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A sugar pill for all your mental ills

MagazineNovember 2015 (Vol. 26 Issue 8)A sugar pill for all your mental ills

Psychiatric drugs are dangerous, and one researcher reckons they are the third major cause of death after heart disease and cancer. They also don't work any better than a placebo.

Here's a novel idea: how about we give everyone who's been diagnosed with a mental disorder, such as depression or anxiety, a sugar pill. Yes, that's right, a dummy pill or, as doctors call it, a placebo.

Irresponsible? Well, the evidence suggests it's not. In fact, most psychiatric drugs seem to have purely placebo effects. In other words, the patient thinks the drug will do some good, so it does. And, of course, sugar pills come without any of the nasty side-effects that seem to be the stock-in-trade of psychiatric medications.

Consider the evidence. Only dementia and Alzheimer's (and some rare chromosomal disorders that nobody can rightly recall) have any biological causes-which means they can be diagnosed by a test or scan. As for the rest, and that's pretty much every other psychiatric disorder, the diagnosis is down to the subjective observations of the psychiatrist.

In making the diagnosis, the psychiatrist looks for behavioural patterns: the depressed person feels sad or has a complete loss of drive; the psychotic shows irrational traits; the bipolar patient has alarming dips and peaks in mood; the attention-deficit child misbehaves, and so on. But as the mental-health watchdog Citizens Commission on Human Rights (CCHR) International points out, behaviour doesn't mean disease. And if there's no disease, medicine won't fix it.

An imbalance of evidence

The pharmaceutical industry disagrees. For more than 40 years, its researchers have pushed the idea that depression does indeed have a physical cause: it's all due to a chemical imbalance in the brain-specifically, low levels of serotonin, a neurotransmitter that allows brain cells to communicate with each other.

The theory launched the SSRI (selective serotonin reuptake inhibitor) family of antidepressants, which includes the most famed psychiatric drug of them all, Prozac (followed close behind by Paxil and Zoloft). The SSRIs generate around $11 billion of sales worldwide every year.

But the theory is false, and even the American Psychiatric Association has quietly walked away from it. The conservative Psychiatric Times agrees; as its editor-in-chief Ronald Pies has written: "In truth, the 'chemical imbalance' notion was always a kind of urban legend-never a theory seriously propounded by well-informed psychiatrists."

If the theory is false, then how come the SSRI antidepressants seem to work? In reality, they don't, or certainly not more than a placebo. After an analysis of all the data-and that includes published research, unpublished papers and studies deliberately suppressed by the drugs industry-Irving Kirsch of Harvard Medical School concluded that some antidepressants increase serotonin levels, some decrease it and the rest have no impact on it at all-and yet they all show the same therapeutic effect, which is about the same as a placebo. Even studies that show a slight improvement over placebo are the result of a super-placebo effect, because most patients are told whether they are being given the drug or a placebo before the trial ends.

And not only do SSRIs have no real effects, but they can even make matters worse in the long run. "The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future," Kirsch writes.1

The fraud squad

If the benefits look to be way beyond placebo, then suspect fraud. Drug giant GlaxoSmithKline (GSK) omitted thousands of pieces of research data from its now "infamous Study 329", published in 2001, which had concluded that its antidepressant Seroxat (paroxetine) was both effective and safe for adolescents with major depression.

But the drug was neither. GSK researchers knew it didn't lift depression and, worse, that it actually increased the chances of suicidal behaviour. They hid the inconvenient truth, recruited a marketing company to write the paper and then hired a leading psychiatrist with numerous financial ties to the drug industry to 'front' the study as if he had researched and written it.2

On the back of this manufactured success story, GSK mounted an aggressive marketing campaign in the US, extolling Seroxat's "remarkable efficacy and safety". It worked: within a year, American doctors and psychiatrists had written out two million prescriptions for the antidepressant to adolescent patients.

Yet less than 12 months after Study 329 had been published, America's drug regulator, the Food and Drug Administration (FDA), began to suspect fraud. It all quickly untangled and, in 2012, GSK was fined a record $3 billion, partly for fraudulent marketing.

A year later, an international research consortium commissioned the University of Adelaide to go through all the data gathered by Study 329, which is how they discovered that thousands of pages of results had never been included. The data revealed that 11 participants taking Seroxat had tried to commit suicide, not five as admitted to by GSK. "Prescribing this drug may have put young patients at unnecessary risk from a treatment that was supposed to help them," said lead researcher Prof Jon Jureidini.3

Danger, danger

Around 470,000 adverse reactions to psychiatric drugs have been reported to the FDA in just the US alone, says CCHR International. The true picture is far worse, it warns, as only around 1 per cent of reactions are ever reported.

