Should you take anti-depressants – and if so, which one?

It was only after I survived a heart attack that I first got an insider’s perspective on how it actually feels to be depressed.  Up until then, like many of you reading this, I was disdainful of this particular mental health diagnosis, often silently smirking things like: “Oh, for Pete’s sake, why can’t they just pull up their socks, quit whining, and get on with it?”

But after my heart attack, absolutely convinced by every twinge that yet another horrific cardiac event was imminent, I somehow fell into the grip of an icy, low-grade terror, what Frances Perkins has described as “the slow menace of a glacier”. I knew something was terribly wrong with me, but could not seem to pull myself out of this dark hole that was my new life.

Later, while at Mayo Clinic, I was actually relieved to learn that these ongoing feelings of profound despair were common. In fact, I learned from cardiologists there that up to 65% of heart attack survivors experience significant depression, yet fewer than 10% are appropriately identified.

Cardiac psychologist Dr. Stephen Parker (and a fellow heart attack survivor who also experienced severe depression himself) writes:

“I think the depression and anxiety following a heart attack are different than the depression and anxiety that most therapists encounter, and both are going to be more resistant to treat because there are damned good reasons to feel anxious and depressedContinue reading

Handy hints for getting along with your drug company

Pity the poor pharmaceutical industry, much maligned by those concerned about marketing-based medicine. Ray Moynihan is one of the most vocal watchdogs of the industry.  He’s the Australia-based co-author with Alan Cassels of a compelling book called Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients.

His work on disease-mongering has intrigued me for years, and now he offers these handy hints for physicians on how to get along with your friendly neighbourhood drug or medical device company.  These hints are in response to a British guideline for physicians written by a multinational stakeholder group, including the Association of the British Pharmaceutical Industry (ABPI). Neither the group’s membership nor funding is declared in the guidelines or on the ABPI website.

Here’s Moynihan’s cheeky advice* in the British Medical Journal for doctors who are reading this guidance: Continue reading

Who’s running the show in industry-sponsored drug trials?

There is strong evidence that medical researchers’ financial ties to their industry funders may directly influence their published positions in supporting the benefit or downplaying the harm of the products they are “studying”. 

For example, there is often a demonstrated difference between internal drug company documents about the research trial results that they fund, and the articles reporting that research that end up in the medical journals that your doctor reads.  The New England Journal of Medicine has referred to this practice as ‘selective outcome reporting’.

But for the sake of clarity, let’s just call it ‘lying’.   Continue reading

The cardiac polypill: why are we still talking about this?

I have a bone to pick about multi-purpose cleaners. Although the product I bought claims to work on all washable household surfaces including dirty windows, kitchen counters, greasy stovetops or hubcap grime, the truth is that, generally speaking, the product does a mediocre job addressing any one task, and a good job at none of them. As convenient as a multi-purpose product sounds, it simply makes better sense to tailor one’s tools for the task at hand.

Which reminds me: why we are we still talking about this cardiac polypill idea? Granted, I am merely a dull-witted heart attack survivor, but I can’t possibly be the only one feeling ever-so-slightly squirmy about the resurgence of  the polypill. It’s a single pill made up of a combination of other pills to reduce heart disease risk, designed for widespread use by all adults over 55 years of age as well as everyone with existing cardiovascular disease.  And it  just might be the multi-purpose cleaner of cardiology. Continue reading