Saturday, 17 July 2010

Accutane vs. Geodon. More on double standards

I watched this vid the other day, 1:43 into it. That was all I needed to see, or hear: "None of us would like it , if one of our children were to die at a young age, especially if it was for taking a medication that was for the treatment of pimples." -Doug Bremner.

Right. Certainly, none of us would like that. And sure as hell it was about time, and the only right thing to happen, when Accutane was pulled from the market last year. And although Hoffmann - LaRoche claimed other reasons to have prompted the decision to pull Accutane, concerns about the safety of the drug, also, and not least, voiced by Doug Bremner, without doubt were crucial to this decision. So, hats off to Doug Bremner's courage!

Anyhow, here's what I simply can't get my head around: if it is so outrageous as, among others, Doug Bremner thinks it is, and as it, indeed, is, that a drug that potentially causes depression and suicidal ideation/behavior as a side effect is used to treat acne, how come it is fully acceptable that drugs, medical treatments, with the side effect profile of Geodon are used to treat what isn't even scientifically proven to be an illness, a medical condition, at all? How come it isn't only acceptable, but apparently even desirable, if I understand Doug Bremner correctly - and it seems I do, since he didn't protest my comparison of his Mark Becker post to Fuller Torrey/TAC propaganda - to be able to force people to take these drugs?

So far, in Denmark there has been filed one complaint about Zyprexa causing diabetes. The complaint was dismissed. Explanation: "schizophrenia" is a far more severe disease than diabetes. So, if you suffer from "schizophrenia", you'll have to live with a side effect of the severity of diabetes. In fact, "schizophrenia", according to the "experts", such as Doug Bremner, must be worse than death. Because, unless you get run over by a bus and killed, or something along those lines, you, eventually, will die from taking drugs like Geodon or Zyprexa. On average, about 25 years earlier than you would have died not taking these drugs. So did the person who filed the complaint here in Denmark, who died from complications related to diabetes, which he had developed thanks to taking Zyprexa.

So, what we've got are drugs for the treatment of something that is not scientifically proven to be a disease, that actually, according to the scientific, psychiatric (!), research that has shown non-medical approaches like Soteria or Open Dialog to produce recovery rates of about 85%, vs. the drugs' 0%, with much greater probability is an emotional, existential problem, than that it is a medical one, that do not only have death as a possible, but, if taken long-term, as advocated by Doug Bremner and most of his colleagues, certain side effect. That is, looking at the scientific facts, any risk-benefit analysis of these drugs clearly tells us that the risks are way out of proportion compared to the benefits. Far more out of proportion than for a drug like Accutane.

Still, there is a public outcry, not least from Doug Bremner himself, for a ban of a drug like Accutane, while there, at the same time, is a just as loud, if not louder, public outcry, not least from Doug Bremner himself, in favor of forced "treatment" with a drug like Geodon.

If it was for Big pHARMa's profit to be at stake alone, I bet, someone like Doug Bremner would be one of the first to go for a ban of neuroleptics. But there is more, much more, at stake than Big pHARMa's profit when it comes to psych drugs. Pimples, acne, don't challenge society's status quo, they don't challenge the collective mass-psychosis that is called modern western civilization to the same extent as existential crises do. Indeed, society, Doug Bremner included, doesn't fear anything, not even death, and not even "if one of our children were to die at a young age", as much as it fears "schizophrenia", that is the confrontation with its own dysfunctionality. "Schizophrenia" begins where the courage to face oneself ends.


Rossa Forbes said...

Hi, Marian, I agree with your comments and in particular, this widespread idea that schizophrenia is so "horrible" that any end justifies the means when it comes to antipsychotic medication. For quite a while Chris took roaccutane which he discontinued about a year before he started to experience symptoms of schizophrenia. Acutane/roaccutane is usually linked to suicide ideation and depression, not schizoprenia. All that is water under the bridge at this point. I would assume that once someone stops taking the drug, suicide ideation, etc. would disappear. Are you aware of any studies that might show otherwise? (I have relied on Dr. Hoffer's thinking that people who experience very bad acne have a pellagra like condition. Therefore, acne can be a precursor of psychosis.

tosommerfugle said...

The danish system for reporting medication side effects is mainly focused on having only the doctors do the reporting. Of course, this means that a lot of complaints may be dismissed without ever being reported. Another reason for the very low number of cases is that the chances of winning a case is so low that lots of people simply do not even attempt.

I read that the name "Geodon" is intented to suggest down (don) to earth (geo). Seems that this can also be taken quite literally :-]

Marian said...

Rossa: "Acutane/roaccutane is usually linked to suicide ideation and depression, not schizoprenia."

