Special Report: Do Psych Drugs Do More Long-Term Harm Than Good?

http://www.youtube.com/watch?v=SIgROnnJbNQ

It was an explosive question: Might it be that the overuse of psychiatric medications is making many people sicker than they would have been, and preventing their recovery? Are the medications causing an epidemic of long-term psychiatric disability?

And it was about to be debated at a pinnacle of psychopharmacology, the top-rated psychiatry department in the country.

The match had drawn a full house to the fabled “Ether Dome” at Massachusetts General Hospital, the historic medical amphitheater where ether was first demonstrated as an anesthetic in 1846.

Against a vintage backdrop of glass cases holding a mummy and a well-used skeleton, the two adversaries were about to engage in a “grand rounds” debate — academic medicine’s intellectual equivalent of hand-to-hand combat.

“Thank you,” Massachusetts General Hospital psychiatrist Andrew Nierenberg said wryly, “for coming to the belly of the beast.”

The question is, author Robert Whitaker responded just as wryly, “Will I survive?”

End of humor. The stakes were too high for jokes. In his new book, “Anatomy of an Epidemic,” Whitaker doesn’t just ask whether long-term medication might often do harm. He presents study after mainstream study that inform his thesis, and he calls for the psychiatry establishment to discuss it openly.

‘The ‘Silent Spring’ of Psychiatry?

A science journalism maven at Harvard told me recently, “Mark my words, this book is going to be the ‘SIlent Spring’ of psychiatry” — a reference to the classic Rachel Carson book that opened the country’s eyes to the harmful effects of DDT.

“Anatomy of an Epidemic” only came out in April; it remains to be seen how widely its ripples will spread. But one thing is already clear: It has set Bob Whitaker, an award-winning local journalist and author of four books, on a personal journey into unexplored territory, to the Ether Dome and beyond.

It is taking him to a national conference on his hypothesis led by psychiatrists and providers of mental health services in Oregon next month. And to a line-crossing move for any journalist: the founding of a non-profit,“The Foundation for Excellence in Mental Health Care,” that will aim to present the science on various psychiatric treatments in a clear and unbiased way.

Most recently, that journey led him last week to stand in the Ether Dome beneath the curved rows of stadium-style seats, speaking upward to the full audience. Most of his listeners looked like students, except for a cluster of older men in the front whose bow-ties or suits gave them the look of staff.

Looking up at the Ether Dome

As the psychiatry establishment goes, this truly was “the belly of the beast”: Massachusetts General’s psychiatry is consistently ranked as the top department in the country by U.S. News and World Report. Sitting at the very front in a dark navy sweater was Jerrold Rosenbaum, the department chair.

Whitaker began with the plot-line about psychiatric drugs that tends to dominate in American society: The introduction of Thorazine in 1955 kicked off a “psychopharmacological revolution” that has included a march of new antipsychotics and antidepressants that are “sort of antidotes to these disorders.” They make it possible to empty institutions, and prevent people from becoming chronically ill. All in all, a positive picture of progress.

Troubling questions

Except that there’s a troubling puzzle: Why, then, did the number of Americans on the disability rolls for mental health reasons triple between 1987 and 2007?

And more troubling questions: Yes, the drugs often help people short-term, and sometimes, longer term. But why do some data suggest that schizophrenics who take anti-psychotics fare worse, long-term, than those who don’t? Why do so many people with depression who take anti-depressants seem to flip into bipolar disorder? And why is the disability caused by bipolar disorder rising so sharply, anyway?

Two of the studies that Whitaker described were particularly striking:

A World Health Organization study [here] found that schizophrenia patients living in poor countries did better long-term than schizophrenics in rich countries. In fact, “Living in a developed country is a strong predictor that a person will never recover from schizophrenia,” he told the audience. “That actually was the study that got me interested in this whole question from the start.”

And a study of 145 psychotic patients over 15 years [here] found that among those who took antipsychotics, only 5% recovered, compared to 40% of those who were off the drugs.

