ET VAKKERT SINN
A BEAUTIFUL MIND

Suksessfilmen ET VAKKERT SINN går nå på kino. Den er absolutt verdt å se. Den handler om nobelsprisvinneren John Nash og hans schizofreni. Det er likevel sneket seg inn en alvorlig feil eller forfalskning. Det er grunn til å undre seg over hvorfor og hvordan?  Filmen gir et sterkt inntryikk av at Nash's helbredelse kunne skje takket være nyere medisiner - nevroleptika  - anti-psykotiske piller..   Sannheten er tvert imot at Nash nektet å ta medisiner. Psykiateren Barry Duncan (PhD) forfatter av boken "The Heroic Client" sier at filmen kan skade mennesker som har diagnoser på psykiske lidelser. . Robert Whitaker skriver i USA Today (4.3.02) at hans helbredelse kunne sees i sammenheng med at han nektet å ta nevroleptika. Både Nash og forfatteren av hans biografi har bekreftet at dette med at han tok medisiner er ren fantasi. Nash selv undrer seg over hvorfor og hvordan dette kan ha sneket seg inn i filmen. Filmen bygger løselig på biografien til Sylvia Nasar. Men ifølge boken sluttet Nash med medisiner i 1970. (Nobels pris i 1994) Naser sier at medisiner trolig ville umuliggjort at Nash kunne vende tilbake til et normalt liv og funksjonere optimalt.

Selv WHO (Verdens Helseorganisasjon)  har igjen og igjen funnet at helbredelsesraten for schizofreni er langt større i fattige land, hvor det ikke brukes medikamenter, enn i vestlige land. WHO sier at hvis en bor i et vestlig land er det "a strong predictor" - en sterk indikator eller bestemmende faktor  på at pasienten aldri vil bli frisk. Med disse opplysningene i bakhodet anbefales filmen på det beste - aller varmeste. Terningkast 6.

Det er alminnelig enighet både blant tilhengere og motstandere av nevroleptika at det er svært utilrådelig å slutte med medisiner på egenhånd.  Det må gjøres i samråd med lege.

Tore Lende
(Innlegg i Stavanger Aftenblad 27.03.02)

22. mars. 2002
 

Tore Lende. Rishagen 12, 4321 Sandnes
51667811
http://lende.no

lende@lende.no
Guestbook

Psykiatriens livstidsdom.  Av spesialist i klinisk psykologi  Reidun Ueland NY  16.10.03
Aase Wahl skriver til meg:
"Takk til deg, du hjertevarme menneske med stor handlingsevne!
Jeg har sett filmen, lest din kommentar....og tenker at over det hele står kjærligheten med stor bokstav "størst av alt er kjærligheten"...til Livet, eget og andres og jordens.
God Påske fra Aase"  (Se også Aases hjemmeside. Den estetisk nytelse - og innholdsmessig i en klasse for seg: www.stelladualis.no)

Hvis dette interesserer deg, se også Arnhilds gripende historie om hvordan hun ble frisk fra schizofreni http://www.lende.no/frisk

Innleggelse gjør meg  sykere  (Aftenbladet 23.11.04 )
Medisinering er eneste behandling   (Aftenbladet  23.11.04)
De gjør ingenting   (Aftenbladet 23.11.04)
Se Dr. William Glassers erfaringer: http://lende.no/psykotisk
Israelsk menneskerettighetsorganisasjon protesterer mot den falske "snikreklamen" for psykiatrisk medisin: http://www.iaapa.org.il/reward.htm
"The film purports to  depict the "recovery" of the north-American mathematician John Nash from the mental illness of "schizophrenia" through the use of "new improved  psychiatric drugs". This is a manifest lie . Nash did not take any psychiatric drugs from 1970 onwards. The propaganda  campaign of this movie tries to prove that psychiatrists and  "medicine" can create a Nobel Prize winner even from a schizophrenic."

Dagbladet 25.03.02  Titusener av gamle dopes ned helt unødvendig viser undersøkelse av sykehjem i Bergen: http://www.dagbladet.no/print/?/nyheter/2002/03/25/321263.html
Det var et team spesialister som i utgangspunktet er positiv til nevroleptika Et annet team, med mer kritiske spesialister,  kunne kommet til et enda mer alarmerende resultet?
--------------------------------------------------------------
---------------



Sent: Thursday, March 07, 2002 2:09 AM
Subject: NEWS- "A Beautiful Mind"
 
 

 Universal Studios
 Publicity

 Dear Julie Brantley,

 I am informed by David Oaks of Support Coalition International, in the  following public statement, of a call for an apology and clarification over the false portrayal in the movie "A Beautiful Mind" of John Nash's recovery  being linked to taking "newer medications" at the time he received his Nobel  Prize, when infact he had been drug free since 1970 and recovered without  any psychiatric drugs.

