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Please begin with an informative title:

The Emperor’s New Drugs is a brilliant, brave and detailed book that exposes Big Pharma’s failure to produce effective drugs to treat depression.  If you or a loved one are taking an antidepressant, or are considering taking one, I would strongly urge you to read the book.  It could change your life.  

If you care about healthcare delivery in this country, then you should care about how Pharma is treating or not treating the 20% of the population who will someday experience a depression.  You should read the book.  And to be clear, I make nothing by promoting the book – it just speaks truth to power.

The book came out in March 2011 and although followed up with a 60 minutes interview on February 19, 2012, the information failed to ignite a firestorm against Pharma.

Well, it turns out that Dr. Kirsch's work was the first shoe, as we said in the day.  The other shoe, the one that really hurts, is that there is a drug with great promise to treat depression, if only we could get our hands on it.  Maybe that'll start the fire.

More below the fold:

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Key excepts from "The Emperor's New Drugs: Exploding the Antidepressant Myth" by Irving Kirsch (Mar 8, 2011), backed up by detailed and unbiased statistical analysis:

“The belief that antidepressants can cure depression chemically is simply wrong.”

“Using these standards to judge the effectiveness of a (antidepressants) is voodoo science to the nth degree.”

“In their most recent analysis of the data, the FDA concluded that, when compared to (sugar pills), (antidepressants) double the risk of suicidal thoughts and behaviors in depressed patients up to the age of 24”

"(side effects of antidepressants include)...sexual dysfunction...seizures...mania..panic attacks...twitching...anorexia...hallucinations..."

"while only a minority report any particular side effect, the number of patients who report suffering from at least one of them is quite high, ranging from half...to the vast majority..."

In summary, antidepressants are more accurately viewed as dangerous, habit-forming, sexual inhibitors that have the occasional side effect of improving depression.  

Even the scientists are now admitting that the entire theory of levels of Serotonin affecting mood is wrong.   Much of the last 50 years of research has been digging in the wrong hole.  To the degree that antidepressants do work, it is because of the placebo effect in which people believe themselves into health, combined with a small and incidental drug effect.

How can you believe Dr. Irving Kirsch, the author of The Emperor’s New Drugs? Well, first there's his background, courtesy of Amazon:

...is Associate Director of the Program in Placebo Studies and a lecturer in medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center. He is also a professor of psychology at Plymouth University in the United Kingdom, and professor emeritus of psychology at the University of Hull, United Kingdom, and ...
Second, if there was an error in his analysis of antidepressants, you could be sure that Pharma would have suppressed the book.  Crickets? I'm betting Pharma hopes you don't get a copy for Christmas.

What to do for those who suffer depression if not for a standard antidepressant?  Our friends in Pharma have had the answer to that for many years, but it’s likely you have never heard of it, or have heard something about something that is not quite ready for prime time.

That something is the drug Ketamine.   It was developed in the 1960’s and has been used as an operating room and emergency room anesthetic ever since.  Surgeons noted how happy their patients were after a procedure, and I know of one battlefield doctor who used Ketamine personally as an antidepressant.

Ketamine is a very safe drug.  An overdose can be lethal, but the dosage for depression treatment is already a small fraction of the dosage used for anesthesia. Other side effects are very minor, and only felt for an hour or so after administration of the drug.

There are issues that need to be resolved in order to use the drug for depression.  The most reliable method of administration is via an IV, which means treatment in a medical office with the appropriate equipment.   That structure will mean that the price of the service initially would be restricted to those who could afford to pay privately.

However, there is research underway to use other methods of administration, including a nasal spray and a liquid version.  Chances are that by the time the vast majority of people are ready to try it, the industry will have developed one of these methods into a commercially viable approach.

How good is Ketamine?  A traditional antidepressant, acting as a placebo plus a slight drug effect, will help about 33% of patients get better over the course of a couple of months.  (What Pharma doesn't advertise is that therapy, a self-help book or exercise would help just as many people just as quickly, and without the side effects of antidepressants.)

In comparison, Ketamine works for more than 70% of patients who have tried a therapeutic dose, and does so in less than one hour.  LESS THAN ONE HOUR.  I still have a hard time writing that, but I have personally experienced it and seen its’ effect in others.  How does it work?  As shown in the picture of two neurons below, Ketamine increased the level of synaptic branching in areas of the brain controlling mood by something like a factor of 4:

"Slide1"

I won’t get into the science of what is happening, because frankly we are all guessing at this point.  After being so wrong on earlier antidepressants, I would hope we’re a little more humble and egoless in our pronouncements of what is going on in something as complicated as the human brain.

Why haven’t you seen a single commercial for Ketamine, while you can’t escape commercials for other drugs?  Well, most people on this site will already intuitively know the answer – Pharma can’t make money with Ketamine, so it has an alternative strategy.

Since Ketamine is such an old drug, the manufacturer no longer has patent protection.  I can’t overstate the economic effect of that – the depression dosage of Ketamine sells for about $10 per month compared to patented antidepressants that drug companies can sell for as much as $500 per month.

In order for a drug company to market a drug for a particular illness, it needs to first do human studies that show the drug is safe and effective.  That can cost hundreds of millions of dollars.  Then the drug company spends billions in advertising dollars to educate the public about the benefit of the drug.  There simply is not enough money in a $10 per month drug to fund the human research, spend the money in advertising, capture enough profit to satisfy shareholders and to fend off competitors.

The answer in the mind of drug companies is to develop a new drug, hopefully superior in a meaningful way.  Of course, Pharma is quite capable of developing a drug that is not better in a meaningful way, but appears that way because of the dollars in advertising Pharma will spend.  To some extent, that has already started with Ketamine.  Researchers who are filing new patents for Ketamine on one hand are saying on the other hand that Ketamine is not an appropriate drug to use.  

For those of us in the reality-based community I offer you this: After 40 years of suffering seasonal downturns as part of being Bipolar, I’ve had one of the few depression-free autumns of my adult life.  

Check it out for yourself and your loved ones, and don’t take the first “no” for an answer.

Extended (Optional)

Originally posted to AZ Desert Rat on Mon Nov 26, 2012 at 05:31 AM PST.

Also republished by Mental Health Awareness.

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