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Do antidepressants create more mental illness than they cure?
Robert Whitaker discusses the long-term impact of prescription medication.
15 June, 2020
Photo by Emiliano Vittoriosi on Unsplash
- Many antidepressants show no better efficacy than placebo or talk therapy in long-term usage.
- Proselytizing pharmaceutical interventions has been part of a concerted effort since the 1970s.
- Journalist Robert Whitaker discusses the impact of pathologizing children, moral therapy, and more.
<p>Doctors wrote a <a href="https://www.webmd.com/lung/news/20200603/fda-places-zoloft-on-shortage-list" target="_blank">record number</a> of prescriptions for Zoloft in March, causing the FDA to add this SSRI to its drug shortage list. Zoloft prescriptions then dropped in April—4.5 million, down from 4.9 million—yet these numbers represent a <a href="https://www.goodrx.com/blog/depression-and-anxiety-prescriptions-are-climbing-nationwide/" target="_blank">startling upward trend</a> in antidepressant usage. Nearly <a href="https://www.apa.org/monitor/2017/11/numbers" target="_blank">13 percent</a> of the US population over age 12 now regularly swallow these pills.</p><p>Why would a 12-year-old need an antidepressant? <a href="https://www.madinamerica.com/robert-whitaker-new/" target="_blank">Robert Whitaker</a>, author of "Mad in America" and Anatomy of An Epidemic," discusses the pathologizing of children during our <a href="https://www.earthrisepodcast.com/health/91-do-antidepressants-create-more-mental-illness-than-they-cure-with-robert-whitaker/" target="_blank">recent conversation</a>. Whitaker has won a number of awards for his reporting on the psychiatry industry; he was a Pulitzer finalist for a series on psychiatric research he co-wrote for the Boston Globe. While his investigative reporting covers a range of topics, an important thread weaves together his work: Why do Americans take so many prescription drugs? </p><p>In"Anatomy of an Epidemic," Whitaker points out that as prescriptions for SSRIs, SNRIs, and antipsychotics rise, so do anxiety and depression diagnoses. If these drugs worked, fewer people should be diagnosed. In a for-profit health care system, however, new customers are always needed. Minor complaints are now pathologized. Creating an illness is the best way to sell a drug. </p><p>The 20th century represented a remarkable turning point in medicine. It also marked the beginning of a tragic misunderstanding of mental health. After millions of years of successful evolution, humans were suddenly victims to brain chemistry gone awry. We were sold on the idea that chemical imbalances are the <em>cause</em> of anxiety and depression, not a biological <em>effect</em> created by environmental conditions. Antidepressants predominantly treat a symptom, not the cause, of our malaise. </p><p>As Whitaker mentions, short-term use of antidepressants can be helpful. Even with an <a href="https://bigthink.com/surprising-science/antidepressants-withdrawal" target="_blank">increasing number of studies</a> detailing the negative long-term effects of these drugs, we're swallowing more pills than ever. I chatted with Robert about why that is and how we can course correct. Our talk was edited for clarity, but you can watch the full conversation or read the transcript below. <span></span></p>
EarthRise 91: Do antidepressants create more mental illness than they cure? (with Robert Whitaker)
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="8f49b126e8733bbd95c21de0476fb1f8"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/UnB7tXvztT4?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p><strong>Derek: Why did you begin investigating the medicalization of psychiatry?</strong></p><p>Bob: I co-wrote a series for <em>The Boston Globe</em> on abuses of psychiatric patients in research settings. While I was doing that research, I came upon <a href="https://books.google.com/books?id=koZ9AgAAQBAJ&pg=PA353&lpg=PA353&dq=world+health+organization+bad+outcome+if+living+in+developed+nation+schizophrenia&source=bl&ots=veGZPHysje&sig=ACfU3U2kmTzuMKkuJh8mN73cwOUtaC_iXA&hl=en&sa=X&ved=2ahUKEwiTlKP81YLqAhV4IzQIHUGpCOEQ6AEwCXoECAoQAQ#v=onepage&q=world%20health%20organization%20bad%20outcome%20if%20living%20in%20developed%20nation%20schizophrenia&f=false" target="_blank">two World Health Organization studies</a> on outcomes for schizophrenia patients. They were cross-cultural studies in nine different nations, and both times they found outcomes were much better in poor countries than "developing" countries. India, Colombia, and Nigeria fared better than the US and other rich countries. The World Health Organization actually concluded that living in a developed country is a strong predictor you'll have a <em>bad outcome</em> if you're diagnosed with schizophrenia. I wondered why living in a developed country, with all of our advances in medicine, would be a predictor of a bad outcome.</p><p>The common narrative was how we were making progress in treating mental disorders. We were finding that they were due to chemical imbalances; we had drugs to fix those chemical imbalances. Yet here were cross-cultural studies finding something much different. </p><p>I also found that they use antipsychotics very differently: for short-term but not long-term. That also went against what I knew to be true. </p><p>The final thing that launched me into this was looking at a Harvard study that found outcomes for schizophrenia patients in the US had declined in the last 30 years; they're no better than they'd been in the first third of the 20th century. That also belied the narrative of progress.</p><p><strong>D: I was prescribed Xanax for a short period of time when I suffered from severe panic disorder. When I explained to my doctor what was happening, she immediately said, "What you're going through is no different than any physical disease." When I read "Anatomy of an Epidemic," it struck me how <a href="https://books.google.com/books?id=XhPp_o6bB3EC&pg=PA46&lpg=PA46&dq=howard+rusk+depression+is+like+any+physical+disease&source=bl&ots=JxGt_sAk5g&sig=ACfU3U1CvTvw9vhS8QXzZG_S4Sxn58Bkvg&hl=en&sa=X&ved=2ahUKEwiTn_ih1oLqAhXEIjQIHW72BFgQ6AEwAHoECAoQAQ#v=onepage&q=howard%20rusk%20depression%20is%20like%20any%20physical%20disease&f=false" target="_blank">this exact message</a> had been marketed as the proper approach for treating mental health in the early fifties. Writing of that era, you discuss the American Medical Association, pharmaceutical industry, and government working together to drive that narrative.