Antidepressants-Apparently informed consent is not required?

Antidepressants-Apparently informed consent is not required?

By Dr Philip Rouchotas, MSc, ND

As an outpatient ND in Southern Ontario with a practice focused on mental health, I am frustrated? outraged? at the number of patients that present with a recent prescription for an antidepressant, yet having received no discussion of informed consent. Furthermore, they typically have been aggressively reassured that these medications are safe, relatively free from side effects, and not addictive. As I give them the quick, “google” version of side effects, a typical look of shock and horror overtakes the patient. Anyone working in this field knows the very minimal efficacy they deliver, the debilitating list of side effects they induce, and as years pass I am starting to think the antidepressant class of medication to be more addictive than heroin or cocaine.

Yet one outpatient ND’s observations hold little weight when trying to communicate with healthcare providers, or beyond. Luckily, integrative healthcare providers in the world of mental health have been delivered a night in shining armor. Frankly, several ultra- high ranking academics have joined the fray, yet this short communication will introduce Peter C Gotzsche. Cofounder of the Cochrane database of systematic reviews, publisher of dozens of systematic reviews himself, principally in Cochrane and the British Medical Journal. Peter, with the help of a small handful of other high ranking academics have systematically scrutinized evidence relating to antidepressants for over a decade. As their efforts continue to produce little action, their dialogue and writings heighten in scrutiny.

For further reading by this incredible scientist, please see Bielfeldt 2016, Gotzche 2016, and Sharma 2016.(1,2,3,4) Please also consider reviewing his book for the lay public entitled “Deadly medicines and organized crime; how big pharma has corrupted healthcare”. For now, we will review Gotzsche 2017.

A systematic review of ten trials was undertaken, including 1241 patients, all of whom had engaged in a suicide attempt within six months of enrolling in the trial (Gotzsche 2017).3 The main outcome measure was another suicide attempt, comparing usual care to cognitive behavior therapy (CBT). CBT versus usual care reduced the risk of a subsequent suicide attempt by 53% (RR0.47; CI 0.30-0.73, P=0.0009). 

The authors highlight that one included trial provided an unusually large effect, and removing this trial corrected the impact to a 39% reduction in suicide attempt risk (RR 0.61; CI 0.46-0.80).

The conclusion of the authors is as follows: “CBT reduces not only repeated self- harm but also repeated suicide attempts. It should be the preferred treatment for all patients with depression”.

References: 

  1. Bielefeldt, A.Ø et al. J R Soc Med. 2016 Oct;109(10):381-392. 
  2. Gøtzsche, PC et a l.. BMJ. 2016 Feb 10;352:i574. 
  3. Gøtzsche PC, Gøtzsche PK. J R Soc Med. 2017 Oct;110(10):404-410. 
  4. Sharma T, eta l. BMJ. 2016 Jan 27;352:i65.
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