Stoned Out of Their Minds
SOME SHOCKING FACTS
ON PRESCRIPTION DRUGS
Tranquillizers, Sleeping Pills & Antidepressants
by Joan E. Gadsby
Worldwide sales of prescription drugs exceed $300 billion yearly with tranquillizers, sleeping pills, antidepressants and other Central Nervous System drugs accounting for an estimated $76 billion in sales.
Inappropriate prescribing and uninformed use of prescriptions cost healthcare systems billions of dollars worldwide yearly.
Prescription Drugs are the fastest growing sector of worldwide health care costs with health care costs continuing to be the largest component of most governments budgets.
Prescription Drugs are fast exceeding the cost of physician services.
Benzodiazepines have often been called the most widely prescribed group of drugs in the world and the biggest selling drugs in the history of medicine with worldwide sales in excess of $21 billion in 1999.
Approximately 10% - 20% of the world population use tranquillizers and sleeping pills with up to 30% of people over the age of 60 years using these drugs (often over many years having been prescribed them at a much earlier age) and who have become "accidental or involuntary addicts".
By law when a physician prescribes drugs for a patient, the physician is required to ensure that the patient is fully informed of the drugs risks and benefits and consents to the drug therapy with full informed knowledge. Statistics show that this occurs in less than 20% of the patient population.
An estimated 4 million people in the United States have used prescribed benzodiazepine tranquillizers and hypnotics (sleeping pills) regularly for 5 - 10 years or more according to a US study in the early 1990's. Similar figures apply in the UK, Europe and in some Asian countries with the trend continuing.
The World Health Organization (WHO) estimates that 33% of diseases today are caused by medical treatment i.e. iatrogenic or doctor induced illness. Doctors are the third leading cause of death in the US after heart disease and cancer causing an estimated 250,000 deaths each year according to an article published in the Journal of the American Medical Association July 2000.
An estimated 60% of users of tranquillizers and sleeping pills suffer a mixture of adverse effects and withdrawal after 2 - 4 weeks of use (including therapeutic dose levels) due to tolerance and addiction.
Addiction to prescription drugs such as tranquillizers and sleeping pills is the inability to discontinue the use of the drugs as a direct result of the build up of tolerance and when the original dose has progressively less effect and a higher dose is required over time. Tolerance produces a recognized withdrawal syndrome and can precipitate "mini withdrawals" "or inter dose withdrawals" between pills depending on the "half life" of the drugs. This often leads to doctors prescribing increased dosages and/or prescribing another benzodiazepine and/or cross addictions to other drugs, primarily alcohol, to withstand the withdrawal symptoms.
Pharmaceutical companies spend more on marketing and promotion of drugs than on research and development - an estimated $15,000-$20,000 on every doctor with expenditures of $8.3 billion in the United States in 1998.
40% of impaired or dead drivers of motor vehicles show prescription drugs in their systems - predominantly tranquillizers and sleeping pills.
The adverse effects of benzodiazepines can include: paradoxical agitation, increased behavioural disinhibition, impaired new learning, decreased short and long - term memory, impaired psycho - motor functioning, (many times leading to accidents and/or falls), rage, the appearance or worsening of anxiety and depression, suicidal ideation, emotional anesthesia, floppy baby syndrome, the potential for permanent cognitive impairment, tolerance and addiction leading to acute and protracted withdrawal. These effects have been known for over 2 decades but little has been done to address the problem or to change doctors prescribing habits.
The National Centre on Addiction and Substance Abuse at Columbia University in 2001 found that General Practitioners don't properly assess for addictions and alarmingly, fewer than one third can diagnose addiction to prescription drugs - a problem doctors create.
Guidelines for acceptable duration of benzodiazepine use dating back over 2 decades state a maximum of 2 - 4 weeks or for intermittent use only. Most recently, guidelines state 7 - 10 days.
The infrastructure i.e. detox, treatment and recovery centres available and doctors knowledgeable to help people withdraw from tranquillizers, sleeping pills and antidepressants is minimal and in many cases non existent.
Misdiagnosis, misprescribing and mistreatment of patients who trust their doctors to "do no harm" continue today in the area of tranquillizers, sleeping pills and antidepressants.
The high cost to our socio-economic system with the continued indiscriminate prescribing and uninformed usage of these drugs includes health and safety in the work place, career devastation, family dysfunction, productivity losses, car accidents, falls, floppy baby syndrome (similar to fetal alcohol syndrome), lost years of people's lives, lost lives, costs to the legal and justice system, workers' compensation board claims, life and disability insurance claims, social welfare costs, emergency admissions, physicians' fees, pharmacists' fees, drug costs, detox facilities and increased overall costs for healthcare and other public/private sector services.
The elderly receive more than twice the number of prescription for psychotropic drugs as do younger people and can experience drug induced dementia, cognitive impairment and falls after years of use.
Non "psychiatric" conditions account for 70% of tranquillizer and sleeping pill prescribing and usage.
Cross addictions to other drugs and alcohol occur in 73% of benzodiazepine users - many of whom never used or had problems with alcohol or other drugs previously.
A 5 year study (1997 - 2002) in the State of Maine revealed that 88% of suicide overdose victims and 52% of accidental overdose victims had a prescription for at least one drug implicated in the cause of death - including benzodiazepines and antidepressants. A previous study revealed that 43% of emergency admissions for suicide attempts or overdoses involved tranquillizers and sleeping pills.
Prescription drug addiction to benzodiazepines is 10 times the problem of illegal drugs a far more gripping and debilitating than addiction to heroin or cocaine. Withdrawal is recognized to be more difficult, more prolonged and can last months or years depending on the years of use, dosage and the concurrent prescribing with other drugs.
Withdrawal symptoms from tranquillizers and sleeping pills can include insomnia, panic attacks, agitation, hallucinations, paranoia, depersonalization, derealization, depression, pressure in head, anxiety, loss of appetite, weight loss, visual distortions, flashbacks, lack of concentration, agoraphobia, dizziness, sweating, nausea, nightmares, palpitations, creeping sensation in the skin, increased sensitivity to light, touch and smell, pins and needles, numbness, seizures and sometimes death. A too rapid withdrawal causes major hyper excitability of the brain and central nervous system. A slow taper of weeks and months depending on use is recommended under close, ongoing medical supervision by a knowledgeable doctor and/or addiction specialist.
A Canadian report released in May 1999 revealed that in 1997 benzodiazepine prescriptions surpassed all other Phamacare prescriptions for women exceeding cardiac drugs, antidepressants and estrogen. 67% of prescriptions were issued to women.
68% of people prescribed tranquillizers and sleeping pills receive their prescriptions from only one doctor.
A 1996 study at Stockholm University in Sweden revealed that 51% of patients dependent on sedative/hypnotic drugs (tranquillizers and sleeping pills) showed signs of acquired intellectual deterioration and impairment (which can be permanent).
Substance use and mental illness co exist in an estimated 50% - 70% of patients diagnosed with "alleged psychiatric disorders". The DSM III and DSM IV (psychiatric manuals) document substance induced anxiety disorders, substance induced mood disorders and substance induced depressive disorders caused by benzodiazepine use. These ""alleged psychiatric disorders" often disappear once a patient is off all medications and as a result of lifestyle changes including exercise and diet.
