In his keynote presentation to the Louisiana Marriage and Family Therapist Association on February 20, Robert Whitaker pointed to fallacies behind the rampant use of pharmaceuticals as first-line treatment for psychological problems, Cont’d pg 3 drawing on long-term studies, population statistics, and a lack of scientific theory behind the $70 billion global psychiatric drug market. Whitaker, an investigative journalist, is the author of Mad in America and Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.
He laid out three hours of research showing that while short-term benefits give the impression of benefit, the longterm outcomes portray a very different and disturbing picture. In a review of research, experts, critiques of theory, and epidemiological data, Whitaker puts forth a compelling argument that antidepressants do more harm that good, that schizophrenics do better off medication than on, and that children taking stimulates are more likely to progress to chronic illness than if they go without medication.
Whitaker built on his Anatomy of an Epidemic, the first book to lay out an investigation of the long-term outcomes for those taking psychiatric drugs, and to place in a cultural and historical context, and call into question conclusions built primarily on short-term perspectives.
Whitaker told the audience that that psychiatric drugs were designed around a model of “chemical imbalance” in the brain that arose in the 1970s based on the dopamine theory of schizophrenia and serotonin theory of depression. However, evidence never confirmed these theories. As early as 1984, he explained, the National Institute for Mental Health (NIMH) wrote, “Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” By 2011 Ronald Pies wrote for a Psychiatric Times review, “In truth, the chemical imbalance notion was always a kind of urban legend, never a theory seriously propounded by well-informed psychiatrists.”
Despite this prescribing increased over time, said Whitaker. At the same time, the drugs cause long-standing changes in the brain, something that has been known for almost 20 years. In 1996 the former director of HIMH, Stephen Hyman, said that psychiatric medications “create perturbations in neurotransmitter functions” and cause “substantial and long– lasting alterations in neural function.”
Whitaker outlined for the attendees how the illusion of benefit happens. One example is that antipsychotics reduce the “target symptoms” by disrupting the way the brain works. And this same effect causes a relapse when the drug is stopped. Physicians see in the short run that symptoms are reduced and that patients relapse if they go off the drug. But the drug creates a new set of problems for the patient compared to the long-term and to those not on the medications.
Looking at population statistics over time, Whitaker showed that in the 1920s, 30s, and 40s, the recovery from depression was high. The majority of those with depression experienced only a single episode. And only 13 percent fell into the chronic area. But by the 1960s and early years of antidepressant use, researchers were seeing a “shortening the intervals” between episodes, and a “change to a more chronic course.” By the 1980s both the National Institute of Mental Health and the American Psychiatric Association had a new view––that depression was recurrent and chronic. By 1997 researchers reported that 50 percent relapsed and only 3 percent went into remission. The longer the patient had been on antidepressant the higher the relapse rate, Whitaker told the audience. By comparing studies for national and international sources, he showed that those not mediated fared as well or better than those receiving the medications. He found much the same pattern with other illnesses, including bipolar illness.
Long-term research on medications with children, such as stimulates for ADHD, are consistent. In the 1990s NIMH looked at long-term improvements for the use of stimulants and found none. William Pelham, from the State University of New York at Buffalo and one of the principal investigators in that study, said, “We need to confess to parents that we’ve found no benefit. None. And we think that with drugs, the benefits should outweigh the risks.”
The routine use of psychotropics has been coming under fire and gaining notice in the psychological and behavioral health communities. In 2013 the Louisiana Psychological Association hosted Dr. Irving Kirsch, author of another line of books on the small clinical benefit of medications. Kirsch stunned the audience at a Tulane conference with facts on science, politics, and the antidepressant drug industry. He showed strong evidence that antidepressants are 75 percent placebo and that FDA approvals are skewed to favor drug companies. Kirsch’s exhaustive research is included in his 2011 book, The Emperor’s New Drugs: Exploding the Anti-depressant Myth.
Coverage of the work of Whitaker and Kirsch and others have stimulated more research and debate, and been picked up by major news outlets.
In a 2010 article in Journal of the American Medical Association (JAMA), researchers followed Kirsch and concluded that antidepressants have minimal use for mild or moderate depression.
The theme went to Newsweek, “Why Antidepressants Are No Better Than Placebos,” and to The New Yorker, “Head Case: Can psychiatry be a science?” The author, Louis Menand, pointed to Kirsch’s book, and also Gary Greenberg’s Manufacturing Depression, to highlight problems in the psychiatric industry. But Richard Friedman, M.D., criticized the research and warned, “Before You Quit Antidepressants…” in the New York Times.
Last year, Mehmet Oz (Dr. Oz) took the antidepressant issue to task on his popular daytime television show, with a hard-hitting special, “The Truth About Antidepressants,” where he said, “Antidepressants don’t work for most patients. They can even make your problems worse.”
Discussion at the February Louisiana Marriage and Family Therapists conference included a straightforward dialogue about the rights of patients and in particular of parents, to obtain a fully informed understanding of the limitations of these medications and a list of the harm.
Dr. Judith G. Miranti, Director of Counseling programs at Xavier University of Louisiana and a Clinical Fellow of the American Association for Marriage and Family Therapy, told the Times that the presentation was enlightening. But, “… morally perplexing to me as a mental health practitioner,” she said.
“Much to my disappointment, I learned from Mr. Whitaker’s research, that there was no evidence to support the long-term positive outcome regarding academic achievement. Instead, the results showed that the conditioned worsened with longer use of the stimulants. This presents for me a moral and ethical dilemma,” she said. “Now I realize before I would ever recommend psychotropic medications to treat certain symptoms/conditions that I would disclose to my clients the short and long terms effects of the medications.”
Tom Moore, marriage and family therapist and Director of the Red River Institute noted the importance for informed consumers.
“Medical practitioners who treat their patients with psychotropic medications run the greatest risk for doing their patients harm,” Moore said, “but are among all mental health providers least likely to inform their patients of the potential ineffectiveness— and harmfulness– of the form of treatment they employ. In light of the wide spread use of drug therapy in this country by so large a number of licensed medical practitioners, this certainly represents a major public health concern that must be addressed by the state regulatory bodies that oversee medical practice.”
Dr. Matt Morris, President of the Louisiana Marriage and Family Therapists Association and Associate Professor of Counseling at Our Lady of Holy Cross College, told the Times that the theme of “therapeutic alternatives to psychotropic medications particularly as a first-line intervention,” was very well received by attendees. “Robert Whitaker and Dr. Jackie Sparks,” Morris said, “were extremely competent presenters who enriched our conference greatly.”