30 parliamentarians from all parties calling for NICE to revise their guidelines on depression

Hmm. Is this heading for a "we are all a bit mentally ill" and even further stretching of depression labels and a wider net being cast.

What about anxiety disorder, who decides what the definition of that is when people are working more and more hours for less pay and may suddenly think this is all nonsense and impossible.

There's more use of psychologists in the work place. Is that good for power balance relationships? Does the government get to make the definition of anxiety disorder in a culture where industrial action is so weak, unions are lame and people are terrified of loosing their job. There's austerity and working poverty. What if the things your employer wants you to do are questionable.

Who would be comfortable taking on employers when the things they are being asked to do at work become increasingly stretchered. Can the company just send one of to an occupational psychologist to be diagnosed with "anxiety disorder", or sent for "mental health support"?

Are they going to use this ludicrous "mindfulness" nonsense to "retrain peoples thinking".

I am so sceptical of the government drive to "destigmastise mental illness and provide "more services". It basically means that the government wants to declare more people mentality ill, when no one even knows what it means now and depression and anxiety are such loosely defined terms. Labels can be slapped on people in bad power balance relationships.

One only has to "be depressed" for two weeks to qualify for a diagnosis of major depressive disorder.

I feel that the constant bombardment of "destigmatisation of mental illness" in the media and on tv is not going to provide more services for real mental health issues or "mental diseases" but it could lead to lots of young people in the next generation "coming out as mentally ill", due to normal experiences and reactions to life, as it becomes "less stigmatised" in an era wherby the DSM has increasing control even though it is increasingly ludicrous.

What happens if one has claimed mental illness before and they experience a set of "vague physical symptoms". Are they then more likely to have diagnosis missed or ignored?



Is this really going to improve people rights overall?
 
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Esther12 said:
Looks like this is supportive of Wessely's attempts to get change, as written about by @Hole Ousia: https://www.s4me.info/threads/simon...mail-on-a-blog-here-it-is-on-hole-ousia.5001/

Also seems relevant to claims that NICE should operate entirely independently of political pressure that we've seen in response to concerns about their ME/CFS guideline.
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This whole business is intriguing and so far i have not been able to work out what it is actually about.

It seems that psychiatrists are not happy with NICE guidelines. But why? Are they recommending too many drugs? Or the wrong sort of psychotherapy? And what exactly is the problem with the evidence?

And we have this weasel word 'stakeholder' which can mean anything from a commercial outfit wanting to rip off anyone they can and a poor patient wanting some treatment.

Does anyone know exactly what the beef is about?
 
Jonathan Edwards said:
This whole business is intriguing and so far i have not been able to work out what it is actually about.

It seems that psychiatrists are not happy with NICE guidelines. But why? Are they recommending too many drugs? Or the wrong sort of psychotherapy? And what exactly is the problem with the evidence?

And we have this weasel word 'stakeholder' which can mean anything from a commercial outfit wanting to rip off anyone they can and a poor patient wanting some treatment.

Does anyone know exactly what the beef is about?
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Ye its something about psychiatrists, disagreements, spurious definitions, lack of transparency and the status quo wanting the control. Even the "beef" isn't defined.

No one can agree on some made up stuff and whats the best subjective route to take or something and what set of bad data is better than another set for different subjective experiments on patients groups who have experts in charge of them who want the singular right to wear the blue cardigan over the other lot who all disagree.

But also some people think pills is bad cos Freud is better than pills but others think Freud did too much coke and just made shit up and therefore the new made up shit is better cos people in Islington made it up while they were drinking Evian in a Gastro Pub after reading the Guardian and it came into truth via a show of hands.

Oh, and there's no transparency and no one is allowed to ask Wessely any questions cos hes like a god who doesn't answer to anyone and he can tell a bloke down a pub anythinkkk he wants cos that's his right and stuff.

So shut up ye cos he aint bovvered!

Who'd have thunk it!!
 
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large donner said:
Is this really going to improve people rights overall?
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Well-said, @large donner. And no, I don't think this improves human rights. I don't think this is the intent.

I am so often reminded of movies like "Equilibrium"; only in reality, it's done much better: no need to take a pill, only the fear of getting a stigmatizing diagnosis or loosing something, like the job.

I also agree help for people won't get better. This is all very sad and troubling.
 
Jonathan Edwards said:
Trouble is because they are all wearing blue cardigans I cannot work out who is on which side.
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Yes true, except Wessely cos he wears a long gown made from animal skin and walks with a staff and did go up a hill (probably Highgate cos they were all already in Islington reading the Guardian) and did bring back the truths on a tablet.

He did then maketh the journey across land from Islington to Whitehall, (bloody nightmare that whatever way you try to go) stopping off in a lodge halfway.

Two funny handshakes and a raised trouser leg later, he did make it to Whitehall where he laid the truth down for all peoples. Then he did go quiet.

His followers said unto him why have you forsaken us, and he replied "I haven't Michael I just fucked you over there's a difference", go spread the word on twitter and you shall be granted an eternal pension.

Michael took to the information superhighway and began to talk in the opposite of tongues cos no one could understand him and........
 
Astonishing that SW is a signatory to a letter which states:
Ensuring that the views and experiences of those who use the services are properly taken account of, should be the sine qua non of a publicly funded body tasked with devising clinical guidelines, particularly as these services are fundamentally shaped by the guidance NICE produces.
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Perhaps patient experiences only count if they are suffering from an illness that isn’t ME, in which case “properly taken account of” should be interpreted as “completely ignored”.

I wonder if this letter should be quoted to those reviewing the NICE ME/CFS guideline.