There is extensive worldwide concurrent prescribing of benzodiazepines with antidepressants to approximately 60% of patients/consumers (often prescribed to counteract the adverse/side effects of one category of drugs with another).
Many patients are prescribed several different benzodiazepines and several different antidepressants at the same time. In some cases, patients are further prescribed neuroleptics and then anti psychotics. It is not unusual to find patients on 3 - 7 different nervous system drugs. This is all part of a market "dollar" driven healthcare system based on an antiquated "disease model" and dependent on a chemical cocktail of drugs.
A booming market also exists for antidepressants such as Prozac, Paxil, Zoloft, Luvox, Wellbutrin and Effexor with worldwide sales in the billions of dollars. Antidepressants (often referred to as the follow up to Valium 25 years later) in the United States in 2000 reached $10.4 billion in retail sales up 21% over 1999 and representing a startling five fold increase since 1993.
In the United States in 2000 Prozac sales (Eli Lilly) reached $2.6 billion, Zoloft (Pfizer) reached $1.9 billion, Paxil (Smith Kline Beecham) $1.8 billion, Wellbutrin (Glaxo Smith Kline) $850.9 million and Effexor (Wyeth - Ayerst) $815.8 million.
Antidepressants including Prozac, Paxil, Zoloft, Luvox and Celexa can have significant side effects including drug induced mania leading to suicide, suicidal ideation, violence, criminal acts, disinhibition or out of control behaviour; drug induced severe anxiety, agitation and depressions; drug induced obsessions and compulsions; drug induced akathisia (an internal sensation of agitation or discomfort that drives a person to move about and also to lose impulse control); tolerance and addiction leading to a recognized withdrawal syndrome which can include bouts of overwhelming depression, insomnia, fatigue and life - threatening physical effects, psychosis and violent out bursts.
During the past decade and with greater frequency, there has been an alarming increase in murder/suicides, suicides, domestic violence, bizarre mass killings, mother (parents) killing children, road and air rage, school shootings and workplace violence in North America where documented evidence has shown the involvement of Prozac, Paxil, Zoloft, Luvox, SSRI/Antidepressant drugs and/or other mind/and mood altering drugs.
Most monographs and drug formularies for antidepressant drugs state "effectiveness and safety in long term use has not been evaluated". Concern has also been expressed regarding antidepressant prescribing to young children and adolescents (since these drugs have not been approved for use in children under 18 years of age). One million children in the US were reported taking antidepressants in 1999 - including mint flavoured Prozac.
Safe use of antidepressants during pregnancy has not been established with drug monographs and drug formularies stating that antidepressants should not be administered to women of child bearing potential unless in the opinion of the treating physician the expected benefits to the patient markedly out weigh the possible hazards to the child or fetus.
Prescription Drugs are big business with high profits. The ongoing creation by major international drug companies of expanded markets and new markets for antidepressants include new "alleged diseases" such as "social anxiety disorder" for which Paxil is being promoted heavily in advertising; Prozac as Sarafem to treat "mood imbalances associated with premenstrual syndrome" and since Prozac has gone off patent, the drug manufacturer, Eli Lilly has received approval to market a once weekly version of the drug (based on its "new coating").
The drugging of children with Ritalin, another highly addictive central nervous system stimulant, continues with increasing regularity and controversy with Ritalin use nearing a world record. In the United States, usage of Ritalin increased an estimated 70% between 1990 and 1998. Is it a question of "hook" them young and they are customers for life to addictive prescription drugs including tranquillizers, sleeping pills and antidepressants?
BE AN INFORMED AND AND KNOWLEDGEABLE CONSUMER! Sources: International research and statistics compiled over 12 years from various sources. © Copyright 2003, Joan E. Gadsby
Big Brother in Your Medicine Cabinet
By Jordanne Graham
The Bush Administration wants to give drug companies a mandate to test and drug our children, and then us. This is really scary.
As with most of the legislation proposed by the current White House, the New Freedom Initiative looks and sounds good on the outside, but tucked away into the recesses and convolutions of legislative language is a proposal to screen every American, including you, for mental illness. This screening is not elective, and it circumvents the long-cherished notion of parental consent before a medical or psychological test can be carried out: of course, it starts with school children.
Stop Drug Ads
Tell Congress: Stop Prescription Drug Ads
Each year, drug executives spend $4 billion on prescription drug ads for pills they say will make you feel happier, sleep better and improve your sex life.
The ads are not educational, and do not promote public health. They can be extremely dangerous, as the Vioxx tragedy shows.
The Public Health Protection Act will stop all direct-to-consumer drug ads. Thirty-nine organizations have endorsed this legislation.
Now we need your help.
Tell your Members of Congress to introduce the Public Health Protection Act. Take action now.
Fears for a drugged generation
January 7, 2007
A STAGGERING 337,553 prescriptions for antidepressants were written for children and adolescents in the past year, raising fears about whether "happy pills" are being used as a quick-fix for despondent youngsters.
Australia's drug regulator, the Therapeutic Goods Administration, has not approved any antidepressant medicines for children or adolescents younger than 18 but can not prevent doctors from prescribing them.
Medical regulators and drug companies warn against the use of antidepressants in young people and there is concern that the drugs, including the newer breed known as serotonin reuptake inhibitors (SSRIs), have been associated with suicidal behaviour in the young.
Yet more than 75,500 prescriptions for antidepressants were written for children under 15 in 2005-06, according to figures prepared exclusively by Medicare Australia for The Sunday Age.
A further 262,000 antidepressant prescriptions were filled for youths aged between 15 and 20 in 2005-06. In Victoria there were 12,351 antidepressant scripts for children aged 14 and younger in 2005-06. In the 15-to-20 age group, 64,663 medicines were prescribed.
There is concern particularly that Prozac (fluoxetine), the only SSRI that appears to be more effective than a placebo in children, will become the new Ritalin, the drug of choice for a spate of attention deficit hyperactivity disorder diagnoses in the 1990s.
[photo with following test] Thousands of Victorian children are being prescribed antidepressants despite misgivings throughout the medical community Photo: John Donegan
Melbourne psychiatrist George Halasz sees the increasing use of antidepressants as further evidence of what he calls "diagnostic creep". Not that long ago, he says, sadness was simply sadness and shyness was shyness. Today, along with myriad conditions once regarded as normal, sadness and shyness can be diagnosed respectively as depression and social phobia and treated with a pill.
"There is a problem in our culture where we're finding it a lot more difficult to cope with ... events which have always been part of life — births, deaths, accidents, illnesses," Dr Halasz says. "As we have less time to attend to these natural transitions and natural stresses, there is very strong demand on the medical profession to alleviate suffering."
But psychologist Michael Carr-Gregg says SSRIs can be an essential adjunct to cognitive behaviour therapy. "There are kids on this planet today who I've treated who simply wouldn't be here if it wasn't for antidepressants," he says.