Yes, there could be confounding factors; certainly, patients who were doing better were likelier to go off the drugs. But “I think history is telling you this story,” Whitaker said. “With first-episode patients, you actually want to delay using anti-psychotics, because a significant percentage will get better without needing to go on the drugs, and long-term, you want to try to get as many people off as possible.” A group in Finland began using the medications in that selective way in 1992, he said, and to great success. [That study is here.]

“I don’t think that’s an anti-medication story,” he said. “I think it’s a best-use-of-medication story.”

The refutation

Dr. Andrew A. Nierenberg, director of Mass. General’s bipolar research program and a Harvard professor of psychiatry, disagreed.

“I’m going to refute much of what you said,” he warned after he took over the podium.

In particular, he challenged Whitaker’s numbers on the dramatic rise in the disability rolls, pointing out that according to epidemiological studies, the prevalence of mental illness has remained roughly the same in recent decades. Disability rates, he said, remained similarly stable — even as far more people sought treatment.

“If anything,” he allowed, “We’re realizing over time that our medications don’t work as well as we would like them to in some ways, but I also would assert that it doesn’t cause the amount of harm asserted in the book.”

Getting it ‘backwards’

Nierenberg also directly challenged the 15-year study of schizophrenics. The study’s author himself stated that his findings could be interpreted as meaning that “People who had been doing better said, ‘I don’t want to take this anymore’ and stopped,” he said. To claim that the people did better because they were off medications, he said, ‘is backward.”

As for schizophrenia in poor countries, Nierenberg said, consider a two-year epidemiological study of outcomes among 510 schizophrenics in China. Those who got no treatment did worse in every category than those who did receive treatment, he said.

More: Other longitudinal research that used sophisticated analyses to adjust for the severity of the disorder shows, he said, that among thousands of episodes of depression, patients who got treatment virtually doubled their odds of getting better and cut in half their odds of getting depressed again. And in a half-dozen studies, the longer psychosis went untreated, the worse the outcomes, he said.

The rhetoric ramped up. Nierenberg also accused Whitaker of “gratuitous and misinformed attacks” on the pharmaceutical industry and academia; of denying that mental illness and psychiatry have a biological basis; and of “omitting contradictory data.” Also, “faulty and simplistic reasoning” that “confuses cause and effect.” He said Whitaker “misinterprets outcome studies and comes up with wrong conclusions that end up an indictment of psychopharmacology.”

‘This book contains misinformation’

“The book should have a warning label,” he said: “This book contains misinformation.”
We have, he concluded, “a profound disagreement about the data and what it shows.”

Whitaker riposted on several of Nierenberg’s points. On biology, Whitaker said, “It’s not that I don’t believe there are biological causes involved; what I don’t believe is that these drugs ‘fix’ a known chemical imbalance.”

On the Chinese study, he said, the study was skewed because some of its subjects had already been ill for ten years; and “No one is saying that no treatment is a desirable thing. The question is what treatment.”

On depression, Whitaker said, in fact, the untreated group had milder, shorter episodes and one-third the rate of disability of the treated group.

Public trust

As he concluded, Whitaker’s own rhetoric ramped up: “Why do we, as a society, believe that these drugs fix chemical imbalances?” Why do we believe new drugs are better than older ones? “What are the storytelling forces in our society and who do we trust as a population to give us the honest truth? We believe in academic psychiatry,” he said. “We want you to be the arbiters of honest information.” Yet, he said, new drugs get hyped; studies showing negative results don’t get published.

“My appeal here is that we need an honest discussion of the data,” he said. “You’re right,” he told Nierenberg. The end of the book did hold an indictment: “I don’t think academic psychiatry, which had that trust, has honored that trust and been fully open with the public.”

The chief’s belief

No punches pulled. But the hour-long session ended on a conciliatory note. Department chair Jerrold Rosenbaum noted that “We were the place that first began to highlight the risks of treatment discontinuation” — in which patients’ symptoms flare up when they try to go off a drug — “and how to sort that out from relapse. We had our share of criticism from industry and colleagues, and this is still an important question.”