</strong></p><p>B: I love science. It's one of the most beautiful manifestations of the human mind. What I gradually came to understand is that we weren't seeing the presence of a scientific mind in this creation of the narrative of a chemical imbalance.</p><p>Guild interests were at play. You said you were told that "this is like any other physical disease." The reason that works so well for a commercial narrative is because I can't get a drug approved for "anxiety of life" or "general unhappiness." But I can get a drug for panic disorder. I can get approved for something seen as a biological condition. </p><p>From a pharmaceutical point of view, if you can create a narrative that the discomfort of life is a biological condition, you're going to expand your market dramatically. Before 1980—which is when panic disorder was first identified as a specific disorder—the group of things that were seen as biological was pretty small. It was going to be hard for the pharmaceutical market to expand beyond that. </p><p>Why did psychiatry want to tell this tale? Psychiatry in the fifties and sixties had a lot of Freudian impulses and psychodynamic thinking. Then in the seventies, you see a guild whose survival as a medical discipline was under attack. As the benzodiazepines were popping up—those were the first real popular psychiatric drugs—there were problems with addiction, withdrawal, and lack of efficacy over time. </p><p>In the seventies, the American Psychiatric Association <em>as a guild</em> felt threatened. Diagnoses were being challenged. It was in competition with talk therapy counseling and other ways of approaching wellness. You can see them saying, "How can we rise above this competitive fray?" </p><p>Well, what image has power in American society? The white coat. They said, "We need to put on the white coat. If we call these <em>diseases of the brain</em>, we're now in that field of (almost) infectious disease medicine." You start telling yourself a story and you're going to want to believe that story. You can see psychiatry trying to convince itself that these diseases are chemical imbalances. </p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzM5MjE5Mi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NzM5MjkxMX0.ixqWHFTHuR6KEVh-p5qjw9rxP05nKqJ3d2SgPpqTP8o/img.jpg?width=1245&coordinates=0%2C33%2C0%2C110&height=700" id="e47b7" class="rm-shortcode" data-rm-shortcode-id="68b976b8d09a0dccbd18f53e77b19205" data-rm-shortcode-name="rebelmouse-image" alt="A worker at Galenika, a major Serbian pharmaceutical company" />
A worker at Galenika, a major Serbian pharmaceutical company, stacks on October 23, 2009 packages of Bensedin anti-depressant pills. "A Benjo a day takes your troubles away," said a tongue-in-cheek Belgrade graffiti featuring the slang name of the popular antidepressant in the 1990s.
Photo: AFP via Getty Image
<p><strong>D: A <a href="https://bigthink.com/surprising-science/ketamine-depression" target="_blank">recent analysis</a> showed that trials for esketamine were rushed and did not show true efficacy, but the FDA approved the drug anyway. This is the first psychedelic approved for medical use, yet we seem to be making the same mistakes as with other drugs. How do we break this loop? </strong></p><p>B: When a pharmaceutical company wants to get a drug approved, they're going to design the study in ways that make their drug look good. There are all sorts of tricks. If you know of certain side effects, don't put them on the checklist of problems that you look for and you won't get nearly as many spontaneously reported actions. People who are funding the studies of these drugs by and large have a vested interest in seeing them approved.</p><p>Our mechanism of approval is also misunderstood. People generally think that if a drug is approved by the FDA, that means it's safe and good for you. The FDA isn't actually saying that the benefits outweigh the harms. It's saying we have this standard for approving a drug: if you can show two trials where it has statistically significant benefit over placebo, that's a sign of efficacy.</p><p>Let's say you have a drug that provides a relief of symptoms in 20 percent of people. In placebo it's 10 percent. How many people in that study do not benefit from the drug? Nine out of 10. How many people are exposed to the adverse effects of the drug? 100 percent. </p><p>They'll pass that drug because it meets this small standard of benefit over placebo. And they're not subtracting the risk; they're just warning of the risk. It's not up to doctors to decide whether it's helpful. This process is just saying, "it's met our societal standard for getting it on the market."</p><p>We also don't measure long-term exposure. If you look at Xanax, it doesn't show any efficacy after about four weeks. If you're taking it on a daily basis, you really should get off it. But all sorts of people have been on it for two years, three years, five years, 10 years. We don't have a mechanism for assessing what happens to people on these drugs for that amount of time.</p><p><strong>D: Why does the medical industry not discuss the <a href="https://bigthink.com/21st-century-spirituality/the-power-of-the-placebo-effect" target="_blank">power of placebo</a> more often? </strong></p><p> B: This goes to a larger question about how we think about wellness as a society. There have been a lot of changes in medicine, but the benefits of antibiotics created a mindset about how effective drugs could be for whatever ails you. It set in motion this idea that medicine could come forth with pills that could help whatever you might be presenting with. You see this rapid rise in the use of prescriptions as well.</p><p>Increasingly, doctors found themselves in a position where patients were hoping to leave with a prescription. You can't write a prescription for placebo. It would probably be very helpful if you could. The interaction between doctor and patient is actually a sort of placebo interaction. The patient comes for help, they think the doctor has magical potions, and they want to leave with that magical potion. That's in our mindset.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzM5MjE4Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzODQ0MzY3NH0.ZUMyclTXpcVMXlqmutVdfIoVLsBbQA3N7wZKvE2Sz8k/img.jpg?width=1245&coordinates=0%2C94%2C0%2C14&height=700" id="e8a72" class="rm-shortcode" data-rm-shortcode-id="b30e0d54424df0af7965002a1a0e3783" data-rm-shortcode-name="rebelmouse-image" alt="Artwork: Original building of The Retreat, York. Instituted 1792." />