 I would like to see Universal Studios publish a pamplet to be given to every  movie goer correcting this distortion of facts as well as a correction  statement added to the begining trailers on the movie screen.

 Please let me know what your intentions are for correcting this, soonest.

 Regards
 Wayne Smyth
 PO Box 262
 SUBIACO 6904
 Western Australia
 

 ~~~~~~~~~~~~~~~~~~~~

 PUBLIC STATEMENT - March 6, 2002

 From: Support Coalition International

 To: Universal Studios, Imagine, and
 DreamWorks Pictures

 The film "A Beautiful Mind" has an ugly  distortion:

 Author Robert Whitaker revealed in a USA  Today commentary on March 4th that John  Nash's recovery was linked to his refsual to  take psychiatric drugs called "neuroleptics."  [See copy of Whitaker's column below.]

 Apparently bowing to political correctness,  the filmmakers instead had Nash claim he was  taking "newer medications" at the time he  received his Nobel Prize. John Nash and his > biographer have confirmed this statement is  fictitious. Nash was drug free.  This film is helping millions admire the  resilience of psychiatric survivors. But  this film also seriuosly misleads the  public. The fact is, many people -- like  Nash -- recover without taking psychiatric  drugs. By caving in to pressure, the film > has become an advertisement for the  psychiatric drug industry. Nash himself  wonders if the fact that one of the film's  writers is related to a psychiatric  professional played a role in this  distortion.  This film says it was inspired by Nash's  life. But it dishonors his hard won victory. On behalf of 100 grassroots groups advocating  for the human rights of people diagnosed with  psychiatric disorders, we request that  Universal, Imagine and DreamWorks Pictures  issue a public statement of apology and > clarification about this distortion.

 Sincerely, David Oaks, Director
 Support Coalition International
 http://www.MindFreedom.org

-end -

USA Today_ March 4, 2002 Page 13A

 Mind drugs may hinder recovery

 By Robert Whitaker

 The movie A Beautiful Mind, nominated  for eight Academy Awards, has brought  welcome attention to the fact that  people can and do recover from  schizophrenia, a severely disabling > disorder that affects about one in 100  Americans. Unfortunately, the film  fabricates a critical detail of John  Nash's recovery and in so doing,  obscures a question that should concern  us all: Do the medications we use to
 treat schizophrenia promote long-term  recovery -- or hinder it?

 In the movie, Nash -- just before he  receives a Nobel Prize -- speaks of  taking ''newer medications.'' The  National Alliance for the Mentally Ill > has praised the film's director, Ron > Howard, for showing the ''vital role of  medication'' in Nash's recovery. But as  Sylvia Nasar notes in her biography of  Nash, on which the movie is loosely  based, this brilliant mathematician  stopped taking anti-psychotic drugs in 1970 and slowly recovered over two  decades. Nasar concluded that Nash's  refusal to take drugs ''may have been  fortunate'' because their deleterious  effects ''would have made his gentle  re-entry into the world of mathematics  a near impossibility.''

 His is just one of many such cases.  Most Americans are unaware that the  World Health Organization (WHO) has  repeatedly found that long-term  schizophrenia outcomes are much worse  in the USA and other ''developed''  countries than in poor ones such as  India and Nigeria, where relatively few  patients are on anti-psychotic medications. In ''undeveloped'' countries, nearly two-thirds of  schizophrenia patients are doing fairly  well five years after initial diagnosis;  about 40% have basically recovered. But  in the USA and other developed  countries, most patients become chronically ill. The outcome  differences are so marked that WHO  concluded that living in a developed  country is a ''strong predictor'' that  a patient never will fully recover.

 Myth of medication

 There is more. In 1987, psychologist  Courtenay Harding reported that a third  of chronic schizophrenia patients  released from Vermont State Hospital in > the late 1950s completely recovered.
 Everyone in this ''best-outcomes''  group shared one common factor: All had  weaned themselves from anti-psychotic > medications. The notion that  schizophrenics must spend a lifetime on > these drugs, she concluded, is a  ''myth.''

 In 1994, Harvard Medical School  researchers found that outcomes for  U.S. schizophrenia patients had  worsened during the past 20 years and  were now no better than they were 100  years earlier, when therapy involved  plunking patients into bathtubs for  hours. And in 1998, University of  Pennsylvania investigators reported  that standard anti-psychotic  medications cause a specific area of  the brain to become abnormally enlarged  and that this drug-induced enlargement  is associated with a worsening of  symptoms.  Comprehensive care succeeds  All of this has led a few European  physicians to explore non-drug  alternatives. In Finland, doctors treat newly diagnosed schizophrenia patients  with comprehensive care: counseling,  social-support services and the selective use of anti-psychotic  medications. Some patients do better on  low doses of medication, and some  without it. And they report great  results: A majority of patients remain  free of psychotic symptoms for extended  periods and hold down jobs.

