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Are Psychiatric Medications Making Us Sicker?

Are Psychiatric Medications Making Us Sicker? 1

Dave Plunkert for The Chronicle Review

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close Are Psychiatric Medications Making Us Sicker? 1

Dave Plunkert for The Chronicle Review

Three years ago, I was reminded in dramatic fashion of the chasm between psychiatry and more-effective branches of medicine. My 14-year-old son, Mac, while playing lacrosse, emerged from a collision with his right arm askew. I drove him to a local hospital, where an orthopedic surgeon on duty immediately diagnosed the injury: dislocated elbow. He gave Mac an oral and local anesthetic and put him in a portable X-ray machine that showed Mac's elbow joint on a screen, in real time. Watching the screen, the doctor quickly snapped Mac's elbow back into place.

Overcome with gratitude to the doctor, I was leading my groggy son out of the hospital when my cellphone rang. An old friend, whom I'll call Phil, was on the line. He was in the psychiatric ward of a New York hospital, to which his 16-year-old son had been committed. The boy, who was taking antidepressants for depression, had threatened to commit suicide, not for the first time. The doctors were recommending electroconvulsive therapy, or ECT. Knowing that I had written about shock therapy and other psychiatric treatments, Phil asked my opinion. The fact that Phil had called me, a mere journalist, for advice in such a dire situation spoke volumes about the troubles of modern psychiatry.

I first took a close look at treatments for mental illness 15 years ago while researching an article for Scientific American. At the time, sales of a new class of antidepressants, selective serotonin reuptake inhibitors, or SSRI's, were booming. The first SSRI, Prozac, had quickly become the most widely prescribed drug in the world. Many psychiatrists, notably Peter D. Kramer, author of the best seller Listening to Prozac, touted SSRI's as a revolutionary advance in the treatment of mental illness. Prozac, Kramer said in a phrase that I hope now haunts him, could make patients "better than well."

Clinical trials told a different story. SSRI's are no more effective than two older classes of antidepressants, tricyclics and monoamine oxidase inhibitors. What was even more surprising to me—given the rave reviews Prozac had received from Kramer and others—was that antidepressants as a whole were not more effective than so-called talking cures, whether cognitive behavioral therapy or even old-fashioned Freudian psychoanalysis. According to some investigators, treatments for depression and other common ailments work—if they do work—by harnessing the placebo effect, the tendency of a patient's expectation of improvement to become self-fulfilling. I titled my article "Why Freud Isn't Dead." Far from defending psychoanalysis, my point was that psychiatry has made disturbingly little progress since the heyday of Freudian theory.

In retrospect, my critique of modern psychiatry was probably too mild. According to Anatomy of an Epidemic (Crown Publishers, 2010), by the journalist Robert Whitaker, psychiatry has not only failed to progress but may now be harming many of those it purports to help. Anatomy of an Epidemic has been ignored by most major media. I learned about it only after Marcia Angell, former editor of The New England Journal of Medicine and now a lecturer on public health at Harvard, reviewed the book in The New York Review of Books in June. If Whitaker is right, American psychiatry, in collusion with the pharmaceutical industry, is perpetrating what may be the biggest case of iatrogenesis—harmful medical treatment—in history.

As recently as the 1950s, Whitaker contends, the four major mental disorders—depression, anxiety disorder, bipolar disorder, and schizophrenia—often manifested as episodic and "self limiting"; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. Since 1987, the percentage of the population receiving federal disability payments for mental illness has more than doubled; among children under the age of 18, the percentage has grown by a factor of 35.

This epidemic has coincided, paradoxically, with a surge in prescriptions for psychiatric drugs. Between 1985 and 2008, sales of antidepressants and antipsychotics multiplied almost fiftyfold, to $24.2-billion. Prescriptions for bipolar disorder and anxiety have also swelled. One in eight Americans, including children and even toddlers, is now taking a psychotropic medication. Whitaker acknowledges that antidepressants and other psychiatric medications often provide short-term relief, which explains why so many physicians and patients believe so fervently in the drugs' benefits. But over time, Whitaker argues, drugs make many patients sicker than they would have been if they had never been medicated.

