Prescribed Harm News Updates
Bias and Biomarkers/Antidepressant Efficacy and the Myth of the Chemical Cure/Benzo Stigma/Patient Preference and Ethical Prescribing
Over the last month, I’ve been writing for the Inner Compass Initiative (ICI) blog about the latest prescribed harm news. Catch up on the articles below and be sure to follow ICI for more!
Survey shows antidepressant efficacy is mediated by patient beliefs
“The survey results suggest that withdrawal effects are not likewise mediated by the subjective beliefs of patients. Instead, respondents reported experiencing withdrawal effects on cessation regardless of what they believed about the causes of mental health conditions or the mechanism of antidepressant action. Given the tendency of withdrawal-skeptical psychiatrists to attribute withdrawal symptoms to the nocebo effect, or to claim that people harmed by psychiatric drugs are simply imagining their symptoms, this is quite ironic. This survey suggests quite the opposite: the suffering caused by withdrawal is an objective reality in a way that the supposed benefits of antidepressant treatment effects are not.”
Is it ethical to prescribe antidepressants purely on the basis of ‘patient preference’?
“Cutting corners might save clinicians time in the short term, but inappropriate antidepressant prescribing has downstream consequences that are bad for both individual patients and society as a whole. Although there is no evidence that depression is caused by a biological deficit, and systematic reviews find that antidepressants have minimal benefits, both the “chemical imbalance” theory and the myth of the “chemical cure” are tacitly affirmed when a doctor prescribes an antidepressant. This in turn shapes the patient’s implicit beliefs, reinforcing the idea that their well-being is dependent on the drug.”
New UK benzo guidelines perpetuate stigma and enable prescribed harm
“As Horowitz states, “The inclusion of a dedicated section on recognising addiction and misuse, rather than recognising dependence and withdrawal risk, risks misdirecting clinical attention away from the most common mechanism of harm, that can affect a majority of users.” Not only that, it also risks further alienating patients already suffering the ill effects of inadequate medical advice. Being treated as an addict by a medical professional, having done nothing more than take a drug as prescribed, adds insult to injury. Harmed patients should not be made to feel morally culpable for experiencing withdrawal effects when they were not given the opportunity to make an informed choice about taking a dependency forming substance in the first place.”
Bias and biomarkers in the DSM-6
“This means that it’s not clear whether the diagnoses listed in the DSM actually represent meaningful categories. This isn’t to question the reality of the mental and emotional distress experienced by patients or even the need for a conceptual framework to guide optimal treatment decisions. It’s simply to observe that the way the DSM categorizes distress appears arbitrary and epistemologically unsound. There is an air of unreality about the way psychiatry’s central text goes about defining diagnostic categories, and this is particularly concerning given that DSM diagnoses are ultimately used to justify psychiatric interventions that can have life-altering consequences.”