Summary of Dr. Oz’s entire TV show on The Truth about Antidepressants   Leave a comment

PART 1

On his April 3, 2013 TV show, Dr. Oz’s discussed The Truth about Antidepressants. I think Dr. Oz did a good job. My main concern, however, is with the editing of the show Dr. Oz began with an emphasis on the “horrible” side effects antidepressants can cause. Ironically, labeling antidepressants as bad or the same as placebos was not the essential message that Dr. Oz intended people to take from his show. However, – as shown by the posts on his blog and on his Facebook – that was precisely the message that many people got.

Despite the way the show was edited, as it progresses it becomes clear that Dr. Oz is really talking about the fact that the majority of antidepressants are being prescribed by non-psychiatric physicians – not by a psychiatrist for a psychiatric diagnosis. The show emphasizes that nearly 80% of all prescriptions for antidepressants are written by non-psychiatrists. Nearly 73% of these prescriptions are given without a proper psychiatric diagnosis. “This can lead to dangerous results,” Dr. Oz said, “If you’re taking antidepressants, talk with a psychiatrist.” The show reiterates that it is critical that a psychiatrist who has training on how to deal with these severe illnesses supervise antidepressants.

I hope not to belabor the point, but I would like to emphasize Dr. Oz’s warning on The Truth about Antidepressants by using the converse of his argument. The Truth about Antidepressants is the show Dr. Oz calls one of the most important episodes he is going to do this year – one he is passionate about.  Using a converse analogy, I will reverse the elements of his thesis.

I am a physician. I specialize in psychiatry. I have been granted medical licenses in three different states, all of which say that I am licensed to practice medicine and surgery. After graduation from medical school, I completed further hospital training as an intern in pediatrics, neurology, internal medicine, and the emergency room where – among other things – I delivered babies and performed minor surgery. If I chose to, I could purchase the very finest scalpel in the world. But it would still not be a good idea for you to let me perform surgery on you. If I did so – and if other psychiatrists did so – we might be talking about the “horrible” side effects that scalpels can cause. But that would not be the relevant conclusion. Psychiatrists are, of course, not trained as surgeons. They should not cut people open, and patients should not allow psychiatrists to perform surgery on them.

This is the precisely Dr. Oz’s point. Psychiatrists are medical doctors trained in the diagnosis and treatment of mental disorders. Dr. Oz urges people to see psychiatrists, who are trained to diagnose and treat mental disorders with which people may be suffering.

The following is a summary of part 1 of The Truth about Antidepressants.

Dr. Oz announced that he is doing what he calls one of the most important shows he will do this year – one he is passionate about – what he calls The Truth about Antidepressants. As I said, I am concerned with the impression with which the show begins. Dr. Oz said antidepressants don’t work for most patients. They can actually make your problems worse. They may even cause deadly harm. New research, he said, has shown that they do not help anymore than placebos. They can cause horrible side effects like irritability and sexual dysfunction. They can increase the risk of birth defects and suicide in teens and young adults. They may actually change the brain and make depression worse. His introduction can easily confuse people. However, he clarifies his message as the show progresses. His guest is Dr. Drew Pinsky, an addiction specialist – not a psychiatrist – but a physician who prescribes antidepressants and who admits that doctors have prescribed them excessively.

Dr. Oz asked how we have come to this. Dr. Pinsky replied that the biggest problem is that the system does not allow talking and developing a therapeutic relationship with the patient. And thus the system encourages primary care doctors to prescribe. Dr. Pinsky also added that the way health insurance is structured, it is almost impossible to get a referral to a psychiatrist. Consequently, non-psychiatrists prescribe the bulk of antidepressants.

The following is a summary of part 1 of The Truth about Antidepressants:

Dr. Oz:                       So, 2004… the FDA required that manufacturers put a suicide-warning label on antidepressants. Why is that?

Dr. Drew Pinsky:  It’s relatively uncommon but in some populations, particularly children and adolescents, you can increase suicidal thinking. And I tell you the real problem that I see is because so many antidepressants are prescribed by primary care doctors like myself.  They aren’t doing the proper evaluations and, for instance, can precipitate a manic episode. And that can produce suicidality. They don’t differentiate between unipolar depression and bipolar depression.

Dr. Oz:                    …[A]ntidepressants… have increased over 400%. …it’s primarily among women…. How is that possible?

