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National Institute Of Mental Health Forsakes the DSM, the Bible Of Psychiatry

NIMH's move away from the DSM is a necessary paradigm shift that will, in the long run, enable researchers to find new ways to improve psychiatric diagnosis, and heal a society which is simultaneously under-treated for mental illness and over-medicated in all of the wrong ways. Dr. Thomas Insel, the director of the NIMH, explained that while the DSM manual has improved reliability and helped to standardize mental health treatment across different health care providers, the diagnostic categories still lack underlying scientific validity. He wrote: "Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever."

The pharmaceutical industry is no stranger to fake news - STAT

The DCI Group’s founders began their careers running a campaign for tobacco called the smoker’s rights movement, which sought to reframe public health concerns over secondhand smoke as a matter of personal choice and freedom. The DCI Group also helped block bills to permit the reimportation of FDA approved drugs. Turing Pharmaceuticals hired DCI to help CEO Martin Shkreli when he came under legal scrutiny for high drug prices and securities fraud.

Tianjing Li: What’s not shared—building on the FDA’s transparency momentum – The BMJ

While I applaud and welcome the initiatives that FDA is taking to enhance the transparency of its decision making, how, I wonder, can the scientific community raise their game in making use of the wealth of information contained in CSRs? Until now, it is debatable whether the value of CSRs is fully appreciated by the average clinicians. While methodological investigations have been carried out by a handful of academic researchers who are keen on fixing the pervasive problem of selective reporting and transforming the landscape of clinical trial data sharing, very few systematic reviews on drug interventions have included data from CSRs. One recent survey of 160 systematic review authors (over 7,000 invited) found that only 20 authors requested regulatory data and only 12 included CSRs in their systematic reviews. This observation implies that systematic reviewers need guidance, training, and resources to disentangle the rich information contained in CSRs. Likewise, evidence users, particularly those who may believe selective reporting is a story of the past, should keep a vigilant eye on claims made in the published literature about the efficacy and safety of drugs.

Antidepressant withdrawal

About half (54%) met their goal of completely discontinuing one or more medications; 46% reported another outcome (use was reduced, use increased, or use stayed the same). Concerns about medications’ effects (for example, long-term effects and side effects) prompted the decision to discontinue for 74% of respondents. They used various strategies to cope with withdrawal symptoms, which 54% rated as severe. Self-education and contact with friends and with others who had discontinued or reduced medications were most frequently cited as helpful. Although more than half rated the initial medication decision with prescribers as largely collaborative, only 45% rated prescribers as helpful during discontinuation. Of respondents who completely discontinued, 82% were satisfied with their decision.

Shhhh

Investigators turned to Paddock’s physician. The doctor described Paddock as “odd” and as a man who showed “little emotion.” He believed that Paddock may have had bipolar disorder but told police that his patient had refused to discuss the issue further. Paddock didn’t appear to be abusing any medications, the doctor noted. In fact, he seemed fearful of medication in general. While he had been treated for anxiety, Paddock had refused antidepressant medication.

Study reveals lack of self-awareness among doctors when prescribing opioids: Emergency department physicians underestimated how often they prescribed opioids, but prescriptions decreased after they saw their actual data -- ScienceDaily

Some 65 percent of those surveyed prescribed more opioids that they thought they did. Michael and his team found participants discharged 119,428 patients and wrote 75,203 prescriptions, of which 15,124 (or about 20 percent) were for opioids over the course of the 12-month study. The researchers then monitored the doctors after they were shown their actual prescription rates. "Everyone showed an overall decrease in prescribing opioids," Michael said. "After seeing their real data, the people with inaccurate self-perceptions, on average, had 2.1 fewer opioid prescriptions per 100 patients six months later and 2.2 percent fewer prescriptions per 100 patients at 12 months."

