Are Psychiatric Drugs Improving Australia’s Mental Health Care?
Should Asia follow Australia’s actions?
On 21st to 24th Feb 2019, Sydney is hosting the 7th World Congress of Asian Psychiatry with the theme, Mental Health Care Across Asia: Union In Diversity. Sounds good but is it?
Escalating Psychiatric Child Drugging in Australia
Antipsychotics: By 31 December 2015 there were over 16,500 Australian children under 17 prescribed antipsychotics, 1,384 of those aged 2-6-years-old.1 Side effects reported to Australia’s drug regulatory agency, the Therapeutic Goods Administration (TGA) include: a 13- year-old boy on Zyprexa gained 45 kgs over 6 months, another 13-year-old also on Zyprexa experienced both rapid and slow heartbeat and blacked out.2
Antidepressants: Another 49,052 Australian children under 17 years were prescribed antidepressants in 2015 with 1,459 of those aged 2-6-years.3 However no antidepressant is approved for children under 18 for depression.4 Australia’s drug regulatory agency (TGA) has now issued 3 psychiatric drug warnings to warn of the risk of suicidal behaviour with antidepressant use.5
Number of Side Effects Reported: As of December 2017 there were 41,317 adverse drug reactions linked to psychiatric drugs reported to the TGA, 1,439 of these deaths.6 The use of these drugs is in the face of more than 60 warnings for psychiatric drugs issued by the TGA since 1995. Yet, there are over 4 million people on a psychiatric drug in Australia with 1.2 million of those in NSW.7
“Early Intervention”: the Facts
Attendees at the World Congress of Asian Psychiatry will be able to visit a headspace youth mental health centre. Headspace’s founding director is psychiatrist Prof. Patrick McGorry, an advocate of “early intervention” treatment for mental disorders, treating those “at risk” of psychosis. I.e. they don’t have it but could get it. How non-scientific is this? Essentially it is an arbitrary list of behavioural symptoms, which psychiatrists claim can predict the onset of “psychosis.” Often predicted at age 12-14-years-old, psychiatrists can then treat the adolescent to “prevent” the “disorder.” Potentially dangerous antipsychotics may be prescribed as part of this “treatment.” 8 Headspace’s “At risk evidence summary” for young people developing psychosis estimates 82% to 90% will not go on to develop psychosis within a year of diagnosis. Despite this, the premise is that youth should still be treated now.9
There are now 15 headspace centres in Australia that treat youths for so called “at risk” of psychosis.10 Prof. McGorry’s Orygen Centre currently operates 4 of these 15 headspace centres directly.11 These 15 Headspace centres operate based on Orygen’s early psychosis model. Orygen has been funded by drug companies Eli Lilly, AstraZeneca, Janssen-Cilag and Bristol-Myers Squibb.12
An independent evaluation report released in 2015 of psychiatrist Prof. McGorry’s headspace centres revealed that of the 26,058 evaluated 12-25-year-olds seen by headspace, only 13% had a “clinically significant improvement,” 28% had no change and an astounding 24% either declined or significantly worsened. Consultation costs alone ranged from $136 to $1,000 per visit.13
Headspace is also now one of the two delivery partners in Australia’s biggest school based mental health program (Be you).14
Prof. McGorry has received unrestricted grant funding from Janssen-Cilag, Eli Lilly, Bristol-Myers Squibb, AstraZeneca, Pfizer and Novartis. He has acted as a paid consultant for, and has received speaker’s fees and travel reimbursement from all or most of these companies. He has also received honoraria for consulting and teaching from Roche and Lundbeck.15
Conflicts of Interest
The Congress fails to publicly disclose any conflicts of interest between psychiatrists speaking and the pharmaceutical industry—an industry that often benefits from promotion of their psychiatric drugs during such meetings. A cursory review of conflicts of interest found at this Congress include:
