[PAA-Discuss] Fwd: The Chronicle of Higher Education - Are Psychiatric Medications Making Us Sicker?

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http://chronicle.com/article/Are-Psychiatric-Medications/128976/

September 18, 2011
Are Psychiatric Medications Making Us Sicker?

Dave Plunkert for The Chronicle Review
Enlarge Image

By John Horgan

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            (Dave 
Plunkert for The Chronicle Review)
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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The information herein shall not be considered an endorsement of anyone 
discontinuing psychiatric drugs. If you are stopping taking medication  
IT IS ADVISABLE TO REDUCE DOSES GRADUALLY WITH EXTREME CAUTION, as it 
is difficult to predict who will have problems withdrawing. It is worth 
getting as much information and support as you can, and involving your 
doctor wherever possible. You will find free withdrawal information 
here:  http://theicarusproject.net/HarmReductionGuideComingOffPsychDrugs
                                                                   

FOR MORE INFORMATION ON WITHDRAWAL:: Get Dr Peter Lehmann's book, 
Coming off Psychiatric Drugs: Successful Withdrawal from Neuroleptics, 
Antidepressants, Lithium, Carbamazepine and Tranquilizers.  This 
valuable resource comes in US, UK, Greek. and German editions.