Confessions of a Renegade Psychiatrist

I felt this sensation in the pit of my stomach — it was a combination of sympathy and anger — listening to Annie tell me, through tears, about her postpartum journey into the world of psychiatry. 

Three separate psychiatrists dismissed me when I expressed concerns about taking an addictive medication like Klonopin. It’s been two years, I can’t get off it, I’m on 4 psych meds and I feel worse than I ever did before I started this treatment.”

Three separate psychiatrists dismissed me when I expressed concerns about taking an addictive medication like Klonopin. It’s been two years, I can’t get off it, I’m on 4 psych meds and I feel worse than I ever did before I started this treatment.”

Annie was ushered into the promise-filled halls of psychiatry 3 months after the birth of her first baby when she began to experience racing heart, insomnia, vigilance, irritability, and a host of physical complaints including joint pain and hair loss. No one did bloodwork, asked about her diet, or cared about any of the myriad observations about her body and its changes in functioning. This was a “head-up” intervention. I believe women deserve better. People deserve better.

Most patients who come to me for treatment of depression and anxiety do so because they want answers. They want to know WHY they are struggling. The closest they will be offered by their prescribing psychiatrist or primary care doc is some reductionist hand waving about serotonin imbalances. I think it is time to speak to these patients with respect, truthfulness, and to offer them more than a life-long relationship with a pill (or pills as it will inevitably become over the years). First, let’s review some basics:

Depression is Not A Serotonin Deficiency

Thanks to direct-to-consumer advertising and complicit FDA endorsement of evidence-less claims, the public has been sold an insultingly oversimplified tale about the underlying driver of depression. Here’s how we know depression is not a serotonin deficiency corrected by Zoloft:

You might wonder: Well, then how is it that antidepressants are a billion dollar industry and I have all these friends who are so much better on them? Some pioneering individuals have investigated the data supporting antidepressant efficacy and have made compelling arguments for what is called the “active placebo” effect accounting for “breaking blind” in placebo-controlled trials. In short, the expectation of relief and subsequent change in symptoms experienced by “responders” is related to perception of side effects. This analysis suggests that antidepressants may only have 10% efficacy above and beyond the placebo effect. When you also consider the suppression of negative studies (permission of sedatives in trials, replacement of non-responders, and allowance of placebo washout) by pharmaceutical companies, you may start to worry that you have been sold a bill of goods. When inefficacy, long-term risks, increase in suicidality and violent behavior are taken into account, it is a marvel to observe the star-power of these medications.

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Republished from: Green Med Info