Yes, exactly. I didn't say that Accutane causes "sz". But depression also is a side effect of neuroleptics, such as Geodon. Another one is sudden death due to heart failure...

All that I've seen of studies on Accutane (Bremner, et al., 2005, for instance) shows that depression and suicidal ideation ceases once the Accutane is discontinued.

Marian said...

tosommerfugle: Doctors do the reporting, and they decide whether a complaint is justified and accepted, or not - at least they serve as the expert consultants at these decisions: "One craw doesn't peck another one's eye," as the Germans say.

Marian said...

Rossa, P.S.: I checked a bit out on a possible link between "sz" and skin problems like acne. I've heard people say that things like skin problems as well as arthritis - and other health problems - often go together, why some researchers believe, the same genes that are responsible for these physiological problems may be responsible for "sz", too.

I found that zinc deficiency obviously often is found in "schizophrenics" as well as in people suffering from skin problems like acne, psoriasis, or vitiligo (which is me), and arthritis (me, too). So, there may well be a link. I just wonder - the first thing that came to my mind when I associated "acne - skin problem" is that our skin often is the first organ to react to and reflect emotional problems, stress.

The second was that there are three circumstances that make a "real", so to speak, zinc deficiency, at least in my case, unlikely: 1. I grew up with meat and shellfish (with oysters being the no.1 zinc supplier, followed by meat and some other shellfish like crabs and lobster) for dinner on a daily basis, and, except for that I replaced the meat for a couple of decades with fish and shellfish, I've stuck to this "habit" to this day. 2. The arthritis started to improve, and vanished eventually entirely, at the same time as I had my last crisis. It hasn't been around since. And I haven't been taking any supplements, or treated it with any other natural or pharmaceutical remedies. (I can't say anything about the vitiligo as I haven't kept an eye on it, and it isn't as apparent as on most of the pictures you can find on the net.) 3. The same can be said about the "sz". The only thing I've done about that is talk therapy: becoming conscious of, and working through trauma.

So, I wonder, if the link could be that emotional distress leads to somatic symptoms, too, because it causes the body to go into a state where it has difficulty making optimal use of nutrients, although they're supplied in sufficient quantity. Rather than that the link is genetic, or a true vitamin/mineral deficiency.

Mark p.s.2 said...

Great post, well written.

re: rossa forbes"I would assume that once someone stops taking the drug, suicide ideation, etc. would disappear."
IMO The feelings would disappear, the thoughts might stay.

Suicide is a complex action that comes from a feeling. A person can not feel suicidal, they feel something that leads to the conclusion suicide is the solution. The automatic suicide conclusion from a feeling has to be UN-taught.

Example of a normal conclusion from a feeling:"I feel like making a sandwich." The person has to feel hungry first to get to the complex action of preparing food to eat to solve the problem of feeling hungry.

Example of a abnormal conclusion. " I feel like killing myself" The person feels horrible or despair and doesn't want ( or can't work) to face the cause(s), face the work to change the situation or themselves.

RE: skin rash. Could be a symptom of Gluten allergy or Crohn's disease.

Anonymous said...


I agree with a lot of your points... That being said I'm very pro-choice when it comes to medications (especially antipsychotics) and I think they DO have a place in psychosis treatment and are incredibly helpful for SOME people.

Clearly, to me, there is also a big difference between acute psychosis (which can be INCREDIBLY disabling, albeit not for everyone) and acne...

Finally, I am a huge advocate of minimal med approaches (like Soteria and the Finnish "Acute Psychosis Integrated Treatment Project") BUT these were not no-med programs. At two-year follow-up somewhere around 50% had taken no antipsychotic medications (and roughly 50%) had--albeit it far less than control subjects. I'm also notsure where you're getting your 80% vs 0% recovery statistic.... The fact is a lot of people recover REGARDLESS of treatment and others don't. Both the Soteria and Finnish studies used a variety of follow-up measures (e.g. % working, GAF score, etc.) and I've never seen this translated into 80% recovery...not is "recovery" particularly easy to quantify.

Again, I don't mean to be hostile or too critical, I guess I just don't think this whole issue is so black and white...

Anonymous said...

I'm the previous poster... As I was interested and hadn't read these studies in a while I reread through Seikkula's 2006 Follow Up Study (comparing Open Dialog with the "Integrated Treatment of Acute Psychosis" approach). I'm assuming this is what you were referring to 'cause the recovery rates for both groups--over 80% in full time work/school and with no psychotic symptoms--truly are astounding. I'd forgotten quite how astounding... However, 27% of these folks were indeed on antipsychotics at some point during treatment, so my point remains that these are minimum med and not no-med approaches. Clearly it's great to minimize AP use, but I do think some people really benefit from them...just not everyone (or perhaps even the majority).

