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February 2018 (Vol. 28 Issue 11)

It’s mental: psychiatric drug sales double, yet they don’t work

About the author: 
Bryan Hubbard

It’s mental: psychiatric drug sales double, yet they don’t work image

There’s a pill for every mental and psychological ill—from schizophrenia, depression and anxiety to hyperactivity. The trouble is, say two leading psychologists, they don’t work

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 percent 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—marking an 8 percent rise from 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.

No cure

In fact, all three possibilities are playing some part in the paradox, and they can be summarized in the oft-heard complaint: 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 developing countries, where only 15 percent are taking neuroleptics, compared with developed countries, where 61 percent 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 judgment—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.

Not medical

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 behavioral 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.

Cashing in

Psychiatry has abandoned its legacy and become just another delivery system for the pharmaceutical 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 drug industry. By the time he left the editorial board of the DSM–IV, 69 percent of them had ties with the industry, and unusual mental disorders had suddenly become major social problems needing drug therapy.

One example from the 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 behavior,” 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 behaviors to the ranks of psychiatric disorders requiring drug therapy.

Drugs that are ‘killing 500,000 people a year’

Not only do psychiatric drugs not work, but they’re also dangerous and could be responsible for some half a million deaths among people aged 65 and older in the West every year, argues Professor Peter Gøtzsche, of the Nordic Cochrane Centre in Copenhagen, Denmark.1

The dangers of the drugs go unrecognized for several reasons, argues Gøtzsche. For one, they are often tested against a placebo, or dummy pill. This means that the patient has to go ‘cold turkey,’ and the dreadful ensuing withdrawal symptoms—which have even driven some schizophrenia patients to suicide—help to exaggerate the drug’s benefits in comparison.

Deaths are also invariably underreported in trials funded by the drug’s manufacturer. Gøtzsche estimates there are 15 times more suicides among people taking antidepressants than has been estimated by the United States Food and Drug Administration (FDA). On reviewing trials of the best-selling antidepressants Prozac (fluoxetine) and Paxil (paroxetine), Gøtzsche calculated that there were 14 suicides among the 9,956 patients taking either drug, while the FDA recorded just five suicides in a much bigger trial population of nearly 53,000 patients. One reason for this enormous discrepancy has to be down to the FDA’s habit of tracking patients for only the first 24 hours after they’ve stopped taking the drug.


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References

Main

References

1

Br J Psychiatry, 2012; 200: 393–8

2

EMBO Mol Med, 2016; pii: e201606650

3

BMJ, 2015; 351: h6019

Drugs that are ‘killing 500,000 people a year’

References

1

BMJ, 2015; 350: h2435

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