The rate of prescriptions for drugs to treat mental disorders is doubling every decade. Psychiatric drugs are being handed out in ever-increasing numbers to treat the supposed epidemic of depression, anxiety, hyperactivity, schizophrenia, stress and psychoses.
It’s a pattern that’s being reported in every developed country around the world; in the UK, for example, more than 57 million prescriptions for antidepressants were handed out in 2014 alone, which was up 7 per cent from the previous year and a fivefold increase since 1992. Similar rises have been seen with other psychiatric drugs; in that same year, 10.5 million prescriptions were written in the UK to treat psychosis—where people lose touch with reality—making it an 8 per cent rise on the previous year, while the prescribing of stimulants to treat hyperactivity in children rose by a similar rate.
In the US, antidepressant prescriptions doubled between 1996 and 2005, and similar patterns have been seen across Western Europe and New Zealand.1
But there’s an extraordinary paradox about this growing mountain of prescription pills: there’s been no reciprocal increase in cases of mental problems.
Rates of depression have been flat over the same 10 years that antidepressant prescriptions doubled, and the incidence of people with a mental disability hasn’t risen since the 1950s. Yet, the percentage of people affected has increased sixfold over the past 60 years, which suggests that either the drugs aren’t effective and the same people are taking them over their lifetime, or the drugs are actually making the problem even worse, or medicine simply doesn’t understand what mental illness is and what causes it.
In fact, all three possibilities are playing some part in the paradox, and they can be summarized in the oft-heard plaint: the drugs don’t work or, if they do, it’s not for long. Jürgen Margraf and Silvia Schneider, professors of clinical psychology at Ruhr-University Bochum in Germany, say the drugs are having only short-term effects and not curing the problem. If patients stop taking the drugs, the symptoms return, but if they continue taking them, their symptoms are likely to get worse. This is certainly true of the drugs that treat anxiety disorders, depression and ADHD (attention-deficit/hyperactivity disorder), and they suspect it’s also the case for schizophrenia treatments.2
The pair tracked the effectiveness of a range of psychiatric drugs, including:
Benzodiazepine tranquillizers. These should be taken only for very short periods because they are highly addictive, and their serious withdrawal symptoms include worsened anxiety, cognitive impairment and functional decline, facts recognized by most health agencies, which have been issuing warnings about these drugs since the 1980s.
Antidepressants. These work no better than a placebo, or sugar pill, according to the latest studies. Worse, studies of children and adolescents show that the SSRI (selective serotonin reuptake inhibitor) antidepressants are not only ineffective, but actually harmful. A similar picture emerges among adults who take the drugs over long periods of time: their depression deepens and their depressive episodes increase in frequency. In short, antidepressants are escalating depression and also making the patient more likely to commit suicide.
Neuroleptics. Used to treat schizophrenia, these also don’t seem to be doing much good. The World Health Organization (WHO) has established that the long-term prospects for schizophrenia patients are consistently better in the developing countries, where only 15 per cent are taking neuroleptics, compared with the developed countries, where 61 per cent are. And despite the growing number of prescriptions, the patient’s chances of a full recovery, or even of seeing any improvement in symptoms, is the same today as it was in 1900, before any drugs were available to treat the problem.
Changing the brain
So why don’t the drugs work? One reason could be because they’re producing a physical effect on the brain, say Margraf and Schneider. Psychiatric drugs shrink the frontal lobes—the brain’s ‘control panel’, which deals with emotions, problem-solving, memory, language and judgement—while enlarging the basal ganglia, which control movement and coordination, and cause a progressive loss of frontal-lobe white matter, which leads to a deterioration of cognition such as usually seen in dementia patients.
Children and adolescents who are given psychiatric drugs are the most vulnerable because their brains are still developing. As a result, they’re more likely to suffer from mental problems later as adults. Indeed, animal studies have shown that rats given antipsychotic medication when they are young are more likely, as adults, to suffer from depression and anxiety, and to have problems with coordination and movement.
But, say Margraf and Schneider, there’s an even more fundamental reason why the drugs aren’t working: most mental disorders don’t have a physical cause. Medical orthodoxy maintains that these disorders are the result of problems with neurotransmitters, the chemicals that send information throughout the brain, or because of a chemical imbalance, especially of serotonin, which is believed to be the cause of depression.
But the chemical imbalance theory is a myth, and there’s never been much evidence to support the idea that neurotransmitters are the cause of other mental disorders, they say. And groups like The Council for Evidence-Based Psychiatry agree; its report, ‘Unrecognised Facts about Modern Psychiatric Practice’, begins with the bald claim: “There are no known biological causes for any of the psychiatric disorders apart from dementia and some rare chromosomal disorders. Consequently, there are no biological tests such as blood tests or brain scans that can be used to provide independent objective data in support of any psychiatric diagnosis.”
If there is no biological cause, then no chemical agent, such as a drug, will reverse it.
Yet, mental disorders like depression and schizophrenia are real enough, so what’s going on? Margraf and Schneider believe the problem comes from applying the standard medical model of disease to psychiatric conditions. For one, the latter come and go—whereas a heart problem, for instance, is always there—and there may be a range of causes, including environmental and psychological ones.
The most important causes, though, say Margraf and Schneider, are what they call ‘psychosocial factors’, such as having a sense of control, pursuing mental activities and delaying gratification.
As such, ‘talking cures’ like cognitive behavioural therapy (CBT) are far more effective than any drug could ever be. CBT has been proven to be far more effective than drugs across a range of psychiatric conditions, they argue.
One major study, which reviewed 11 previously published randomized controlled trials involving 1,511 patients with major depression, agreed. When CBT was tested alongside antidepressants, it was just as effective—but without the side-effects of the drugs.3
But proof of efficacy isn’t the issue, say Margraf and Schneider, it’s the lack of resources. More therapists need to be trained in CBT techniques and the current medical model relegated to a secondary role—because the drugs, they’re just not working.
Psychiatry has abandoned its legacy and become just another delivery system for the drugs industry, says leading psychiatrist Allen Frances, who led the Task Force that defines mental diseases for psychiatry’s bible, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), before breaking ranks.
Today, he’s telling the world about the medicalization of psychiatry and its close ties to the drugs industry. By the time he left the editorial board of the DSM–IV, 69 per cent of them had ties with the industry, and unusual mental disorders had suddenly become major social problems needing drug therapy. One example from DSM-5, published in 2013 after Frances resigned, was the elevation of ‘oppositional defiant disorder’ (ODD) to an antisocial problem that could be treated with antipsychotic drugs.
ODD is characterized by “an ongoing pattern of disobedient, hostile and defiant behaviour”, and symptoms include questioning authority, negativity, defiance, argumentativeness and being easily annoyed. Not surprisingly, that pretty much sums up many a teenager and, indeed, the DSM sees ODD as often going hand-in-hand with a diagnosis of ADHD (attention-deficit/hyperactivity disorder).
Previous editions of the DSM had already elevated arrogance, narcissism, above-average creativity, cynicism and antisocial behaviours to the ranks of psychiatric disorders requiring drug therapy.