That question is at the heart of the new documentary, "Medicating Normal."
- The directors of the new documentary, "Medicating Normal," want psychiatrists to require informed consent when writing prescriptions.
- Long-term effects of antidepressant usage do not have to be documented for FDA approval.
- Big Think talks to producer/director Wendy Ratcliffe and film subject, Angela Peacock.
While humoral theory was finally abandoned with the acceptance of germ theory, Hippocrates offered many important insights into the nature of disease. The humors pointed to bodily causes of disease at a time when many thought divine forces were at play. ("Men think [epilepsy] divine merely because they do not understand it," wrote one Hippocratic student.) Though disease specificity of blood and phlegm took time to understand, important ramifications for the future of medicine were being considered nearly 2,500 years ago.
The most interesting humor was black bile. Black liquid secreted by the spleen, the temperamental correlation resonates: melancholy. Hippocratic students recognized depression as an imbalance and sought methods to cure it. Over the centuries, various tinctures and herbs addressed melancholy. Doctors agreed targeted medicine helped the patient overcome the imbalance leading to depression; they also believed depression was a natural state that everyone experiences from time to time.
Our views on depression changed when twentieth-century pharmacology entered the picture. Doctors had terrible ideas, such as electroshock therapy and lobotomies, but one of the worst might be the chemical imbalance theory of the brain. As former psychiatrist Dean Schuyler wrote in his 1974 book, most depressive episodes "will run their course and terminate with virtually complete recovery without specific intervention."
That's not how the growing pharmaceutical industry treated it. The pathologizing of depression meant that doctors—in this case, psychiatrists—could diagnose and treat what had long been considered a natural part of life. As often happens in drug development, a substance is discovered and only then is a disease needed for it to treat. Mental health seems particularly useful in this process.
Depression wasn't the only mental health condition to be pathologized. Anxiety is a big one. Lack of focus is another. Any minor deviation from a perceived norm has, over the course of the 20th century, become subjected to diagnosis and, thanks to the lobbying power of the pharmaceutical industry, pharmacological treatments with little to no informed consent.
Take Angela Peacock, an Iraq War veteran that was medically retired due to PTSD. Upon her return in 2004, she was put on one drug after another. By 2006, that meant 18 different drugs. "That took away my ability to even know there's anything wrong with that," she recently told me prior to an online screening of "Medicating Normal" a new documentary that challenges the market for increasingly over-prescribed and under-studied prescription drugs.
EarthRise Podcast 93: Medicating Normal (with Angela Peacock & Wendy Ratcliffe)
During our talk, Peacock is seated next to director and producer, Wendy Ratcliffe. Co-director Lynn Cunningham was initially inspired to pursue this topic when a family member's health deteriorated after 15 years of psychiatric medication. A Harvard graduate and star athlete, this family member is now on disability and exhibits poor mental health.
This brings up a question modern psychiatry rarely confronts: Why are prescription drug rates and rates of anxiety and depression increasing? If the former worked, shouldn't the latter be in decline?
That's not what's happened. Ratcliffe decided to produce "Medicating Normal" after reading Robert Whitaker's 2010 book, "Anatomy of an Epidemic." (Whitaker is featured in the film and was recently featured in my column.) For over three years, the crew followed five people (including Peacock) around as they dealt with the terrifying health consequences of medication dependence.
"These medicines are causing an epidemic of disability," Ratcliffe says. When I ask what she learned about the pharmaceutical industry while making the film, her eyes light up. She shakes her head in disbelief.
"I'm totally shocked by the FDA process: medications that are designed to be taken for many years or even a lifetime, to get them approved they only have to be shown to work better than a placebo over three to six weeks. There is no obligation to test these drugs for long-term side effects. I was shocked to discover that pharmaceutical companies pay for most of the research on their own drugs. They design the research to get the result that they want. When they don't like the result of the trial, they throw it out."
