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Are Psychiatric Medications Hurting More Patients Than They Help? (scientificamerican.com)
An anonymous reader quotes Scientific American's Cross-Check blog:
Two new posts on this website have me contemplating, once again, the terrible possibility that psychiatry is hurting more people than it helps. Reporter Sarah G. Miller notes in "1 in 6 Americans Takes a Psychiatric Drug" that prescriptions for mental illness keep surging. As of 2013, almost 17 percent of Americans were taking at least one psychiatric drug, up from 10 percent in 2011, according to a new study. "Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs..."
This increase in medications must be boosting our mental health, right? Wrong. In "Is Mental Health Declining in the U.S.?," Edmund S. Higgins, professor of psychiatry at the Medical University of South Carolina, acknowledges the "inconvenient truth" that Americans' mental health has, according to some measures, deteriorated...
It's all more evidence of something their blogger wrote in 2012. "American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis -- harmful medical treatment -- in history."
This increase in medications must be boosting our mental health, right? Wrong. In "Is Mental Health Declining in the U.S.?," Edmund S. Higgins, professor of psychiatry at the Medical University of South Carolina, acknowledges the "inconvenient truth" that Americans' mental health has, according to some measures, deteriorated...
It's all more evidence of something their blogger wrote in 2012. "American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis -- harmful medical treatment -- in history."
Think of two solutions to mental illness:
1. One that works - quick, fast, cheap, done.
2. One that requires multiple visits to a doctor, every two weeks for 10 years. Oh, and lots of expensive drugs.
Guess which one is incentivizes doctors and drug companies to pursue it?
The truth the medical fraternity face is that many have had their lives ruined by the drugs they religiously believe in. The 'evidence' rests on a mire of untested and flawed assumptions (in particular the premises of the statistical methods used to relate data to conclusions: many of which cannot be justified unless the possibility of and influence of complex brain behaviour can be safely ignored). The clinical psychology fraternity, and a number of 'maverick' psychiatrists are, more and more, putting across why mainstream 'medical psychiatry' has much wrong. But this is all too easily swamped by billion dollar marketing machines, lobbying and selective sponsored trials which have a habit, like 'proven by science' infomercials, of showing the sponsoring company's products as better than others.
John_Chalisque
(1) Suicide rates -- In the US I think the increase in suicide rate is likely attributable to increased firearm ownership. There is no evidence that I know of that indicates that the increased level of gun ownership presents an increased risk to others -- in fact the rate of firearm homicide has gone down (along with most other violent crimes). But suicidal impulses -- which are very common -- plus a handgun in your pocket... that is a very dangerous combination.
(2) Rate of DoD PTSD rising -- likely to have to do with the influx of veterans from three wars (Gulf 1 & 2 + Afghanistan), plus a higher survival rate from severe physical trauma.
(3) Rise of opiate abuse -- coincides with the appearance of new prescription drugs and more aggressive prescribing of pain medication.
(4) Rise in disability awards -- conflated with a drive to recognize mental disabilities as on a par with physical ones.
At my age I've lived through many a moral panic, and this feels like the beginnings of one. Which is not to say mental illness doesn't cause real suffering, or that we shouldn't make it more of a priority. But what we need are more evidence-based approaches. Unfortunately we seem to be headed in the opposite direction.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
Whereas once upon a time it was quite normal in society for everybody to drink alcohol regularly, nowadays it is unfashionable to be an alcoholic so psychiatric medications have taken over.
A hundred years ago, if I had anxiety I would just drink booze to get over it. Now I take Paxil. Not only am I spending a lot less money (because a single pill costs less than a bottle of wine or 6-pack of beer), but I can safely drive a car, and I'm not an asshole to my family.
You may also notice that it seems every other kid is on some medication for ADD/ADHD. Why? My guess is that it's because we can't beat them anymore. Now that it's no longer socially acceptable to hit children who act out we have to medicate them instead.
dom
The single biggest influence on the state of psychiatry today is moral conservativism and other assorted panderings to popular culture and the law. Their desire to stay profitable and respectable in mainstream society long ago destroyed any real credibility they had as a serious hard science.
Pretty much every highly effective anti-depressant ever made (including but certainly not limited to opioids and dopaminergics) is a scheduled substance and almost never prescribed for depression, because apparently every single human being alive is just a helpless addict just waiting for the chance to swallow twenty pills at a time chasing a high. SSRIs have abysmal efficacies, but that didn't stop them from pushing the placebo revolutionary drug Prozac to being one of the most prescribed drugs in the country. A lot of people are still under this weird impression that antidepressants work by re-establishing some natural balance of neurotransmitters present in "normal" people, when there's every indication that this is not the case. (FDA is partially at fault here allowed pharma companies to put out some ads that strongly implied this was how SSRIs worked.)
And it's not as if modern antidepressants aren't addictive; like many psychotropic drugs, SSRIs and SNRIs induce physical dependency with potentially severe withdrawal symptoms if abruptly terminated.
No, the actual difference between modern antidepressants and "addictive" drugs that actually make you feel good is... the latter actually work. Consistently and compellingly. And it's for that very reason that they are deemed dangerous. Drugs that are highly effective in enabling human happiness work better at higher dosages (which is how dosage increase works among most drugs that are actually effective, if you think about)... which of course leads to massive problems among the subpopulations of people who have poor impulse control or are overly euphoria-craving.