1 in 6 adults getting Adderall experience acute anxiety in 4 months

Acute anxiety symptoms occurred in 4 of 7 patients with a comorbid anxiety diagnosis. CONCLUSION:

JCM | Free Full-Text | Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives | HTML

Benzodiazepines are some of the most commonly prescribed medications in the world. These sedative-hypnotics can provide rapid relief for symptoms like anxiety and insomnia, but are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients take benzodiazepines long-term without ever receiving evidence-based first-line treatments (e.g., psychotherapy, relaxation techniques, sleep hygiene education, serotonergic agents). This review discusses the risks and benefits of, and alternatives to benzodiazepines. We discuss evidence-based indications and contraindications, and the theoretical biopsychosocial bases for effectiveness, ineffectiveness and harm. Potential adverse effects and drug-drug interactions are summarized. Finally, both fast-acting/acute and delayed-action/chronic alternative treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—should be determined based on functional recovery and not merely sedation.

Our Other Prescription Drug Problem | NEJM

Benzodiazepines have proven utility when they are used intermittently and for less than 1 month at a time. But when they are used daily and for extended periods, the benefits of benzodiazepines diminish and the risks associated with their use increase. Many prescribers don’t realize that benzodiazepines can be addictive and when taken daily can worsen anxiety, contribute to persistent insomnia, and cause death. Other risks associated with benzodiazepines include cognitive decline, accidental injuries and falls, and increased rates of hospital admission and emergency department visits. Fortunately, there are safer treatment alternatives for anxiety and insomnia, including selective serotonin-reuptake inhibitors and behavioral interventions. Just as with opioids, some patients benefit from long-term use of benzodiazepines. But even in low-risk patients, it is best to avoid daily dosing to mitigate the development of tolerance, dependence, and withdrawal.

Another Mass Shooting, Another Psychiatric Drug? Federal Investigation Long Overdue | CCHR International

Despite 27 international drug regulatory warnings on psychiatric drugs citing effects of mania, hostility, violence and even homicidal ideation, and dozens of high profile shootings/killings tied to psychiatric drug use, there has yet to be a federal investigation on the link between psychiatric drugs and acts of senseless violence.

Chapter 5—Medical Aspects of Stimulant Use Disorders - Treatment for Stimulant Use Disorders - NCBI Bookshelf

Some researchers and clinicians describe the development of stimulant-induced psychosis as an evolving process. Panel members depicted MA users as having brief and transient psychotic episodes before a full-blown psychosis emerges after more extensive chronic use. MA users often recognize these early psychotic effects and try to stave them off by self-medicating with alcohol or decreasing drug use. In several articles, Ellinwood and colleagues describe the evolution of MA-induced psychosis as progressively abnormal behaviors--beginning at moderately high doses--with intense feelings of curiosity about the environment and patterns of exploration that result, for example, in examining the punctuation periods in a magazine text for evidence of a secret code (Ellinwood et al., 1973).

Department of Health | The amphetamine withdrawal syndrome

Animal and human studies have confirmed that the methamphetamine withdrawal syndrome may be protracted (the mood disturbance may last up to a year in some cases) and tends to be more severe than cocaine withdrawal (see Cho & Melega, 2002 for a thorough review; Davidson et al., 2001; Volkow, Chang, Wang, Fowler, Franceschi et al., 2001). Similarly, there is some evidence to suggest that individuals who have experienced a methamphetamine-related psychosis are at risk of further psychotic episodes, even in the absence of further psychostimulant use (Yui, Ikemoto, Ishiguro & Goto, 2000).

Engineering euphoria

Isomers of the same molecule, although very similar, often have different effects. For instance, the right-handed isomer of methamphetamine, dextromethamphetamine, is the most potent human stimulant known: This is the “meth” that tweakers crave. But the left-handed isomer of methamphetamine, levomethamphetamine, is a vasoconstrictor with little to no psychoactive effect and is used in nasal decongestants and inhalers. In contrast, both isomers of amphetamine are psychostimulants, so Shire combines both the l- and d- isomers in Adderall, each packaged in two different types of salt carriers. By creating a custom racemic mix of l- and d- isomers, and by using a custom blend of salt carriers for each molecule, Adderall meets the definition of an amphetamine formulation that can be patented for prescription use. In a word: genius. Formulating the perfect blend of speed for children sounds like a task more suited to a crime syndicate than a pharmaceutical company, but Shire put some serious thought into packaging amphetamine into pills for kids with short attention spans. The l- isomer of amphetamine, levoamphetamine, packs a euphoric rush of norepinephrine for a quick and speedy high, with a small release of dopamine for a short period of increased alertness and focus. Levoamphetamine (a.k.a. benzedrine) is a favorite of tweakers who want the most bang for their buck. The d- isomer of amphetamine, dextroamphetamine, produces less of an initial rush but increases the supply of dopamine and norepinephrine in the brain’s synaptic clefts for many hours. Dextroamphetamine (a.k.a. dexedrine) is considered by many to be the first “smart drug,” used experimentally to increase focus, memory, and intelligence.