Original building of The Retreat, York. Instituted 1792.
Photo: Wikimedia Commons
<p><strong>D: One of the most powerful stories in "Anatomy of an Epidemic"</strong><strong> is the 19th century Quaker practice of <a href="https://en.wikipedia.org/wiki/Moral_treatment#:~:text=Moral%20treatment%20was%20an%20approach,from%20religious%20or%20moral%20concerns." target="_blank">moral therapy</a>. Can you foresee a return to this sort of model?</strong></p><p>B: I love the humility in it. They admitted they didn't really know what causes madness, but here's the key: they said, "we know they're brethren. They're humans, like all of us." Then they asked, "What do we like? We all like a comforting environment; we need shelter; we need food; it's good to have interests; it's good to have socialization and respect toward each other." </p><p>One of the beautiful aspects of moral therapy is they wanted to create these residences out in the country. They thought nature could be very healing, diet could be very healing, a little glass of port at four in the afternoon could be healing.</p><p>My favorite part of the moral therapy approach was they would hold a mirror to reflect the image back not of a bad person, but the image of someone who<em> could be in society</em>, who could be with others without fear. They were creating environments where people felt safe and found meaning. They felt respected as well.</p><p>If you look at the medical notes, these people were psychotic. They were having trouble assessing reality. Historians found that with this sort of comforting environment many people, about two-thirds, their psychosis would abate naturally over time. Most would never come back to the hospital; they would have a time of psychosis rather than a chronic illness.</p><p>Our drug basis is very different: <em>We're going to fix something wrong with the inside of your head</em>. Moral therapy is about fixing the environment you move through and creating a new environment. Our mental health arises within environments, not just the inside of your head. </p><p><strong>D: I walked a half-mile to school at age six, so I come from quite a different time, even though I'm only 44. If I was growing up now, I would be put on a drug for ADHD, as I was pretty hyper. Yet our prefrontal cortex doesn't fully develop until our twenties. <strong>The idea of putting six-year-olds on these drugs is insane. </strong></strong></p><p>B: This is one of the biggest moral questions of our time: How do we raise our children? The biggest moral question of our time is climate change. If we don't respond to that, we're really screwing future generations. But it is a big question.</p><p>We've created a pathologizing environment for them. Why did we do that?</p><p>If you go back to the early nineties, the drug companies recognized the adult market for SSRIs was being saturated. Where's the untapped market? Kids.</p><p>You had already started to see that with stimulants for ADHD, but what you see post-1980 is market forces: pharmaceutical companies worked with academic psychiatry to start talking about all of these childhood disorders and the need to medicate them.</p><p>What I find particularly distressing is that all the data you can find on medicating kids is ultimately negative, even on symptoms, cognitive function, social functioning, and academic achievement. Most frightening of all—since you opened this with ideas of frontal lobe development—all of our animal studies show that these drugs affect brain development.</p><p>If you look at the harm done from pathologizing childhood, it's so broad-based. Kids are taught to monitor their own self. If they find themselves sad, that's wrong, that's abnormal. Whereas in the past, you might think, "I'm sad today." You're expected to be happy, and if you're not happy, that's a problem. We've created a situation where kids are primed to think, "something's wrong with me," and parents are primed to think, "something's wrong with my kid."</p><p>Going back to moral therapy: Do we ask about the spaces kids inhabit today? You got to walk a half-mile to school. How many kids get to walk to school today? How many kids feel pressure by second grade to start getting good grades because they have to worry about getting into college?</p><p>You create a narrative that helps drive people into this "abnormal" category, so they start using these drugs. And we have all this evidence that it isn't benefiting kids. </p><p>We've seen rising suicide rates in kids. Then there's the rise in antidepressants, too. Go to college campuses today, the percentage of kids that <a href="https://time.com/5190291/anxiety-depression-college-university-students/" target="_blank">arrive with a diagnosis</a> and a prescription is 25 to 30 percent. Do you really think 30 percent of our kids are mentally ill? </p><p>You've given kids messages that they're abnormal, ill, and compromised, instead of giving them messages of resilience, of how to grow into life. You can't chase happiness. You can chase meaning in life. You can chase doing things that have some meaning to the social good. I can't just try to be happy. Happy visits you when you're engaged in social relationships, meaning, community, that sort of thing.</p><p>The pathologizing of kids is taking away the right of every child to become the author of their own life: to make choices, to try things out, to decide what they want to be, and to grapple with their own minds.</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
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Photo by Anusha Barwa on Unsplash
- A 2019 study in Journal for the Scientific Study of Religion found that religious believers are more likely to own dogs than cats.