There is recent evidence that doctors are responding to concern about antidepressants for young people — Medicare Australia's figures reveal a decline in the past three financial years. In 2005-2006 there were 27,300 fewer scripts written for those younger than 15 than two years earlier. The number of prescriptions for those aged 15 to 20 in 2003-04 was 315,227; in 2005-06 the figure had fallen to 261,999.
Prescriptions for those younger than 18 are written off-label: that is, the decision is made by an individual clinician despite the lack of clinical testing and accurate dosage information.
Dr Daryl Efron, a consultant pediatrician at the Royal Children's Hospital, believes the prescription of SSRIs for children is declining with the realisation that they are not as effective as counselling and because of concerns about side-effects such as suicidal thoughts and behaviours.
Despite this, 337,553 scripts were filled out in the past year for children and adolescents, raising questions about whether antidepressants are being used as a quick fix.
SSRIs have revolutionised the treatment of depression. The drugs inhibit the absorption of the neurotransmitter serotonin in the brain. They are less toxic, safer and have fewer side effects than tricyclic antidepressants.
The European Medicines Agency recently approved the use of Prozac for children from the age of eight, and the US Food and Drug Administration has approved it for children with major depressive disorder.
In Australia youth depression is often not recognised or acted on. A national survey found that of depressed adolescents, only 11 per cent had sought help from a GP and 17 per cent used mental health services.
It was not possible from the Medicare date to say how many children and adolescents are on antidepressants.
2 Reports: Spending on psych drugs Up 150%_Diagnosis of Depression 25% Inflated
ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)
Promoting Openness, Full Disclosure, and Accountability
http://www.ahrp.org/ -- http://ahrp.blogspot.com/
According to a new report by the U.S. Agency for Healthcare Research and Quality (AHR&Q), U.S. spending on psychotropic drugs climbed from $7.9 billion in 1997 to $20 billion in 2004--that's an increase of 150% in just seven years. After years of marketing, these drugs now carry the most severe Black Box label warnings.
The sharpest rise in spending was for antipsychotic drugs (a.k.a. neuroleptics) which were approved only for use in managing schizophrenia and bipolar disorder--together these account for 2% of the population. Yet total purchases to treat these conditions more than tripled -- from $1.3 billion to $4.1.
These second generation neuroleptics are the most toxic of all psychotropic drugs: they interfere with normal metabolic, endocrine, and cardiovascular function. Their mechanisms of action induce debilitating chronic disease--including hyperglycemia, insulin-resistant diabetes, stroke and heart attacks.
Antidepressants, the AHR&Q study found, accounted for more than half ($12.1 billion) of the total expenditures for psychotherapies in 2004. These drugs trigger psychosis and antisocial aggressive, violent, manic behavior posing threat of harm to self (suicide) and others (homicide).
The drugs have not proven a clinical benefit. Instead, they have worsened the symptoms for which they were initially prescribed, such as stress or difficulty falling asleep. Antidepressants and antipsychotics have been shown to undermine mental and physical health in some persons for whom they were prescribed. The drugs disrupt normal mental and physiological functions and have been shown to induce psychosis, hallucinations, and suicidal behavior.
Why, people may ask, are these drugs so widely prescribed and how did they become blockbuster sellers? The answers are found in the unintended consequence of ill-advised laws that gave drug manufacturers too much influence on government policy
and in documents unearthed in litigation and in the subjective non-empirical diagnostic criteria. Company documents show that drug companies have engaged in aggressive marketing of these drugs despite knowledge of their hazardous effects--and they have actively influenced the diagnostic prescribing criteria.
A just released report in the Archives of General Psychiatry by investigators from New York University, Columbia University, University of Pennsylvania, and Rutgers, delivers a major blow to the validity of psychiatry's diagnostic criteria. The authors examined the distinctions used for diagnosing "major depression" and found that 25% of those "diagnosed" with "major depression" in accordance with the criteria set forth in psychiatry's diagnostic guide-the DSM -IV--are not clinically depressed. They are responding normally to traumatic life events.
The Washington Post correctly notes, "The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs." The most aggressive of these diagnostic chekclists is TeenScreen with its 84% false-positive misidentification rate.
The DSM-IV is a product under the influence of industry as has been documented by Drs. Lisa Cosgrove and Sheldon Krimsky:
Further evidence of corruption behind the spiraling sales statistics for psychotropic drugs is documented in company reports and memos. Alex Berenson of The New York Times disclosed the content of Eli Lilly Zyprexa documents showing that th ecompany concealed the evidence of harm produced from physicians and the public.
Instead, the airwaves were flooded with false and misleading advertisements whose claims are contradicted by the evidence of the drugs' safety hazards.
The FDA failed to intervene.
Industry, in collaboration (i.e. collusion) with influential mental health professionals and industry funded "advocacy" groups--including the American Psychiatric Association, the National Institute of Mental Health, Mental Health America, the American Academy of Child and Adolescent Psychiatry, the National Alliance for Mental Illness--succeeded in getting these drugs listed as first line treatments in psychiatry's prescribing guidelines hospital formularies.
TMAP--the Texas Medication Algorithm Project--is Big Pharma's psychotropic drug sweepstakes.
The academic architects of TMAP and TMAP promoters in state government and academia, should be questioned under oath to determine how the flow of cash from industry influenced the formulation and adoption of TMAP by numerous state mental health departments.
*Of note: New York Governor Eliot Spitzer appears to have completely reversed his informed legal action in the public interest when, as Attorney General, he filed suit against GlaxoSmithKline to persuade drug companies to disclose the facts about drug safety to the public. As a newly elected governor, he made a political appointed to appease the mental health drug industry cartel.
Eliot Spitzer appointed Michael Hogan, PhD, Commissioner of NYS Office of Mental Health. Dr. Hogan was a pivotal promoter of TMAP and the expanded use of the most expensive psychotropic drugs when he headed the Ohio Office of Mental Health, and chaired the President's New Freedom Commission on Mental Health which gave TMAP a federal seal of approval. Dr. Hogan also serves on the National Advisory Council of TeenScreen, the other market expansion scheme.
Contact: Vera Hassner Sharav
THE WASHINGTON TIMES
Spending on psychotherapeutic drugs soars
By Joyce Howard Price
April 1, 2007
Spending on antidepressants and other prescription drugs to treat mental disorders climbed from $7.9 billion in 1997 to $20 billion in 2004, an increase of more than 150 percent, a new federal report says.
"It is quite an increase. It is an important thing to take note of," said Marie N. Stagnitti, the report's author and a senior survey statistician with the U.S. Agency for Healthcare Research and Quality. The agency is part of the Department of Health and Human Services.
Purchases of psychotherapeutic drugs rose from 141.9 million to 244.3 million during the seven-year period. The number of people who reported buying these drugs increased from 21 million to 32.6 million during that time.
The study found that antidepressants accounted for more than half ($12.1 billion) of the total expenditures for psychotherapies in 2004. Spending for those drugs, which include commonly prescribed medicines such as Prozac, Paxil and Zoloft, more than doubled from $5.1 billion in 1997.
The total number of antidepressant purchases skyrocketed from 88.3 million in 1997 to 161.2 million in 2004, and the number of people who reported making such purchases increased from 15.3 million to 24.8 million.
