from the world's big
Robert Whitaker discusses the long-term impact of prescription medication.
- 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.
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>
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>
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>
We must rethink the "chemical imbalance" theory of mental health.
- 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.
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>
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>
Researchers look into the drug's association with pronounced optimism.
When most people think of LSD (lysergic acid diethylamide) the image that comes to mind is hallucinating hippies at Woodstock, but the drug's original use was psychotherapeutic. As early as the 1960s, researchers showed that LSD reduces depression, anxiety and pain in patients with advanced cancer, and recent years have seen a resurgence of interest in the drug's beneficial effects. In 2014, Swiss psychiatrist Peter Gasser published the results of a study showing that LSD could alleviate the symptoms of severe anxiety disorder. And a 2016 study from Imperial College London showed that LSD could increase levels of optimism and openness for extended periods of time.
A new study in nature reports that LSD minimizes fear recognition and enhances emotional empathy and sociality. Is it time to widely utilize 'trip treatment'?
A new study in nature reports that LSD minimizes fear recognition and enhances emotional empathy and sociality. Is it time to widely utilize 'trip treatment'?
Resurgence in psychedelic research is picking up after a 50-year hiatus. With a recent admission that Nixon’s war on drugs was really an attempt to quiet minorities and radicals—psychedelics being swept into this mess—few researchers have been bold enough to conduct controlled studies, regardless of how little recreational and ceremonial usage has not waned.