific dead-ends (in the case of antipsychotics) or because they realize that the public are no longer able to stomach more me-toos (in the case of antidepressants).

So what's actually causing drug company flight from psychiatry Dr. Stahl? A few months ago you called it a business decision. Now you're blaming pharmascolds. Maybe next month insurance companies will be the culprit.... (See below for his quote).

"I was just in Cambridge in May, I don't know if I told you this at this meeting, but there were 60 people invited from 16 drug companies that went over, like, 8 or 9 different pharmacological mechanisms of add-on to schizophrenia to see if it would help cognition; ampakines, alpha-7 nicotinic, I don't know what all—5HT6, all these things...didn't work, didn't work, didn't work, didn't work, didn't work, didn't work, didn't work.

Basically, the pharmaceutical industry is going to basically trash this pretty soon. Most of the pharmaceutical industry is leaving the treatment of depression. You know that, right? All the big companies say the drugs work well enough, nobody's going to pay any more for them, so there's no new innovation going on probably in 9 out of 10 big companies now in depression.

Now they're saying the same thing for cognitive symptoms of schizophrenia. They've failed and failed and failed, so this gets pessimistic, and I don't want to be pessimistic, but I can't not tell you the truth. And so we need to keep things alive by making sure we do the best with the treatments that are out there, and continue to tell the pharmaceutical companies and the governments that these are important problems, there are unmet needs, there are huge sufferings, and it is worth doing the research to fix it."

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I agree with some aspects of what dr. carlat is saying and with some of dr.Stahl’s remarks.

In his book “Unhinged” dr.Carlat blames the Big Pharma for the “15 minutes med. checks” that psychiatrists do now-a-days.

I am not defending pharmaceutical industry (they need to scale down their marketing departments and use the extra money for research into new products, rather than making more of the same), but it was the managed care in the 80s who stopped reimbursing psychiatrists adequately for psychotherapy to the point that younger psychiatrists totally gave up on it.

Our leaders in the APA are the ones to blame for the current status of events rather than the Big Pharma. They became so out of touch with day to day reality of the psychiatric practice, that (at least I feel) they do not represent us, grass root psychiatrists, any longer. The APA leaders are not the “hired guns” of Big Pharma. They are the ones who offered their services to the pharmaceutical industry. These narcissistic academics keep “inventing” more and more new diagnoses in the DSMs, inviting the Big Pharma to “find new treatments” for the” new” disorders. This only leads to loss of credibility not only in the society at large, but also among psychiatrists.

We psychiatrists need to clean our own house first.
I suggest we start with:
1. Getting rid of the corrupted academics from the APA
2. Uniting American Psychiatric Association with American Psychological Association into one grass root organization that would devote its energy to the innovation and patient care(rather than spending time and money fighting each other).
3. Getting rid of bigger and bigger DSMs(ICD should suffice).
4. Let’s go back to basics and focus on alleviating the pain and suffering of the patients.

Instead of blaming Big Pharma let’s look in the mirror first.

Adonis Sfera, MD
Dr.sfera@gmail.com

who you gonna believe?

An implicit assumption in Dr. Stahl’s original post is that academics are putting out great stuff and their reports are reliable. The disaffection of Pharma with psychiatry couldn’t possibly be due to the academics screwing up, could it?

Well, a new report in Nature Reviews Drug Discovery (September 2011) puts a searchlight on this smug assumption. A companion commentary hammers home the message: more than 50% of published results from academic laboratories cannot be repeated in an industrial setting, and so drug discovery targets proposed from academic centers cannot be relied upon for corporate research initiatives.

The research areas considered in this review were oncology, women’s health and cardiovascular. There is no reason to think that it would be any different in psychopharmacology.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

I am from India ,our situation is bit different but ,whatever Dr.Stahl has written is very true.Edison didn't stop trying for new filaments even after many failure.So new drug invention will be there with failures it doesn't mean to stop and control with ridiculous regulation.Within limitation of ethics this can be done but its very obvious to get angry for over-ethics.Its nothing wrong to take freebies from pharma as they are also doing business and we are part of that.If you are getting paid for your expertise nothing wrong as we are not only field in the world like this.
On contrary we should thank Dr stahl for raising voice for this injustice.

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Are future psychiatric treatments doomed?
Yes.
The pharmacological variety.

The past fifty years have been an abysmal failure, and it's time to move on now.

Are all treatments doomed?
Not the non-drug variety...
We haven't even begun to help people heal and recover without psychiatric drugs.

It's time we got started!

Duane
discoverandrecover.wordpress.com

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

Are future psychiatric treatments doomed?
Yes.
The pharmacological variety.

The past fifty years have been an abysmal failure, and it's time to move on now.

Are all treatments doomed?
Not the non-drug variety...
We haven't even begun to help people heal and recover without psychiatric drugs.

It's time we got started!

Duane
discoverandrecover.wordpress.com

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

My apologies for the accidental duplicate comment.
Duane

Re: Are future psychiatric treatments doomed? Be careful what you ask for...you just might get it.

"This in a field where over half of legitimate practice is off label! " The irony in this sentence is staggering; particularly in light of the Real World outcomes for patients. It is not moral, therapeutic, or ethical medicine; yet it is called "legitimate practice." The "legitimate practice" of psychopharmacology has fatally infected psychiatry; and was then purposely spread and now permeates other medical specialties. This infection has spread in spite of the fact psychopharmacology is neither Evidence-Based or therapeutic for far too many patients. Real human beings lives whose lives are forever altered, and not for the better---who are supposed to be psychopharmacology's the primary beneficiaries; but are in fact it's unwitting victims. The pseudo-legitimate standard practice of drugging symptoms of distress and emotional, behavioral difficulties ignores the Hippocratic Oath to "First, do no harm..." that is what must be remembered. Psychopharmacology's success relied on ignoring the Hippocratic Oath, the Ethical Guidelines for Informed Consent of the medical profession, and the Nuremberg Code. It is no tragedy for it to be at long last recognized for the failure it is; WHAT TOOK SO LONG?