 John Nash's recovery from schizophrenia  is a moving story. But we are not well  served when the movie fibs about the  anti-psychotic drugs' role in his  recovery. If anything, his story should  inspire us to reconsider  anti-psychotics' long-term efficacy  with an honest, open mind. That would  be a first step toward reforming our  care -- and if there is one thing we  can conclude from the WHO studies, it  is that reform is vitally needed.  Perhaps then we could even hope that  schizophrenia outcomes in this country  would improve to the point that they  were equal to those in poor countries  such as India and Nigeria.

 Robert Whitaker is the author of Mad in  America: Bad Science, Bad Medicine, and
 the Enduring Mistreatment of the  Mentally Ill.
 http://www.usatoday.com/usatonline/20020304/3909657s.htm

 - end -
 
 

 To get a copy of Mad in America, plug the
 title into the MAD MARKET search engine:

 http://www.mindfreedom.org/madmarket/
 
 

 Does Drug Company Marketing Now
 Include Product Placement in the Movies?

 By Barry Duncan, PhD,  Author of
> _The Heroic Client_

 Have pharmaceutical companies learned   that product placement in high grossing  movies is an excellent way to influence  public opinion? Have drug company  advertising execs watched too many einiken/Swordfish commercials?  Consider the high profile and now Oscar  nominated film "A Beautiful Mind." In  the film, the mathematical genius John  F. Nash played by Russell Crowe says,  "I take the newer antipsychotics. They  don't cure me, but they help." This is  a totally fictionalized statement; By  all accounts, Nash took no  antipsychotic medication after 1970. This of course predates the so-called > "newer antipsychotics" by some 20 plus > years.  Consider the following  corroborations of the fact that Nash  did not take these drugs:

 1. Sylvia Nasar in her award winning  biography of Nash, "A Beautiful Mind,"  writes on page 353, "Nash's refusal to  take the antipsychotic drugs after  1970, and indeed during most of the > periods when he wasn't in the hospital  during the 1960s, may have been  fortunate."

 2. Sylvia Nasar, once again, in a 1994  article (The New York Times, Sunday, November 13, pp. 3, 8), "The Lost Years  of a Nobel Laureate" reports the  impressions of arguably the two most
 important persons in Nash's life: his  wife (Mrs. Nash) and his sister (Mrs.  Legg). Talking about Nash's "miraculous  remission," Nasar says, "And as happens,  for reasons unknown, in the case of some people with schizophrenia, it was not,  according to Mrs. Nash or Mrs. Legg,  due to any drug or treatment."

 3. John Hoey, MD, in the article, "The  Peculiar Genius of John Nash" published  in the Canadian Medical Association  Journal in 1999 (160:870) said, "How to > account for this spontaneous
 remission -- Nash refused to take  antipsychotic drugs after 1970-is a  matter of conjecture and the price that  Nash has paid for both his illness and  his recovery is a distressing  calculation."

 4. And John Nash's own words in his  1994 autobiography on the Nobel Prize Website:  http://www.nobel.se/economics/laureates/1994/nash-autobio.html
 "But after my return to the dream-like  delusional hypotheses in the later 60's  I became a person of delusionally  influenced thinking but of relatively  moderate behavior and thus tended to  avoid hospitalization and the direct  attention of psychiatrists."

 5. Finally, in a recent (February,  2002) phone interview, Nash was  questioned about the impression the  movie gave that his recovery was due to  the newer medications. He was asked
 whether that impression was accurate or  artistic license. Nash said it was  artistic license.  So, from several sources, including  Nash himself, Nash's amazing  transformation was NOT due to any drug  or treatment. The fictionalized  statement in the movie, then, raises  many questions: "  How did such a statement get added > to the script? "  Whose interests are  served by such a statement? "  Did the  expert, Max Fink, MD, influence this  invented reality regarding Nash's life?  Or someone else? "  Who is the expert  working for or affiliated with? "  Is  he affiliated with any of the companies  that produce the newer antipsychotics?  "  Did the drug company pay for that  inserted statement like other companies  purchasing the placement of their  products?

