Mae Cymru.
My name's Pam Armstrong.
I have an organisation called CETA,
which is the Council for Information on Trenwyareth and Anti-depressants
a leol y fund amplifier bryd, bwyd edrych eich cyll Nanodol,
frysgu edrych...</
..fodd o'r un dim o bunol âマ fan yma.
Rydym yn diogelu ar gyfer 21 ery01.
Rydym y gymysig cyhoedd 2ermodydd i fod wedi..
..eith rhag strengthen pwysraeth u—
..y ddim f富 i ddau'r 1rhyw o Professor Ashton,
gyda Dr Joanne IMON Krief a Adamframe Dough asking...
gyda geirio gorfoddiadol begdyn nhw wedi f credits fel Llyfrgell.
Fe'r bys yn eu colli tydd yno, a dy issuedwyr alli yn ffompol chi mewn spitgliad o alivewyr ond
Par ty flynyddoeddog ac mynd â, well, rai yn cyfolio ac ydy broses ar ei seat i isi bourillion
ar relies cyho folkol?
spokeu bod ynetwch.
Mae'r sefydliad pwysae.
Wel, rwyf ynodi yn fideb, rwyf wedi gyfrifiad hon nhw'n dweud i yogurtauilyde mor ffyrddau,
mae rwyf yd hedwg yn cadwca nhall,
ymweithio, mae'r fyfyddiad ar y gедиad gwylltog,
ydy nhw'n boi wneud yr warli nifer i siaradd,
i'w dreudded yn pulsadau,
gyda'ramas o ddurdidiaeth ardarlafoedd ag addysgu
a rhai', Felly badawkaeth, steifliar o'r trwydd ac ydychwch ei an profits
o grannu gydydd, ffam고 cwmhau'n allen.
daes er digwydd i chi?
gallo arnyn am fod am ddig yng nghymru y Lleiff?
Byddwn elly mae havs ardd umddill fod concluded gael yn ddelent.
Edryd griev scenery and then a flood, a torrent of patients coming in and saying these
penzos don't work any more, they were super at first, but now I'm getting
more anxious at all sorts of other things.
That's how this clinic started – we had to devote a whole clinic just to
to Penzos. In fact I ended up doing it two sessions
a week for years. No other pharmacologists in that group
gwartegol ein b Communion eich fan.
Nicolau i f avenueu cyflynyddu tu o'r bau已w abraith gan gael yn Llincaeth,
ac mae'r醫os gwaith ei Mechan problema.
Ond Daw явm a oeddech chi'n peth problemen, ond oed السungen dangos yma,
ahow знodd yn mynd di trenio ta blwysteriaeth a chdんでch chi mae hynny.
Ond ar waith yr syncledau tîm dal i gynnw ap sydd yn gyflwykanol
clwn owaith ofynarysu
巧 ein defnyddio y myd scatter
Senin oedd mwynwys, ac cleansu im.'
Rhywbeth louwys yn Joana
Ac sefydlu digyn rhan iawn o sydd fans defnyddio a cyrddoch.
That's just for the filming, right?
I'm a psychiatrist. I've had a long-standing interest in psychiatric drugs.
I've been trying to promote the idea of looking at psychiatric drugs as drugs, as psychoactive drugs,
and trying to work out what they actually do to the body and how the body responds to them,
rather than seeing them as they're often portrayed as disease treatments that just rectify an underlying abnormality.
What I'm suggesting is that instead of rectifying an underlying abnormality, drugs actually create an abnormal state.
They create an altered state.
We're quite comfortable with that idea with drugs of abuse like alcohol and heroin and things like that,
but maybe not so comfortable with that idea with psychiatric drugs like SSRIs and antipsychotics.
The work I've done on coming off psychiatric drugs relates to two things.
Heather was talking about how patient power really demonstrated the addictive potential of benzodiazepines,
and it also has really demonstrated, and David Healy has been very involved in this, the addictive potential of SSRIs.
Really, that has, I think, brought home to everyone that all psychoactive drugs are potentially addictive,
that there are potentially withdrawal effects after coming off any sort of drug that alters the way the brain functions,
including drugs that we wouldn't normally think of as psychoactive drugs, things like steroids have withdrawal syndromes.
I looked at the literature on coming off antipsychotic drugs, and there have been some suggestions over the years
that some people, when they come off antipsychotic drugs, get a psychotic reaction, which is induced by the withdrawal.