Whitaker compiles anecdotal and clinical evidence that when patients stop taking SSRI's, they often experience depression more severe than what drove them to seek treatment. A multination report by the World Health Organization in 1998 associated long-term antidepressant usage with a higher rather than a lower risk of long-term depression. SSRI's cause a wide range of side effects, including insomnia, sexual dysfunction, apathy, suicidal impulses, and mania—which may then lead patients to be diagnosed with and treated for bipolar disorder.

Indeed, Whitaker suspects that antidepressants—as well as Ritalin and other stimulants prescribed for attention-deficit disorder—have catalyzed the recent spike in bipolar disorder. Though bipolar disorder was relatively rare just a half-century ago, reported rates of it have increased more than a hundredfold, to one in 40 adults. Side effects attributed to lithium and other common medications for bipolar disorder include deficits in memory, learning ability, and fine-motor skills. Similarly, benzodiazepines such as Valium and Xanax, which are prescribed for anxiety, are addictive; withdrawal from these sedatives can cause effects ranging from insomnia to seizures, as well as panic attacks.

Whitaker's analysis of treatments for schizophrenia is especially disturbing. Antipsychotics, from Thorazine to successors like Zyprexa, cause weight gain, physical tremors (called tardive dyskinesia) and, according to some studies, cognitive decline and brain shrinkage. Before the introduction of Thorazine in the 1950s, Whitaker asserts, almost two-thirds of the patients hospitalized for an initial episode of schizophrenia were released within a year, and most of this group did not require subsequent hospitalization.

Over the past half-century, the rate of schizophrenia-related disability has grown by a factor of four, and schizophrenia has come to be seen as a largely chronic, degenerative disease. A decades-long study by the World Health Organization found that schizophrenic patients fared better in poor nations, such as Nigeria and India, where antipsychotics are sparingly prescribed, than in wealthier regions such as the United States and Europe.

A long-term study by Martin Harrow, a psychologist at the University of Illinois College of Medicine, found an inverse correlation between medication for schizophrenia and positive, long-term outcomes. Beginning in the 1970s, Harrow tracked a group of 64 newly diagnosed schizophrenics. Forty percent of the nonmedicated patients recovered—meaning that they could become self-supporting—versus 5 percent of those who were medicated. Harrow theorized that those who were heavily medicated were sicker to begin with, but Whitaker suggests that the medications may be making some patients sicker.

Several possible objections to Whitaker's case against psychiatry come to mind. First of all, as Harrow speculates, over time heavily medicated patients may not fare as well as less-medicated patients because the former truly are sicker. Also, the recent surge in mental disability may stem, at least in part, from a decrease in the stigma associated with mental illness, spurring more people to seek and obtain treatment and government assistance. In her review, Marcia Angell called Whitaker's book "suggestive, if not conclusive," which seems right to me. At the very least, Whitaker's claims warrant further investigation.

Although Whitaker doesn't address electroconvulsive therapy, its persistence strikes me as yet another symptom of the weakness of modern psychiatry. It fell out of favor in the 1970s, in part because of its negative portrayal in the 1975 film One Flew Over the Cuckoo's Nest, and yet about 100,000 Americans a year still receive ECT. Studies suggest that the therapy can provide temporary relief from acute depression, but virtually everyone who receives electroconvulsive therapy relapses within a year without further treatment. Proponents claim that ECT has few significant side effects, but this year an FDA panel ruled that ECT should remain classified as a "high-risk" procedure because it can cause persistent memory loss and other side effects. If SSRI's and other psychiatric medications were truly effective, ECT would long ago have been tossed into the dustbin of failed psychiatric treatments.

So what happened to Phil's son? When Phil called me, I told him that if my son were suicidally depressed, I'd resist giving him shock treatment unless doctors convinced me there was absolutely no alternative. Phil decided against ECT, and his son, after being released from the hospital, gradually stopped taking antidepressants too. He still struggles with depression, and he smokes more marijuana than Phil would like. But he is healthy enough to be starting college this fall.

John Horgan is director of the Center for Science Writings at the Stevens Institute of Technology. His next book, The End of War, will be published by McSweeney's Books in November.

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  • rosiecee 1 day ago
    We must not forget about the violence being caused by the newer antidepressants, too, especially the school shootings.