“My belief,” he continued, “is that there are some people for whom Bob’s hypothesis is probably true, and others for whom it’s not, and our challenge is to learn enough about the biology of the disease, the genetic propensities, and be able to predict and match treatments to those patients so we get it right.”

“We are quite primitive now,” he said, “I think you’d all agree with that.”

The last word went to Marlene Freeman, an associate professor of psychiatry in the audience. “Most of us are humbled by what we do every day,” she said. “We do our best to give our patients the most accurate risk-benefit analyses of treatment choices.”

Well-designed studies to really answer the questions you raise are very expensive, she told Whitaker. If you could take some of your passion to the National Institute of Mental Health and get them to fund some of them, “We’d be very grateful.”

Actually, the very last word goes to yours truly. My verdict is that both sides came away bloodied but unbowed. And that I’m very happy that Bob Whitaker is getting his wish for open discussion. The public discourse about psychiatry tends to be polarized, tainted by drug-company money or by extreme anti-psychiatry views that paint practitioners as evil villains. The debate that Whitaker is raising may be full of arguments with sharp bite, but it sounds well-meaning and rational.

When I read his “Anatomy of an Epidemic,” I found it highly persuasive — persuasive enough to make me significantly more wary of psychiatric medications — but still just the beginning of a discussion that needs more data to feed it. Judging by the response at the Ether Dome, that debate may be a lively one for a long time.

Whitaker will likely have a role with the new Foundation For Excellence in Mental Health Care, he said, so he may have to give up writing about psychiatry as a journalist. But perhaps he’ll be able to chronicle a transformation in psychiatry toward better long-term outcomes.

“I don’t want to give up writing,” he said. But “if you do have a book that seems to be making an impact, and you do think it’s an important subject that affects lives, you sort of have to go with that.”

Recently, I had the chance to read a beautifully written essay by an MIT student who had been hospitalized, diagnosed with bipolar disorder, and prescribed a variety of drugs that, he writes, caused side effects ranging from kidney problems to extreme paranoia to a general deadening of his curiosity and creativity. When he came upon “Anatomy of an Epidemic,” he writes:

I didn’t think much of it upon first inspection, but ended up reading the entire thing in one sitting. For the first time, I was seeing a thoroughly-researched collection of studies that vindicated my personal experience. I saw dozens of charts, each with at least one data point dedicated to me. The long-term effects of psychotropic drugs were, I learned, largely unknown. This had been mentioned to me in the past, but always as an aside. Whitaker’s message seemed clear and convincing: psychiatric drugs do seem to have a purpose for specific cases, but the current practice of “long-term treatment” may have consequences that do significant harm to the patient.

Readers, your thoughts and questions on this topic are deeply welcome in the comments section. And you can listen to Radio Boston’s recent segment with Whitaker and Nierenberg here.

(A 2011 Favorite)

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  • http://www.facebook.com/profile.php?id=100002856427654 Lisbeth Jardine

    6th Extinction–all the way around. Extinguishing the wild biosphere–creating crazy societies no one can be sane in, poor or rich.

  • Anony

    Is this the same Andrew Nierenberg that gets funding from pharmaceutical companies, many of which produce psychiatric drugs?

    As Robert Whitaker writes about Nierenberg’s enormous conflict-of-interest:

    “He has served as a ‘retained consultant’ for the following companies: Abbot Laboratories, AstraZeneca, Basilea Pharmaceutica; Brain Cells, Bristol-Myers Squibb, Eli Lilly, Epi-Q., Genaissance Pharmaceuticals, GlaxoSmithKline, Innapharma, Janssen Pharmaceutica, Jazz Pharmaceuticals, Merck, Novartis, Pfizer, PGxHealth, Schering-Plough, Sepracor, Shire, Somerset Pharmaceuticals, Takeda Pharmaceuticals, and Targacept.

