Op Ed: Psychiatry on the Ropes–WP / Evidence-based Psychiatry– Multi-Discipline Conference_ NYC
Mon, 4 Oct 2004
An Op Ed article in The Washington Post by Shannon Brownlee (below) nails the elite procurers of psychotropic drugs who have long denied the ominous signals of drug-induced harm: “You’d think the psychiatric research community would have noticed that the drugs can be dangerous for some patients — particularly kids — and may not be terribly effective for most.”
The heated debate about the concealed evidence contradicting the claimed value and safety of antidepression drugs threatens the very legitimacy of psychiatry. Psychiatry’s bona fides as a legitimate medical discipline is being challenged inasmuch as “thought leaders” of psychiatry have failed to follow ethical and scientific professional standards. The public has lost trust in psychiatry’s recommendations which are shown to be tainted by financial ties to psychotropic drug manufacturers.
Inasmuch as psychiatry’s leadership–including the National Institute of Mental Health–conducted the trials, they should be held accountable for failing to report about evidence of drug-induced harm. They, better than others, have known that the drugs they recommend have in many cases worsened patients’ condition rather than improved it.
“Aside from the patients who have suffered and died, the other tragedy of the antidepressant era is that some of the brightest minds in academic medicine have spent so much time and money on research that has done so little to elucidate the three-pound universe inside our skulls. Far from being the most studied drugs on the planet, the SSRIs are simply the most heavily marketed, while the mind and its illnesses remain as mysterious as the cosmos.”
The pillars of psychiatry betrayed public trust and squandered public funds by pretending the drugs have been found “safe and effective” when they knew the results to be otherwise. In return for the financial rewards and privileges granted to them by taxpayers, academic psychiatrists have debased the profession by selling their soul to drug merchants.
The debate is certain to get even more heated as new revelations about the corrupted drug safety reviewing process in the UK and the US are made public.
See: Drugs licensing flaws exposed: Pfizer advised on how to get antidepressant approved by member of body deciding on application. Sarah Boseley. The Guardian. Monday October 4, 2004. http://www.guardian.co.uk/uk_news/story/0,,1318945,00.html
See: The drugs industry and its watchdog: a relationship too close for comfort? Rob Evans and Sarah Boseley. The Guardian. Monday October 4, 2004 http://www.guardian.co.uk/uk_news/story/0,,1318946,00.html
**NYC CONFERENCE OF INTEREST**
A 3-day multi-disciplinary conference for professionals, students, and the general public. Sponsored by The International Center for the Study of Psychiatry and Psychology, and AMEDCO, LLC. (CME credit applies)
“CRITIQUING DISEASE MODELS OF PSYCHOLOGICAL DISTRESS and developing and Implementing Effective Psychosocial Theories and Interventions.”
When: OCTOBER 8TH 9TH AND 10TH, 2004, 8 A.M.-5 P.M.
Where: SHERATON LAGUARDIA EAST HOTEL 135-20 39TH AVENUE, FLUSHING, NEW YORK 11354
GEORGE ALBEE, Ph.D., Researcher and past president of the American Psychological Association
MARY BOYLE, Researcher and author of “Schizophrenia: A Scientific Delusion?”
PETER BREGGIN, M.D., Founder and President Emeritus ICSPP, author of “Toxic Psychiatry”
CELIA BROWN, President of Mind Freedom
JOSEPH GLENMULLEN, M.D., Author of “Prozac Backlash”
DAVID HEALY, M.D., Researcher and author “Let Them Eat Prozac”
BERTRAM KARON, Ph.D., Outstanding Psychoanalyst, researcher, and prolific author
NADINE LAMBERT, Ph.D. Author, educator, researcher
VERA HASSNER SHARAV, Founder and President of Alliance for Human Research Protection AHRP
ROBERT WHITAKER, Prize wining investigative reporter and author of “Mad in America”
For Conference Program, Registration Form and CEU Information
CONFERENCE CO-CHAIR: DOMINICK RICCIO, PH,D.
1036 PARK AVENUE, SUITE IB
NEW YORK, NY 10028
Contact: Vera Hassner Sharav
THE WASHINGTON POST
Mysteries of the Mind
By Shannon Brownlee
For anyone sitting in a nondescript ballroom at the Bethesda Holiday Inn last month, the testimony from families whose children had killed themselves — by hanging, by knife wound — while taking antidepressants was heartbreaking. For the families, however, the subsequent decision by the Food and Drug Administration panel that heard their stories — to require a suicide warning on the antidepressants’ labels — was a vindication. And a long-awaited one at that. Several of the family members who testified have been arguing for more than 13 years that the drugs can trigger devastating side effects.