- Researchers found that hardcore evangelicals are less likely to own pets than more the progressive religious.
- Pet ownership also skews political: Democrats prefer cats while Republicans choose dogs.
<p>Bastet was the daughter of the sun. The ancient Egyptian goddess was originally a fierce lioness warrior—a strong woman with the head of a big cat. Over time, her image morphed into a recognizable house cat until, as domestication commenced, her role disappeared altogether. I suppose it's difficult treating the furry purring machine rubbing up against your leg as an all-powerful solar goddess.</p><p>Strangely, there aren't a ton of feline deities. Bastet is by far the most famous. There's Dawon, the tigress that carries the fierce goddess, Durga, into combat; Bali's panther god, Barong Ket; Ovinnik, the black cat that chases away evil ghosts on Polish farms; and China's Li Shou, also revered by farmers for decimating mice and rats. Given their ubiquity in our world, you'd think cats would have a more religious presence. </p><p>Perhaps we can point to believers' lack of appreciation for cats. That's the topic of a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jssr.12637" target="_blank">2019 study</a>, published in the Journal for the Scientific Study of Religion. University of Oklahoma associate professor, Samuel Perry, and Eastern Illinois University assistant professor, Ryan Burge, wanted to gauge pet ownership among church goers. The religious prefer dogs by a wide margin: 74.9 percent to 40.3 percent. </p><p>Americans love dogs. With over 70 million claimed, we own 2.5 times as many canines as the runner-up, China. We also love spending money on pets: over $72 billion in 2018. That's more than on all sports combined. </p><p>Previous research points out religious tradition and biblical literalism don't necessarily predict pet ownership, though the team did discover that evangelicals are less likely to own a pet than progressive faiths. That's also true for people that attend church most often. </p>
Jackson Galaxy's Top Tips For Cat Owners | My Cat From Hell
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="bfc883e7258e80ec94eb01e1ccae29ab"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/Rjol1zMVcos?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>For this study, Perry and Burge used a 2018 survey with 2,348 respondents. Half replied to questions about pet ownership, with mean average of 1.72 pets per household. They broke down statistics on the three largest religious groups: evangelicals, mainline Protestants, and Catholics.</p><p>Biblical significance only affects evangelicals. Since the Bible isn't exactly PETA-friendly, with all the directives about lording over the kingdom, hardcore religious appear less likely to support animal rights and are more likely to tolerate cruelty toward other species.</p><p>On a related note, pet ownership is political: dogs are more likely to live in rural, Republican-leaning regions, while cats dominate urban, Democratic strongholds. </p><p>The most interesting aspect of their study involves speculation about pet owner psychology. Apparently, the most religious households think about what a pet can <em>do</em> instead of adopting them for what they <em>are</em>.</p><p style="margin-left: 20px;">"We would expect that Christian conservatism―as indicated by evangelical affiliation and more literalist interpretations of the Bible―would predict the ownership of family pets that have more practical utility such as dogs, but not necessarily cats."</p><p>Cat owners are often considered isolated, neurotic individuals, whereas "dog people" are social and extraverted. Indeed, dog park visits and walking around the neighborhood appear to be motivating factors for owning a dog. Larger families tend to be more religious <em>and</em> own more dogs as well. </p><p>The antisocial aspect of cat owners has recently been downplayed. A few crazy ladies can't ruin the image for the rest of us. Pet ownership is psychologically healthy: Having an animal reduces your anxiety and depression, as well as increases self-esteem among adults and children.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzM4NTQ4Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0Nzc3ODA2N30.ctJDA012TxjQee-4VyA7ysSDvSR4TkhalZvljgDNGqs/img.jpg?width=1245&coordinates=0%2C604%2C0%2C261&height=700" id="df5f5" class="rm-shortcode" data-rm-shortcode-id="f463c1cd1f95a46fa5f72f8cfaae84f8" data-rm-shortcode-name="rebelmouse-image" alt="dog lying on carpet with paw on top of cat" />
Photo by Tatiana Rodriguez on Unsplash