Drug-Induced Psychosis: How to Avoid Star Gazing in Schizophrenia Research by Looking at More Obvious Sources of Light

They administered dextroamphetamine by mouth on days 1, 3, and 5 to 10 healthy volunteers, and measured the effect on striatal dopamine release before exposure, then the day of first exposure, then 2 weeks later after the third dose, using the PET/[11C] raclopride technique. Each dose of amphetamine caused greater dopamine release in the ventral striatum together with greater behavioral responses. Indeed, 1 year later there was a greater psychomotor response and greater increase dopamine release compared to the initial dose, in the ventral striatum, progressively extending to the dorsal caudate and putamen (Boileau et al., 2006). Such findings have led to the “dopamine sensitization” hypothesis of schizophrenia which postulates that a sensitized dopamine system is responsible for the genesis of psychotic symptoms (Peleg-Raibstein et al., 2009).

The Link Between Psychotic Disorders and Substance Use | Psychiatric Times

The most robust body of evidence for the relationship between the onset of psychotic disorders and drug use comes from the Swedish conscript studies.12,13 Baseline drug use information was taken at intake to the army for these studies. The authors found that cannabis use, and to a lesser extent amphetamine use, predicted onset of psychotic disorder later in adulthood. The explanatory variable was age at use, with younger age predicting psychotic disorders. This relationship did not exist for other drugs used, such as cocaine. A more recent cohort study in New Zealand confirmed the relationship between cannabis use and the onset of psychotic disorders.14 This study demonstrated that younger age of first cannabis use predicted younger age of psychotic disorder onset in individuals with the Val/Val genotype for COMT on the Val158Met polymorphism (a gene that codes for the activity level of an enzyme involved in the breakdown of dopamine).

Adderall for ADHD / ADD: Uses, Dosages, Side Effects, and Benefits of Treatment

There have been 11 reported cases of psychotic reaction from among 7,000,000 prescriptions for Adderall written since 1996.

ADHD drugs increase brain glutamate, predict positive emotion in healthy people -- ScienceDaily

In this new study, subjects were first screened for mental and physical health and then underwent MRI spectroscopy scans designed to detect the concentration of neural compounds in specific regions of their brain. From the medical literature on psychostimulants, White and her team wanted to look in the anterior cingulate cortex, which is a "hub" brain region that connects multiple brain networks involved in emotion, decision-making and behavior. They found that two ADHD medications, d-amphetamine and Desoxyn, significantly increased the overall amount of glutamate in the right dorsal anterior cingulate cortex, even after controlling for possible confounding factors, such as volume of gray matter in the region. The rise in brain glutamate predicted both the duration and the intensity of positive emotion, measured by participant ratings about whether they liked the drug or felt high after consuming it.

Electroshock before exercise?!

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Men and women have opposite genetic alterations in depression: A study examines the sex-specific molecular changes in major depressive disorder -- ScienceDaily

Most of the genes that had altered expression were changed in only men or only women. However, genes that were altered in both men and women were changed in opposite directions. Women had increased expression of genes affecting synapse function, whereas men had decreased expression of the same genes. Women had decreases in genes affecting immune function, whereas men had increased expression of these genes. Additionally, the researchers applied their methods to data from a different set of subjects and replicated the opposing changes.

Psychiatric Medications Kill More Americans than Heroin

According to data from the MEPS (Medical Expenditure Panel Survey) database, the number of prescriptions for psychiatric medications (i. e. sedatives, antidepressants, psychostimulants, and antipsychotics) increased 117% between 1999 and 2013, from 197,247,557 prescriptions in 1999 to 427,837,506 prescriptions in 2013. Meanwhile, death rates from psychiatric medication overdose climbed a whopping 240% over the same time period, from 1.31 deaths per 100,000 in 1999 to 4.46 deaths per 100,000 in 2013 (we are excluding the CDC death rate data from 2014 since the MEPS 2014 data has not yet been published).