That being said we do also need more replication--this study was relatively small and comprised of all first-episode patients. (Statistical outcomes are, unsurprisingly, generally worse for multi-episode patients...)

Marian said...

Anonymous: 85% of both Soteria's and Open Dialog's clients do (did) recover to an extent that they are able to lead an independent life, and don't need any treatment anymore.

I know that biopsychiatry usually mentions recovery rates between 10 and 30%. The problem here is biopsychiatry's definition of recovery. I have a friend who was declared "recovered" by the system - and the system was not happy having to do this, his doctors grit their teeth (and one may wonder, shouldn't they have been over the top excited??... ), but had to do it because he hadn't reported any "symptoms" for five years. - Well, the problem was that he still took Abilify. I'm with Ron Unger in this: someone may be in recovery while still taking drugs, they may also be socially recovered, but they're not fully recovered as long as they need the system's services, be it drugs (mostly) or whatever else.

Now, the system usually defines "schizophrenia" as a chronic brain disease. Meaning you actually can't achieve full recovery. All you can hope for is a partial, social recovery, and maybe, with a lot of luck, periods where the "illness" is "in remission", as they put it, and you maybe don't even need drugs. So, according to biopsychiatry's own definition of "schizophrenia", the recovery rate its "treatment" produces is 0% when we're talking full recovery.

I know that it is the politically most correct thing to be "pro choice", and I myself was, for a long time. I'm not anymore. I don't judge people for taking psych drugs when they don't have any other option. But it is my sincere conviction that, in the long run, what is needed are alternatives, and a ban of neuroleptics. I know that neither Soteria nor Open Dialog are (were) 100% drug-free. But the Quakers' Moral Treatment was. And also Moral Treatment had recovery rates of ca. 85%. Achieved entirely without the use of psych drugs.

Anonymous said...

Well, hmmm, interesting. I've actually never heard anyone make this particular argument about recovery before... Personally, I guess, I'm not a big fan of the word/construct "recovery" at all--it's just way too subjective, too vague, too multi-dimensional--and always already assumes that there is something to recover from. Who's to say when someone else is or isn't "recovered"? Not to mention that "recovery" has been totally coopted by all kinds of mainstream interests, including Big Pharma.

I guess I'd be interested to hear you say more about exactly what you think recovery is and why and how there can ever be any kind of objective criteria for recovery (such that we can say Ms X is "recovered" but Ms Y is not).

Marian said...

Anonymous: I couldn't agree more with everything you say about recovery. Personally, I don't believe "mental illness" to be medical, biological illness, nor do I believe that "psychosis", basically, is a "bad" thing to happen to a person. And people recover from illnesses and other things that represent setbacks. Also, to recover means to regain something that has been lost, but how can you regain something you've never had?

The true "illness" IMO is the self-effacing adjustment to others' needs that precedes "psychosis", and makes it a necessity if you don't want to lose yourself, or your self, entirely. So, to regain the state of self-denial that initially drove you mad, and that by most people is seen as "sanity", "normalcy", doesn't seem desirable to me.

When I use the term recovery, or more precisely full recovery, I therefor use it more in the sense of "discovery". When it comes to existential suffering I think, it isn't about to end all the suffering, but to recognize what it actually is: a very important part of life. So, my definition of being recovered basically is having left the mh system with all its labels and "treatments" behind, having liberated yourself from its definitions of and control over you.

A lot more could be said about this. For instance, when I, with Courtney Harding, regard not receiving any treatment anymore a criterion for full recovery, "treatment" of course also includes something like talk therapy. But talk therapy essentially is trying to figure things out through communication in an interpersonal relationship with another human being, and thus it lies on a continuum with our everyday relationships. Where do these end, and where does therapy, treatment start? There are certain, formal differences between a relationship with a friend, a family member or just someone you ran into in the street on the one hand, and a therapist on the other. But do these formal differences necessarily always make the relationship with the therapist more therapeutic, more "treatment", than any other relationships? And does "treatment" end, other than formally, when I end a relationship with a therapist, while I continue to have relationships with friends and family?

Anonymous said...

So pathetic that someone would attempt to suggest that Schizophrenia is worse than Diabetes... Methinks it's really the psychiatrists who need the schizophrenics more than the other way around...


Franky said...

I have tried a few different anti-psychotics and find Geodon to be far and away the best. Risperdal worked as an anti-psychotic, but it made the depression worse and made me gain 25-30 lb's. So far, I have had no side effects with Geodon. I think I have found a winner.

Marian said...

Good for you Franky.