The Conference Itself: Is supported by pharmaceutical companies, Lundbeck, Otsuka and Sumitomo Dainippon Pharma. Pfizer are exhibiting.16
The Royal Australian and New Zealand College of Psychiatrists (RANZCP): Are co-hosting the conference. Their 2017 Annual Report, lists Janssen, Lundbeck, Pfizer, Merck Sharp and Dohme, Servier, Otsuka and Teva Pharma as supporting their activities.17
Norman Sartorius: Former president of the World Psychiatric Association, has served as a consultant to Eli Lilly, Janssen, Lundbeck, Servier and Wyeth. He has been a member of the advisory board of Eli Lilly.18
Bernhard Baune: Head of the Department of Psychiatry, Adelaide University and in 2018 was a member of the advisory boards of Lundbeck and Janssen‐Cilag. He has also received honoraria from Lundbeck, Otsuka, Janssen‐Cilag, Servier, AstraZeneca, Pfizer, Wyeth, Bristol‐Myers Squibb.” 19
Perminder Sachdev: Professor of Neuropsychiatry at University of NSW (UNSW) has received payment for lectures from Eli Lilly and Pfizer.20
Malcolm Hopwood: Former president of RANZCP, the Ramsay Health Care Professor of Psychiatry, University of Melbourne based at Albert Road Clinic, has been on the advisory board for Lundbeck, received speaker’s fees/honoraria from Janssen-Cilag, Servier, Wyeth and travel support from Eli Lilly, Janssen-Cilag, Lundbeck and Servier.21
Chee Ng: Department of Psychiatry University of Melbourne based at St Vincent’s Mental Health, has received speaker honoraria from Servier, Bristol-Myers Squibb, Organon, Eli Lilly, GlaxoSmithKline, Janssen- Cilag, AstraZeneca, Wyeth, and Pfizer.” 22
Eric Chen: Eric Chen: Director of Psychosis Studies and Intervention Program, Hong Kong University, has participated in a paid advisory board role for Otsuka, received educational grant support from Janssen‐Cilag and received research funding from AstraZeneca, Janssen‐Cilag, Pfizer, Eli Lilly, Sanofi‐Aventis and Otsuka.23
Naotaka Shinfuku: Kobe University, Japan, has served as a consultant and/or participant in scientific meetings organised by Eli Lilly, Pfizer, Servier and Lundbeck.24
Xin Yu: Institute of Mental Health, Peking University, has been a consultant and/advisor to or has received honoraria from: Pfizer, Lundbeck, Xian Janssen, Eli Lilly, Sumitomo, Abbot, Eisai and Novartis.” 25
Jun Shigemura: Department of Psychiatry, School of Medicine, National Defense Medical College, Japan, has received speaker fees from Daiichi Sankyo Company, Limited., Dainippon Sumitomo Pharma Co., Ltd., GlaxoSmithKline, Kyowa Hakko Kirin Co., Ltd., Meiji Seika Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd, Otsuka Pharmaceutical, Pfizer Japan Inc., Shionogi & Co., Ltd. and Yoshitomiyakuhin Corporation.26
Ziad Kronfol: Professor of Psychiatry and Psychiatry Clerkship Director at Weill Cornell Medicine in Qatar, has indicated has had a significant financial interest or other affiliation with GlaxoSmithKline, Merck & Co. Inc.27
Shigenobu Kanba: Chairman and professor of Neuropsychiatry, Kyushu University Graduate School of Medicine, Japan, has received grant/research support from Pfizer, Ono, GlaxoSmithKline, Astellas, Janssen, Yoshitomiyakuhin, Eli Lilly, Otsuka, Dainippon Sumitomo, Meiji Seika Pharma and honoraria from Pfizer, Janssen, GlaxoSmithKline, Eli Lilly, Otsuka and Wyeth.28
Nor Zuraida Zainal: Consultant Psychiatrist at University Malaya Medical Centre, Kuala Lumpur, has received grants from Pfizer Malaysia Sdn Bhd, Johnson & Johnson Sdn Bhd, Servier Malaysia Sdn Bhd and Lundbeck.29
Parents have the right to know
While children and adults can suffer from emotional trauma, parents are not told that unlike for medical conditions, there are no blood or urine test, brain scan (MRI, PET scan) or any physical or genetic test to scientifically/medically confirm the existence of the mental disorders children are labelled with. Mental problems, while very real, are not physical diseases.
