Bad Medicine: The medical untouchables

Des Spence has rightly spent much of his medical career highlighting issues in relation to the iatrogenic disaster that has engulfed society following the excessive and ill informed use of prescription medications. He is to be commended on this but he has not been the only voice in the debate. The petition before the Scottish parliament highlights key issues to a complex problem. Medicine and treatments have always gone through periods of underuse and overuse. The issue is sometimes not the drugs themselves, but as he highlights, the scrutiny of the evidence presented and the vested interests involved in over marketing of such medications. An alcoholic will likely say he wished he never took his first drink and we are poor at predicating of who will develop alchololism. One only needs to watch society's response to the tragedy of Charlie Guard (a child with a terminal illness who was being kept alive due to the supposed transforming nature of a poorly evidenced medical treatment) to see that a calm reflection of the inadequacies and vagaries of our understanding of diseases, their treatments and their prognosis is needed.

Spence has to be honest to indicate that for some patients the sheer nature of their problems and distress (on the background of a regulatory and medical education environment that highlight patients rights more than their responsibilities) mean that doctors will do their best to do something rather than offer nothing. It takes a brave doctor to face a distressed patient and family and highlight that there is no treatment with any good evidence on offer. That is the correct decision in many cases. Does he really wish to castigate the doctor who offers a treatment with poor evidence rather than none? Spence also has to admit that we are now facing patients with much a much more complex mixture of both physical and psychological problems than his forebears and he may have faced at the start of his career. This has also been combined with a certainty of some governmental organisations recommendations (not just clinical experts) that provided a false sense of security to many clinicians. The overarching issue here is the scrutiny of medical evidence and both he and his GP colleagues are not exempt from that onerous and complex task. Inappropriate prescriptions are just a poison by another name. He should be congratulated in his work but be aware that any medical crusade is likely to also be the bearer of suffering and that may include a broadbrush denial of some medications that can have addictive potential. It is much more useful to admit the greyness of medicine and to put systems in place to observe such treatments and act where necessary. As busy GP he will be aware of the problems of undertaking such a task. This will likely be more painful than a transient appearance on television.

I am one of the 'medical untouchables' referenced in Dr Spence's article.

Those of us who dare to raise our heads above the parapet and question the value of medicating vast swathes of our society with dependence-forming psychotropic drugs are routinely ignored, shot-down, our views little valued. Just over 30 years on antidepressants I think more than qualifies me to express an opinion. In that time I saw my health deteriorate as a result of side-effects and my motivation for life diminish, every day a struggle to get out of bed. I tapered off venlafaxine back in 2011 and I must say that 'discontinuation syndrome' does not do full justice to the hell that was my experience. Persistent withdrawal symptoms lasts for many of us far beyond the generalised 6 weeks set out by the Royal College of Psychiatrists on their website. This desperate situation led me to the risks of polypharmacy as more drugs were prescribed, such as Seroquel and diazepam, none of which helped but added to the harm. In such unbearable circumstances some us feel compelled to attempt suicide, I include myself in that number. None of the doctors or psychiatrists I saw were willing to accept that I was suffering anything other than a return of my original mental health problems. I must underline my symptoms went far beyond the issue of relapse. I have subsequently become drug free but not completely well as a result of my long association with psychotropic medication.

It would appear that there is a majority in the medical profession that would prefer that patients like myself are not only not seen but most definitely, not heard. Dr Des Spence has my gratitude for his very brave stance, I just wish there were more like him otherwise the rates of the 'medical untouchables' will continue to rise.

It is encouraging to be now living in a time when a GP is prepared write an article acknowledging the serious problem we now have around the prescribing of antidepressants and the physical dependence that for some can ensue. I would like to echo Marion Brown’s comment that GPs have been failed by the system, a system which has resulted in them being lied to and misled by the antidepressant manufacturers and so-say experts.

I was first prescribed an SSRI in 1996. My GP at the time had been assured by his pharmaceutical rep that this was an effective, non-addictive treatment for my intermittent insomnia and PMT. I witnessed the same GP being assured over the phone by the drug company, when I had concerns about pregnancy, that it was entirely safe and that there were many 'healthy (drug name) babies' out there. Later, when I had worked out for myself that I was now physically dependent on this drug (from the extreme and unbearable withdrawal effects that arrived within 36 hours of stopping the drug and magically disappeared after 36 hours of reinstatement), my current GP met with a brick wall when asking the manufacturer for advice on how I could further dilute the liquid version in order to slow my taper. I count myself as lucky that she did what she could to support me — that is not the experience of many people.

The MHRA said this week about SSRIs: 'It is recommended that they are only used when strictly indicated and patients should be closely supervised, particularly in early treatment and following dose changes.'

It is now extremely urgent that GPs have two sets of clear guidelines at their disposal:

1. When and how to prescribe, supervise, and monitor patients on antidepressants.
2. How to recognise, support, and guide patients who have or may have physical antidepressant dependency.

Co-operation between the BMA, GPs, and patients is vital in finding a way through, to quote from Marion’s letter, this 'untouchable' subject.

Thank you so much Dr Spence for your honesty and courage. It doesn't matter what you look like, sound like, speak like – please ignore your childrens' comments and carry on speaking out about drug side effects! And also thank you for drawing attention to the petition sent to the Scottish Parliament. It is indeed a pitiable state of affairs that this is what has to happen to highlight the plight of damaged patients. What else can they do? Where can they go?

It's over 20 years since our son became depressed during his teens and our little family was introduced to psychiatry. Since then we have watched in horror how side effects of one drug would lead to introduction of another and so on; a proper toxic carousel. Seroxat first prescribed 22 years ago when aged 16, continued for 5 years, and led to mania, delirium, and psychosis. He was hospitalised, prescribed antipsychotics, and misdiagnosed as schizophrenic. Prescribed citalopram for a further 4 years, he was tried unsuccessfully on 14 different antipsychotics.

After 9 years on SSRIs, a helpful GP started SSRI reduction. In hindsight we think he was taken off too quickly. Then began what we guess was withdrawal syndrome. This consisted of severe paranoia, agoraphobia, depersonalisation, derealisation, psychosis, and hostility. Five years in and out of psychiatric wards was followed by 7 years in residential care. Experiences in hospital we believe led to PTSD from which he is still recovering. 

When he was 15, we were told he was ‘university material’. Now under mental health sections for 9 consecutive years, he has spent two decades trapped in an incestuous system which has deprived him of education, employment, relationships, independence, and sanity. We need you to keep to have the courage to keep talking Dr Spence! But we need more like you.