Dr. Drew:               …. We have become a pill society. Pharmaceutical companies [advertise] direct to consumers. We have limited time with patients. Patients come in and demand a medication. And in every study that’s ever been done on the treatment of depression, the outcomes always shows that talk psychotherapy with medical management – which may or may not include medication – is what’s required to have a satisfactory outcome. We never get the psychotherapy part. The medical management isn’t sophisticated. Bad outcomes.

…It’s that they just don’t work as well as we thought they did. And they may cause more problems and more depression down the line.

Dr. Oz:                    How do they make it worse?

Dr. Drew:                  …I think it’s because we don’t carefully select the population that needs to be treated. There’s specific treatment for specific diagnoses. It’s not a shotgun. And my biggest concern is that most of the prescribing is done by primary care people like internists, family practioners, and gynecologists. And we have little or no training in the assessment and use of these substances. So how could it possibly be good?

Dr. Oz:                         I think it’s one step further, everybody. There’s new evidence that antidepressants may also make your depression come back. …People who were treated by antidepressants… were actually twice as likely to get it again compared to a placebo.

Here is the link to the video of part 1 of this episode:    http://www.doctoroz.com/videos/truth-about-antidepressants-pt-1

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PART 2

 On his April 3, 2013 TV show, Dr. Oz’s aired The Truth about Antidepressants. As the show proceeds to part 2, Dr. Oz talks about the adverse effects of antidepressants that often occur because the majority of antidepressants are prescribed by primary care doctors who do not have adequate, specialized training in distinguishing between types of depression and their treatments.

I wish to underline Dr. Oz’s vital point about the importance of distinguishing different types of depression.  Depression is not a one-size-fits-all problem, and its proper management does not involve a single tool. Depression is a word in our language that carries multiple meanings. For example depression can be a perfectly normal mood in certain circumstances – such as during the loss of a loved one or being in a destructive relationship, or having an unsatisfying job. I do not believe that what I will call Mother Nature gave us the normal capacity for depression just to torture us. I do not believe that Mother Nature gave us the normal capacity for depressor so that doctors and ‘big pharma’ could make money by prescribing or manufacturing antidepressants. I believe Mother Nature gave us the capacity for normal down regulation of our mood –normal depression – as a gift.

The analogy that I will use is the situation of placing your hand on a hot stove. You feel pain. But that unpleasant pain is a gift. Otherwise you would burn the flesh on your hand. So, too, with normal depression. You feel bad in certain circumstances. It hurts, but it may help you to remove yourself from a destructive situation or to let go of someone with whom you can no longer have a relationship. To distinguish depression as an illness from depression as a normal reaction to adverse circumstance, I use the term, ‘demoralization” to differentiae it from ‘ depression’.

If you or I were taken prisoner and tortured, we would not be happy. No antidepressant would make us happy in a miserable situation. Yet people, for example demoralized by a bad or abusive marriage, sometimes go to their family doctor and ask, “Do you have something for depression?” Often – but not always – the doctor says, “Yes.” But in such a situation the antidepressant will not relieve the demoralization. Demoralization is not an illness. It can be normal and unresponsive to an antidepressant.

Even when we are talking about an illness of depression, there is more than one kind of depressive illness. For example, some people are currently depressed but have bipolar (manic-depressive) illness. An antidepressant can make bipolar disorder worse. And bipolar disorder can take many forms, e.g., Bipolar Disorder I, Bipolar Disorder II, rapid cyclic bipolar disorder, mixed states. Some people have seasonal affective disorder the can be treated with light therapy. Some people have major depressive disorder of the melancholic type. Some have atypical depression. Some have dysthymia. Some depressions are situational and best treated by talk therapy. These various types of depression do not all respond to the same therapeutic intervention – such as talk therapy, medication, ECT, transmagnetic stimulation or any number of other treatments offered up to suffering individuals.

Depression is not a one-size fits all treatment issue.

The following is a summary of part 2:

Dr. Drew Pinsky:              As a primary care doctor, I have no training in distinguishing between [types of depression], I could really mess things up.

Dr. Oz:                                Sometimes you [the patient] cause problems that may actually get you to hurt yourself or run into problems even getting off these pills.

Dr. Daniel Amen – psychiatrist:   For the right person, it can be really helpful. Depression is a real illness that has serious consequences. But for the wrong person, it can be a disaster and make them more impulsive, more irritable, actually hurt the people you care about.

Dr. Oz:                                   …There are a lot of folks who are on antidepressants, not because they’re depressed, but because they’ve got other issues that they want to deal with.