Parents and others are also not always told at time of prescribing that no one should stop taking any psychiatric drug without the advice and assistance of a competent medical doctor due to “withdrawal syndrome.” This side effect is worsening of existing symptoms or new not before experienced symptoms while withdrawing.
GET THE FACTS
Parents should always be informed of medical and educational solutions that do not rely upon heavy, mind-altering drugs. CCHR is currently providing a free documentary: Psychiatry: Friend or Foe? The Untold Story of Australian Psychiatry, that addresses information that is not usually shared by psychiatrists prescribing psychotropic drugs or the companies that make them.
- Department of Human Services, Strategic Information, Division Information Services Branch, PBS/RPBS Reports for requested items [antipsychotics], Report Number: MI5329, 2015 calendar year, Report Date: 27 May 2016. http://cchr.org.au/wp-content/uploads/2016/08/Numbers-on-Antipsychotics-30-May-2016.pdf
- Therapeutic Goods Administration, Public Case Detail, Case Numbers: 220675 & 127249. http://cchr.org.au/side-effects/antipsychotics
- Department of Human Services, Strategic Information, Division Information Services Branch, PBS/RPBS Reports for requested items [antidepressants], Report Number: MI5329, 2015 calendar year, Report Date: 27 May 2016. http://cchr.org.au/wp-content/uploads/2016/08/Numbers-on-Antidepressants-30-May-2016.pdf
- “Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005.
- Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Medicines associated with a risk of neuropsychiatric adverse events,” Volume 9, Number 2, June 2018; Department of Health and Ageing Therapeutic Goods Administration, Medicines Safety Update, “Antidepressants – Communicating risks and benefits to patients,” Volume 7, Number 5, October-December 2016 ; “Suicidality with SSRIs: adults and children,” The Australian Therapeutic Goods Administration, Adverse Drug Reactions Bulletin, Vol. 24, No. 4, August 2005.
- Therapeutic Goods Administration Database of Adverse Event Notifications-Medicines, List of reports generated for each antidepressant, antipsychotic & ADHD drug as of 15/12/2017 and added manually. https://www.tga.gov.au/database-adverse-event-notifications-daen
- Download Excel Spreadsheet on this link under first graphs, “Table PBS2: Patients dispensed with mental health related prescriptions, by type of medication prescribed and prescribing practitioner, states and territories, 2016-17. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-related-prescriptions/prescriptions
- “Australian Clinical Guidelines for Early Psychosis, Second edition,” Orygen The National Centre of Excellence in Youth Mental Health, June 2016, pages 7 & 52.
- “Evidence Summary: Identification of young people at risk of developing psychosis,” headspace National Youth Mental Health Foundation, 2015. https://headspace.org.au/assets/Uploads/Evidence-Summary-Identification-of-Young-People-at-Risk-Developing-Psychosis.pdf
- “Other funding,” Orygen Youth Health Research Centre, Orygen web page, accessed 18th February 2012. Please contact CCHR if you would like a copy of this reference.
- “Is headspace making a difference to young people’s lives? Final report of the independent evaluation of the headspace program,” UNSW, 2015 pages.6, 42.