The study found that the sharpest rise in spending was for antipsychotic agents, or medications used to manage schizophrenia, bipolar disorder and other psychotic disorders. Total purchases to treat these conditions more than tripled -- from $1.3 billion to $4.1 billion.
Likewise, total expenditures for central nervous system stimulants to treat pain and control seizures nearly tripled during the seven years -- from $600 million to $1.7 billion. The number of people who said they bought at least one of these drugs increased from 2.1 million to 3.3 million, and the total number of purchases of such prescriptions swelled from 11.8 million to 19.7 million.
Meanwhile, purchases of sedatives, hypnotics and medicines to ease anxiety nearly doubled from $900 million to $2.1 billion. Total purchases of those drugs climbed from 24.5 million to 39 million, and the number of people who said they bought at least one of those drugs surged from 5.4 million to nearly 8 million.
Ms. Stagnitti said she is interested in doing more research in this area to determine factors involved in the increase. She thinks it is important to determine how socioeconomic background and insurance coverage influence access to drugs to improve mental health.
Attempts to get reactions Friday from professional or advocacy organizations such as the American Psychiatric Association and Mental Health America were unsuccessful.
But the National Institutes of Mental Health (NIMH) said on its Web site the "burden of psychiatric conditions has been heavily underestimated."
It said a massive study called the "Global Burden of Diseases" found that mental illness accounts for more than 15 percent of the disease burden in established market economies, such as the United States. "This is more than the disease burden caused by all cancers," NIMH said.
Criteria for Depression Are Too Broad, Researchers Say Guidelines May Encompass Many Who Are Just Sad
By Shankar Vedantam
Tuesday, April 3, 2007; A02
Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are used.
The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs.
Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.
The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.
The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful -- but normal -- responses to life's stresses. Supportive therapy, on the other hand, may be useful -- and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression.
The researchers -- including Michael B. First of Columbia University, the editor of the authoritative diagnostic manual -- based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said.
An estimated one in six Americans suffer depression at some point in their lives. Under the more limited criteria the researchers urged, that number would be 25 percent lower.
"The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous," said lead author Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry. "There is a trend to treat people in this somewhat mechanized way."
Said First: "One issue this would play out at is at the level of medication. If someone has a normal grief reaction, you wouldn't give that person an antidepressant, you would favor counseling. If someone has major depression you would be more likely to medicate. So this could influence how clinicians think about medications or psychotherapy."
Drawing the line between normal and abnormal suffering has long been controversial in psychiatry, because people who have no disorders often experience the same symptoms as those who do, but their reactions typically are less prolonged and intense. Where to draw the line involves a degree of subjective judgment: If the criteria are too strict, some people who are depressed may not receive help.
After First oversaw the writing of the current edition of the manual, for example, a number of doctors contacted him about difficulties they had in applying the diagnosis, First said. One described a patient who was feeling acute grief after the death of her dog. The manual says doctors need not diagnose depression if symptoms follow the death of a loved one, and the doctor wanted to know whether the death of a pet met the criterion.
That question, First said, illustrated how difficult it was to establish a set of criteria that could encompass the complexity of human sorrow: The death of a spouse or a family member, he said, was only one of many things that could cause an acute grief reaction.
But he warned that people who are in pain after a divorce or other stressful event should not conclude that they simply ought to "buck up." They should seek the counsel of clinicians who would take the time to explore what caused the symptoms and whether they need treatment.
Still, Wakefield and Allan Horwitz, a researcher at Rutgers University who studies the sociology of mental disorders, said their study, which was published in this month's issue of the Archives of General Psychiatry, pointed out that sadness has increasingly come to be seen as pathological in the United States. They have written a book called "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder."
Pharmaceutical companies, the psychiatric profession and patient advocacy groups have all contributed to the phenomenon, Horwitz added. Companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease makes it easier to do studies, and psychiatry has come to think of itself as "the arbiter of normality," he said.
Patient groups, Horwitz added, think that the stigma attached to mental illnesses would be reduced if they were shown to be more common.
"The way in which people interpret their emotions is changing," Horwitz said. "People are starting to think that any sort of negative emotion is unnatural, that they can take medication and feel better. What that can also do is . . . make it less likely for people to make real changes in their lives that might be better than medications."
Antidepressant prescribing soars
The number of prescriptions for antidepressants in England has hit a record high despite national guidance advocating alternative treatments.
More than 31 million prescriptions for drugs such as Prozac were issued in 2006 - a 6% rise on the year before.
The figures come as two studies showed "startling" benefits of country walks in people with depression.
Mind, the charity that reported the findings, said GPs should consider "ecotherapy" as a valid alternative.
The National Institute for health and Clinical Excellence issued guidance in 2004 recommending that antidepressants should not be used as first-line therapy for mild to moderate depression.
Instead patients should be offered guided self-help and psychological therapies in the first instance.
But figures from the Information Centre indicate the number of prescriptions for antidepressants are still on the rise.
In particular prescriptions for a group of drugs known as SSRIs, which include Prozac, rose by 10% last year from 14.7m to 16.2m.
There have been fears that the drugs are linked to suicidal thoughts and self-harm in some cases.
In 2003, experts said SSRI antidepressants should not be given to teenagers after experts' concerns they made some patients suicidal.
However, Prozac is still recommended for under-18s, as it is thought that the benefits of taking this particular drug outweigh any potential risk, but only for those with severe depression.
Mind, the mental health charity, say the UK is trailing behind other countries in the use of other therapies.
In the Netherlands, Italy, Germany, Austria, Belgium and Slovenia, patients with depression are prescribed agricultural work.
Holland has 600 care farms that are part of the health service compared with 43 in the UK none of which are aimed at mental health.
In a report on ecotherapy, Mind said 93% of GPs have prescribed drugs due to lack of alternatives.
Ecotherapy, described as getting outdoors and getting active in a green environment, should be considered as a treatment option they said.
Researchers at the University of Essex compared a walk in a country park with a walk in a shopping centre in a study of 20 people.
They found 71% reported decreased levels of depression after a country walk compared with 45% after a shopping centre walk.
Participants also felt much less tense and reported greatly increased self esteem after a green walk.
But after a walk in a shopping centre, 50% said their feelings of tension increased and 44% said their self-esteem decreased after the walk in a shopping centre.
A separate survey of 108 people who regularly take part in green activities run by local Mind associations found 90% said it was the combination of nature and exercise that had the greatest effect on them and 94% said green activities had lifted their depression.
Paul Farmer, chief executive of Mind said ecotherapy was a credible, clinically-valid treatment option and needs to be prescribed by GPs especially as access to treatments other than antidepressants was extremely limited.
"We're not saying that ecotherapy can replace drugs but the debate needs to be broadened."
Marjorie Wallace, chief executive of the mental health charity SANE, said: "GPs are now encouraged to diagnose depression yet without the availability of qualified counsellors and therapists they have little choice but to hand out a prescription - or send the patient away empty-handed, leaving them with less hope of treatment and recovery."
The NHS is currently rolling out a programme of providing people with access to computerised CBT and the government has set up 10 pilots to explore ways of speeding up access to talking therapies.
A spokesperson for the Department of Health said: "Central to our efforts is the ability for people who are ill to be able to quickly get the right kind of therapy, instead of being prescribed medication."
