RxISK

Making Medicines Safer for All of Us

Gambling on SSRIs

16 Comments

Is Consent to an SSRI Possible

The idea that we had a right to know what our treatment options are and should be able to consent to the option that looks right for us – even if that conflicts with the views of the doctor we are seeing – arose in the 1950s linked to breast cancer treatment, electroconvulsive therapy (ECT) and treatment trials (research).

The original drug treatment trial consent forms informed us this was research and one of the treatments was not yet approved.  Now they explicitly tell us, companies will share nothing about us with anyone – in practice that includes not sharing key information with regulators like FDA.

Up till 1962 we did what doctors told us. Some informed us about their planned course of action but only in order to get us to do precisely as we were told. Suggestions that our view might be put in the balance and found as reasonable as our doctors’ left many of them incredulous.

See Chapter on Informed Consent.

In the pre-informed consent era, consenting to a treatment at the hands of a surgeon or psychiatrist seemed to imply that they knew what they were doing to the point that the outcome was pretty certain before the treatment was delivered. It was more a question of the optics of ECT versus a drug or mastectomy (an entire breast) versus lumpectomy.

Humankind cannot bear very much reality.  Delegating responsibility (our narcissism – the idea that we know enough to cope) to a doctor, in loco parentis (Dad), is more comfortable than taking a gamble with life or death stakes alone.

In a system that requires our consent to be informed rather than have consent decided for us, you might think we would be more aware of the gamble we are taking.  But in practice, this doesn’t follow .

Isotretinoin, Finasteride and SSRIs bring more than life and death into the mix – they involve our semi-eternal identities. We are being offered a choice between effortlessly having the identity we want (if we are lucky) or having to work for and settle for less than what we really want.  None of us are immune to temptation. Say Yes to the Apple – You’re worth it.

A Delusion and a Snare

In addition, if regulators didn’t exist, pharmaceutical companies would have had to create them. They need a group they can point to and blame when things go wrong.  The latest example of companies blaming regulators can be seen in the Failure of Regulators apparently to warn about dopamine agonists and impulse control disorders.

The BBC can publish this article about dopamine agonists and the terrible problems they can cause because the article blames regulators and not companies. They wouldn’t get to publish an article blaming companies – who say patient safety is their first priority and they are as dismayed as we are at a glitch that regulators missed that seems to have destroyed a lot of lives.

The politicians side with companies and in the UK and Europe are busy reframing the regulations governing the regulators of medicines to make (in the public interest, of course) countries like the UK and Europe attractive places for ex European now American pharmaceutical companies to do business. A bloated and flabby regulator rolling over and accepting blame for things going wrong is good for business but can only squash any of us in the bed beside them.

In the midst of all this, we, who are being courted to give our consent, seem to expect that properly informing us of the problems a drug can cause means they aren’t going to happen. If they happen, we figure we must not have been properly informed.

The idea of Informed Consent is a Delusion and a Snare.

Taking a Poison is always a Gamble. The Gamble is better taken with a doctor on your side (because you’re worth it) rather than in the form of a prescription from a double agent.

This is not a diatribe against pharmaceutical companies, many of whose employees could have written this post.  The idea of and original images for the Professional Suicide Note in this post’s video came from a company guy.  Not just the idea but the actual slides.

The document showing Study 329 was a Fraud came from a company gal.  The idea that doctors don’t have a thought in their head not put there by companies came from another company guy – saying exactly this to a bunch of doctors who prided themselves on being the bees knees in sophistication, but who managed not to hear what he was saying.

Forget Jehovah saying – Find me 10 just doctors and I will not Destroy Medicine – see  If I Find You Ten Just Doctors.  Today’s issues are simpler than a Biblical struggle beween Good and Evil.  A more reasonable Jehovah today would say – Find me 10 doctors with their eyes open as to where their real interests lie and I won’t Bomb Medicine back to the Stone Ages.

Gambling Transcript and Video

The Gambling on SSRIs transcript is here.

The Knotty Problem of Consent

Bad as Medicine now is as regards Consent, Law is worse.  When Informed Consent began playing out in the 1950s and 1960s, lawyers were cautious about the idea, recognizing that what was being brought in for one profession today might extend to their profession tomorrow.

You will not be told today that SSRIs can trigger homicides. Your doctor will definitely not take responsibility for prescribing the drug to you.  You may have a perfect Not-Guilty case – a case where most reasonable people would say if s/he had not been put on that drug, these events would not have happened.  But your lawyers will insist on making you a felon and a lunatic rather than fight that case for you.