None of this is a surprise to Danish Prof Peter Gotzsche, who estimates that psychiatric drugs are so dangerous that they are the third major cause of death after heart disease and cancer. Antipsychotics, often given to dementia patients to keep them quiet, increase the risk of heart disease, diabetes or stroke; psychiatric drugs increase the risk of falls, which can have deadly consequences in the elderly, while antidepressants have been linked to arrhythmias, or irregular heartbeats, and suicidal thoughts.

Gotzsche, a researcher with the independent Cochrane Collaboration, claims that drug regulators have deliberately underplayed the dangers of psychiatric medications and also suppressed data. The rate of suicides among adolescents and young adults taking SSRIs is 15 times higher than the rate reported by the FDA, says Gotzsche, whose new book-Deadly Psychiatry and Organised Denial (People's Press, 2015)-explores the dangers.

He recruited three students to investigate the true dangers of psychiatric drugs. "What we have found is truly astonishing . . . the skeletons in this closet have been tumbling out at an alarming rate. Sleeping pills, for instance, stop being beneficial after a couple of weeks, yet patients are left on them for years, while antipsychotics are licensed if they show an effect in two placebo trials, no matter how small that effect is," he said.4

And as that effect is rarely more than placebo, why not just hand out sugar pills and get similar benefits, all without the life-threatening side-effects?

Mistakes that made millions

Many of the biggest-selling and most lucrative psychiatric drugs came about more by accident than design, and mainly in the 15 years after the end of World War II in 1945.

Lithium became the standard treatment for manic depression after researcher John Cade diluted uric acid with the elemental metal. When he did so, laboratory guinea pigs survived (after having died when injected with uric acid straight from the urine of manic-depressive patients), and also became sedated when injected with just lithium on its own. The same happened when it was tested on himself and his patients.

Thorazine (chlorpromazine) became the first approved drug for schizophrenia in 1952-and it came about because a hospital ran out of ice. Cold-induced 'hibernation' was then the standard treatment for schizophrenia, and a French hospital had also started to use chlorpromazine to enhance the hibernation effect. But one day, the hospital ran out of ice and so used the drug on its own-and considered it successful.

Ciba-Geigy, as the Swiss drug company known today as Novartis used to be called, wanted to emulate the success of Thorazine and so enlisted the help of Roland Kuhn, a doctor and researcher who worked in an asylum.

He tested a drug that, like Thorazine, was an antihistamine. This drug, imipramine, was given to some of his schizophrenic patients, but they became even more agitated.

One "rode, in his nightshirt, to a nearby village, singing lustily. This was not really a very good PR exercise for the hospital", one of Kuhn's researchers noted. But it did elevate the mood of patients, making Tofranil, as the drug became known, the first antidepressant and one of the first 'blockbuster' psychiatric drugs.

Leo Sternbach, a chemist with Hoffmann-La Roche, was about to throw away the last dregs of a compound he'd been testing, as it was pharmacologically inert. But something told him to test the last sample-and it showed muscle-relaxing and sedative properties.

This gave birth to the next family of blockbusters-arguably the most lethal psychiatric drugs of them all-the benzodiazepines, which includes Librium and Valium.

As psychotherapist Gary Greenberg noted, "By 1960, the major classes of psychiatric drugs-among them, mood stabilizers, antipsychotics, antidepressants and anti-anxiety drugs, known as anxiolytics-had been discovered and were on their way to becoming a seventy-billion-dollar market.

Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not)".1

REFERENCES
1 Greenberg G. 'The Psychiatric Drug Crisis'. The New Yorker, 3 September 2015

Did you know?
There are no known biological causes for any psychiatric problem other than Alzheimer's disease, dementia and a few rare chromosomal disorders. There are no biological markers for depression, anxiety, bipolar disorder, ADHD (attention-deficit/hyperactivity disorder), psychoses, OCD (obsessive-compulsive disorder) or mania, for example, so any diagnosis is down to the subjective judgement of the psychiatrist or doctor.

Did you know?
The psychiatrist's bibles, the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD), which describe every known psychiatric disorder, are compiled through a voting system involving just a small group of academics. Very few of the listed conditions are supported by any objective or scientific evidence.

Did you know?
SSRI antidepressants are prescribed to resolve a 'chemical imbalance' in the brain, yet no such imbalance can be found and the theory has been scientifically discredited.

REFERENCES
1 Z Psychol, 2014; 222: 128-34
2 BMJ, 2015; 351: h4629
3 BMJ, 2015; 351: h4320
4 Gotzsche P. 'Prescription pills are Britain's third biggest killer'. Daily Mail.com, 14 September 2015


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