They added the demonstration sites were showing early signs that quick access to therapy reduced the time that patients are ill and helps individuals to regain their independence.
Professor Mayur Lakhani, chair of the Royal College of GPs, said: "We reject the suggestion that GPs prescribe antidepressants too readily.
"GPs consider the need for antidepressants only after a careful assessment of the patients? clinical condition.
"The real story is the lack of access to services such as talking therapies and the long waiting lists for these. GPs find themselves in a difficult position because of limited services."
AP: Pain medicine use has nearly doubled
By FRANK BASS, Associated Press Writer
MYRTLE BEACH, S.C. - People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it.
The amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.
More than 200,000 pounds of codeine, morphine, oxycodone, hydrocodone and meperidine were purchased at retail stores during the most recent year represented in the data. That total is enough to give more than 300 milligrams of painkillers to every person in the country.
Oxycodone, the chemical used in OxyContin, is responsible for most of the increase. Oxycodone use jumped nearly six-fold between 1997 and 2005. The drug gained notoriety as "hillbilly heroin," often bought and sold illegally in Appalachia. But its highest rates of sale now occur in places such as suburban St. Louis, Columbus, Ohio, and Fort Lauderdale, Fla.
The world of pain extends beyond big cities and involves more than oxycodone.
In Appalachia, retail sales of hydrocodone — sold mostly as Vicodin — are the highest in the nation. Nine of the 10 areas with the highest per-capita sales are in mostly rural parts of West Virginia, Kentucky or Tennessee.
Suburbs are not immune to the explosion.
While retail sales of codeine have fallen by one-quarter since 1997, some of the highest rates of sales are in communities around Kansas City, Mo., and Nashville, Tenn., and on New York's Long Island.
The DEA figures analyzed by the AP include nationwide sales and distribution of drugs by hospitals, retail pharmacies, doctors and teaching institutions. Federal investigators study the same data trying to identify illegal prescription patterns.
An AP investigation found these reasons for the increase:
_The population is getting older. As age increases, so does the need for pain medications. In 2000, there were 35 million people older than 65. By 2020, the Census Bureau estimates the number of elderly in the U.S. will reach 54 million.
_Drugmakers have embarked on unprecedented marketing campaigns. Spending on drug marketing has gone from $11 billion in 1997 to nearly $30 billion in 2005, congressional investigators found. Profit margins among the leading companies routinely have been three and four times higher than in other Fortune 500 industries.
_A major change in pain management philosophy is now in its third decade. Doctors who once advised patients that pain is part of the healing process began reversing course in the early 1980s; most now see pain management as an important ingredient in overcoming illness.
Retired Staff Sgt. James Fernandez, 54, of Fredericksburg, Va., survived two helicopter crashes and Gulf War Syndrome over 20 years in the Marine Corps. He remains disabled from his service-related injuries and takes the equivalent of nine painkillers containing oxycodone every day.
"It's made a difference," he said. "I still have bad days, but it's under control."
Such stories should hearten longtime advocates of wider painkiller use, such as Russell Portenoy, head of New York's Beth Israel pain management department. But they have not.
"I'm concerned and many people are concerned," he said, "that the pendulum is swinging too far back."
_More people are abusing prescription painkillers because the medications are more available. The vast majority of people with prescriptions use the drugs safely. But the number of emergency room visits from painkiller abuse has increased more than 160 percent since 1995, according to the government.
_Spooked by high-profile arrests and prosecutions by state and federal authorities, many pain-management specialists now say they offer guidance and support to patients but will not write prescriptions, even for the sickest people. The increase in painkiller retail sales continues to rise, but only barely. There was a 150 percent increase in volume in 2001. Four years later, the year-to-year increase was barely 2 percent.
_People who desperately need strong painkillers are forced to drive a long way — often to a different state — to find doctors willing to prescribe high doses of medicine. Siobhan Reynolds, the widow of a New Mexico patient who needed large amounts of painkillers for a connective tissue disorder, said she routinely drove her late husband to see an accommodating doctor in Oklahoma.
Perhaps no place illustrates the trends and consequences for the world of pain better than Myrtle Beach, a sprawling community of strip malls, hotels and bars perched along a 60-mile strip of sand on the Atlantic Ocean. The metro area, which includes three counties, is home to 350,000 people but sees more than 14 million tourists annually, drawn to its warm water, golf courses and shopping.
During the eight-year period reflected in government figures, oxycodone distribution increased 800 percent in the area of Myrtle Beach, partly due to a campaign by Purdue Pharmaceuticals of Stamford, Conn. The privately held company has pleaded guilty to lying to patients, physicians and federal regulators about the addictive nature of the drug.
Use of other drugs soared in the area, too: Hydrocodone use increased 217 percent; morphine distribution went up 180 percent; even meperidine, most commonly sold as Demerol, jumped 20 percent.
It is no small wonder that federal authorities suspected the area was home to a notorious "pill mill," or a clinic that dispenses prescription medication without verifying that it's needed.
The U.S. attorney for South Carolina secured a 58-count indictment in June 2002 against seven physicians and one employee of the Comprehensive Care and Pain Management Center, a nondescript storefront on Myrtle Beach's main drag.
Tipped off by local pharmacists concerned about an increase in the volume of painkiller prescriptions, the federal investigation created a furor in the medical profession. The owner, D. Michael Woodward, was sentenced to 15 years in the case and has relinquished his license.
A second physician, Deborah Bordeaux, had worked at the clinic less than two months before quitting in disgust. Bordeaux, now serving a two-year prison term, was threatened with a 100-year sentence if she did not help the prosecution.
Officials with the Justice Department and the DEA would not discuss what some activists say is a "war on doctors."
Reynolds, the widow who drove her late husband hundreds of miles for his pills, became an activist after the Myrtle Beach indictments. She contributed money to appeal some of the criminal convictions in South Carolina and started the Pain Relief Network, an advocacy organization for people living in pain. She believes the doctors sent to prison were railroaded.
"It was a witch hunt," she said.
Bordeaux's husband, Edworth Swaim, agrees. A retired U.S. Postal Service employee, Swaim believes his wife was sentenced to two years because she would not turn on her former colleagues. Even though Bordeaux had worked at the clinic less than two months and eventually sued over what she alleged was rampant Medicare fraud, he said she did not stand a chance of avoiding prison.
"She wasn't guilty of anything, so she wasn't going to plead to anything," Swaim said. "She was absolutely railroaded, made an example of. I can't tell you how angry I am."
Myrtle Beach physicians are not convinced that the "Myrtle Beach Eight," as they became known, were innocent.
A Myrtle Beach internist who also works in addiction medicine, Brian Adler, said physicians were flooded with patients seeking pain medicine after the clinic was shut down.
The community has a slightly higher-than-average number of older people and relatively high numbers of people between 21 and 64 who describe themselves as disabled.
"There's a significant problem with narcotics in this area," Adler said. After the pain management clinic closed, "all those folks were like rats, scurrying from a burning building, trying to get their fix."
Other physicians were concerned about patients with legitimate needs for painkillers. The federal bust raised the stakes.