    He has received grants/research support from Bristol-Myers Squibb, Cederroth, Cyberonics, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Lichtwer Pharma, Pfizer, Shire, and Wyeth-Ayerst Laboratories.

    He has been a member of the speakers’ bureaus for Bristol-Myers Squibb, Cyberonics, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Shire, and Wyeth-Ayerst Laboratories.”

    Basically, Nierenberg, you’ve lost all credibility even before anyone reads or hears the first words of anything you write or say.

  • anonymous

    long term dangers of psychiatric drug use – http://www.breggin.com/

  • anonymous

    I bought into the idea that taking meds was the best long term for my health. I was dead wrong. Now I have an irreversible condition (tardive dyskinesia) from the meds. My overall physical and mental health has declined steadily ever since the start. The meds were effective at first for controlling me when I was an out of control impulsive teenager. After the start I should have just learned to live by controlling my mind thoughts and behavior on my own without pills to do that for me.

    One problem is these meds have to be stored at certain temperatures, otherwise they become ineffective. The patients’ resulting mental confusion and doctors misinterpreting patients’ symptoms leads to more meds prescribed. The mental confusion of ineffective meds impairs judgement, even during adverse reactions and crisis situations during toxic drug levels, when patients should be at a hospital but are confused.

    The one post below describes it very well.”
    Much too often these people end up in the long term going down a path
    that involves chronic relapses, multiple drug changes, additional drugs
    added, emergence of new symptoms, stronger drugs and “cocktails”
    including antipsychotics, and resultant decreased ability to function
    normally in life–not to mention mental and emotional suffering.

    its essentailly a downward spiral. for the long term, natural is the way to go. its too late for me to decide that now. with the tardive dyskinesia and other health problems. they have ruined my life

  • anonymous

    Let me tell you first hand experience

  • No Scripts for Me

    Often times insurance companies would rather pay for a prescription than treatment because the costs are lower, the rate of recovery is quicker (often 4 weeks for onset of these psychotropic medications), and the person is “stable”. But does that solve the problem? No. Pharmaceutical companies are a for-profit organization. Why would they make a product that will “fix” a problem? They would eventually go out of business. Thus, by dosing our society and initiating and creating more problems via the long-term and side effects, they can create yet another medication and make even more money… The cycle perpetually continues. Put more emphasis on quality treatment and I think long-term, your results are better.

  • jgm

    Rhiannon, 
    You are right on target with your post. Everything you state is accurate. It is largely a US societal (and world) problem that is not addressed, or ignored, that causes so many people to be on chronic psychotropic meds. I am starting to see cases of early-onset dementia in my practice and I do not doubt the link between these medications and cognitive decline. It is a tragedy of the highest sort. 

  • John joseph

    I know about psychiatric misuse and torture in New Zealand and India.I have first hand experience of how amazingly eager the psychiatrists are to drug any potential victims.Psychiatric diagnosis is a joke.And they know nothing about how these drugs or the brain works.So naturally it is more toxic than helpful

  • Natasha Tracy

    I certainly appreciate this discussion. I think many medications are over-prescribed. There are many reasons why this is likely the case but it’s a problem to be addressed.

    And of course the long-term effects of these medications are unknown. As are the side effects for every other medication developed within that time-frame.

    I think what is particularly healthy about the discussion above though, is the ability for both sides to talk. Whitaker raised a lot of interesting points but not all his assertions are supported by his data and some have directly opposite data. But it’s really difficult for either pole to discuss anything like the middle.

    I am a mental health writer as well, and a bipolar and what I’ve learned is that there are many subtypes of a mental illness and we are not able to spot them and treat them appropriately. I very much wish we could. But until then, some of us have no choice but to be on medication to survive. And I really hope everyone can respect that as much as I respect people who choose to get off medications.