Paroxetine, Cognitive Therapy or Their Combination in the Treatment of Social Anxiety Disorder with and without Avoidant Personality Disorder: A Randomized Clinical Trial - FullText - Psychotherapy and Psychosomatics 2016, Vol. 85, No. 6 - Karger Publishers

CT was superior to paroxetine alone and to pill placebo at the end of treatment, but it was not superior to the combination treatment. At the 12-month follow-up, the CT group maintained benefits and was significantly better than placebo and paroxetine alone, whereas there were no significant differences among combination treatment, paroxetine alone, and placebo. Recovery rates at 12 months were much higher in the CT group (68%) compared to 40% in the combination group, 24% in the paroxetine group, and 4% in the pill placebo group.

Heart attack patients prescribed antidepressants have worse one-year survival -- ScienceDaily

After adjusting for baseline characteristics the researchers found that the rates of stroke and subsequent heart attacks were similar between the two groups, but patients prescribed antidepressants had significantly worse survival. The rate of all-cause mortality at one-year after discharge was 7.4% in patients prescribed antidepressants compared to 3.4% for those not prescribed antidepressants (p<0.001). Antidepressant prescription was an independent predictor for mortality, and increased the odds by 66% (odds ratio: 1.66; 95% confidence interval: 1.16 to 2.39).

Goodman: Did Fetal Alcohol Exposure Help Create Mass Murderer Nikolas Cruz? – Respvblica

I believe that Nikolas Cruz has a form of fetal alcohol/drug syndrome, a diagnosis that can be readily made by his facial characteristics. I am an experienced neuropsychiatrist.

Crappy studies

Unfortunately, the extant studies on side effect risk of the stimulants used for ADHD treatment have many limitations. All have been restricted to relatively short durations of exposure; and most are based on an assumption that a dose of methylphenidate is equivalent to half of an equal dose of amphetamine. Therefore, amphetamine is administered at 50% of the methylphenidate dose using fixed-dose designs, rather than titrating to a pre-determined efficacy endpoint before comparing adverse events. Most studies have not incorporated measurement of plasma drug level achieved although few relationships between these common adverse events and plasma levels have been noted 15. Nevertheless, it is potentially important that treatment within approved dose ranges with amphetamines, especially newer extended-release formulations, have produced residual low, but detectable, steady-state blood levels up to 24 h after administration. Thus many individuals experience some degree of continuous drug exposure. Although not tested, this finding suggests that cardiovascular complications, which have been associated with both normal aging and amphetamine abuse in young addicts, may appear earlier in older adults receiving maintenance amphetamine treatment 26. Regarding the detection of risk for uncommon or rare severe psychological or behavioral reactions to stimulants, controlled studies have not been large enough to pinpoint risk factors or determine differential risk by treatment assignment. Finally, a common observation across studies of the pharmacokinetics, pharmacodynamics, and safety profiles of amphetamine is the high degree of interindividual variability across most measures and endpoints. This variability calls for additional caution in application of the increasingly common practice of prescribing stimulants concurrent with use of other psychotropic medications 27, 28.

Understanding the Relationship Between Amphetamines and Psychosis | SpringerLink

Most people with psychosis, who use stimulants, also use cannabis, and cannabis is the most commonly used illicit drug among first-episode schizophrenia cases [40, 44, 45, 46, 48, 49, 50]. A recent review of stimulant-use disorders in people with psychosis found that cannabis use was the variable that most strongly correlated with stimulant use [51•]. Cannabis and methamphetamine have been suggested as the two most important drugs involved in the pathogenesis of psychosis and schizophrenia [34]. As the effect of cannabis, to a certain extent, counters that of amphetamines, users often take it to end amphetamine binges. Studies on psychosis in users of amphetamines seldom report on concurrent cannabis use. Given that cannabis often accompanies the use of amphetamines, it is uncertain to what extent the effect of cannabis might have influenced the evidence on the association between amphetamines and psychosis.

PsycNET Record Display - PsycNET

amphetamine psychosis can, in some cases, almost exactly replicate endogenous schizophrenia.