When radio commentator Rush Limbaugh settled a federal case charging him with illegally obtaining painkillers, he did not get prison time. Neither did NFL star Brett Favre, who publicly acknowledged an addiction to Vicodin that he obtained legally.
To pain management specialists, they were being blamed for everyone's addiction.
The DEA cites 108 prosecutions of physicians during the past four years; 83 pleaded guilty or no contest, while 16 others were convicted by juries. Eight cases are pending, and one physician is being sought as a fugitive.
In congressional testimony, the agency's deputy assistant administrator, Joseph T. Rannazzisi, estimated that fewer than 1 percent of the nation's physicians — under 9,000 — illegally provide prescription drugs to patients. He told lawmakers it is far more common for people to illegally obtain prescription drugs from friends and family members.
"It is not merely illegal but could feed or lead to an addiction and place that loved one in a life-threatening situation," Rannazzisi said.
It is impossible to reliably measure painkiller abuse.
A 2004 government study estimated between 2 million and 3 million doses of codeine, hydrocodone and oxycodone are stolen annually from pharmacies, distributors and drug manufacturers. The AP's analysis only included retail sales and did not include estimates of diverted pharmaceuticals.
John Charles, director of medical affairs at the Grand Strand Regional Medical Center in Myrtle Beach, practices pain management. A few years ago, Charles said, he took a drastic step to reduce his potential legal risks: He stopped prescribing painkillers.
The decision gave him peace of mind, but he does not expect there to be less of a need for painkillers or physicians who prescribe them.
"People with cancer are surviving longer, elderly people are living longer," Charles said. "So, physicians are walking a fairly fine line. We're walking a narrow path. And I think we'll continue to see it for a while."
More Americans taking drugs for mental illness
By Julie Steenhuysen
Tue May 5, 2009 4:18am EDT
CHICAGO (Reuters) - Many more Americans have been using prescription drugs to treat mental illness since 1996, in part because of expanded insurance coverage and greater familiarity with the drugs among primary care doctors, U.S. researchers said on Tuesday.
They said 73 percent more adults and 50 percent more children are using drugs to treat mental illness than in 1996.
Among adults over 65, use of so-called psychotropic drugs -- which include antidepressants, antipsychotics and Alzheimer's medicines -- doubled between 1996 and 2006.
"What we generally find is there has been an increase in access to care for all populations," said Sherry Glied of Columbia University in New York, whose study appears in the journal Health Affairs.
"Mental health has become much more a part of mainstream medical care," Glied said in a telephone interview.
In 2006, they said 16 percent of adults 65 and older had some form of mental health diagnosis.
The researchers culled data from several large public surveys of health in the United States, including from the National Center for Health Statistics, the Agency for Healthcare Research and Quality, the Substance Abuse and Mental Health Services Administration and the Social Security Administration.
Glied said expanded drug coverage under Medicare, the federal insurance program for the elderly, and the State Children's Health Insurance Program for poor children, helped make such drugs more affordable.
The study found the number of children diagnosed and treated for mental health conditions by their primary care doctor doubled between 1996 and 2006.
"The increases in prescription drug use were particularly rapid in the early part of this decade, between 1996 to 2001," Glied said. "For most groups, they have slowed down since then."
The researchers did not report total numbers of people treated or calculate the dollar value of the drugs taken.
One worrisome finding, Glied said, was that there has been little progress in access to care among people with more serious mental illness. They found treatment for older adults with mental limitations who need help dressing, eating, or bathing fell between 1996 and 2006.
About 7 percent of Americans with serious mental illness wind up in jail or prison every year, the researchers said.
"New policies are desperately needed to reduce the flow of people whose primary problem is a mental disorder into the criminal justice system," wrote Glied and colleague Richard Frank of Harvard Medical School.
While the study shows expanded mental health coverage for people with insurance, especially for those covered in government health plans, they said the ongoing recession and swelling ranks of the uninsured will likely mean less mental health coverage for many Americans in the near future.
(Editing by Maggie Fox) - http://www.reuters.com/article/healthNews/idUSTRE5440V120090505
All depression to end by 2025
Entire nation to be completely stoned, complacent, impotent "real soon now"
By Mark Morford,
SF Gate Columnist, Wednesday, August 19, 2009
Hey, want a fun thing to do when you're just sittin' 'round the zeitgeist, waiting for a bolt of enlightenment or maybe just the apocalypse to rain down destruction and locusts and Godspit on your sinful little head? Something to do whilst you're nakedly sipping some fine sake and wondering when the melting icecaps will raise the oceans sufficiently that you can start taking a boat to work?
Extrapolate. That's what you can do. Draw it out. Take it to its natural conclusion. Grab hold of a juicy piece of ripe, low-hanging news and lick it and stroke it and promise to make it breakfast, and let it coo and whimper and whisper its wicked secrets in your hungry little id. Hey, it beats fornication. Oh wait, no it doesn't. Never mind.
Here's a good piece to start you off: Did you know that the use of prescription antidepressants in America has literally doubled in a mere 10 years? It's true.
From about '96 to '05, they say the number of your fellow patriots taking behavioral meds jumped from 13 million to a whopping 27 million, which is fully 10 percent of the American population, not including babies and cats and the Duggars. And that's only through '05. The actual number is probably far closer to 15 or even 20 percent by now.
Are you amazed? The slightest bit surprised? Taken aback? Of course you're not.
This is where you do it. This is where you get to load up your satire gun, fire up your dour prognosticator and crank your extrapolator to full power, and draw some nifty, if dubious, conclusions.
Because, do you know what this means? It means that, very soon now, maybe three, four or 30 years hence, just about every American and most of the planet, too, will be on some sort of narcotic, behavioral med, modifier, zinger or zapper or calmer or leveler designed to mollify or numb or dry up all your saliva, give you some really weird dreams and make you never want to have sex. It's not all that tough to imagine, really.
But why stop there? Extrapolate a bit further. Because if you look at it just right, this also means all depression and unhappiness will soon be coming to an end. Isn't that great? No more depression! At last! No more war. No more road rage. No more gangs. No more screaming at the dog or yelling at your spouse about the general lack of oral sex in your morning routine. Imagine.
Not quite convinced? Fine. Let us dissect. Let us perform a dangerous feat of only semi-drunken math to verify it all and keep your extrapolator well lubed and pumping hard. Ready?
Let's see: 13 million in 10 years translates into a little more than one million new antidepressant users every year, correct? That breaks down to about 90,000 per month, or 3,000 new users every 24 hours, which is about 125 every hour, or roughly two Americans jumping on the antidepressant train every single minute, 24 hours a day, every day of the week, nonstop forever and ever until we all die happy and narcotized and free. Praise Jesus.
But wait, that's not exactly accurate either. Because as we all know, modern life is nothing if not accelerating, gaining momentum like a Republican in a meth lab, like Sarah Palin shopping at Neiman's, like those aforementioned polar icecaps. The quicker they liquefy, the more exponentially they freak everyone out. Fun!
Did you know the world population is all set to reach seven billion straining, colliding bipeds by 2011? That overall, the global population is still exploding, and no one has the slightest clue how we're going to feed everyone, clothe them all and give them sufficient access to a nearby Starbucks?