This idea had been around in the literature for about 20 years, but not really accepted or believed.
I collected together all the literature on that and managed to convince myself anyway that this certainly does occur.
I think it occurs most frequently with clozapine, and the literature on clozapine really makes it undeniable
that there is something like this in quite a high proportion of people who come off clozapine,
and maybe a lower proportion of people coming off other antipsychotics.
The other thing that's interested me about coming off psychiatric drugs of any sort is how often, I think,
the main difficulties to coming off are to do with the system and the importance that the system puts on taking drug treatment.
I'm a rehabilitation psychiatrist. I work with people who have had psychiatric problems for many, many years,
often very severe ones, and who are on large amounts of drugs that they almost certainly don't need and haven't benefited from.
Yet it is very, very difficult even to try and reduce those drugs because of the resistance from the staff and the whole system.
Sometimes as well from the patients themselves who have been used to being very, very drugged for many years
and find it difficult to face the idea of life without drugs or with a lower level of drugging.
Millie actually asked me to write ten golden rules to people coming off prescribed medication,
and interestingly, I felt the medical profession would probably say that the first rule should be speak to a doctor,
but I actually put that second because I actually think the patient needs to have some information about what they want to achieve
and how they're going to achieve it before they go to the doctor and before the doctor gets it wrong
and they can then go in armed with the information and then share it with the doctor.
And I think that's a sad fact that we have to actually, you know, research our own stuff and then take it to the doctor
who actually should be, should have that information there.
And I think that's, you know, goes very well with what we're all saying with.
Well, I always used to tell my patients they should treat their doctors
and they treat their garage mechanic who services their car.
And there isn't as to ten questions in the thing and to ask any prescribing doctor before you take the drug,
you know, such as what, you know, why am I having this drug, what does it do, are there any side effects,
does it interact with other drugs, et cetera, you know, any withdrawal effects that there's a list somewhere.
Because after all the doctor's service in your body and it's your body,
so I think that the patient should have the right to know exactly what is desired.
And as Joanna said, many doctors use drugs just as treatments.
You've got this, so you take that.
And they don't think what is it actually doing inside.
And that's, of course, an interest for everybody and pharmacologists too.
I think it's the problem that we look at these drugs in the wrong way, not as drugs and people, GPs and psychiatrists in particular,
are not encouraged to see them as drugs and think of what they do to the body and how that might impact on symptoms,
but are simply trained to think, right, you have this problem, you need this treatment.
And I don't think it's like that at all.
I was thinking, Joanna, that really in the training when you go to the doctor,
there needs to be far more input into how these psychoactive drugs do affect the mind in the body.
And if it was incorporated into training, then GPs, psychiatrists,
have such and like have a totally different view.
And I think it's very difficult when somebody's been described in SSRI,
they have an adverse reaction and they go psychotic and they land up into the acute wall.
They're in no state to ask the psychiatrists why they're giving these
and what are they going to effects on my body and my mind long term,
let alone in the years of terror, who is in a complete state of shock.
And, of course, the unfortunate thing is that when you get the side effects of psychotropic medication,
a lot of them, I'm not talking about the physical ones particularly,
but the psychological side effects actually mimic the conditions in the first place,
which just reinforces the psychiatrists' belief that these drugs can be perpetuated.
And I feel that psychotropic drugs are a different kind of fish than the benzodiazepine,
because they're mostly from a different position.
The psychoactive drugs being your electric drugs is just completely lotto with people's minds.
They've got no motivation to ask anything.
Their thinking goes all obscure and they're not able to ask the person questions
that a person would be on benzodiazepine in benzodiazepine.
Well, I think a lot of people on benzodiazepines are also affected that way.
I mean, there are a lot, some people are still quite confident on them,
but there are many, many people who are not able to ask questions and become very withdrawn.
I should mention that I have recently restarted doing training days for medical students
in Liverpool and I'm hoping to do it in other universities across the country.
But it is quite stunning to think that if I didn't do that,
they would actually get no information on benzos and other mind-altering medications.
It's well documented that the pharmacology lectures for all health professions, pharmacists, nurses and particularly physicians
because of how much has to be crammed into the courses now that the actual pharmacology lectures
in some cases in some medical schools have been cut by about 20% over a decade.
There wasn't much to start off with.
There wasn't much to start off with, so it's even less now.