<p>After over two decades of living with cats, there are two personal notes I have of this <a href="https://www.psychologytoday.com/us/blog/unique-everybody-else/202006/why-religious-people-are-less-likely-own-cats" target="_blank">and related</a> studies. </p><p>While cats are independent animals, they are not antisocial. My wife and I have three cats. Every evening, three cats surround us on the couch; this is an <a href="https://www.instagram.com/p/B8vDPhyHk6l/" target="_blank">actual photo</a> she snapped while we were watching a movie. Hardly a night passes without all three sleeping on our bed—socially distanced, as cats do. Two hang out in my office daily while I'm writing; the third has claimed a cubby just outside my office door. </p><p>Like other animals, cats respond to how you treat them. If you act as if they're antisocial, they'll respond in kind. If you regularly play with and hold them, especially from an early age, you've got a companion for life. As they are extremely territorial creatures, if you construct a living environment conducive to their needs—lots of places to climb up high and look out windows—they're going to love living in that environment. Adopting one and refusing to meet them on their terms guarantees antisocial behavior. </p><p>The other comment is more speculative. Western religion is based on top-down authority. God gives directives; humans follow. This plays well with the psychology of dogs (which, to be clear, we also love). Dogs understand reward and punishment. If they could read, they'd love the Bible. </p><p>Punishment doesn't work on cats. They're not designed that way. If you scream at a cat while he's urinating on your carpet, he's going to think, "Why is this ape yelling?" not "I shouldn't be doing this." You probably shouldn't own a cat if you can't come to terms with this feature of their psychology.</p><p>Cats understand rewards, which is why <a href="https://www.adventurecats.org/backcountry-basics/how-to-clicker-train-a-cat/" target="_blank">clicker training</a> is so effective. They'll never realize that urination + carpet = bad, but they will get that urination + litter box = treat, especially if you tether the treat to a clicker. (Clicker training also works for dogs, horses, and other animals.) </p><p>If you're trained to believe in a god that doles out punishment to criminals and rewards the faithful, you'll inherently understand dogs. By contrast, domesticated cats are the offspring of nature's fiercest killing machine. They have no need for your punishment or deities, but they will accept your treats. Think of it as tithing. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
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Withdrawal symptoms from antidepressants can last over a year, new study finds
We must rethink the "chemical imbalance" theory of mental health.
05 June, 2020
Photo Illustration by Joe Raedle/Getty Images
- A new review found that withdrawal symptoms from antidepressants and antipsychotics can last for over a year.
- Side effects from SSRIs, SNRIs, and antipsychotics last longer than benzodiazepines like Valium or Prozac.
- The global antidepressant market is expected to reach $28.6 billion this year.
<p>In her book, "Blue Dreams: The Science and Story of the Drugs That Changed Our Minds," psychotherapist Lauren Slater discusses psilocybin and MDMA as potential treatments for depression. Sadly, she hasn't tried either given her longstanding antidepressant usage. As <a href="https://bigthink.com/21st-century-spirituality/its-time-to-integrate-psychedelics-into-therapy" target="_self">she told me</a> in 2018, psychedelics are contraindicated to Prozac. Yet she sees hope in this class of drugs for a wide range of mental health treatments. </p><p>After I described the psychedelic experience, she replied, </p><p style="margin-left: 20px;">"I can imagine them very vividly, but it's not the same as actually getting to take them. I think if I could actually get to take a psychedelic, a lot of what I fear would go away. And I think I would be a better person because of it. But I do understand I have a sort of intuitive understanding of what they do."</p><p>Slater has been taking antidepressants for decades. While aware of the problems with long-term usage, she is unable to withdraw given the crippling side effects. This is a <a href="https://www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html" target="_blank">serious problem</a> for millions of antidepressant users, as detailed in a <a href="https://pubmed.ncbi.nlm.nih.gov/32259826/" target="_blank">new review</a> published in the journal <em>Psychotherapy and Psychosomatics</em>.</p><p>Written by University of Florence Associate Professor of Clinical Psychology, Fiammetta Cosci, and Maastricht University's Guy Chouinard, the review points out popular antidepressant and antipsychotic medications, including SSRIs and SNRIs, exhibit more severe withdrawal symptoms than benzodiazepines (such as Valium and Xanax), Z-drugs, and ketamine. </p><p>Benzodiazepines were first synthesized in 1955. This class of tranquilizers took the place of Meprobamate (Miltown), which is considered one of the world's first blockbuster drugs. As Miltown lost favor due to a growing population of addicts, benzos took its place in psychiatry offices. By the late seventies, benzos were the world's most prescribed medications despite growing evidence of their addictiveness and side effects. By contrast, SSRIs and SNRIs are generally considered less damaging than benzos—an assessment that must now be reconsidered. </p>
Challenging the Chemical Imbalance Theory of Mental Disorders: Robert Whitaker, Journalist