And all of this plays directly into the hands of religious and social conservatives who have for millenia made careers out of claiming that anything that people like too much must be bad. You'd think that more people would be suspicious of a profession claiming to be a science that was, just a couple generations ago, trying to chemically castrate people against their will to cure them of their homosexuality... ah well.
Sorry to burst your bubble but neurochemistry is really at the 'try this for two weeks and come back to see me'. Even if you are a Board Certified (TM) psychiatrist. We really are at the very beginning of understanding what the brain is doing and how to modify it.
The situation is much more complex than TFAs suggest - 'psychiatric health' is a pretty vague and shifting target. Depends on your culture, your role in society, your age, your financial situation, your sex, the sex of the idiot sitting next to you, who is president and much more - including your genetic and epigentic makeup. If you are a creative type, you might want to feel a wider breadth of emotions than if you are flying 747's. This doesn't even begin to approach the questions of what goal does 'psychiatric health' have for the society. The powers that be might want everyone on an emotional zombie program. The hoi polloi not so much.
G-23 Paxilon Hydrochlorate anyone?
Any mental health professional will tell you that the meds don't work all that well. But they do work. People who really did need to be institutionalized before the advent of antipsychotics are out in the community. It's not entirely clear that this helps them or the community but the drugs are arguably doing something useful.
Using broad brush numbers like the amount of antidepressant prescriptions and trying to correlate them with other broad brushed studies using vague and varied methodologies and trying to say anything intelligent is a fool's errand.
Faster! Faster! Faster would be better!
I have the Harvard Guide to Psychiatry DSM IV (I need to get V). I had to get it for some sort of bearing on peculiar grad students I kept running into. For awhile, I thought I was a strange attractor. Then I came to the conclusion that academia is simply more accommodating to oddness than business world, so it accumulates a wider variety of "clientele".
Anyhow, it quickly becomes clear that one person with symptoms doesn't have entirely this condition or that condition. Rather, they pick from a smorgasbord of conditions. So each case is different. Add a bit of time for them to water and feed their conditions (and they do), then they get rather full-blown oddness. Some have learned to do bank shots off the reactions they generate in other people. These are difficult cases to handle because they are working you but you still feel sorry for them.
The best psychiatry can do with drugs is try this or that combination in the hopes of hitting the magic one for the oddball in their office. And then the oddball's physiology is changing over time due to age, diet, or just general physical drift. So what works one year might not work the next. The easiest to deal with are those with an identifiable condition like hyper or hypo thyroid. Few are ever this simple.
I see a lot of in-recent-decades cultural shifts that can easily explain a rise in depression.
I wouldn't exactly dispute the gist of your claims, but I think the relevant psychological factor has little to do with your trends.
People in the past may not have divorced as much, but how much has infidelity actually risen? How much has "kids being raised in broken homes" risen compared to, say, rate of child abuse if you go back more than a couple generations? People used to whip their kids. You had pre-adolescents working in coal mines. Everybody (including kids) used to be basically slightly inebriated most of the time, back when water was frequently unsafe and the carrier of disease... so drunken beatings were pretty much normal.
Family situations were undeniably a lot worse back in the "good ole days." Even in the 1950s or whatever "golden age" of the American middle class family you might imagine from Leave it to Beaver, a significant number of people were taking some sort of crap for a "pick me up" that we'd conflate with drug use today.
Main difference: we didn't TALK about this stuff as much, outside of town gossip. We lamented the stories of the folks "on the other side of the tracks," and those people lamented the stories of the REALLY poor folks they knew. Today, we all lament our own situations.
Or, you talk about leaders as if corruption in politics were new. 'Twas always thus, but perhaps we didn't TALK about it as much.
Or, you talk about the decline of middle class numbers. Yeah, it's a bad trend. But, if we're going to talk about history, even most "poor" people in a place like the U.S. today are living with conditions leagues ahead of the "middle class" a couple centuries back.
I'd bet if you took a bunch of middle-class American folk and took them back to the 17th century and let them even lead a reasonably "upper-class" life then, a significant number would just commit suicide within a year... whereas the 17th-century folks were perfectly happy with what they had.
Why would anyone expect depression rates to go down in an environment like this?
I wouldn't exactly expect depression rates to go down, but I do think they're rather unpredictable based on objective living conditions of a population. There have been quite a few studies looking at "happiness" in more "primitive" cultures around the world and realizing that satisfaction and happiness have relatively little to do with anything objective, and a lot to do with your own perception of your life and the world around you.
Your post is a good example of the way narratives of cynicism and outright pessimism have taken over the way many people perceive themselves and their lives today. They turn on the news and they don't hear "Murder rate continues 1000+-year trend downward!" or even that murder rates or child abduction rates or whatever have fallen a lot in the past couple generations. Instead, they hear about bad stuff happening today or this week or this year. CONSTANTLY.
I am NOT arguing that we just bury our heads in the sand and ignore the news, but there is a lot of truth in the statement "Ignorance is Bliss."
If you thought about your examples a little more, you'd realize this is even encoded in your own "data." Why do people get divorced so often today, for example? Generally, it's because they claim to be "unhappy," and they think doing something else will make things better. Except the data shows they are MOSTLY WRONG. Divorce rates for second marriages are something like 66%; divorce rates for third marriages are close to 75%.
If people actually knew what "made them happy" and were capable of seeking it out rationally, the divorce rate should go down with more experience in marriages. Instead it goes up.
The issue is that people are not objective about their own experiences. They are mostly incapable of making objective assessments of how their sit