Whitaker told me about the original trial for the benzodiazepine, Xanax. At four weeks, it outperformed the placebo. At eight weeks, however, there was no discernible difference between the placebo and Xanax. By 14 weeks, the placebo outperformed Xanax. To get around this inconvenient data, Upjohn only reported the four-week data. The FDA approved the drug.
That was in 1980. In 2017, 25 million Xanax prescriptions were written.
Pharmaceutical companies understand how to get FDA approval. Like oil companies, they're clueless when tragedy strikes. They don't know how to deal with the long-term side effects of their drugs, so they ignore them. Ratcliffe says the doctors she talked with weren't trained in tapering protocols or educated about the negative impact of the drugs they prescribe. The reflexive response is another drug, not an honest investigation of the drugs themselves.
Wendy Ratcliffe and Lynn Cunningham at the premiere of Medicating Normal at the Santa Barbara International Film Festival.
Credit: Wendy Ratcliffe
This is the process that led to Peacock being prescribed 18 drugs at once. The side effects, she confirms, are not minor.
"From a patient standpoint, I thought dizziness meant I had to get up slowly. The dizziness I experienced coming off of antidepressants and benzodiazepines was like, I can't walk. It was like walking on the Grand Canyon in high heels on a tight wire."
Though the final benzodiazepine nearly killed her, Peacock finally abandoned all drugs in 2016. Today, she feels old parts of herself coming back, but she's not yet whole. She's not sure she'll ever be. Currently living in her RV, she travels around the country educating former vets and promoting the documentary. Unlike her time on prescription drugs, she now has a mission.
"The way we bring people home from war and then put them on drugs is not right," she says. She is doing her best to change that fact.
Both women agree on an important point: psychiatry needs informed consent. The problem, Ratcliffe says, is that "psychiatry lobbying groups feel that informed consent impedes their ability to prescribe." She compares the industry to the NRA: any criticism is treated as a potential keystone that, if removed, will take out the entire system. In reality, all patients are asking for is honesty about how these drugs interact in their bodies.
We don't know the long-term effects because pharmaceutical companies don't have to study them. If the industry isn't required to disclose these effects, and psychiatrists remain ignorant of the real damage being done to some of their patients, informed consent remains an intangible dream with no pathway to reality.
As Whitaker writes in "Anatomy of an Epidemic," antidepressants don't treat chemical imbalances—they create them. Over 2,500 years ago, doctors recognized melancholy as a natural part of life—one that, as Schuyler and others realized, goes away with time. Yet for a growing number of Americans, depression will never fade because they weren't informed about the potential consequences of the prescription they were handed. They never know what they're being told to swallow.
Researchers at the Max Planck Institute have pinpointed a neurological trend in those genetically predisposed with depression.
- The left hypothalamus is enlarged in those genetically predisposed to suffer from depression.
- The worse the form of depression is, the larger the hypothalamus.
- While no cure for this enlargement is yet known, researchers now know where to focus their efforts.
As I write this, my pet cat Balthazar is in an oxygen tank in the emergency room after having fluid in the lungs. While we're waiting for the battery of tests to return, congenital heart disease is a likely culprit—the ultrasound revealed an enlarged valve. We'll likely have to re-home him. Animals with pre-existing conditions need the right environment if they're going to survive.
Humans are no different. While genetic testing is changing our understanding of medicine, environment matters. Create proper exterior conditions and you could thrive no matter the genes. Yet the wrong environment can exacerbate sleeping cells and transform them into giants.
Why exactly so many people are suffering from depression must be considered on a case-by-case basis, though the conditions for this disorder to thrive are certainly apparent. As of 2015, 4.4 percent of the world's population was dealing with some form of depression. In America, 6.7 percent of the adult population suffer from a major depressive disorder every single year.
As researchers at the Max Planck Institute for Human Cognitive and Brain Disorders write,
In the search for the underlying causes of this widespread disorder, researchers have concluded that it could arise from predisposition combined with an individual's environmental stress factors.