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="41699c8c2cb2aee9271a36646e0bee7d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-8BDC7i8Yyw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>With the global antidepressant market <a href="https://www.researchandmarkets.com/reports/5017384/antidepressants-global-market-report-2020-30?utm_source=dynamic&utm_medium=GNOM&utm_code=mmlpx9&utm_campaign=1380453+-+Global+Antidepressants+Market+(2020+to+2030)+-+COVID-19+Implications+and+Growth&utm_exec=jamu273gnomd" target="_blank">expected to reach</a> $28.6 billion this year, pharmaceutical companies go to great lengths to downplay the long-term effects of these drugs. Slater writes that lithium showed clinical efficacy in treating depression but has never been approved by the FDA (except for manic-depressive disorder). The real issue: you can't patent an element.</p><p>In the review, Cosci and Chouinard categorize withdrawal symptoms into three groups. University of West Georgia instructor of psychology, Ayurdhi Dhar, <a href="https://www.madinamerica.com/2020/06/review-documents-short-long-term-withdrawal-effects-psychiatric-drugs/" target="_blank">breaks them down</a>: </p><p style="margin-left: 20px;">"New withdrawal symptoms and rebounds are short-lived, temporary, and reversible. However, new withdrawal symptoms are new for the patient (nausea, headaches etc), while rebound symptoms refer to the sudden return of primary symptoms that are often more severe than pre-treatment. Persistent post-withdrawal disorder refers to 'a set of long-lasting, severe, potentially irreversible symptoms which entitle rebound primary symptoms or primary disorder at a greater intensity and/or new withdrawal symptoms and/or new symptoms or disorders that were not present before treatment.'"</p><p>Each class of drugs cited in the review produce some withdrawal symptoms. Benzos and Z-drugs can cause confusion, sweating, rebound anxiety, and psychosis, generally lasting between two to four weeks (though <a href="https://www.madinamerica.com/2018/01/cognitive-impairment-long-term-benzodiazepine-use-remains-even-drug-withdrawal/" target="_blank">in some cases</a>, impaired cognition can last longer). Ketamine, the <a href="https://bigthink.com/21st-century-spirituality/ketamine-is-helping-alleviate-depression-fast" target="_self">first psychedelic</a> approved for clinical use in America, can produce rage, tremors, palpitations, and hallucinations, though the effects are short-lived: three days to two weeks. </p><p>The authors find that SSRIs, SNRIs, and antipsychotics have the worst record for withdrawal symptoms. Antidepressants can produce pain, numbness, depressions, stroke-like symptoms, and much more. With SSRIs, impaired memory, sexual dysfunctions, panic attacks, and pathological gambling can continue for a year after discontinuation even if the patient tapers off slowly. </p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzM3NTMxNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwNTUxMDE0NX0.hYdBPNzcJOE_YyajacMhEA2Jv6HhFceUMBfMYsD8Z0Y/img.jpg?width=1245&coordinates=0%2C68%2C0%2C39&height=700" id="89d8d" class="rm-shortcode" data-rm-shortcode-id="d6c7d329010934707a3450ecdba4285c" data-rm-shortcode-name="rebelmouse-image" />
A bottle of antidepressant pills named Effexor is shown March 23, 2004 photographed in Miami, Florida.
Photo Illustration by Joe Raedle/Getty Images
<p>In 2014, Professor Peter C. Gøtzsche of The Nordic Cochrane Centre in Copenhagen <a href="http://www.deadlymedicines.dk/wp-content/uploads/2015/05/3-G%C3%B8tzsche-Psychiatry-gone-astray.pdf" target="_blank">published an article</a> highlighting the dangers of antidepressants (featured in Robert Whitaker's "Anatomy of an Epidemic"). Gøtzsche calls for psychiatrists to abandon the longstanding myth of the chemical imbalance theory of the brain. He believes popular pharmacological interventions are the true source of imbalances.</p><p style="margin-left: 20px;">"We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders, and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. It is very bad to give patients this message because the truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract."</p><p>As the #BLM protests are exposing more than ever, systemic issues around inequality and racism create the environmental conditions for mental health problems to manifest. Chemical imbalances are a symptom; writing a script does not treat the cause of depression or anxiety. </p><p>While a certain percentage of depressed and anxious patients will benefit from short-term usage of prescription medication, mounting evidence against their long-term use, as detailed in this new review, must force the medical establishment to rethink its approach. The for-profit health care system has failed us too long. We can no longer afford to pay its toll. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
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Why is Gen X more stressed than other generations?
A Penn State study finds today's middle-aged are experiencing much higher stress levels than 30 years ago.
11 May, 2020
Photo By Getty Images
- A study based at Penn State found the middle-aged are much more stressed than other age groups.
- While most generations average a 2 percent increase in stress levels from 1990, those aged 45-64 show a 19 percent uptick.
- The reasons include concern for their children, fears of unemployment, and a deluge of information.