    - Natasha

    • Jeff Kelly

      You Natasha, like many on the net including so called professionals who run the zoo of the mental illness system, are only supporting the status quo, when the status quo is lousy. You do not have to be on medications to survive. I prescribe a course of at least 17 orgasms per day. Not only will you not need any medication, if you smoke you will lose all desire for it and if you drink, you will lose all desire for that. The only thing I can say is I cannot guarantee you will lose all desire for chocolate.

  • http://twitter.com/bkstagestudios Backstage Studios

    I certainly appreciate this discussion. I think many medications are over-prescribed. There are many reasons why this is likely the case but it’s a problem to be addressed.

    And of course the long-term effects of these medications are unknown. As are the side effects for every other medication developed within that time-frame.

    I think what is particularly healthy about the discussion above though, is the ability for both sides to talk. Whitaker raised a lot of interesting points but not all his assertions are supported by his data and some have directly opposite data. But it’s really difficult for either pole to discuss anything like the middle.

    I am a mental health writer as well, and a bipolar and what I’ve learned is that there are many subtypes of a mental illness and we are not able to spot them and treat them appropriately. I very much wish we could. But until then, some of us have no choice but to be on medication to survive. And I really hope everyone can respect that as much as I respect people who choose to get off medications.

    - Natasha

  • Disloj

    “We are quite primitive.” Nah, To Modest There! In Propaganda and Fraud Psychiatry is not primitive – is at the forefront.

    Florinated “SSRI” Prozac – they suppressed the suicidality and homicidality information starting in 1986 (Baum Hedlund Law). They got the FDA to BAN Tryptophan, for decades – the popular serotonin production precursor dietary supplement pill (Dean Manders, CERI), they got a Giant Prozac pill on the cover of Time Magazine, they told people Prozac would make them “type A” successful people (or “B”).

    Whitaker really ought to additionally tell people of the suppression of biochemical Psychiatry. Between ’67 and 1973 Psychiatry’s inner circle attacked and outcast Medical treatment in Psychiatry – Biochemical treatment

    Treating “depression” with SAMe, Trytophan or DHA, or “schizophrenia” with niacin or Phosphatidylserine has to be forbidden and never spoken of for the Goebbels-type Big Lie – Psychiatry – to “make sence” to people – in the 1984 Orwell (1584 Malleus Malificarum) fashion it does.

    A founding father of the Fraud of Psychiatry is Donald Klein, M.D. He established that exclusively non-Medical Psychological diagnoses would be used in Psychiatry – employing word-tests, Interview and Professional Opinion – and that – Medical Treatment _ in the form of *Patented* Centrally Acting Drugs would be the mainstay treatment. (Along with, secondarily, Electroshock and Psychosurgery – being the other two biological intervention sub-specialties here.) This mind-boggling anti-rational stance held uniformly and without variance has lasted for decades of ever increasing profit.

    50 years of Ritalin and all attempts by (actual) Doctors to treat using (Actual) Medicine have been blocked as… Fraudulent. Hah! Way to go Klein!! Yellow dye is good for You! Trust Us we’re Doctors! Sugar and MSG are approved in fine food products! What’s led got to do with it?

    Now their propaganda is using the term, traditional, for… Ritalin ( not, like, say, Herbal Medicine… traditional: Ritalin.) If there is a Medical explanation for ones psychiatric diagnosis then it is then nullified, as, a, – quote – mimic has been found. That is, if there is a medical cause and treatment for ones diagnosis… then it is retroactively invalidated, since the diagnosis excludes medical cause and treatment (being Psychological Psychiatric in nature… its a Psychiatric Diagnosis) – then, the treatment, is, Medical – using drugs, shock or psychosurgery (being that the Problem is Medical – the Psyche is inside their brain – a Material object.) Judge them objectively according to professional judgment, and treat them with concrete Material interventions. (Incarceration without due process, beating, cold wraps, insulin shock, metrazol shock, four point restrant, neurological drugging with injections of fat soluable viscous toxic Halogen contain fluid into the buttock of the restrained or threatened people to soak into their bodies and nerves for weeks by moving slowly into and through their fatty tissues.) Neutonian Science, objective and material – Besides being humanitarian Doctors, respected highly professional people, these are Men of the Modern Western Scientific World.