This is the Prima Facie situation we face – transported from the Sexual Assault domain to Pharmaceutical Assault.  It’s one thing to take a Gamble on a Medicine. We should not also have to take a Gamble on our Doctors when we seek medical help and a further Gamble on our Lawyers when we seek justice.

This is the last post for the moment in our Consent Series

Idle Thoughts

Will we be able to solve these problems? Of course we will.

 

 

Zen

 

Short Clips

Birth of SSRIs

https://youtube.com/shorts/sByY3ZOKg1w?feature=share

https://www.instagram.com/p/DWqk-sVjB3M/

https://www.tiktok.com/@antidepeffects/video/7624425387166076182

Good doctor and misinformation

https://youtube.com/shorts/iHyL9JWMiwA?feature=share

https://www.instagram.com/p/DWqlIULDK-T/

https://www.tiktok.com/@antidepeffects/video/7624427514647170326

SSRIs can cause…

https://youtube.com/shorts/YKRzZQHVW6o?feature=share

https://www.instagram.com/p/DWqlQkbDO0N/

https://www.tiktok.com/@antidepeffects/video/7624432388759768342

@antidepeffects

Gambling and SSRIs at RxISK.org Blog https://rxisk.org/gambling-on-ssris/ https://youtu.be/jvolHEd-9R0 #ssri #antidepressant #sideeffect #doctor #rxisk

♬ original sound – Antidep Effects

Trustability Test

https://youtube.com/shorts/vqoSZvi98ZE?feature=share

https://www.instagram.com/p/DWqleMhDB1K/

https://www.tiktok.com/@antidepeffects/video/7624435352782048534

Simple Truths

https://youtube.com/shorts/VOjaQzwxV08?feature=share

https://www.instagram.com/p/DWqlokfDC1d/

https://www.tiktok.com/@antidepeffects/video/7624436743676235031

Trust and Consent

https://youtube.com/shorts/nDcxUa3cowQ?feature=share

https://www.instagram.com/p/DWq7FVzDHHg/

https://www.tiktok.com/@antidepeffects/video/7624511760619408662

Reader Interactions

Comments

  1. Sit with the Video. Suck it in. Read the Transcript.

    Tick. Tick. Tick. Tick. Tick.

    Gambling with SSRIs – Pure Dead Brilliant

    The Conjuring Act – RxISK squares up to it with beatific cartoons in glorious technicolour, the messages Loud and Clear. A Swansong to the Era of a New Dawn, What’s Up Doc? Didn’t you like it? Will you Stick to Your Gurns and Guns? Will you stay on the Conveyor Belt of Pharma with the Ghosts? Will you Open your Eyes and your Ears to who is in front of you and not stay in bed with those who chose you to play to the crowd, to play your violin when shooting your breeze.

    This is a tough-nut to crack but all the cracks are here – Trial Exposure Advisory – A Deep Dive with an elegant caution and wit. RxISK hits all the right notes, the strings are taut, the rockets are firing, the uplift is here, the landing less sure. Informed and Consent strikes a wobbly course if you don’t know where you are going and everyone around you doesn’t know where you are going.

    The Swinging Pendulum

    The idea that patients could be brought up to speed about a knowledge base that it had taken a physician a lifetime to acquire was considered bizarre.

    They are only Antidepressants from a Marketing Point of View – Free Will? The Casino –

    Reply

  3. This entire, brilliant series is superbly constructed and invaluable. Thank you.

    Your work maintains the hopes and dreams of those whose lives have been destroyed by prescriber ignorance and denial: – (combined with our indoctrinated touching of the forelock to drug-promoting Key Opinion Leaders) : – that one day, prescribers may, at last, watch, listen and learn.

    In the meantime, I wonder: how many prescriptions for SSRIs/SNRIs/ADs have been given to patients, with no ADR warnings, whilst I have been reading, watching and writing this comment?

    We were indoctrinated with a false narrative regarding drug regulation and prescription drug safety systems sInce our first weeks of training in clinical practise at medical school.

    Reply

  5. ‘Almost the only thing you should trust about SSRIs if you can read it accurately is YOU,’ ‘The idea of Informed Consent is a Delusion and a Snare’

    This works so well as the final dramatic act – the climax of the series. Let us call her – Sensoria – staring down into the SSRI safety void.