<p>When I was young, I used to walk to school uphill in the snow in both directions, even in June. It would take three hours to get there and five to return home. Kids today, they don't know suffering. </p><p>That's all a lie, of course, though I do recall my grandfather expressing a similar sentiment. He was also likely joking—sarcasm is a family trait—but there is a persistent notion that things get easier in every generation. As we grapple with the <a href="https://www.fool.com/careers/2020/05/09/unemployment-is-at-its-worst-since-the-great-depre.aspx" target="_blank">highest unemployment numbers</a> since the Great Depression, we now know that's not true. </p><p><a href="https://news.psu.edu/story/618484/2020/05/07/research/middle-age-may-be-much-more-stressful-now-1990s" target="_blank">New research</a> from Penn State claims what my Gen X peers have long suspected: middle age really is harder now, at least when compared to that Golden Era of the nineties. Kurt Cobain perfectly captured our existential duress 30 years ago. We're still dealing with cultural and economic trends that are adding more stress to our lives. </p><p>The team found a slight increase among all age groups when comparing the tens to the nineties. For respondents aged 45-64, that number jumped much higher. On average, people reported a 2 percent increase in all stressors, says David Almeida, professor of human development and family studies at Penn State. That equates to an additional week of stress every year. A different story unfolded with Gen Xers and younger Boomers. </p><p style="margin-left: 20px;">"<span style="background-color: initial;">What really surprised us is that people at mid-life reported a lot more stressors, about 19% more stress in 2010 than in 1990. And that translates to 64 more days of stress a year."</span></p>
Nirvana - In Bloom (Official Video)
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="b4c32ff484128fd1d739e9637c0e2cd4"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/PbgKEjNBHqM?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>While this research pulls from data that's a decade old, consider a <a href="https://learning.linkedin.com/blog/advancing-your-career/stress-at-work-report--who-is-feeling-it-the-most-and-how-to-com?mod=article_inline" target="_blank">2019 study</a> by LinkedIn that found Gen Xers are significantly more stressed than neighboring generations. In that study, the top five stressors were work-life balance, confidence in job future, sense of purpose, work politics, and access to tools that let you do your job. </p><p>The meme war between Millennials and Boomers has always relied on a strange dynamic, considering that the former <a href="https://www.cnbc.com/2019/11/05/millennials-earn-20-percent-less-than-boomersdespite-being-better-educated.html" target="_blank">earn 20 percent less</a> than the latter despite being better educated. Gen X sits in the middle: <a href="https://www.marketwatch.com/story/this-depressing-chart-shows-the-jaw-dropping-wealth-gap-between-millennials-and-boomers-2019-12-04" target="_blank">earning less</a> (relatively) than their parents while <a href="https://www.cnbc.com/2019/09/19/how-much-millennials-earn-compared-to-their-parents.html" target="_blank">bringing in more</a> than their children. Life is not defined by money alone, yet it is an important factor when discussing <a href="https://www.webmd.com/balance/guide/causes-of-stress#1" target="_blank">stress levels</a>: job satisfaction, being overworked and underpaid, and feeling insecure in your employment are some of the biggest stressors in modern life. </p><p>For this study, the team at Penn State collected data from 1,499 adults in 1995 and compared it with responses from 782 adults in 2012. Each participant had been interviewed every day for eight consecutive days, in which they were asked about life stressors: relationship and friendship issues, finances, work problems, prospects for the future. The interviewers assessed how much impact these stressors had on other aspects of their lives. </p><p>Almeida expected to see higher rates of dissatisfaction in young adults. He was surprised that the most affected demographic was middle-aged respondents. He doesn't believe it's all about them, however. He puts at least part of the burden on concern for their children, who, as mentioned above, face a tougher job market. </p><p>And it's not going to get easier. As Washington state congresswoman Pramila Jayapal <a href="https://www.vox.com/2020/5/6/21243442/pramila-jayapal-stimulus-negotiations-coronavirus-covid-19-economy-ezra-klein-show" target="_blank">recently stated</a>, we keep discussing getting back to "normal" when many Americans haven't experienced normal for decades. We need to discuss what the economy looks like a year from now: the jobs that will be available, the industries we need to say goodbye to, and a plan for finally addressing income inequality. Instead, we're forcing low-wage workers to return to unsafe working conditions in hopes of a normality that never really worked for them anyway. </p><p>Almeida also speculates that the rapid pace of change due to technology could be adding additional stress, especially to Gen X. The entire "optimization market" overwhelms us by constantly making everyone feel behind. An entire class of supplements purported to enhance creativity, boost memory, and improve overall brain performance is <a href="https://www.globenewswire.com/news-release/2020/02/19/1987135/0/en/Nootropics-Market-To-Reach-USD-5-32-Billion-By-2026-Reports-And-Data.html" target="_blank">estimated to reach</a> $5.32 billion by 2026. With such an emphasis on "optimizing" every aspect of employment and life, the fear of falling behind creates elevated levels of stress.</p><p>The daily deluge of information, which often leads to <a href="https://www.calnewport.com/blog/2019/09/03/on-the-surprising-benefits-of-an-un-mobile-phone/" target="_blank">smartphone addiction</a>, is cognitively draining. Almeida suspects this is yet another factor negatively impacting the middle-aged right now. Gen Xers sit at the intersection of a technology-light childhood while also recognizing its role in today's workforce. Navigating the middle terrain is rough. </p><p>Everyone's stress levels are rising. Twenty-eight percent of working parents that are currently sheltering at home are experiencing a "<a href="https://www.axios.com/coronavirus-parents-stress-066aa3e1-d1d9-4112-84ed-c65184d04e39.html" target="_blank">trauma-related mental health disorder</a>." The World Economic Forum <a href="https://www.weforum.org/agenda/2020/04/this-is-the-psychological-side-of-the-covid-19-pandemic-that-were-ignoring/" target="_blank">believes</a> the second half of 2020 will be even worse for stress and depression. The above 2 percent number for most age groups will likely increase in the coming months. </p><p>And there's Gen X, leading the way again, as if we were built for this moment. How sturdily remains another story. Now give me <a href="https://www.youtube.com/watch?v=LdF_Vo4B6Ms" target="_blank">my two dollars</a>. </p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>. His next book is</em> "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</p>
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Attending religious service once a week found to lower risk of suicide and other "deaths of despair"
08 May, 2020
Photo by Ronny Hartmann / AFP
- A study of nearly 100,000 health care workers found that those who attend weekly religious services are less likely to die from a "death of despair."