 It is not coincidental that many  articles and reviews of the movie close  with information about the newer  antipsychotics, commenting on their  less serious side effects than the  older varieties like Thorazine. For  example, consider this excerpt from the  _Seattle Times_ (February 3, 2002):

 "Nash's approach came at a time when  the pharmaceutical industry was coming  out with more effective drugs whose  side effects were milder than those he  had initially been placed on. Today, there have been major advances, and  mental health experts say newer  anti-psychotics such as Zyprexa,  Seroquel and Geodon do not have the  debilitating side effects of some of  the older drugs."  Setting aside the questionable  scientific veracity of those marketing  statements (new drugs always promise  more effectiveness and less side  effects only to be shown later to be  comparable to their predecessors, e.g., tricyclic antidepressants v. SSRIs), the  process through which one man's story of  courage and determination fueled by hope  and the love of his partner is channeled  toward the marketing of "modern medical  breakthroughs" is both remarkable and  curious.

 The justification that will be given  for the fabricated line in the script  will be fear of giving the "wrong  message" about recovery from  schizophrenia.  "Experts" will say that  cure without drugs is very rare and  could give those suffering and their  families a false hope that something  other than drugs can help them.  However, it is not rare at all.  Longitudinal studies show that many  actually share Nash's story and reclaim  their lives with community support and  the love of family and friends. This  "right" message is particularly ironic  because Nash actually had to escape  treatment and psychiatry before making
 his unique personal recovery.  The influence and marketing acumen of  the pharmaceutical industry is  legendary and many reports of the  insidious nature of conflict of  interest, ghost writing practices, etc
 are filed with an alarming but often 1 ignored regularity. The "right message"  crafted in the film and promulgated in  reviews and echoed by "experts" do  those suffering and the public a great  disservice. The film recasts Nash's  personal story of redemption as an  example of how important drugs are to  any reclamation of one's life, instead  of an inspiring account of how people  can overcome the most oppressive treatments and severe psychological  distress with their own resources and  support systems. And I can't help but  wonder, does drug company marketing now  include product placement in the movies?

 Barry Duncan, PhD <Barrylduncan@cs.com>

- end -
 

 To get a copy of "The Heroic Client," plug the
 title into the MAD MARKET search engine:

 http://www.mindfreedom.org/madmarket/

 You are encouraged to forward this NEWS RELEASE
 to all appropriate places on and off the Internet.
 

 For more information:

 David Oaks, Director
 Support Coalition International
 454 Willamette, Suite 216
 PO Box 11284
 Eugene, OR 97440-3484 USA

 email: oaks@mindfreedom.org
 web: http://mindfreedom.org
 phone: (541) 345-9106
 toll free in USA: 1-877-MAD-PRIDE
 fax: (541) 345-3737

 Win human rights in the mental health system!
 
 

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NEWS RELEASE - March 5, 2002
 http://www.zoloft.com

   IN THE SIX MONTHS SINCE 9/11,     THE PSYCHIATRIC DRUG  INDUSTRY CASHES IN

 AMERICAN PSYCHIATRIC ASSOCIATION'S  NEWSPAPER REPORTS THAT DRUG    COMPANIES VASTLY INCREASED  ADVERTISING & SALES AFTER 9/11

HUMAN RIGHTS GROUP ASKS FDA  TO "STOP THE DRUG COMPANIES FROM
 EXPLOITING TRAUMATIZED AMERICANS."

NEW YORK CITY - It's been six months  since 9/11... and the drug companies are creating new victims of the disaster,  says a human rights group. Immediately after the atrocities of  9/11, the psychiatric drug industry  swung into action, saturating the  market with ads for their common  "anti-depressant" psychiatric drugs... and boosting their income.  Critics of the psychiatric drug  industry claim the advertising  seriously misleads a public left  vulnerable by the trauma of 9/11. David Oaks, president of Support  Coalition International, especially  picked Pfizer for criticism: "Here is  drug company based in New York City itself, but after 9/11 they vastly  increased their ads for Zoloft, lying to  the public about the mechanism and  dangers of their products. The FDA  should pull these Pfizer ads now."  In their TV & web ads, Pfizer claims Zoloft  "corrects a chemical imbalance"... though  no such imbalance has ever been proven: http://www.zoloft.com/   Pfizer also assures the public that  Zoloft is "not habit-forming," even though  researchers are familiar with a common  "discontinuation syndrome" when subjects  try to quit SSRI-type anti-depressants. "Pfizer is playing word games," said Oaks. "Pfizer claims a drug is abit-forming only  when there's craving... but there are other > types of dependency and addiction."  The American Psychiatric Association's own newspaper, _Psychiatric News_,> noted that the rapid inrease advertising  and income in the psychiatric drug > industry came at the same time researchers  showed there are few differences between  the products advertised (see BELOW). - end -
 
 