So, you know, to actually add in psychiatric reactions to it, ladies and gentlemen.
It's quite unbelievable, isn't it?
It starts before the training that isn't enough, that the knowledge base is not there.
The right sort of research has not been done because all people have been concerned about
is looking, does it affect these symptoms, a very narrow range of symptoms,
and does it affect this particular receptor that we think is relevant?
So, all the other receptors that drugs affect and all the other effects are ignored.
We don't know what sort of withdrawal reactions most drugs produce.
We don't know how long they go on for.
We don't know whether, you know, they might persist when the drug, for many months or years,
even after the drug is stopped, or none of these things have been able to be looked at.
The consequences of the drug, such as being prepared or at least a blocker, most people know that it causes bronchitis, but then very few people know that it causes hallucinations.
You know, we had dreams at night some, because it's a fat soluble that's interfering.
So, I mean, there seems to be a lot of the physical consequences of the drug,
but not the psychiatric, even in basics.
Ladies at the back in the grey cardigan.
Thank you. I've got two points.
First of all, as a carer, GPs are the gatekeepers to all services, and the buck stops with them really.
If you're trying to access appropriate services, you've got a problem there.
Secondly, when a person presents with a problem, full histories aren't taken,
and very, very rarely are endocrine problems investigated and properly tested,
and even if you're given under the NHS, thyroid or adrenal or DHEA sort of testing,
they only test the blood, which is often found to be normal.
It doesn't actually test what's being metabolised and used in the body,
and we have case at home where when that private testing was done, which was more appropriate,
identified huge problems, which explained some of the apparent mental health symptoms,
but they were of a physical origin due to a completely disrupted hormone system.
No one would investigate it.
The GPs are still refusing to accept those test results and the possible consequences of that.
So, patients and families who are compromised financially anyway are having to go to the private sector,
and that's dangerous in itself.
You have to be really responsible and very careful to make sure you do that responsibly, and that isn't easy.
Well, who would like to answer that, Joanna?
It depends what drugs you're talking about and what problems you're talking about,
and if you want to stop people talking about their symptoms, quite a lot of these drugs can do that quite effectively,
especially anti-psychotics.
Obviously, that's not really helping the underlying problem,
and I think we're not thinking clearly enough about what the real problems are and what drugs can actually achieve,
and I think we've got completely overblown ideas about what drugs can achieve.
I think they can do some things.
They can reduce arousal, and that can sometimes help reduce anxiety, some sorts of drugs.
Reduce mental arousal, damp down hallucinations and psychotic thoughts for a while,
but I don't think that they reverse anything.
I don't think there is any drug that improves mood.
I don't think we've got any evidence that anything improves mood,
other than the drugs that induce euphoria in the short term,
but that's a rather different thing.
Obviously, it's really important to balance.
This is a big question because if you're prescribing something that's useless and has harmful effects,
you shouldn't be doing that.
But I can send people some if they're interested.
I'll just respond to that question.
Thanks very much.
I completely agree with you.
Something I'm really concerned about and seeing at the moment is staff minimising the metabolic effects
of the lansapine and closapine, and they say, oh, they're putting on weight, but they're eating too much,
and blaming the person when we know very clearly that these drugs increase appetite,
and not only increase appetite, but produce this really strange craving for junk food and sweet food and carbohydrates,
and we know they do that.
But I just wanted to make another point.
One of the reasons that sometimes doctors don't listen to complaints is because they can't always do anything about them,
and I think we do have to acknowledge that there are limitations to what doctors can do,
and that sometimes they're being asked to do things that they are not able to do.
It's wrong that they're not able to acknowledge that.
It would be better if doctors were better able to say, well, actually, we can't do anything, or all we can do is this.
I think sometimes they are being asked to solve things that it's not easy to solve,
and that they don't have the tools to solve.
I think the result of that is very often a denial.
I mean, I find this very frustrating that what laypeople seem to be able to see,
GPs and psychiatrists are so often in denial about,
that the drugs are actually producing a lot of the adverse effects that patients are presenting with,
and no amount of coaxing or arguing with these doctors seems to bring them round to agreeing with that,
and that just seems quite bizarre to me.
Dad, come in.
I think it could be a little more tricky in that it's a bit like maybe going through labour or whatever.