- The Harvard researchers note that women are considerably less likely to die such a death than men.
- Community support seems to be a major reason for helping people grapple with existential distress.
<p>In late April, the news hit us hard: Lorna Breen, an emergency room doctor in a Manhattan hospital flooded with coronavirus patients, <a href="https://www.nytimes.com/2020/04/27/nyregion/new-york-city-doctor-suicide-coronavirus.html" target="_blank">committed suicide</a>. According to her father, the emotional toll of treating these patients was too much for her to handle. Even though she previously exhibited no sign of mental health issues, witnessing so many people being rolled into her facilities already dead was overwhelmed.</p><p>It's hard to describe the chaos of an overbooked emergency room. I worked as a patient monitor at Robert Wood Johnson University Hospital for two years. The environment can transform from silent to slammed in a heartbeat. While my job was to ensure that patients didn't try to kill themselves, it was impossible to miss the emotional challenges of being a doctor or nurse working a 24-hour shift, or even an 8-hour shift. </p><p>New York City claps for their health care force nightly. It's a beautiful sentiment, yet when you're working in the thick of this virus, hoping to both help others and not become infected yourself, the weight is heavy. I recently talked to a friend who is an emergency room physician's assistant at a particularly hard-hit hospital. He told me that he recently yelled at someone in his neighborhood for not wearing a mask, and he is the last person I'd ever suspect of yelling at anyone. Your environment changes you. We are a different people now than just a few months ago. </p>
Why religion is literally false and metaphorically true | Bret Weinstein
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="bb748b6454d9ea27e58c41be9c4b50f6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/c0_J998UD9s?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>A <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2765488" target="_blank">unique new study</a> at the Harvard T.H. Chan School of Public Health found an interesting link between mental health and health care workers: those who attend a religious ceremony once a week are less likely to suffer from a death of despair. These include dying by suicide and alcohol or drug overdoses. </p><p>The researchers collected data from 66,492 female registered nurses and 43,141 male health care professionals, including dentists, pharmacists, and optometrists. The women's data was collected from the large-scale Nurses' Health Study II, conducted between 2001-2017. The men's data comes from the Health Professionals Follow-up Study, conducted from 1988-2014. </p><p>The researchers note that life expectancy in the US has been decreasing since 2015. This coincides with an increased rate of midlife death from suicide, unintentional drug or alcohol poisoning, and alcohol-related chronic liver disease and cirrhosis. While "deaths of despair" was initially coined to describe the psychological effects of unemployment, the weakening of traditional support systems, such as religious services, are also implicated with higher drug and alcohol use and suicide. This is a particular challenge that we are navigating in the era of social distancing. </p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzI2Mzk5OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0MzU3NDQzOH0.FOnNRX5aQE5jK9yxuRgQO_S_TpjfrFw0xiJMNoIZ9vg/img.jpg?width=1245&coordinates=0%2C31%2C0%2C75&height=700" id="1eaeb" class="rm-shortcode" data-rm-shortcode-id="cc3ae7e0dccc48abcb555fc5b18086ff" data-rm-shortcode-name="rebelmouse-image" />
Buddhist monks wearing facemasks take their places for prayers inside the Wat Bowonniwetwiharn temple as Thais are encouraged not to gather inside places of worship, in an attempt to stop the spread of the COVID-19 novel coronavirus, on Visaka Bucha Day in Bangkok on May 6, 2020.
Photo by Lillian Suwanrumpha / AFP
<p>Previous studies have shown that religion is a positive determinant in health and mental well-being. Lower risks of suicide, heavy drinking, depression, and substance abuse has been observed in the religious. As they phrase it,</p><p style="margin-left: 20px;">"Religious participation may promote health and well-being through strengthening social integration, encouraging healthy behaviors, and providing a sense of hope, meaning, and purpose in life."</p><p>According to their research, religion tends to positively impact women more than men. The nurses had a 68 percent lower risk of death during the period studied. Men experienced a 33 percent reduced risk.</p><p>Research associate and data scientist, Ying Chen, who was first author of the study, notes that this is especially important information at this time. </p><p style="margin-left: 20px;">"These results are perhaps especially striking amidst the present COVID-19 pandemic. They are striking in part because clinicians are facing such extreme work demands and difficult conditions, and in part because many religious services have been suspended. We need to think what might be done to extend help to those at risk for despair." </p><p>Religion might not be a cure-all, but for alleviating symptoms of despair, religious services appear to help. Whether seeking existential guidance or social support, we are social animals. Community matters. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>. His next book is</em> "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</p>
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