In continuing my discussion of Robert Whitaker’s Anatomy of an Epidemic from my last post, I begin with the results of a study on the use of anti-psychotic medication for treating schizophrenia; it is one of many such studies discussed by Whitaker which report very similar outcomes. This study was funded by the National Institute of Mental Health (NIMH) and conducted at NIMH’s clinical research facility in Bethesda, Maryland. According to Whitaker:
“[T]hose treated without drugs were discharged sooner that the drug-treated patients, and only 35 percent of the non-medicated group relapsed within a year after discharge, compared to 45 percent of the medicated group. The off-drug patients also suffered less from depression, blunted emotions, and retarded movements.” The investigators reported that, over the long term, the medicated patients were “less able to cope with subsequent life stresses.”
Study after study shows that, in the short term, anti-psychotics do reduce unrealistic thinking, anxiety, suspiciousness and auditory hallucinations, but in the long-term, they make those continuing on medication much more prone to relapse and re-hospitalization than non-medicated patients or patients given a placebo. “Schizophrenic patients discharged on medications were returning to psychiatric emergency rooms in such droves that hospital staff dubbed it the ‘revolving door syndrome.’ Even when patients reliably took their medications, relapse was common, and researchers observed that ‘relapse is greater in severity during drug administration than when no drugs were given.'”
In other words, schizophrenic patients who received no medication had much better long-term results than those treated with anti-psychotic drugs. This jibes with both (1) a historical comparison between long-term outcomes for schizophrenic patients prior and subsequent to the introduction of anti-psychotics; and (2) a comparison between long-term outcomes for schizophrenics treated with anti-psychotics in the developed world versus those in poor countries treated without them (much better). Study after study bears this out.
In short-term usage, psychiatric medications for psychotic disorders have value in stabilizing patients and reducing the severity of their symptoms, but long-term usage makes those people more prone to relapse and “may prolong the social dependency of many discharged patients.” And here is the tricky part: If patients are withdrawn from their medications, they do poorly, then do better once they have been put back on those drugs. For this reason, it appears to be proof that the drugs “work”; but do they only “work” in the sense that they ameliorate a problem created by placing the patient on those very drugs in the first place? In study after study, it is patients given no medication whatsoever who have the best outcomes.
Whitaker goes on to conduct a similar outcomes analysis for benzodiazepines, with similar results: patients with no exposure to those drugs do best. It is his discussion of the Selective Serotonin Reuptake Inhibitors (SSRIs), however — the class of drugs widely used today for the treatment of depression — which I found the most disturbing. Study after study undertaken during the late 1990s-early 2000s showed that SSRIs were no more effective than placebos for the treatment of depression. You’ve probably heard about these studies already, from Newsweek or the mainstream media. They tell only half the story.
As he did with his analysis of the effects of anti-psychotics and benzodiazepines, Whitaker turns to comparisons between (1) the outcomes for patients given anti-depressants (including the earlier tricyclics) and (2) the outcomes for those who received no medication. Here are the results of three (among many) studies he discusses.
In a Dutch study, 76% of those not treated with an antidepressant recovered and never relapsed, compared to 50 percent of those prescribed a drug in that class.
In a 1997 study from a large inner-city facility in England, scientists reported that 95% of the depressed patients who had never received medication saw their symptoms decrease by 62% during a period of six months, while those treated with anti-depressants saw only a 33% reduction in symptoms.
At the University of Calgary, one researcher accessed the Canadian health database and analyzed the five-year outcomes for 9,508 depressed patients. He found that those on anti-depressants were depressed for an average of 19 weeks per year vs. only 11 for the non-medicated patients.
Every study reports the same finding: exposure to anti-depressants leads to a worse long-term prognosis. An international study by the World Health Organization found that of the “740 people identified as depressed, … it was the 484 who weren’t exposed to psychotropic medications … that had the best outcomes. They enjoyed much better ‘general health’ at the end of one year, their depressive symptoms were much milder, and a lower percentage were judged to still be ‘mentally ill.’ The group that suffered most from ‘continued depression’ were the patients treated with an antidepressant.”
The conclusion is inescapable: even if SSRIs have any short-term benefit (debatable), their continued use makes you worse. It’s difficult for patients who have already been medicated to understand this. As I’ll discuss in my next post, exposure to anti-depressants alters your neural synapses, introducing an imbalance that wasn’t there before; withdraw the drug and the patient seems to do much worse, then “recovers” once returned to the drug or another one in the same class. It may appear as if the medication is working, when in fact, it’s only treating a disorder that the drug itself created.
Since the introduction of Prozac in 1987, the rates of disabling mental illness in this country have skyrocketed. In fact, contrary to what we have been led to believe, we currently have a mental health crisis of epidemic proportions. “Today, major depressive disorder is the leading cause of disability in the United States for people aged fifteen to forty-four. … [N]early nine million adults are now disabled, to some extent by this condition.” Whitaker believes that it is the prolonged use of anti-depressants that has led to this epidemic; I find the data and his argument entirely persuasive.
To make matters worse, there are the side effects. Long-term use of SSRIs causes “sexual dysfunction, suppression of REM sleep, muscle tics, fatigue, emotional blunting, and apathy … [and] is associated with memory impairment, problem-solving difficulties, loss of creativity, and learning deficiencies.” These impairments to cognitive function are quite common and are a contributing factor to the rise in disability due to depression.
Finding Your Own Way:
Are you reading this book yet? I’m doing my best to give you a flavor for the mass of statistical analysis and studies Whitaker presents, but the book will of course be much more powerful and persuasive.