Still, many of those who have been involved in the effort to get the word out are undoubtedly wondering why it took so long. Psychiatric researchers first reported that the antidepressants known as SSRIs could spark suicidal thoughts and actions in young patients back in 1990, just three years after the first major SSRI, Prozac, hit the market. Since then, there have been thousands of scientific papers published on these medications. You’d think the psychiatric research community would have noticed that the drugs can be dangerous for some patients — particularly kids — and may not be terribly effective for most.
The fact is, many academic psychiatrists did notice, and some spoke up, but practically nobody listened. “There has been a collective decision to ignore the evidence,” says Jane Garland, head of pediatric psychiatry at the University of British Columbia Children’s Hospital in Vancouver. “Our clinical practice guidelines say these things are safe and effective. The published papers say these drugs are effective and well tolerated. But the argument is very weak when you really look at the data.”
That collective decision has its roots in the problem that has beset psychiatry since the days of Sigmund Freud: Understanding the mind is really hard to do. It’s not as if physicians can administer a blood test to determine if a patient is depressed or anxious or obsessive-compulsive. Rather, psychiatry defines — and diagnoses — psychiatric disorders on the basis of subjective symptoms that are reported by patients or observed by doctors.
As a result, what gets counted as significant mental illness versus, say, unusual behavior or a minor disability has tended to expand and contract with changing social mores. Homosexuality was classified as a mental illness one year and a lifestyle choice the next, while severe shyness has now been elevated to a disease known as social anxiety disorder. Meanwhile, what’s actually going on inside a patient’s brain remains a cipher.
The diagnosis of mental illness has also been dictated in part by whatever is available to treat it. The psychiatric community has a long history of falling in and out of love with a succession of drugs that have been touted by the drug industry for whatever mental disorder is in vogue at the moment. In the 1960s, the vast majority of symptoms were interpreted as signs of anxiety disorders, and tranquilizers such as Valium were seen as the antidote for patients who weren’t sick enough to be hospitalized. By the 1980s, the diagnosis du jour was depression, and the tranquilizers gave way to antidepressants such as Elavil and Nardil.
Unfortunately, this earlier class of antidepressants had their own problems. Nardil and other drugs of the class known as monoamine oxidase inhibitors (MAOIs) could trigger dangerously high blood pressure, while the so-called tricyclic antidepressants such as Elavil could be used to commit suicide by overdose. Enter Prozac, which was touted by manufacturer Eli Lilly as being safe at any dose. Never mind that studies showed that Prozac and the other SSRIs that soon followed (Zoloft, Paxil, Serzone, Luvox, Effexor, Celexa and Lexapro) were no more effective than older antidepressants, and that patients stopped using them in droves because they didn’t like the side effects; psychiatrists greeted the new drugs with open arms.
Bernard Carroll, a professor emeritus of psychiatry from Duke University recalls, “You never saw anything like the mass hysteria over the ‘next generation’ antidepressants.” This enthusiasm was driven in part, he says, by thought leaders in academic psychiatry, who were “desperate to demonstrate that all the federal research dollars that had been shoveled their way for 25 years actually had a payoff.”
But the new antidepressants were also appealing because they fit neatly into the nascent understanding of the role of neurotransmitters, or brain chemicals, in mental illness. According to the prevailing theory, depression and suicide were linked to low levels of the neurotransmitter serotonin. The SSRIs, which stands for selective serotonin reuptake inhibitors, were thought to restore the chemical to healthy levels in the brain.
The notion that depression is a biological ailment, like Alzheimer’s, proved enormously appealing to patients. It relieved much of the stigma of mental illness, which could now be viewed not as a personal or moral failing, but as a glitch of biology. The serotonin theory also appealed to the medical community, for a slightly different reason. It made the mind seem more knowable, less like a black box, and psychiatry seem more like real science, instead of a lot of Freudian talk about repression and sex. Psychiatrists could now say to patients, you are sick because of a deficiency, and these drugs will restore you to normalcy and mental health.
If only psychiatric disease were that simple. In reality, there is little research to show that being a quart low on serotonin leads to depression, and even less to suggest that patients who commit suicide have lower levels of serotonin than normal people. And nobody really knows what SSRIs actually do in the human brain.