So then, if we factor in insane population growth and the general acceleration of suffering and stress and misery in the world, and with it the concomitant, ever-increasing need to take some magic chemical compound to help calm it all down, we can safely say that it will be far more than two new users per minute -- probably more like one every second. Tick. Tick. Tick. There's three new users right there! How amazing it will be. And soon!
Of course, it's all a bit silly, is it not? Rare indeed are extrapolations like this very accurate. Rarely do such forecasts actually come to pass, given how they never take into account the wildcards, the potholes, the potential upheavals of what's expected.
Something always changes. There are always unforeseen variables, factors that no one saw coming. Who knows what might happen? Who knows what could affect those disturbing numbers? Maybe we won't have a totally antidepressed, overly medicated population by Malia Obama's second presidential term after all.
Our adorably insane conspiracy theorists posit that some lethal, ugly combination of global pandemic or WWIII or nuclear "accident" will soon reduce the world population to about a billion humans, and therefore will totally relax the stress levels overall and mitigate the need to take any pill whatsoever, mostly because we'll all be dead.
Others say global warming will soon solve many of our problems, simply by wiping out massive sections of livable space and taking giant gobs of the population with it, thus leaving the rest of us with far more access to really good wine and pot and Ecstasy and porn and, well, who needs Zoloft?
Or maybe it won't quite be so dour. Maybe it will be a more delicious confluence of world-changing factors that will ease the desperate need to antidepress.
Maybe the grand sea change, the great promise President Obama has already set in motion -- toward a new intelligence, peace, humanitarianism, environmentalism, the arts, a transformation of who the hell we think we are and just what the hell we think we're doing here -- will create a new, far healthier world sooner than most think.
Maybe, in short, there are more interesting, divine factors at play than most people are, at this moment at least, willing to realize. Possible? Of course it is. Shall we extrapolate?
Prozac 'found in drinking water'
Traces of the antidepressant Prozac can be found in the nation's drinking water, it has been revealed.
An Environment Agency report suggests so many people are taking the drug nowadays it is building up in rivers and groundwater.
A report in Sunday's Observer says the government's environment watchdog has discussed the impact for human health.
A spokesman for the Drinking Water Inspectorate (DWI) said the Prozac found was most likely highly diluted.
The newspaper says environmentalists are calling for an urgent investigation into the evidence.
It quotes the Liberal Democrats' environment spokesman, Norman Baker MP, as saying the picture emerging looked like "a case of hidden mass medication upon the unsuspecting public".
He says: "It is alarming that there is no monitoring of levels of Prozac and other pharmacy residues in our drinking water."
Experts say the anti-depression drug gets into the rivers and water system via treated sewage water.
The DWI said the Prozac (known technically as fluoxetine) was unlikely to pose a health risk as it was so "watered down".
The Observer says the revelations raise new fears over how many prescriptions for the drug are given out by doctors.
In the decade leading up to 2001, the number of prescriptions for antidepressants went up from nine million per year to 24 million per year, says the paper.
The Environment Agency report concluded that the Prozac in the water table could be potentially toxic and said the drug was a "potential concern".
The exact amount of Prozac in the nation's drinking water is not known.
Are Prozac and Other Psychiatric Drugs Causing
the Astonishing Rise of Mental Illness in America?
By Bruce E. Levine, AlterNet - via Prez at USA-Exile dot org
An interview with investigative reporter Robert Whitaker, about the dramatic increase in mental illness disability and its surprising cause. - April 28, 2010
In 1987, prior to Prozac hitting the market and the current ubiquitous use of antidepressants and other psychiatric drugs, the U.S. mental illness disability rate was 1 in every 184 Americans, but by 2007 the mental illness disability rate had more than doubled to 1 in every 76 Americans. Robert Whitaker was curious as to what was causing this dramatic increase in mental illness disability. The answers are in his new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown Publishers, April 2010).
Whitaker’s findings will create a problem for both Big Pharma and establishment psychiatry, but his credentials and his craftsmanship will make it difficult to marginalize him. Whitaker is the author of four books including Mad in America, about the mistreatment of the mentally ill. As a reporter for the Boston Globe, he won a George Polk Award for medical writing, a National Association of Science Writers Award for best magazine article, and was a finalist for a Pulitzer Prize.
Bruce Levine: So mental illness disability rates have doubled since 1987 and increased six-fold since 1955. And at the same time, psychiatric drug use greatly increased in the 1950s and 1960s, then skyrocketed after 1988 when Prozac hit the market, so now antidepressant and antipsychotic drugs alone gross more than $25 billion annually in the U.S. But as you know, correlation isn’t causation. What makes you feel that the increase in psychiatric drug use is a big part of the reason for the increase in mental illness?
Robert Whitaker: The rise in the disability rate due to mental illness is simply the starting point for the book. The disability numbers don’t prove anything, but, given that this astonishing increase has occurred in lockstep with our society’s increased use of psychiatric medications, the numbers do raise an obvious question. Could our drug-based paradigm of care, for some unforeseen reason, be fueling the increase in disability rates? And in order to investigate that question, you need to look at two things. First, do psychiatric medications alter the long-term course of mental disorders for the better, or for the worse? Do they increase the likelihood that a person will be able to function well over the long-term, or do they increase the likelihood that a person will end up on disability?
Second, is it possible that a person with a mild disorder may have a bad reaction to an initial drug, and that puts the person onto a path that can lead to long-term disability. For instance, a person with a mild bout of depression may have a manic reaction to an antidepressant, and then is diagnosed with bipolar disorder and put on a cocktail of medications. Does that happen with any frequency? Could that be an iatrogenic [physician-caused illness] pathway that is helping to fuel the increase in the disability rates?
So that’s the starting point for the book. What I then did was look at what the scientific literature -- a literature that now extends over 50 years -- has to say about those questions. And the literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness.
In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug-- say have a manic episode after taking an antidepressant -- and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic pathway that is helping to fuel the increase in the disability numbers.
Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature -- and this really is a tragic story -- clearly shows that our drug-based paradigm of care is a primary cause.
BL: I have a clinical practice and I have seen several examples of what you are talking about, and I had previously read several of the scientific studies that you detail in Anatomy of an Epidemic, so I am not exactly a naïve reader. However, in reading your book and seeing the enormity of the problem and just how much overwhelming evidence there is for a horrible crisis, I started getting a little sick to my stomach. I wonder, as you got into the research, did you start drawing comparisons to Rachel Carson and Silent Spring? Specifically, this is such a huge unnecessary tragedy, affecting several million people including children, yet there is virtually no discussion of it in the mass media.
RW: A journalist friend of mine, who was a long-time reporter at the Washington Post and Newsday, said that he too was reminded of Silent Spring when he read Anatomy of an Epidemic. And, in fact, I was stunned by much of what I found when I was researching the book, and I did at times become overwhelmed by the magnitude of the tragedy. Let me give a specific example.
When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children. But once psychiatrists started putting “hyperactive” children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants. Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature. And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up “rapid cyclers,” which means they have severe “bipolar” symptoms, and that they can now be expected to be chronically ill throughout their lives.