    Drug the brain and you have instant Psychology. How modern! Keep drugging the patient (and many many many many more patients) and their Psyches stay changed. Maintenance therapy, insight is important for compliance. Non-compliance brings the threat of the harm of relapse. Ching $$ !!

    You could support their personal growth and psychic development, or you could biochemically test them and promote their return to brain body health, or both. But there would be no fun and profit there! Better, much better, to detect that they are different than others using your secret professional detection methods, label and stigmatize them for life, and control them and control their detected and measured deviance from normal-good functioning ordered people (according to your profession overview of *everyone* in the captive populous…) do whatever you deem is needed to control them and their disease, the disease of them, the contagion, for their whole lives. For the good of the community and their good. Electric shocks across the temple large enough to cause Grand Mal seizure, maybe death. Drug them, make cuts in their brain, tie them down and leave them in a room, beat them. Then everyone will be safe from Them; and you preform a socially valuable function – and are paid proportionaty, as well as given the deference and respect from lessers that you and your kind merit.

    Wow just like the clergy detcting witchs and the apostate, heathens and infidels back in the dark ages. Oh wait, it is not like that, it’s the same thing. These are the dark ages, they aren’t over yet. Wee are still living them.

    Thomas A. Ban, M.D.

    Psychopharmacology is “dedicated to the study of mental pathology with the employment of centrally drugs”

    Neuropharmacology the scientific discipline that deals with the detection and identification of structures responsible for the psychotropic effects of centrally acting drugs.

    ____________________________________________________________________

    2001 Sahebarao Mahadik
    Oxidative stress and role of antioxidant and omega-3 essential fatty acid
    supplementation in schizophrenia.
    http://www.ncbi.nlm.nih.gov/pubmed/11370992

    3. Oxidative stress can lead to global cellular with predominantly neuronal peroxidation, since neurons are enriched in highly susceptible EPUFAs and proteins 4. Such neuronal peroxidation may affect its function that may explain the altered information processing in schizophrenia. 8. The patients in developed countries show higher levels of lipid peroxidation and lower levels of membrane phospholipids as compared to patients in the developing countries. 9. Initial observations on the improved outcome of schizophrenia in patients supplemented with EPUFAs and antioxidants suggest the possible beneficial effects of dietary supplementation. 10. Since the oxidative stress exists at or before the onset of psychosis the use of antioxidants from the very onset of psychosis may reduce the oxidative injury and dramatically improve the outcome of illness.

  • Disloj

    Natural Cure for Depression, Bipolar, ADHD, Schizophrenia
    Abram Hoffer, M.D. Psychiatrist May 2006
    http://www.youtube.com/watch?v=X9cg4454mYA&feature=related

    “Orthomolecular means we emphasize proper nutrition, the use of vitamins in adequate quantities – which may be large or small – minerals, we use everything we can to help our patients get well – we are not against drugs, but we are against the way that they are being used today, we are in favor of the Proper Use of drugs – that is minor quantities and get the patient off as soon as you can – so that’s Orthomolecular.”

    Dan Burdick, Eugene Oregon

  • The_cape_cod_mermaid

    I do not subscribe to the ‘better living through chemicals’ school of thought. However, when services for people with mental illness is not covered by insurance, or the mentally ill person has no insurance and relies on some form of state assistance, chemicals are the easiest way to go.
    Talk therapy, cognitive behavior therapy and the like only work when there are enough clinicians willing to spend the time and enough resources to pay for it.
    I run a skilled nursing facility. Clearly 75% of my residents have a psychiatric diagnosis. Of the 118 people in the building, 76 of them take at least one antipsychotic medication.
    It’s all well and good for researchers to tell me that the drugs may not work or may be harmful in the long run, but my staff has to have some way to deal with these people. Two licensed people for 41 residents with 4 nurses’ aides. If we didn’t have medications to deal with these people, I don’t know how we (or they) would manage.