Dr. Drew Pinsky:                 I had something hammered in me in medical school – which is ‘no diagnosis, no treatment, no diagnosis no treatment.’ You can’t treat the symptom and expect a good outcome. You treat diagnosis. And if your diagnosis isn’t accurate, you cannot expect a good outcome. So the specific diagnostic situation… is to be fully flushed out before you even contemplate a treatment.  It may or may not include medication. But we are being so unsophisticated, and we are too prone to pull out a prescription pad.

Dr. Oz:                        Depression fundamentally is not a disease. It’s a symptom.

The link to the video of part 2 of Dr. Oz’s show is http://www.doctoroz.com/videos/truth-about-antidepressants-pt-2

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PART 3

On his April 3, 2013 TV show, Dr. Oz’s aired The Truth about Antidepressants. In part 3 the show also takes on ‘big pharma’ and the health insurance industry. Dr. Drew Pinsky also addresses the stigma of psychiatry. He tells a patient that doctors anticipate resistance from patients should the doctor recommend a psychiatrist.

The following is a summary of part 3:

Dr. Oz:                        You worry that doctors are actually pushing, advocating, women to take antidepressants who might not need them.

Dr. Drew Pinsky:     Not just doctors but how about the pharmaceutical companies going out direct to consumers? We have to share the blame for this, all of us, every one of us -patients – I’m a patient, I’m a doctor – we all need to share this blame. The pharmaceutical companies went direct to consumers. [Patients] come in and they say, “I want this pill…. And that’s a shame. They need to let doctors do their job. We have to fight for patients to get the referrals they need which is the other place we fall down.

Dr. Drew Pinsky asks a patient:   “If [your] doctor had said, “Would you please see a psychiatrist or a therapist,” would you have resisted that? As a primary care doc, we expect that resistance! Patients, you’ve got to go in and fight for that. You’ve got to say, “I want to see an expert. I want to see someone who actually does this work, not my gynecologist, who doesn’t do that.”

The link to the video of part 3 of Dr. Oz’s show is http://www.doctoroz.com/videos/truth-about-antidepressants-pt-3

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PART 4 

In part 4 of Dr. Oz’s April 3, 2013 TV airing of The Truth about Antidepressants, he emphatically states, “The single most important thing I want you all to get out of this show” is “If you don’t go to a psychiatrist… you’re taking an unnecessary chance…. They [non-psychiatrists] don’t think [antidepressants] make you worse. Do [antidepressants] play a role saving lives? Absolutely! Are they right for everyone who’s on them? Absolutely, no way! There’s no way you can defend that. And when I see the information coming out… it makes me angry.

The following is a summary of part 4.

In this segment, Daniel G. Amen, MD, a psychiatrist,  joins Drew Pinsky, MD, a primary care physician and Dr. Oz.

Dr. Oz:             Who should be the first person to give you an antidepressant?

Dr. Daniel Amen:     A psychiatrist, someone who has training in how to use these medications appropriately.”

Dr. Drew Pinsky:         And how to assess them, too. Hey listen! I’m a perfect paradigm. I’m being encouraged both by the patients, by the system, by the pharmaceutical industry to prescribe medicines as an efficient way to help patients. I’m telling you. It’s a bad idea. I agree with Dr. Amen. My peers should not be prescribing them because we are not trained to assess this properly.

Dr. Oz:            What I think is the single most important thing I want you all to get out of this show… I don’t want any women in America to get on an antidepressant unless they talk to a psychiatrist first… because they’re going to untrained professionals in this space…. If you don’t go to a psychiatrist… you’re taking an unnecessary chance…. They [non-psychiatrists] don’t think [antidepressants] make you worse. Do [antidepressants] play a role saving lives? Absolutely! Are they right for everyone who’s on them? Absolutely, no way! There’s no way you can defend that. And when I see the information coming out… it makes me angry. Because we can do better. But we’re going to have to do it together. It’s you out there saying, “Hold it a second. I’m a little down. But I’m also fighting with my spouse. I’m not happy at work.”

…Depression’s like angina. You don’t just treat angina. You find out why you have the angina, and you treat that problem. There are two other things that we need to do before starting an antidepressant. First off you must demand a work-up from your doctor to figure out what can be causing it.

Dr. Drew Pinsky:         Absolutely, that’s our job as primary care is to rule out a medical cause that’s contributing or causing the depression symptom. And we rule that out. Then refer people on.  And we have to fight for our patients with these insurance companies that don’t want to give us these referrals.

The link to the video of part 4 of Dr. Oz’s show is   http://www.doctoroz.com/videos/truth-about-antidepressants-pt-4

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