In humans, researchers at the Max Planck Institute have discovered a brain region that grows in size when suffering from a major depressive disorder: the hypothalamus.
Whenever any of us face a stressful situation, our HPA (hypothalamic-pituitary-adrenal) axis is triggered. This is what floods our bloodstream with cortisol in preparation of fighting, flying, or freezing. As soon as the situation is resolved, this system is overrode by other systems that bring our biology back into balance.
Those predisposed to depression, however, don't come back down. Even the inkling of stress sets them off, as the researchers note, "full throttle." This can even occur when there is no actual stressful situation. In such people, the researchers discovered, their left hypothalamus was, on average, 5 percent larger than those without such a predisposition.
Jessica Orrico / Unsplash
In fact, those with more severe forms of depression exhibited even larger hypothalamuses. And while medication might treat the symptoms, it made no difference on the size of the brain region that matters most.
The hypothalamus is part of our brain's limbic system, which plays a major role in emotion, behavior, motivation, and memory. Evolutionarily speaking it is often referred to as our "reptile brain," the idea being that it links us down the ladder to the fight-flight-freeze mechanisms inherent in all mammalian (and earlier) life. Specifically, the hypothalamus controls our body temperature, hunger and thirst, and circadian rhythms. It is also the conductor linking our nervous system to our endocrine system, the loop that floods our body with cortisol when stressed.
Unfortunately, the researchers do not know what this physical correlation means or how to treat it. But the discovery of an enlarged region is a start. By pinpointing therapies to reduce its size, which in normal humans is about the size of a penny, there could be a reduction of severity in relationship to depression.
Researchers at the American Chemical Society examine whether or not cough medicine has scientific merit.
In a new video posted on the American Chemical Society's Reactions YouTube site ("Does Cough Medicine Really Work?"), chemists argue that there is no conclusive evidence that cough medicine is effective. The group of researchers came to this conclusion after examining a number of systematic reviews that compared data from numerous studies.
Here the overall take from the American Chemical Society's Reaction team:
"There’s very little evidence that cough syrup is effective at treating coughs. And carefully performed clinical trials show that these medications are generally no better than a placebo."
As the Reactions team pointed out, clinical trials showed that widely-used cough medicines generally did no better than a placebo in treating symptoms. They examined Antitussives (blocking cough reflex), Expectorants (loosening the mucus), Decongestants (narrowing the blood vessels of the lung and nose to reduce congestion), and Antihistamines (decreasing mucus associated with allergies).
While the researchers found little benefit to over-the-counter cough medicines, they also stated that there was no real medical downside (outside of an overdose, especially with children) to taking the medication. The improvement of health one may feel from taking cough medicine may be tied in with the well-documented placebo effect. ("Placebos Relieve Pain, Even When Patients Know the Treatment Isn't Real")
Treating Your Cold Without Pharmaceuticals
There are an endless array of natural remedies that people use to soothe coughing and reduce the symptoms of a cold. The researchers at the American Chemical Society touched upon the popular usage of zinc, vitamin C, and echinacea and determined that likewise there was little scientific backing to the health claims. Honey, however, may have some merit and is in new of continued study.
The three suggestions made by the American Chemical Society's Reaction team was to:
1. Drink plenty of fluid in order to lower your cough reflect and thin out mucus.
2. Take a steamy shower, or use a humidifier, to reduce congestion
3. Use a hard candy or cough drop to increase saliva production, which will soothe an irritated throat.
Lastly, there is always the old standby of chicken noodle soup. Outside of its nostalgic appeal, there may be some scientific merit in having a cup of soup when suffering through a cold. According to the Mayo Clinic:
[I]f you're sick, chicken soup may help you feel better. Warm liquids, such as chicken soup, tea or warm apple juice, help speed up the movement of mucus through the nose. This relieves congestion and limits the amount of time viruses are in contact with the lining of your nose. Plus, soup and other liquids help prevent dehydration.