    • Srlama

      So you’re saying that when used as chemical restraints, the medications you have administered help staff to deal effectively with the shortages in help, and the shortfall in resources. That is not a case you are making for quality care, I am afraid. I started my career working in two nursing homes while in college, and saw much the same thing. Kudos for you for being willing to speak the ugly truth.

  • Rhiannon

    Mr. Whitaker declined to post this here. I have no such compunctions:

    Andrew A. Nierenberg, MD receives or received Grants/research support: from Bristol-Myers Squibb Company; Cederroth AB; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; Janssen Pharmaceutica; Lichtwer Pharma; NARSAD; NIMH; Pfizer Inc; Shire; The Stanley Foundation; Wyeth-Ayerst Laboratories.

    Retained consultant: Abbott Laboratories; AstraZeneca; Basilea Pharmaceutica, Ltd; BrainCells Inc; Bristol-Myers Squibb Company; Eli Lilly and Company; EPI-Q, Inc; Genaissance Pharmaceuticals, Inc; GlaxoSmithKline; Innapharma Inc; Janssen Pharmaceutica; Jazz Pharmaceuticals; Merck & Co, Inc; Novartis; Pfizer Inc; PGxHealth; Schering-Plough; Sepracor Inc; Shire; Somerset Pharmaceuticals, Inc; Takeda Pharmaceuticals North America, Inc; Targacept, Inc. Honoraria: Bristol-Myers Squibb Company; Cyberonics, Inc; Eli Lilly and Company; Forest Laboratories, Inc; GlaxoSmithKline; MGH Psychiatry Academy; Physicians Postgraduate Press, Inc; Shire; Wyeth-Ayerst Laboratories Stock shareholder: Appliance Computing II, Inc (Mindsite); BrainCells Inc

  • Rhiannon

    I appreciate this discussion–for one thing, it’s fairly rational and even-tempered, which is a nice change. I do understand why emotions run high around this topic, because, on the one hand, many caring and very well-intentioned providers have been prescribing these medications believing that they were helping people, and it must be devastating to even contemplate that they may have harmed some of them instead. And on the other hand, many people have been harmed grievously by the overuse of psychiatric medications, and they understandably have strong feelings about the tragedies in their own lives. So feelings run high.

    I appreciate the discussion of antipsychotics and outcomes in psychosis. But I notice that when academics argue this subject there seems to be more discussion of psychosis and less discussion about the much more everyday prescribing of psychiatric medications to help people who are not experiencing the emergence of pathologic behavior, but rather are going through fairly normal but distressing situations that come up in life: grief, trauma, stress, being a victim of crime, dealing with childhood sexual abuse, et cetera.

    In my own life, these are the people who I see suffering most from the too-quick overuse of these drugs. People who, for example, had no history of depression in the past, who are put on an SSRI because they’re feeling stressed and “down” due to losing their jobs; and then are put on a benzodiazepine to go along with it because of the akathisia and overstimulation caused by the SSRI; and are then unable to get off either one because of the rebound effects caused by the changes in their brain chemistry and function induced by the drugs. Much too often these people end up in the long term going down a path that involves chronic relapses, multiple drug changes, additional drugs added, emergence of new symptoms, stronger drugs and “cocktails” including antipsychotics, and resultant decreased ability to function normally in life–not to mention mental and emotional suffering.

    Of course, I care about the people on antipsychotics who may perhaps have done better untreated, or treated differently. But there are millions more who never showed any sign of psychosis, who were in fact completely normal to begin with, who are now experiencing cognitive dysfunction, mental and emotional suffering, emotional instability, ruined marriages, emergence of new psychiatric conditions resulting in new diagnoses such as “bipolar 2,” a host of physical problems, loss of careers, and disability–as a result of being started on medication for initial conditions that were normal human emotional reactions to situations that are not at all unusual in life.

