I have had the great privilege and pleasure of working with a group of colleagues in Vermont who share my interest in bringing the humble and democratic ways of working developed in northern Finland and Norway to our state. Many of us were introduced to this work by Robert Whitaker’s description of Open Dialogue in Anatomy of an Epidemic and Daniel Mackler’s documentary Open Dialogue, and some of us worked with Tom Anderson, who came to Vermont in the 90s.
Some had traveled to Europe to attend the annual meeting of the International Network for the Treatment of Psychosis, the group of clinicians who had been working in this way for the past two decades. Others had the opportunity to train with Mary Olson, PhD at the Institute for Dialogic Practice. We have formed study groups and developed small teams who are beginning to introduce this way of working to our clinics.Read More
The Foundation for Excellence in Mental Health Care was founded in 2011 with the hope of expanding what many had come to believe was a narrow and faulty understanding of psychiatric conditions.Read More
BACKGROUND: Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy.
AIMS: We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression.
METHOD: We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v. those without.
RESULTS: In total, 45 studies were included. In most analyses, pharmacotherapy consistently showed significant effectiveness over psychotherapy, g = -0.11 (95% CI -0.21 to -0.02) in industry-funded trials. Differences between industry and non-industry-funded trials were significant, a result only partly confirmed in sensitivity analyses. We identified five instances where authors of the original article had not reported financial COI.
CONCLUSIONS: Industry-funded trials for depression appear to subtly favour pharmacotherapy over psychotherapy. Disclosure of all financial ties with the pharmaceutical industry should be encouraged.
Get Full Text: Journal site
© The Royal College of Psychiatrists 2017.
On March 14th, I celebrated six months in my new position as Director of Philanthropy at EXCELLENCE. Why did I choose to work at EXCELLENCE and not somewhere else? I believe in the mission. I believe that five years from now, because of this organization, the mental health care delivery system in the United States will be more compassionate and more effective than it is today.Read More
Peter Gøtzsche of the Cochrane Centre in Copenhagen arranged this conference uncovering what the scientific literature reveals about the effects of psychiatric medication. Those lectures are followed by real world accounts.
Part 1 with Robert Whitaker: Our Psychiatric Epidemic – A Historical Overview.
The serotonin reuptake inhibiting (SSRI) group of drugs came on stream in the late 1980s, nearly two decades after first being mooted. The delay centred on finding an indication. They did not have hoped for lucrative antihypertensive or antiobesity profiles. A 1960s idea that serotonin concentrations might be lowered in depression1 had been rejected,2 and in clinical trials the SSRIs lost out to the older tricyclic antidepressants as a treatment for severe depression (melancholia).3,4,5
When concerns emerged about tranquilliser dependence in the early 1980s, an attempt was made to supplant benzodiazepines with a serotonergic drug, buspirone, marketed as a non-dependence producing anxiolytic. This flopped.6 The lessons seemed to be that patients expected tranquillisers to have an immediate effect and doctors expected them to produce dependence. It was not possible to detoxify the tranquilliser brand.
Instead, drug companies marketed SSRIs for depression, even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance. The tricyclics did not have a comparable narrative.Read More
The idea that our more distressing emotions such as grief and anger can best be understood as symptoms of physical illnesses is pervasive and seductive. But in my view it is also a myth, and a harmful one. Our present approach to helping vulnerable people in acute emotional distress is severely hampered by old-fashioned, inhumane and fundamentally unscientific ideas about the nature and origins of mental health problems. We need wholesale and radical change, not only in how we understand mental health problems, but also in how we design and commission mental health services.Read More