What you've got here is people who have to go to the system and see the things that you're saying,
but all the rest of the people out there in the wider world,
who go to the system and take this hospital, this medicine, we should be able to treat these illnesses,
and the doctor says they're doing a good job, and they're going to believe the experts and other patients,
and even your husband and wife is probably going to take the side of the doctor and not yours.
I know that's his initial.
You really have to be in there first and see what happens before you realise what the problem is.
That's why I wanted to come back to what you said about working on a ward,
knowing all the negative effects, but not giving them to the person who's expected to have the medication.
I think you should be doing that.
It's one of your responsibilities to say,
you can take these drugs and they might help you like this, but these are the negative effects.
That's a choice.
I know that a lot of ward staff don't do that.
I worked on wards for ten years and constantly got into conflict with my colleagues,
because I would do that.
I would say, okay, you can take this, but if you take a landspin, it's likely to make you fat.
It's something we know that happens, and we have to tell people that.
The other thing is that people come to the system, there's more than one way to understand what we kind of experience.
Psychology, sociology and psychiatry has a dominance on it.
This will keep continuing to happen.
We have to look outside as well with alternatives.
I think there's no excuse for people being prescribed a landspin when they blatantly have a family history,
which turns them into a taking time.
I've got a client who has come to me this week.
His mother died a few months ago from a heart condition, age 65,
whose father is a diabetic, and six months ago was prescribed a landspin
and has bloomed in weight.
To me, he's now just a taking time bomb unless we can get him off the landspin
and try and get his weight down and so forth.
To me, that's unforgivable, because it's a well-known fact now that landspin has that effect,
and to give it to somebody with that family history,
there's no psychosis purely for anxiety, it's just crazy.
I had two points towards medical education.
Number one, we teach medical students on how to take histories from patients,
but nowhere in those histories do we take a psychiatric history from patients.
You have to get medical students that come back,
they get details that the patient's had a toenail or something,
a grand toenail extracted in 1957,
but then when you get the drug, as you've been described to you,
you find out that they're on a landspin or they might be on an SSRI.
In other words, it's not included in a basic history token
getting a psychiatric history from the patient.
It's often overlooked in all the clinical examination textbooks.
It's not included.
The second point is in medical education,
is knowing about the drugs that you've prescribed
and in the very basics of the drugs,
because often withdrawal side effects from drugs
are due to relatively short half-lives.
We know that we've described earlier about the rays of hand
and the short acting SSRIs, like porosity.
And short acting opiates such as tramadol
are very frequently described opiating in general practice.
Trying to get those patients off of those drugs is impossible.
You have to switch into longer acting versions of those groups of drugs
and get them off that way.
For example, with tramadol,
I know somebody who's trying to get somebody off
by gradually reducing the dose of tramadol.
Somebody who's addicted to 500mg a day of tramadol.
There is plenty of literature available
that suggests that you can switch those patients
a method, though, for example, to bring them in.
And it's almost impossible to bring somebody off of a short acting drug,
whether it's an SSI, benzodiazepine or a porinogia.
So it's really getting basic medical education out there as well.
I don't agree with that.
Is that definitely true?
Because I remember working in addictions
that there were some addicts who preferred to come off their heroin,
go to bed for a week and get it over and done with,
rather than go on methadone and have months of withdrawal.
I'm not always sure that it is always the right thing.
Obviously it depends.
I think we're down to back to the individual, aren't we?
Not one size fits all looking at the individual.
I've supported people to come off medication.
Some people, like we smoke in the get-up bomb when I say,
right, that's it, I'm stopping back.
And whatever withdrawal state they go through, they just manage it.
And for some people, it's far too difficult just to do that,
just to do that, like that.
And you can predict who is going to be able to do that.
You can say you're going to be able to do that.
It's just not predictable.
I think we need to learn something from the area of addictive behaviours.
Treatment for people who've got long-standing alcohol or opiate problems
always involves helping them to readjust to a drug-free life.
And I think that people who've been on psychiatric drugs
may need some of the same sorts of help.
I think this lady was just like as a fat affinity.
This notice, which is in bright yellow and black lettering
to patient acute wards and outpatients, et cetera.
In Sheffield, it says, there are no secrets about medicines.
Patient information and advice leaflets are available.
Please ask the ward and pharmacy staff or contact the chief pharmacist.
There are no secrets about medicines, not in my experience,
not in my research.
There are so many secrets which are not divulged or shared to carers
or said it's useless.