    The Physicians Desk Reference states that SSRI antidepressants and
    all antidepressants can cause mania, psychosis, abnormal thinking, paranoia,
    hostility, agitation, etc. These side effects can also appear during
    withdrawal. Also, these adverse reactions are not listed as Rare but are listed
    as either Frequent or Infrequent. Go to a search engine and type in SSRI
    Stories where there are over 4,700 cases, with the full media article available,
    involving bizarre murders, suicides, school shootings/incidents [65 of these]
    and murder-suicides - all of which involve SSRI antidepressants like Prozac,
    Zoloft, Paxil, etc, . The media article usually tells which SSRI antidepressant
    the perpetrator was taking or had been using but sometimes the media article
    just says "antidepressant" or "medication for depression".On December 15, 2010, PLoS Medicine released a study
    which showed that, in regard to prescription medications and violence, the FDA
    had received the most reports of violence from the SSRI & SNRI
    antidepressants (except for Chantix, the smoking cessation drug.) The evidence
    of an association with violence was weaker and mixed for antipsychotic drugs and
    absent for all but one of the mood stabilizers. Yet, the antipsychotics and mood
    stabilizers, given for the most serious mental illnesses, bipolar disorder and
    schizophrenia, would be the most likely culprit involved in violence but,
    instead, it was the antidepressants which had the most reports of violence.
    They were given to patients that traditionally were the least likely to commit
    violence, the depressed and the anxious.
  • That is correct. The major media needs to bring this issue to the forefront regarding this problem. There is simply far too much money to be made from these drugs for scientists to be trusted in this sector.

    I say this as a scientist. Scientists who depend for their livelihood on this sector self-select so as to be the people who will support use of such drugs. And incestuous interdependency between the supposedly "objective" scientists in academia and those in industry make it impossible to get anything out which is not positively oriented toward these blockbuster money-makers.

    Thus you see scientific publications engaging in spin-doctoring of objective facts in most cases. This is a very serious problem and it needs much more attention than it is getting.
  • HaroldAMaio 1 day ago
    a decrease in the stigma (editors) associated with mental illness

    You could decrease your association to zero. Please dod so.

    Harold A. Maio
  • sdryer 1 day ago
    I have a gut feeling that this essay is right on the money.  It is hard to imagine that these drugs  can really be considered rational therapies given the inherent pathophysiological challenges that psychiatry has to confront.  Obviously,  the brain is unimaginably complex and we don't know enough about how it works.  (I am a neurophysiologist so I feel like I have some sense of the extent of our ignorance, although I should also note that I have no special expertise in mental disease or in the pharmacology of these drug classes). Because of the complexity of brain function, it is really hard--I should say impossible -- to make any straight line connection between the therapeutic inhibition of reuptake of a neurotransmitter for a few weeks (or years) and the symptoms that the patient reports.   By contrast, if one is treating, say, congestive heart failure, it is much easier to make a connection between what the drug is doing in cells and what you are measuring in the patient in terms of cardiac output.  Paraphrasing a line from the movie Young Frankenstein, compared to the brain, hearts and kidneys are tinker toys.  Also, robust molecular biomarkers for psychiatric disorders are not available-- and molecules that perhaps could be useful in that sense are generally inaccessible since you can't just go in and do needle biopsies on someone's brain because they are depressed (like you can in e.g. breast cancer).  That is assuming you would even know where to look.  Consequently, it's not really possible to come up with truly objective diagnostic categories for these disorders, which may present with somewhat similar behavioral or cognitive complaints but actually end up being quite different clinical entities at a cellular/molecular/physiological level.  As for the drugs themselves, the neurochemicals they generally affect are released more or less like a sprinkler system throughout the brain.  It's hard to imagine that the chronic use of antidepressants would not have unintended consequences.  They may be subtler than the gross motor problems exhibited by patients with tardive diskinesia after neuroleptic treatment (for schizophrenia) but it's still hard to imagine that these interventions can be used for years without some fairly profound compensatory reactions all over the brain.  At one point many years ago after a divorce I want to see a psychiatrist who immediately decided I must be depressed and gave me a prescription for Prozac.  It made me feel awful.  Then he tried in sequence several others antidepressants.  After awhile I realized that the drugs and my conversations with this guy were actually making me feel worse (and draining my bank account).  Reading this essay I realize that I am glad I gave it up. I am not trying to bash the entire profession, and my own experience is completely anecdotal and unscientific, and I fully recognize that some people have truly agonizing mental disorders.  I truly hope we are not making them worse, but given the profits being made, it may not be easy to find out.
  • Great comment.
  • CherylPrax 20 hours ago