Yet the serotonin theory lives on in the public’s mind, while many members of the psychiatric community seem so invested in the power of the SSRIs that they have lost touch with the fact that all psychiatric drugs can have powerful side effects. Many in the field have long insisted that it is the depression that makes patients commit suicide, never the drugs, despite evidence that at least in some cases, it is indeed the medication. Studies of healthy volunteers, for example, have shown that people with no history of mental illness can suddenly begin having suicidal thoughts after taking the drugs.
Meanwhile, some psychiatrists report increasing numbers of young patients with severe psychiatric symptoms, including anxiety and mania, which appeared after they began taking SSRIs. Yet rather than seeing those symptoms as possible side effects of the medication, many academics have interpreted them as signs of previously undiagnosed manic depression, or bipolar disorder. The SSRIs, in their view, are “unmasking” bipolar disorder, which was there all along.
But there are no studies that support the notion that an individual patient’s “underlying” bipolar disorder would have emerged at some later date had he or she not taken the drug. It is equally plausible that the drugs themselves trigger bipolar disorder, rather than uncovering it — just as LSD is known to alter the brain’s wiring and cause flashbacks, and the street drug MPTP can trigger a Parkinson’s-like disorder.
None of which is meant to diminish the suffering caused by mental illness, or to suggest that the SSRIs should be removed from the market. The drugs can, in fact, work miracles, lifting some patients from the depths of depression and releasing others from the grip of compulsiveness and anxiety. Taking an SSRI has undoubtedly prevented some patients from killing themselves, and even the drugs’ most vocal critics prescribe them, albeit with caution. “There is still a place to use [the SSRIs],” says British psychiatrist David Healy, “but we should use them with great care.”
That’s probably what every physician should have been doing all along. But after more than a decade of companies burying their negative studies, of faulty biological theories, and of psychiatrists ignoring the data, maybe it’s time for everybody — patients, parents, doctors and pharmaceutical companies — to pause for a moment and take stock.
Before the antidepressants came along, estimates put the rate of depression at 50 to 100 people per million in the population. Today, we are led to believe that 100,000 Americans per million suffer from the disease. That’s one in 10 people, a thousand-fold increase in about 30 years. It’s hard to imagine that we are plagued with that much more mental illness than ever before.
What’s more likely is that the field of psychiatry, with its shifting, subjective diagnostic categories and its enthusiasm for new drugs, has been acutely vulnerable to “disease mongering.” This is the increasingly common practice on the part of the pharmaceutical industry to broaden the perceived market for a drug by persuading doctors and the public that huge numbers of people suffer from this or that disorder. Between disease mongering and some doctors handing out SSRIs like Pez, antidepressant prescriptions for children have surged 27 percent since the mid-1990s. Today, between 1 million and 3 million kids under the age of 19 are on one or more of these drugs for diagnoses ranging from attention deficit disorder to migraines to schizophrenia. Taking SSRIs has become so commonplace that young people talk casually about needing to “adjust their meds” in response to a rough week at school or a bad breakup.
Meanwhile, doctors have been prescribing these medications without knowing until just recently that, according to the FDA, 2 to 3 percent of their young patients could be at risk for drug-induced suicidal thoughts or actions. Maybe that’s because academic psychiatry has been too busy performing research with a very different agenda to answer the fundamental questions. In their haste to partake of industry research funds and other perks, academic researchers have focused much of their effort on what Carroll calls “experimercials” — studies aimed at expanding the drugs’ “off-label,” or unapproved, markets.
And so doctors still can’t tell which patients are most likely to benefit from taking an SSRI. Nor can they predict which ones are most likely to suffer devastating reactions. They still don’t have any idea how, biochemically, the drugs might trigger suicide and bipolar disorder. In his book “Let Them Eat Prozac,” psychiatrist Healy writes that the story of the SSRIs “reveals a lack of research so complete that academics cannot avoid questions about how well the health science research community serves us.”
Aside from the patients who have suffered and died, the other tragedy of the antidepressant era is that some of the brightest minds in academic medicine have spent so much time and money on research that has done so little to elucidate the three-pound universe inside our skulls. Far from being the most studied drugs on the planet, the SSRIs are simply the most heavily marketed, while the mind and its illnesses remain as mysterious as the cosmos.
Shannon Brownlee is Bernard L. Schwartz Senior Fellow at the New America Foundation. She is writing a book on the excesses of American medicine.
C 2004 The Washington Post Company
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