 Psychiatric News March 1, 2002
  Volume 37 Number 5 Page 9
American Psychiatric Association
Professional News
Drug Makers Find Sept. 11 A Marketing Opportunity

 Jim Rosack

In an effort to boost sales and  differentiate their product from its  competitors, some drug makers  dramatically increased spending on TV  ads following September 11.  In the wake of the traumatic events of
September 11, pharmaceutical companies drastically increased their  expenditures for television advertising of antidepressants and prescription  sleep aids. The increased advertising
came at the same time as a new  head-to-head comparison of the top  three SSRI antidepressants raised  serious questions about the grounds on  which the drugs' manufacturers rest  their marketing  assertions [see story  on AT BOTTOM].

According to data compiled by Nielsen > Media Research, the independent media  research company best known for its  television ratings, pharmaceutical  commercials increased dramatically in  the weeks after September 11.  GlaxoSmithKline, maker of Paxil  (paroxetine)--generally considered to  be the market sales leader among  SSRIs--spent a whopping $16.5 million  on television ads promoting the drug
during the month of October of last  year, nearly twice as much as it did  during the same month in 2000. > Pfizer, the world's largest > pharmaceutical company, spent $5.6  million promoting the benefits of
 Zoloft (sertraline) in treating  posttraumatic stress disorder during  October 2001. In October 2000 the  company didn't buy any commercial  airtime for its highly competitive  product. Depending upon how you look at the  data, both GlaxoSmithKline and Pfizer  can claim the "best selling" label for  its antidepressant. If you consider  total dollar sales figures, Zoloft wins  the competition; however, if you look at
the number of actual prescriptions  dispensed during a given time period,  Paxil usually edges Zoloft by a thin  margin. Paxil usually sells at a  slightly lower price, however, so its  higher number of prescriptions dispensed actually ring up fewer  dollars in the total-sales column.  The current number-three selling  antidepressant, Eli Lilly and Company's  Prozac (fluoxetine), has been struggling > to keep market share after relinquishing  the top spot (both in sales dollars and  number of prescriptions dispensed) last  fall when it lost market exclusivity to  generic competition.

To bolster sales after the events of September 11, Lilly spent just over $2  million on television ads during > October 2001. Comparative figures for > Lilly's promotion of Prozac and Prozac > Weekly during October 2000 were not > available.

Sleep Medications

Companies manufacturing medications to promote sleep also increased their  advertising spending after September  11. The leading prescription sleeping  aid, Ambien (zolpidem), made by G.D. Searle and Co., was heavily advertised  in the weeks after the terrorist  attacks. The company spent just under  > $5 million on television ads during > October 2001, about three times the  $1.7 million it spent during the same  month a year earlier.

With the four products being advertised  to the tune of $28.6 million during the  month of October 2001 alone, many > critics of the pharmaceutical industry  believe that the expensive promotional  budgets only lead to higher prices for  medications. Whether that is true will  continue to be debated, but few doubt  the effectiveness of the advertising.

Total Drug Sales

According to NDCHealth, an  Atlanta-based independent research firm  that tracks prescription data, total sales of the three brand-name SSRIs  amounted to $499.6 million during the  month of October 2001--an increase of  19 percent over a year earlier. If  sales of generic fluoxetine are added  to those of the brand, that figure  increases to just over $650 million.

In only its third month of sales,  generic fluoxetine racked up $154  million in October 2001 compared with  Prozac's $71 million. A year earlier,  just under $200 million worth of Prozac  was sold during the month of October,  making it the market sales leader at  the time.

With the clinical and research  community continuing to group all SSRIs  into one general category, with each  drug being relatively equivalent in  efficacy and safety, the pharmaceutical  companies are pressed even harder to  differentiate their own brand names in  the consumer's minds. Even though that  is an expensive proposition, it  appears, according to the marketing  data, that they are willing to foot the  bill.

http://pn.psychiatryonline.org/cgi/content/full/37/5/
 end -
 ~~~~~~~~~~~~