    UK government has recently introduced e-petitions online.

    sign this ‘Abolish ECT’ e-petition and relegate this barbaric 'treatment' to
    the history books along with lobotomy. We need 100,000 signatures to get it
    debated in parliament.

    sign an e-petition, you must be either:

    •         a citizen of the UK

    •         a resident in the UK (you normally live
    in the UK)

    only takes a minute!  Please pass this


    you for your help.

  • John, regarding ECT, you may find the Read and Bentall study interesting (I did!).  See link http://www.ncbi.nlm.nih.gov/pu... or email me for PDF (www.wessextherapy.co.uk for my email).
    Rosiecee – you mention violence and psychiatric drugs.  I was recently reading a PLoS ONE study by Glenmullen (author of Coming off Antidepressants) and others:  Prescription drugs associated with reports of violence towards others Dec 2010 http://www.plosone.org/article...   Possibly of interest.  Mick
  • John, nothing to do with your article here, but I really enjoyed your book The End of Science - I particularly like the writings of Paul Feyerabend, so was interested in your interview with him.  Mick
  • dannyhaszard 8 hours ago
    PTSD treatment for Veterans found ineffective.
    Eli Lilly Zyprexa can cause diabetes.
    I took Zyprexa a powerful Lilly schizophrenic drug for 4 years it was prescribed to me off-label for post traumatic stress disorder was ineffective costly and gave me diabetes.  
    -FIVE at FIVE-
    The Zyprexa antipsychotic drug,whose side effects can include weight gain and diabetes, was sold for "children in foster care, people who have trouble sleeping, elderly in nursing homes."- *Five at Five* was the Zyprexa sales rep slogan, meaning *5mg dispensed at 5pm would keep patients quiet*.
    -- Daniel Haszard Zyprexa victim activist 
  • wjohnson15 2 hours ago
    I think risperdol and clozapine (except for the leukopenia) have worked better than older drugs for schizophrenic patients, less dopaminergic, extrapyramidal side effects. Remember any tretament for schizophrenics before 1980 invloved big doses of haldol after acute treatment with thorazine. Any WHO reports from other contries concerning mental health must be taken with a grain of salt, definitions of mental illness are different country to country. Phil's son should stop smoking pot, it accentuates most underlying mental illness in depression and schizophrenia , and may represent an attempt to self medicate. ECT is a last resort
  • killing_time 1 hour ago
    You're joking, right? While I completely agree that many people with mild problems are unnecessarily medicated, it seems hard to argue that psychotropic medications have not helped people with schizophrenia and bipolar disorder. Indeed, the disappearance of mental hospitals ("insane asylums") was made possible by psychotropic medications that allow people with schizophrenia to lead relatively normal lives.

    A large-scale study conducted with the Amish tracked bipolar disorder across generations (thanks to excellent record keeping of family ties and few outsiders entering the group) and found that the onset of bipolar disorder has been occurring at a younger age (and symptoms are more severe) with successive generations. (Here is a brief news article about the study: http://pn.psychiatryonline.org... This Chronicle article cites psychotropic medications as the cause, but isn't it also possible that the disorder itself changes as the genes responsible for the disorder are propagated? There may be a biological explanation for why the disorder appears earlier and more severely as it is passed on across multiple generations.

    I agree that most cases of depression probably do not require antidepressants, and likewise, cognitive-behavioral therapy is a much better treatment for anxiety disorders than are anti-anxiety medications. But it is unfair to condemn psychotropic medications as a whole because people are lazy and turn to them when they are unnecessary (hence highlighting their ineffectiveness when compared to other treatments).
  • Large scale studies simply do not show the positive effect. It is that simple.
    That is what the science says, the real science, not the garbage bought and paid for by companies desperate to come up with the next multi-billion dollar a year blockbuster.
  • I've suspected this for a long time.
  • syespinoza 20 minutes ago
    Echoes of  Thomas Szasz....