A lot has been said on the use of antidepressants and whether they are safe and effective in those that use them.
The majority of healthcare professionals who prescribe these medications on a daily basis seem to think that antidepressants have a place in today's society. The majority prescribe them because they have been told, and are still told, that they are safe and effective.
Of course, your average GP doesn't just think that the evidence that these drugs work is based around the clinical trials, spokespersons of pharmaceutical companies and thought leaders. They, apparently, see the results first hand. Depressed Joe feels a whole lot better because of the Prozac that Dr Jones prescribed him 2 months ago. The change in Joe is enough for his Dr to believe that the Prozac is working. The placebo effect rarely enters the mind of Joe or Dr Jones.
I find the history of marketing antidepressant medication fascinating in as much that it is rarely questioned by the masses, even if it was questioned by your average layperson it's, more often than not, met with a shrug of the shoulders and an 'Ah well' attitude.
It couldn't happen to me, right? I'd never allow myself to become depressed, to take an antidepressant people must be weak, why don't they just get a grip of themselves?
Attitudes like this may have there place but the genius of pharma marketing is that they are very convincing but always driven by profit.
An SSRi, like Joe's Prozac, was, and still is, marketed at people who, according to pharmaceutical marketing, have something wrong with his brain. Joe is abnormal compared to the rest of us, he has a chemical imbalance. Nobody, not even the pharmaceutical companies or the prescribing doctor can tell Joe, or indeed the rest of us, what has caused this imbalance. They just know that he has one and that Prozac can help align the imbalance.
Joe goes along with it all because the professional has a white coat and a stethoscope dangling from his pocket or, in typical medical fashion, the doctor wears it proudly around his neck, probably to distinguish himself as that professional. It's kind of like a laminate that allows back-stage entry to see members of a band that the majority of concert-goers have had to pay money to see. We would wear the laminate to distinguish ourselves from the paying guests, we'd wear it with pride - a pride driven by ego that we think makes us better than those that don't have the VIP Access All Areas pass.
So Joe plods along assuming, rightly or wrongly, that Prozac is correcting something that his doctor told him he has.
What if Joe had been duped... what if Joe's prescribing doctor had been duped?
Joe may wake one morning and think to himself that his doctor got the diagnosis completely wrong. There's nothing wrong with my mental health, Joe may think, this could be a physical illness.
Joe may cast his mind back to the initial visit to see his doctor, he may just work out for himself that the diagnosis was based around a talk session.
That stethoscope the doctor proudly dangles from his pocket or neck didn't even come in to play. Joe just may think that it should have.
Joe, as a layperson, may do his own research. He may find that he does not have a chemical imbalance at all. He may learn that his doctor should have ruled out what it could have been opposed to what he thought it was.
Here's a few examples that Joe's doctor could and should have ruled out before scribbling the word 'fluoxetine' on the prescription pad.
Epilepsy, spinal and brain injury, diabetes, chronic renal disease, liver disease, bone and joint disorders, cardiovascular disease, gastrointestinal disorders, disabilities of locomotion, blindness and deafness, mineral and vitamin deficiency.
Physical Health
Joe's doctor didn't bother running tests on any of the above because Joe's doctor has been indoctrinated by a belief system that is rarely questioned by modern day man. It has become so ingrained in the medical profession that to question its validity borders on insanity. It has become the first stop for doctor's, a first-line treatment due to the whole marketing mechanics of pharmaceutical companies in conjunction with eminent thought leaders around the world who sit down, with their laminates firmly affixed, and decide how best to help those with mental disorders when in reality those disorders could in fact be one or more of the physical symptoms listed above.
How do these thought leaders promote their findings?
They do so by scripture [DSM]- a thought process turned into word which is ultimately preached as the Gospel [1]
Joe's doctor, like every other doctor, used the criteria in the DSM which led him to believe that Joe's brain wasn't functioning properly. What Joe's doctor failed to do was rule out if Joe had a general medical condition first. Psychiatric medication jumped the queue and became first-line treatment.
Ironically, it's the DSM guidebook that attempts to educate doctors in the 'The process of differential diagnosis', a six-point check list to assist doctors in diagnosing correctly.
After ruling out numbers one and two, namely, ruling out Malingering/Factitious Disorder and ruling out a substance etiology, Joe's doctor should have then ruled out an etiological general medical condition. [2]
Perversely, a Factitious Disorder is, according to those who sit down, with their laminates firmly affixed, a mental disorder [3]
So, in essence, a guidebook that tries to assist a doctor in getting the diagnosis correct is, in actual fact, sending that doctor, Joe's doctor, down the mental health road. A six-point process of differential diagnosis starts off with a possible mental disorder.
A differential diagnosis is defined as:
the determination of which of two or more diseases with similar symptoms is the one from which the patient is suffering, by a systematic comparison and contrasting of the clinical findings.Joe didn't really stand a chance, did he?
Nine months after Joe's first Prozac pill his wife left him. Joe had started drinking and became violent. He slept most of the day and became apathetic, he didn't really care too much about his appearance either. Joe's kids were happy with the split. They were fed up of his mood swings and didn't like being told to keep the noise down because dad had trouble in tolerating loud noises.
Thirteen months after Joe's first Prozac pill he had just had enough. He considered suicide, it was the first time in his life that he had ever considered such a thing. He went through the pros and the cons. His kids would be devastated if he took his own life, right?
Joe's lack of empathy and fear guided him. They took him to that dark place where there was a hose and a car. He killed himself, carbon monoxide poisoning and an overdose of sleeping tablets.
At Joe's inquest the coroner was told that Joe had been prescribed Prozac because he had a mental illness. Only people who are mentally ill kill themselves. It had nothing to do with Joe's medication because the doctor, well renowned psychiatrist and pooled clinical studies presented at the inquest showed that Joe had a mental disorder and his death was probably a result of this disorder combined with the separation from his wife and kids.
Joe's physical health at the time of being prescribed Prozac was never mentioned because it was never recorded. He was dead now so it was all irrelevant.
Joe's blood samples have been kept by his estranged wife. She started researching about the effects of Prozac. Her once lovable husband had changed since he took it.
She has yet to find out that Joe was a poor metabolizer and that with each 20mg dose of Prozac Joe took he was actually topping up to 30 and 40mg per day. His poor metabolizing system had meant that he could not secrete the 20mg of Prozac quick enough, he was actually overdosing each day without knowing it.
She wrote to the drug company to learn more.
The drug company referred her to her doctor.
**The characters Joe and his doctor are fictitious. I included them in this blog of mine because there are many people like Joe who are, after a 10 minute window with their doctor, diagnosed with an illness that the majority believe as truth. Joe, like many, do not have a physical health check nor are they tested to see if they are poor metabolizers of these class of drugs [SSRi's]
Precautions are in place to protect the Joe's of this world, sadly, they are rarely used because, even in death, we have our laminate wearing experts preaching the gospel of St Diagnostic and global medicine regulators who sit around thumb twiddling whilst touting the benefits of antidepressant medication.
Joe was just a normal guy.
It was the gospel of St Diagnostic that made Joe abnormal. The Prozac just pushed him toward... and beyond the realms of death.
Coming Soon: The Resurrection of Joe
1. Gospel - A thing that is absolutely true.
2. Differential Diagnosis Step by Step - DSM Library
3. Factitious Disorder - [DSM IV]
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