Re: MRCPsych Question of the Day from OnExamination: Which antidepressant to use? – doc2doc.bmj.com

This question was recently posted on doc2doc:
MRCPsych Question of the Day from OnExamination: Which antidepressant to use?

A 64-year-old lady with a moderate depressive illness currently treated with an SSRI presents with increasing fatigue. Her plasma sodium is found to be 122 mmol/L.

Which of the following antidepressants would be preferable in this context?

Agomelatine
Fluoxetine
Mirtazapine
Trimipramine
Venlafaxine”

The correct answer according to BMJ OnExamination is agomelatine (Valdoxan)

I disagree as you can read in my response to the doc2doc question of the day.

I disagree with the answer.

The meta-analysis of published and unpublished studies of agomelatine is misleading
http://www.bmj.com/content/348/bmj.g1888/rr/762419

Any reason not to retract?
http://www.bmj.com/content/348/bmj.g1888/rr/763197

Agomelatina: lo ultimo en antidepresivos 
http://www.medicossinmarca.cl/medicos-sin-marca/agomelatina-lo-ultimo-en-antidepresivos/

I think it is quite the opposite.

“Until regulatory agencies decide to withdraw agomelatine from the market, it is up to healthcare professionals to protect patients from this unnecessarily dangerous drug.”

Agomelatine: a review of adverse effects. Prescrire Int. 2013 Mar;22(136):70-1. 
http://www.ncbi.nlm.nih.gov/pubmed/23593692

I also think that concerns expressed by several authors (listed on websites as the Council for Evidence Based Psychiatry, Mad in America, davidhealy.org, NoGracias, Médicos Sin Marca, others) regarding the effectiveness and safety of antidepressant drugs in humans are legitimate and well-argued.

Re: Putting GlaxoSmithKline to the test over paroxetine
http://www.bmj.com/content/347/bmj.f6754/rr/816737

I am almost certain that the correct answer is not listed on the five possible interventions for this patient: psychotherapy.

It is better to talk and being listened than just medicated with a drug of unknown effectiveness and potentially harmful.

I am still surprised how in many countries around the world psychiatry – inadvertently – is slowly resembling more to an authoritarian specialty instead of an academic and scientific field of the medical profession.

“In the Soviet Union, the need for psychiatric care is more likely to be seen as a cause for shame. Treatment there emphasizes medication rather than talk.”
The New York Times, January 30,1983.
http://www.nytimes.com/1983/01/30/magazine/the-world-of-soviet-psychiatry.html

The use of psychiatric drugs is not supported by the evidence and their use frequently involves coercion, violation of the autonomy of patients (one of the principles of medical ethics).

Re: What Does the New York Times Have Against Psychiatry?
http://chaoticpharmacology.com/2015/05/21/re-what-does-the-new-york-times-have-against-psychiatry-%E2%80%95-drjlieberman-2/

Psychiatry could also be misused as a powerful instrument to suppress whistleblowers.

Psychiatry versus whistleblowers
http://www.bmartin.cc/dissent/documents/#psychiatry

I am not anti-psychiatry at all.

I know excellent psychiatrists, from Colombia and as well as many other countries, some of which were my professors and some of them were also my psychiatrists when I needed to talk about my life struggles, psychiatrists such as Gloria Macias (Cali, Colombia) and José Salmeron (Managua, Nicaragua) emphasizes on psychotherapy for the treatment of their patients, prescribing medication only when it is absolutely needed and – very important too – for a limited period of time.

This is an invitation to dialogue: not only about antidepressant drugs (we need to discuss antipsychotics too).

Related information

Psychiatry Gone Ashtray
http://davidhealy.org/psychiatry-gone-astray/
(Spanish translation via No Gracias: http://www.nogracias.eu/2014/08/10/la-psiquiatria-se-hunde)

Psychiatry has its head in the sand: Royal College of Psychiatrists rejects discussion of crucial research on antipsychotics
http://joannamoncrieff.com/2013/12/20/psychiatry-has-its-heads-in-the-sand-royal-college-of-psychiatrist-rejects-discussion-of-crucial-research-on-antipsychotics/

Read this and other responses via BMJ doc2doc: http://bmj.co/1SuBDFZ

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