 Psychiatric News March 1, 2002

Volume 37 Number 5 Page 25
American Psychiatric Association

Clinical & Research News
SSRIs Show Little Difference As  First-Line Treatment

 Jim Rosack

 The three most popular SSRIs went head  to head in an industry-funded study of > depression treatment in primary care.> The surprise: none of the three came  out the winner.

At a time when pharmaceutical companies  are engaged in an escalating marketing  campaign to distinguish their  antidepressant medication from all the  rest [see story above], a new large  and comprehensive study has concluded  that the three best-selling selective  serotonin reuptake inhibitors (SSRIs)  are nearly indistinguishable as  first-line treatments of depression in  primary care.

In an attempt to study the  effectiveness of SSRIs in the setting  in which the vast majority of them are  prescribed, a large group of primary  care physicians conducted a clinical  trial of fluoxetine (Prozac), paroxetine (Paxil), and sertraline  (Zoloft) to look for differences in  effectiveness, safety, and side-effect  profile. The study's results appear in > the December 19, 2001, Journal of the > American Medical Association.

The outcome appears to have surprised > the primary care physicians and, one  would imagine, troubled  pharmaceutical-industry marketing  executives.

The irony is that the study was funded  by a grant from Eli Lilly and Company,  maker of Prozac, one of the three SSRIs  being evaluated. Lilly did not exert any > influence over the research, despite the  possibility that results might not have been favorable to its product,  according to sources.

Kurt Kroenke, M.D., a primary care  specialist and researcher at the  Regenstrief Institute for Health Care  in Indianapolis, led a group of  collaborators at 37 clinics within two  primary care research networks in the > United States. The primary care > physicians enrolled 601 patients, of  whom 573 completed the study. The group  compared the effectiveness of the three > SSRIs in an open-label, randomized,  intention-to-treat study that would  closely mirror the conditions of  depression diagnosis and medication  treatment in primary care settings.

"This study was very appropriate from  the standpoint that [primary care] is  where the action is," John Greden,  M.D., Rachel Upjohn professor and chair  of psychiatry and clinical neurosciences  at the University of Michigan, told  Psychiatric News. "If we don't look at  it there, then we are missing a great  deal--[psychiatrists] are not seeing  people until they are much worse, in > the later stages of depression."

The study was designed to resemble  real-world practice in that the  decision to initiate antidepressant  treatment was based solely on the  primary care physicians' (PCP) judgment  that there was clinical depression  present that warranted treatment with  medication. It did not require that  criteria for specific diagnoses, such as dysthymia or major depression, be  proven.

Both the PCP and the patient knew that  all subjects would receive one of the  three active SSRI medications; however,  neither knew which drug the patient was  randomized to nor the milligram  strength of the drug (relative  strengths such as "low dose" or  "moderate dose" were used).

The physician was free to adjust dosing  or change to one of the other two  antidepressants based on his or her  judgment of clinical response; however,  medication was intended to be continued  for the entire nine months of the trial.

The investigators used the Medical  Outcomes Study 36-Item Short Form  Health Survey (SF-36) Mental Component  Summary (MSC) as the primary measure of > depression. Secondary measures included  two SF-36 subscales that correlate  highly with depression, a modified  subscale of the Hopkins Symptom  Checklist and Brief Symptom Inventory,  and the Primary Care Evaluation of  Mental Disorders (PRIME-MD), which was  used to correlate retrospectively  patients' symptoms with DSM-IV criteria > as well as to qualify diagnostic  subgroups.