- Patrick D. McGorry, “Is early intervention in the major psychiatric disorders justified? Yes,” BMJ, 4 Aug. 2008. https://www.bmj.com/content/337/bmj.a695.full ; Patrick D. McGorry, “Early intervention in psychosis, The Journal of Nervous and Mental Disease, May 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414340/
- 2017 Financial Report, The Royal Australian and New Zealand College of Psychiatrists, 17 March 2018, p.8. https://www.ranzcp.org/files/about_us/annual-reports-and-strategy/ranzcp-financial-review-2017.aspx
- Diagnostic Issues in Dementia, Advancing the Research Agenda for DSM-V, Edited by: T Sunderland, D V Jeste, O Baiyewu, P Sirovatka, D A Regier, American Psychiatric Association, p. xiii, 2007, https://books.google.com.au/books? id=6HxdLfYeJAIC&pg=PR13&lpg=PR13&dq=norman+sartorius+served+as+consultant+to+eli+lilly&source=bl&ots=kcryXgLjaL&sig=ACfU3U15y2P6F8gx6J7DoRd1_kk9-7feMA&hl=en&sa=X&ved=2ahUKEwic4eydq8HgAhVBMY8 KHWlqBa4Q6AEwAXoECAkQAQ#v=onepage&q=norman%20sartorius%20served%20as%20consultant%20to%20eli%20lilly&f=false ; Mental Health in Public Health, The next 100 years, American Psychopathological Association Meeting, Oxford University Press, 2011, https://books.google.com.au/books?id=ohcYfZsoJw0C&pg=PA326&dq=norman+sartarious+served+as+consultant+to+lundbeck+institute&hl=en&sa=X&ved=0ahUKEwjmkcy2qsHgAhUYY48KHV_lC7kQ6AEILzAB#v=onepage&q=norman%20sartarious%20served%20as%20consultant%20to%20lundbeck%20institute&f=false
- J E Harrison, H Barry, B.T Baune, M. W Best, C.R. Bowie, Daniel S. Cha et al, “Stability, reliability and validity of the THINC-it screening tool for cognitive impairment in depression: A psychometric exploration in healthy volunteers,” International Journal of Methods in Psychiatric Research, Sep, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174931/
- P. S. Sachdev, D.M. Lipicki, J. Crawford, S. Reppermund, N.A. Kochan, J.N. Troller et all, “Factors predicting reversion from mild cognitive impairment to normal cognitive functioning: A population-based study,” PLOS One, 27 March, 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609866/
- Prof. Malcolm Hopwood, “Sexual Dysfunction and Antidepressant Therapy,” https://www.healthed.com.au/wp-content/uploads/2018/08/PWCH18-Malcolm-Hopwood.pdf
- J. Sarris, G. Oliver, D.A Camfield, O.M. Dean, N. Dowling, et al, “N-Acetyl Cysteine (NAC) in the treatment of obsessive compulsive disorder: A 16 week double-blind, randomised, placebo-controlled study,” CNS Drugs, 2015, 29 (9), pages 801 -809. https://minerva-access.unimelb.edu.au/bitstream/handle/11343/55700/NAC%20OCD_RCT.pdf?sequence=5&isAllowed=y
- C.L. Ming-Hui, W. Wing-In Lau, E. Yu-Hai Chen et al, “Clinical and social correlates of duration of untreated psychosis among adult-onset psychosis in Hong Kong Chinese: the JCEP study,” Early Intervention in Psychiatry, 30 Sept. 2013. https://onlinelibrary.wiley.com/doi/abs/10.1111/eip.12094
- K. Sim, G. Ungvari, T. Si, E.K. Chung, Naotaka Shinfuku, C.H. Tan et al, “High dose antipsychotic use in schizophrenia: a comparison between the 2001 and 2004 Research on East Asia Psychotropic Prescription (REAP) studies. British Journal of Clinical Pharmacology, Jan 2009. http://europepmc.org/articles/pmc2668091
- Xin Yu, C.U.Correll, et al, “Efficacy of atypical antipsychotics in the management of acute agitation and aggression in hospitalized patients with schizophrenia or bipolar disorder: results from a systematic review,” Shanghai Archives of Psychiatry, 25 Oct. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434280/
- T. Kamo, M. Maeda, J. Shigemura et al, “Dosage, effectiveness and safety of sertraline treatments for post-traumatic stress disorder in a Japanese Clinical Setting: a retrospective study,” BMC Psychiatry, 7 Dec 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142275/
- American Psychiatric Association 2003 Annual Meeting Program, Disclosure Index, San Francisco, CA, May 17-22, 2003, p. XXVI. http://www.psychconflicts.org/pdfs/APA_Program_2003.pdf
- Keisuke Motomura, Shigenobu Kanba, Editorial, “Lost in translation: Confusion about depression and antidepressant therapy in Japan, Psychiatry and Clinical Neurosciences, 2013. https://onlinelibrary.wiley.com/doi/pdf/10.1111/pcn.12011
- S. Manit, A. Nurmiati, N. Zuraida et al, “ Cognitive dysfunction in Asian patients with depression (CogDAD): A cross-sectional study, Clinical Practice & Epidemiology in Mental Health, 31 Oct, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5712642/ ( Click on “Author Information” above the Abstract).