 
Jonathan Edwards said:
Still cannot tell one lot of blue cardigans from the other. Who is on which side? Which is the bull and which is the beef? Or is it all bully beef from Fray Bentos. Or was it Putin because he is in charge? I'm lost.
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@Amw66's link provides clarification. https://www.madinamerica.com/2018/0...essional-conduct-uk-royal-college-psychiatry/

It seems a group of psychologists, psychiatrists and patients are concerned that the RCP is deliberately ignoring mounting evidence that the side effects of withdrawal from some psychoactive drugs can be long and extremely unpleasant (I think SSRI's are a big focus). They believe the RCP has been deliberately understating the severity of these effects, and recently made a misleading statement in the Times about these effects being mild and limited to a couple of weeks.

I read some of the accounts, and adding to that a few stories I've heard firsthand, there does seem to me a need for greater caution in prescribing these drugs. Also, given what I know about the misleading statements made about MECFS, it seems entirely plausible to me that the RCP might attempt to control the narrative.
 
Woolie said:
It seems a group of psychologists, psychiatrists and patients are concerned that the RCP is deliberately ignoring mounting evidence that the side effects of withdrawal from some psychoactive drugs can be long and extremely unpleasant (I think SSRI's are a big focus).
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Woolie said:
Also, given what I know about the misleading statements made about MECFS, it seems entirely plausible to me that the RCP might attempt to control the narrative.
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Yes, I think I get that far. But which individuals are on which side? I get the impression that Wessely is against the RCP in this case.

My overall impression is that there is an anti-dharma undercurrent that is relevant to Wessely, Lancet, Goldacre, Cochrane and maybe NICE. There are also turf wars within this camp between post-Freudian theoreticians and bulk-buy talking shops. Maybe you can tell by the number of unbuttoned buttons.
 
Ah I get it now, its nothing to do with patients its different interest lobbying "stakeholders", minus patient interests, having a "who runs this manor" shoot out.

If only Berlusconi was the PM and not Theresa May this would be so much more see through.
 
Woolie said:
@Amw66's link provides clarification. https://www.madinamerica.com/2018/0...essional-conduct-uk-royal-college-psychiatry/

It seems a group of psychologists, psychiatrists and patients are concerned that the RCP is deliberately ignoring mounting evidence that the side effects of withdrawal from some psychoactive drugs can be long and extremely unpleasant (I think SSRI's are a big focus). They believe the RCP has been deliberately understating the severity of these effects, and recently made a misleading statement in the Times about these effects being mild and limited to a couple of weeks.

I read some of the accounts, and adding to that a few stories I've heard firsthand, there does seem to me a need for greater caution in prescribing these drugs. Also, given what I know about the misleading statements made about MECFS, it seems entirely plausible to me that the RCP might attempt to control the narrative.
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Here's a quote from the professional information about amitriptyline (by Sandoz):

A sudden discontinuation of a prolonged high-dose treatment with Amitriptyline should be avoided since there can occurr withdrawal symptoms like restlessness, Sweats, nausea, vomiting and sleep disorders.
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https://www.google.de/url?sa=t&sour...FjAAegQIABAB&usg=AOvVaw3_bALD0L9poim4bpc_vFl_

There's also a warning of increased suicidal risk especially at the beginning.

And from https://www.google.de/url?sa=t&sour...FjAEegQIABAB&usg=AOvVaw3d7pnkAJ_Le7V9-yvMzGj0
Antidepressants can cause massive withdrawal problems. For over half Century is known this problem. Roland Kuhn, the antidepressant prototype Imipramine (commercially known as Tofranil) in the mid-1950s in the psychiatric Had introduced treatment arsenal already reported in 1957 by special Withdrawal problems that could easily be confused with a relapse (Kuhn, 1957).
Rudolf Degkwitz, 1971-1972 President of the German Society of Psychiatry and Neurology, published in 1962 results of a study with the imipramine to normal Subjects taking two to three weeks after stopping imipramine nervous, driven or sleep-disturbed and incapable of concentrated work (Degkwitz, 1962)
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(translation via google)

The both references are

Degkwitz, Rudolf: »Über die Imipraminwirkung bei Depressionen«, in: Der Nervenarzt, 33. Jg. (1962), S. 450-457
Kuhn, Roland: »Über die Behandlung mit einem Iminodibenzylderivat (G22355) «, in: Schweizerische Medizinische Wochenschrift, 87. Jg. (1957), S. 1135-1140

which I can't find online to check the correctness of the statement.
 
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Jonathan Edwards said:
Still cannot tell one lot of blue cardigans from the other. Who is on which side? Which is the bull and which is the beef? Or is it all bully beef from Fray Bentos. Or was it Putin because he is in charge? I'm lost.
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As far as I can tell, there are at least 2 different campaigns going on here. The second one (Wessely et al - complaining about NICE guidance being methodologically unsound) seems to be designed to create confusion about the first (Read et al - complaining about whitewashing of antidepressant withdrawl after the large Lancet meta-analysis). Looks like SW and co have managed to get a large number of people to sign up without understanding what they are signing up to. It seems so vacuous, it could be about anything.

Re: the first campaign - I listened to this exchange and think both sides are oversimplifying. Antidepressants are not just placebos (as Read asserts). They are powerful drugs that we do not fully comprehend. They have effects that go far beyond their intended uses (which is why they can be useful in fibromyalgia and ME - possibly because of neurovascular effects), and as such should be used very carefully [bcs they will inevitably have *side* effects]. They can be life-savers. They can also be life-wreckers. They do produce horrid withdrawal effects in some people (I'm pretty sure I'm living with the consequences of that at the moment) that last much longer than the 2 weeks that Gerada and Wessely claim. But in many they are absolutely fine. It's a choatic mess and the RCs need to get a grip and sort it out. Network meta-analyses cannot possibly tell you anything about the complexity - only what happens on average.

Is that a fair summary? Or have I misunderstood as well?
 
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