Greden, chair of APA's Council on  Research, noted that he would have  preferred to see "a real measure of  depression severity used, such as the  Hamilton Depression Rating Scale or the  Beck Depression Inventory."

DSM-IV criteria for major depression  were met in 74 percent of the sample at  baseline, the researchers found, while 0 18 percent met the criteria for  dysthymia and the remaining 8 percent  for minor depression.

 "The data clearly speak for  themselves," said Greden, who directs  the University of Michigan's Depression  Center. "And they did find that all > three medications had the same onset,> the same amount of effectiveness, and  the same adverse-event profile."

After three months on one of the  medications, the proportion of patients  in the entire sample meeting criteria  for major depression dropped to 32  percent from 74 percent at the  beginning of the study. By nine months,  only 26 percent met the criteria for  major depression.

It is important to note that the study  protocol did not include any provision  for providing psychotherapy. "That is  certainly consistent with the care  delivered in such settings," Greden  noted, adding that with the constraints  on time and resources within primary  care, psychotherapy is rarely conducted.

 "But the fight between psychotherapy  and medication has been fought most  vigorously within psychiatry itself,  not in primary care," Greden added. For  people with chronic depression, he said,  the data are clear that the most  effective treatment includes both  therapy and medication.

"But this study does illustrate that in  a primary care setting, you can make a  significant difference in depression."

No statistically significant  differences were reported for any of  the outcome measures between the three  SSRIs.

The three medications studied did not  differ significantly on any of the  outcome measures.  In addition, the number of subjects who  continued to take the drug to which they were initially randomized for the duration of the nine-month trial was  around half for each of the three drugs  studied. The proportion of patients who > stopped taking any of the SSRIs or who > switched to another drug steadily  increased over the nine months, from 13  percent at one month to over 40 percent   at nine months (see chart). Again,  however, no significant difference was  seen among the three SSRIs when  switching or stopping the medication  was assessed.

 Reported side effects were relatively  rare and did not differ by drug.

Cost Implications of Findings

The study demonstrates, wrote the authors, that "these three SSRIs do not  differ across a wide array of  psychological, social, work, and other  health-related, quality-of-life domains  in either the magnitude or the time  course of response."

They note that with generic SSRIs now  becoming available, the results have  "important implications for health care  costs."

While not all SSRIs are created equal,  they concluded that "none of the three > SSRIs in this study can be recommended  over another in terms of  effectiveness."

In an editorial accompanying the  article, Gregory Simon, M.D., M.P.H., a  research assistant professor of  psychiatry at the University of  Washington, noted that "the fact that  SSRI drugs are equally effective on  average does not mean that they are equally effective for individual  patients."

Simon argued that the results of the  primary care study may lend credence to  the push to use drug formularies to  restrict prescribing options to the  lowest-cost SSRI. However, he cautioned  that physicians must retain the  flexibility to be able to switch a  patient to another drug when the  lowest-cost choice is not successful. >
 

 The Take-Home Message

Greden said he was not surprised by the  robustness of the response in a patient  cohort in which nearly three-fourths of  the subjects met the criteria for a  DSM-IV diagnosis of acute major > depression at the start of treatment.

"This was a primary care setting," he  said. "That means that you are catching  the disorder earlier in its life, when  it is best treated and most  responsive."

Greden said the study certainly  confirms that good results are possible > in treating depression in primary care  settings.

"And this is the message of the study  that needs to be emphasized. What  really counts is earlier detection,  earlier intervention, and prevention of  recurrences."

An abstract of the study, with a link  to the editorial, is posted online at  http://jama.ama-assn.org/issues/v286n23/abs/joc10747.html

http://jama.ama-assn.org/issues/v286n23/abs/joc10747.html
> >
> >
> > - end -
> >
> > ~~~~~~~~~~~~~~~~
> >
> > For more information on challenging the  dominance and human rights violations of  the psychiatric drug industry, see:
> >
> > http://www.mindfreedom.org/industry_watch.shtml
> > --
> >
> > David Oaks, Director
> > Support Coalition International
> > 454 Willamette, Suite 216
> > PO Box 11284
> > Eugene, OR 97440-3484 USA
> >
> > email: oaks@mindfreedom.org
> > web: http://mindfreedom.org
> > phone: (541) 345-9106
> > toll free in USA: 1-877-MAD-PRIDE
> > fax: (541) 345-3737
> >
> > Win human rights in the mental health system!
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