Look out – DSM V is just over the horizon

DSM V? – I’m talking about the next version of the Diagnostic and Statistical Manual of Mental Disorders – this is the ‘bible’ when it comes to manuals of mental disorders…

The foremost definitions of depression are those developed by panels of experts convened by the American Psychiatric Association. The APA’s Diagnostic and Statistical Manual was first compiled in 1952 to assist the national census of mental disability, but has since been transformed. It was produced by a panel of experts from the American Psychiatric Association (APA) – an organisation close to and funded by the drug companies.

The fourth edition, known as DSM-IV, was published in 1994 and is now internationally recognised as the prime definition of how to recognise depression and, implicitly, when and how to treat it. DSM-IV definitions are also closely linked to those in the WHO’s International Classification of Diseases (ICD-10) and arguably now drive them.

In 1952 there were 106 different kinds of depression – by DSM IV in 1994 there were over 350 different kinds of depression listed.

In authenticating more and more diagnoses, the DSM process has helped to legitimise a dramatic increase in drug use (the dominant treatment mode) for conditions that become wider and wider in scope.

The work on DSM V is on-going thanks to a partnership between the American Psychiatric Association and the National Institute of Mental Health.

Whose best interests will be served by this new edition, I wonder?

(Thanks to Truthman30 for making me think about this)

The First 2007 Doctors for Dollars Award

And you thought you were just depressed, eh?

But hold on, perhaps you’re not – perhaps you might be suffering from Adult ADHD… yep, Adult ADHD!?

Luckily, Shire Pharmaceuticals has just the drug for you and it has been spreading its cash around to let doctors know and Shire’s messages go something like this: “1) Adult ADHD is underdiagnosed; 2) Adult ADHD is a really bad disease, with lots of terrible consequences; 3) A lot of the patients that present with depression actually have ADHD if you dig deeply enough; 4) Stimulants don’t lead to substance abuse, in fact they prevent future development of substance abuse; 5) Finally, and most importantly, psychostimulants are incredibly effective for Adult ADHD, so prescribe lots of them…”

Now, where have we heard those messages before…?

Thanks to Dr Daniel Carlat and his Carlat Psychiatry Blog – Supporting the search for honesty in medical education – for bringing this story to us.

Read the whole thing here.

MHRA – Breckenridge – Seroxat withdrawal problems

I’ve just read a piece at Seroxat Sufferers – Alasdair Breckenridge (head of the MHRA) is speaking about Seroxat, from The New Statesman in 2005.

It seems Breckenridge was happy that the MHRA had been up to speed on the Seroxat scandal from the very beginning: “If you go back – and I read this out to the Health Select Committee – to the data sheet on Seroxat when it was licensed in 1991, we spelt out word for word the problems of withdrawal from Seroxat, in words that we could not improve now. This idea that the regulators have been hiding the data is just not true. The so-called scandal of Seroxat is something I want to nail every time I speak in front of compatriots because it is absolute rubbish”.

And here is what Breckenridge actually said to the Health Select Committee: “…What the expert working group did was to look at three issues about antidepressants: firstly, the question of withdrawal; secondly, the question of suicidal ideation; and, thirdly, the question of dose. The problem of withdrawal has been well known with antidepressants, especially Seroxat, and I happen to have before me the information sheet, the data sheet which we published, which the MCA published in 1990 when Seroxat was first licensed. If I can just read it to you, it says, ‘As with many psychoactive medicines, it may be advisable to discontinue therapy gradually as abrupt discontinuation may lead to symptoms, such as dizziness, sensory disturbances, sleep disturbances, agitation or anxiety, nausea, sweating and confusion’. That was in 1990″.

I think the questions that arise are as follows: what exactly is a “data sheet” and how was it published and provided to patients in 1990? – because I can tell you that there was NO mention at all of withdrawal problems on the Patient Information Leaflet (PIL) that was provided in each box of Seroxat. Neither was there any advice to “discontinue therapy gradually”.

Also, given that the MCA (today’s MHRA) was aware that Seroxat caused withdrawal problems and one should “discontinue therapy gradually”, then please please tell me why there was no mention of these matters in the PIL. No one in their right mind could argue that the MCA had “nailed” the “so-called scandal of Seroxat”.

If the PIL did not inform patients about how to stop taking Seroxat and about the severity and frequency of withdrawal problems, then what did?