    Actually it’s rather well characterised by a paragraph from a favourite piece (I’m bound to have quoted before) – ‘The Book of Lamentations’ – a critique of DSM5 framed as litcrit:

    ‘Great dystopia isn’t so much fantasy as a kind of estrangement or dislocation from the present; the ability to stand outside time and see the situation in its full hideousness.’
    https://thenewinquiry.com/book-of-lamentations/

    I understand the mechanics of the SSRI safety void as you articulate them – and that of finasteride, isotretinoin, vaginal mesh, valproate etc.etc. But what I find really hard to penetrate is the psychology of medical denial. Do they really not know? For 30 + years? How? Or maybe some of the doctorhood also feel like they’re clinging to the edge of the void? Watching this series might stiffen the sinews and summon up the blood – a tad.

    Until doctors and patients understand these two realities, I fear that humanity is stuffed. As you wrote:

    ‘With a prescription drug, we swallow an unavoidably dangerous chemical. We also swallow information. Good information and a good relationship with your doctor was supposed to transform these hazardous chemicals into safe as possible medicines. ‘

    And Carl Rogers said:

    ‘I realize that if I were stable, prudent and static; I’d live in death. Therefore I accept confusion, uncertainty, fear and emotional ups and downs; because that’s the price I’m willing to pay for a fluid, perplexed and exciting life.’

    But to keep spirits up in the meantime – a very witty post from an X friend – @fworksandconfetti, themselves all but killed by paroxetine:

    ‘JUST IN: Live footage of psychiatrist drawing on his uber scientific clinical mastery to diagnose you with something else because you happened to say the SSRI he prescribed is doing jack shit for you’.

    The image is of a bowl of Alphabetti Spaghetti with the letters BPD surfacing magically, then thrown and slithering down a wall.
    https://x.com/fworksconfetti/status/2040045211024289963?s=20

    As much substance as Alphabetti Spaghetti – covers so much of the commercial ‘mental health’ narrative doesn’t it? But far more deadly.

    Reply

    • The RCT element I think is key. The brotherhood – that includes the sisters – have been trapped in a message. You have to be rational – you have to be scientific. And clinical trials offer the best and most scientific evidence about medicines – the kind that is necessarily placed at the top of the evidence hierarchy an embodies in Guidelines.

      Trapped in that by pharma but told it by the supreme honchoes in medicine from our very best journals to Guideline Makers and also the Ex-Cochraners and even to this day by Peter Goetzche, Tom Jefferson etc great guys but unable to disown the RCT mantra. The good guys wriggle and blame pharma corruption of trials – everything would be okay but for this free lunch aspect. It wouldn’t be okay. RCTs need to be relegated to the bottom of the evidence heap – or perhaps the stage of Hell below the bottom which is would be for meta-analyses and network meta-analyses of RCTs. Its a contradiction in terms to say tha the averages we get from RCTs are evidence.

      Part of the seductive appeal aside from being rational is that doctors get to hand over risk. They no longer have to share it with the person in front of them.

      Your Carl Rogers quote brings out what they are losing by doing this

      D

      Reply

      • Here is the data on the trials in mild depression that brought the SSRIs and SNRIs on the market – you see a doubling of suicidal events compared to placebo. Companies resorted to all sorts of illegal manoeuvres to hide this risk.

        Here is what a drug trial looks like. Companies ran these studies in the 1980s and found that SSRIs make healthy volunteers suicidal, caused dependence and sexual dysfunction but we heard nothing about these problems when the drugs launched.  These Drug Trials enabled companies to engineer their Treatment Trials to hide these problems. 

        Regulators tell us that drugs that kill us or wipe out our sex lives for ever have a positive benefit-risk balance. This claim is based on RCTs, which only look at one of a drug’s effects – that may not be the most common effect. Benefit risk ratios are a drug company invented mantra that regulators have swallowed.

        Clinical Trials Are Unsafe – See DH September 20, 2021 11 Comments

        A new lady doctor arrived in our small rural practice. She was immediately hailed as a super-intellect. She was very direct, a monument of confidence, an older person with considerable experience. I won’t labour on this, suffice it to say, that from the moment of our first meeting, she seemed to think I was a complete idiot. No problem coming off Seroxat/Paroxetine cold-turkey.

        Months later she had a sudden U-Turn as she became aware of me using a syringe with liquid Paroxetine. Three years later she found a psychiatrist had suggested changing to Fluoxetine. When the last bit of paroxetine liquid was gone, and my withdrawal started again she presented me with two packs of Fluoxetine. They went straight in the bin. I would ride this out, this time.

        Gambling on SSRIs, no doubt about it…

        Reply

      • I have encountered quite a few SCIENTISM jocks and jockettes on X – waving the ‘EBM pyramid’ to dismiss the ‘anecdotes ‘ of individual patients who have been harmed. So who is this average patient then? Oh you don’t know – I see.