We also know that the atypical antipsychotics [such as Risperdal and Zyprexa] prescribed to bipolar children cause a host of physical problems, and there is pretty good evidence that they cause cognitive decline over the long term. When you add up all this information, you end up documenting a story of how the lives of hundreds of thousands of children in the United States have been destroyed in this way. In fact, I think that the number of children and teenagers that have ended up “bipolar” after being treated with a stimulant or an antidepressant is now well over one million. This is a story of harm done on an unimaginable scale.
So why hasn’t the media reported on this? The answer is that the media, when it covers medicine, basically repeats the narrative fashioned by the academic doctors who are leaders in the particular discipline, and in this case, academic psychiatrists have told a story of new illnesses -- like juvenile bipolar illness -- being “discovered,” and of drugs for those treatments that are safe, effective and necessary. They tell this story to the public even as their own studies find that their juvenile bipolar patients -- who when they first came to a psychiatrist might simply have been “hyperactive” or struggling with a momentary bout of depression -- are ending up with severe bipolar symptoms and can now expect to be chronically ill for life. The problem is that our society trusts academic doctors to tell an honest story, and in this corner of medicine, it's quite easy to document -- and I did document this in Anatomy of an Epidemic -- that academic psychiatry has belied that trust.
BL: Let’s get to the issue of psychiatric medications fixing “chemical imbalances.” This idea was absolutely crucial in making Prozac and other antidepressants attractive to depressed patients. However, these days even much of the psychiatry establishment has backed off the idea that depressed people have too little serotonin between their synapses and that antidepressants fix this chemical imbalance. Maybe it’s just me, but I can’t help but see the comparison between Big Pharma and the Bush Administration, which told Americans that the U.S. needed to invade Iraq because Saddam Hussein had weapons of mass destruction and he was connected to Al Qaeda. Of course, the Saddam Hussein-Al Qaeda connection was simply a lie, and the WMD rationale proved to be false. Do you believe that Big Pharma and establishment psychiatry were lying about this chemical imbalance theory at the time Prozac hit the market in 1988, or do you believe that they had hoped this theory was true because it sold drugs -- and it just turned out to be wrong?
RW: The low-serotonin theory of depression was first investigated in the 1970s and early 1980s, and those studies did not find that people diagnosed with depression had “low serotonin.” As the NIMH [National Institute of Mental Health] noted in 1984 at the conclusion of such investigations: “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” So why was the public told differently?
The answer is a bit complicated. In the late 1970s, the market for psychiatric drugs declined and psychiatry suddenly saw itself as a profession under “siege,” having now to compete with a burgeoning number of psychologists and other non-physician therapists for patients. In response, the profession -- at its highest levels -- decided to sell the public on a biomedical model of mental disorders, as that model would naturally emphasize the importance of taking “medications” for a disease and it was only psychiatrists who could prescribe those drugs.
This storytelling began with the publication of DSM-III in 1980, which the American Psychiatric Association (APA) heralded as a grand “scientific achievement,” and then soon the APA was announcing that great discoveries were being made about the biology of mental disorders. And once psychiatry began to tell a story that wasn’t science based, but rather was best described as a marketing campaign, I think it began to believe its own marketing slogans. I don’t know this for a fact, but I am willing to bet that Bush, Rumsfeld, Cheney and others began to believe their own public pronouncements about weapons of mass destruction and a Saddam Hussein-Al Qaeda connection, and I think something similar to that happened in American psychiatry when Prozac came to market. The field stopped looking at the science that showed that the low-serotonin theory of depression had basically already flamed out, and instead began to believe its own propaganda.
Moreover, the chemical-imbalance story did more than just spur sales of drugs. It provided psychiatrists with a desirable public image. They were now like doctors in infectious medicine and other respected specialties, their medications “like insulin for diabetes.” The chemical-imbalance story told of medical progress, of a discipline that was unlocking the mysteries of the brain. Indeed, when Prozac came to market, there were newspaper stories about how psychiatry now had a new reason to “feel proud,” and how its public image had improved. So in the late 1980s and early 1990s, the chemical imbalance story is not one that tells of how lying moved into the heart of the field, but rather how professional delusion did.
At some later point, however, as the chemical imbalance story repeatedly fell apart, psychiatrists in the research community understood that they were telling a “fib.” I can still remember -- this was the summer of 1998 -- when I questioned a prominent academic psychiatrist about whether the chemical imbalance story was really “true” and he replied by stating that it was a “useful metaphor” that “helped patients understand why they needed to take their medication.” This really is the tragedy of modern psychiatry -- it became a medical discipline devoted to telling a public story that made its drugs look good, as opposed to telling a story rooted in honest science.
BL: Big Pharma and their partners in establishment psychiatry would like the general public to believe that the only critics of psychiatry are Scientologists. In reality, most scientists who are critics of psychiatry are also critics of the pseudoscience of Scientology. It is my experience that serious critics of psychiatry are not anti-drug zealots. For example, I know that you have talked with “psychiatric survivors” -- ex-patients who want to reform mental health treatment. David Oaks, one of the leading activists in the psychiatric survivor movement, often repeats that some members of his MindFreedom organization continue to take their psychiatric drugs while many choose not to, and what MindFreedom and other psychiatric survivors are fighting for is truly informed choice and a wider range of treatment options. Do you think that David Oaks’ fight is the right one?
RW: Big Pharma and its partners in establishment psychiatry have smartly used Scientology to defuse criticism of their medications. I honestly believe that if Scientology weren't around, then our society could have a much more rational discussion about our drug-based paradigm of care. As for the position taken by MindFreedom and other psychiatric survivors, I basically do think that is the right one to take, with two caveats.
In order to make a “truly informed choice,” a person needs to know the long-term effects of a treatment. It’s not enough for people to be fully informed about the immediate “side effects” of a drug. People need to be presented with information about whether such treatment has been shown to better the long-term course of the disorder, or worsen it. They need to be told about long-term physical and cognitive problems that often arise with every day use of psychiatric drugs. So providing people with a “truly informed choice” is a tall order.
My second caveat is this: As a society, we expect the medical community to develop the best possible form of care. We do not expect a medical community to offer a therapy that regularly leads to a bad end. And so, if we were to draw up a blueprint for reforming the current paradigm of care, it would be nice if the psychiatric community would try to develop therapeutic approaches that involved using psychiatric medications in a selective, cautious way that best promoted good long-term outcomes. In other words, I think psychiatry does have a responsibility to develop a true evidence-based model for using its drugs, a model that incorporates the long-term outcomes data.
In the solution section of Anatomy of an Epidemic, I write of how doctors and psychologists in northern Finland use antipsychotics in a selective, cautious manner when treating first-episode psychotic patients, and their long-term outcomes are, by far, the best in the Western World. So if you believe in evidence-based medicine, then American psychiatry should look to the Finnish program as a model for reform. Doctors have a responsibility to lead, but I think that you see in David Oaks’ position a belief that establishment psychiatry in America cannot be trusted to provide such leadership. He’s right to believe that, of course, and that's what is so tragic about modern American psychiatry.
Bruce E. Levine is a clinical psychologist and his latest book is Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007). His Web site is www.brucelevine.net