        Ironic that in the real commercial world of fast moving consumer goods – FMCG – marketeers know how to use the different types of research and understand their relative significance. Quantitative research – product tests, pricing studies, tracking data etc.– delivers basic measures of scale that get fed into modelling. But the added value insights come from listening to individuals, understanding how they live their lives, what they care about, the meaning derived from ‘relationships’ with brands and products etc.
        The Lilly doctor segmentation study that you shared is that sort of ‘diagnostic’ analysis and they clearly then went on to quantify the segments.

        My instinct has always been that the ‘evidence pyramid’ is not just hopelessly limited and superficial- but also epistemically dated. I’ve used that riposte, to dubious/no effect, to the pyramid wavers – oh, not that tired old epistemic anachronism again.

        In a world where individual humans are able to project their whole (maybe idealised) self through socials, this obliteration of the personal seems so passé. But then it’s perfect AI slop fodder which is industry’s dream -and the intoxicant of those who would be and would be seen to be rational and scientifically sanctified – and thus absolved from personal responsibility. Your tough and unforgiving point.

        Reply

  7. Just to let you all know Rxisk.org has made history!. It is one of over 5 million names placed inside an sd card which is inside a gimp (teddy bear head) inside the Artemis space capsule flying round the moon. Rxisk.org has also got a boarding pass as proof of its journey. You can see the gimp being held by the astronauts in the video below. Once the capsule is back on earth the sd card will be placed with other artifacts from the mission inside a museum forever. Rxisk is now at this moment on the far side of the moon.

    https://www.bbc.co.uk/news/videos/ce3d5gkd2geo

    Reply

  8. Thread/Shorts from Dan Johnson 1 – 8

    https://x.com/DanJohnsonAB/status/2040119864489341199

    Dan Johnson@DanJohnsonAB

    8. The complaint was made under D.C. Consumer Protection legislation. The Judge dismissed the action over standing, not because of truth or falsity of the original article, but because it is not clear whether a scientific publication qualifies as a “consumer good or service”.

    Goosebumps – Gambling on SSRIs…

    Reply

  9. The question is how to get people to see the light without sounding like a Fortean. There is a sense that most people would walk straight off a cliff if you told them that, on average, RCTs showed a small but significant improvement in cancer risk.

    I mean, “can people levitate?”

    The best argument I’ve found is to point out that other professions do their jobs everyday without RCTs and don’t suffer the slightest inconvenience. Mechanics fix cars. Engineers design bridges. Silicone Valley gets along just fine.

    It is all about appearances, though. Even when your peers echo your ideas, they go to great pains to make sure their audience does not mistake them for one of the tinfoil-hat types. They are the “rational” ones. You are a contrarian simply because you do not play caveat whack-a-mole. You assume those listening are intelligent and do not require a tedious list of every exception.

    But tediously covering one’s arse is de rigueur.

    On any given issue, the world now seems divided into two camps. I am old enough to remember when people held whole rainbows of beliefs and listened to each other with a kind of wary curiosity. Now everything is trench warfare. Your best friend, or even your own mother, might be a class traitor.

    I don’t hate RCTs. In the same way I love a good textbook but the DSM needs to be relegated to the depths of hell, so too RCTs, because such things can only be good if they make you think more not less. RCTs and the DSM can come back in out of the cold once they’re no longer operating as thought terminating clichés.

    Reply

    • What’s happened to Curiosity? Curiosity is central to Science and Hope.

      In Tumbler Ridge, a small town of 2,400 persons, in British Colombia, the assailant swallowed 280 mg. of Sertraline, one of the most prescribed drugs on the market. Many have lost their lives to Sertraline or caused havoc to others.

      What of this? What killed curiosity about this?

      Reply

  11. Gambling on Doctors

    Alan Cassels reposted

    Dr Anna Kindy@DrKindyMLA

    The Health Professions and Occupations Act HPOA is a sweeping overhaul of how all of healthcare will be regulated in BC and politicizes Healthcare Regulation.

    ALL Health College boards will now be appointed by the Minister of Health and ALL members of the discipline tribunal will be appointed by the Director of discipline who is appointed by government. S

    Saying that appointments will be by merit is meaningless when this same NDP government just scrapped the office of the independent Merit Commissioner whose role was to provide oversight of “merit-based” appointments and hirings.

    Ultimately, this will not only increase censorship of the frontlines but drive healthcare providers out of BC.

    How is this supposed to make patients safer???

    https://x.com/DrKindyMLA/status/2042315538249257127

    Reply

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