    Surely nobody can argue that these people should not have been given a trial of supportive psychotherapy (and perhaps the balm of time) before being put on powerful medications that we do not understand thoroughly and that have only a slight edge (if any) over placebo.

    I think it’s way past time for a robust and rational discussion of the wisdom of the very widespread practice of prescribing psychiatric medications for situations where people are merely experiencing normal human distress in response to distressing conditions.

  • sara

    This is fantastic enterprise reporting. Thank you for taking us to the Ether Dome and for clearly reporting both sides. The studies about schizophrenic in developing countries/vs.rich countries are intriguing. And thank you for sharing with us the personal essay by the MIT student.
    This blog just gets better and better.
    Thank you, Carey and Rachel.

    • Disloj

      In developing countries they can not afford maintenance drugging with expensive psychotroic drugs. They also can’t afford the prepared overprocessed food, the industrial food.

      Sugar’s correlation with more psychosis and worse is robust. Malcolm Peet has a Report, International Variations in Schizoophrenia Outcomes and Depression Prevelence in Relation to National Dietary Practices,  that makes refernce to these World Health Organziation Reports (ISPP, and DOSMeD) and which is an important addition to the point being made. It is another multi-country analysis which follows on the heals of the ISPP and DOSMeD studies investigating causes.

      Developing countries can’t afford as much of the Modern Industrial Medicine,  Nor as much of the over-processed Industrial food, (and junk food, cigarettes and beer, auto-exaust…)

      Weston Price Foundation covers the Impact of Western Food and has brilliant biochemical insight into diet and nutrition topics.

       Butter and saturated fat are not the problem. Puffed Cerial is a Killer. (Cerial Killer.)

       EPA/DHA fish oil is ‘precious but perilous’; really, if the co-factors were not missing from food to make Omega 3s in the body, and other such considerations, then lots of EPA/DHA would be unnessesary.   

      When people ever mention Nutrient Treatment it is to say that EPA/DHA is given… B-6 Vitamin C and Magnesium may be more to the essence of the matter; and that Fish Oil can go bad inside the body if the person does not have Vitamin C and E along to protect it after ingestion, and if they have high oxidative stress, as is likely with depression and psychosis labels, unwellness in general.

      I want to see this Malcolm Peet article mentioned in the same statements that the IPSS and DOSMed are by Robert Whitaker and his fans.

      Check Out SAFE HARBOR for articles on Biochemical Therapies
      for Mental Health
      www alternativementalhealth com

      Dan Burdick, Eugene, Oregon
         

      • Jeff Kelly

        Exactly, you hit the nail right on the head!!

  • Gloria

    Thank you Robert Whitaker superb, trustful medical journalist “In the News” and Vince Boehm grand whachdog of wrongful criminal psychiatry. So much we owe you for keeping us informed . The research by pshyciatrist Nierenberg should be suspended, all is needed is several deep detoxification of all the organs under secure environment and the person will be cured of psychosis, almost like a miracle. But the brain damage will contitue for ever. The rest are lies. Mother and Guardian with 15 years of experience.

  • Amyeupham

    thank you for publishing this. Whitaker speaks the truth. Psych. drug withdrawal nearly took my life, as did the polypharmacy before I HAD to withdraw. Way to go Bob. You are our Silent Spring

  • grieving celebrant 1955

    When I was first hospitalized, I had been, within the prior 18 months, drugged and raped by an authority figure from my school whom I had known and trusted. I was16 at that time. When I related this information to my parents, they did not believe me, and my mother and brother spirited me off for a “Sunday drive” which ultimately took me to the state mental hospital 140 miles from home, for an evaluation that took roughly three weeks. I was sent to a locked ward full of psychotic men, where I was interviewed for between five and ten minutes by a psychiatrist. Only minutes after this, I was released into the general population and it was meds call. I was put on liquid Stelazine, on which I remained for the duration of my time there. There was no one to talk to, and anyone who became agitated or angry was dealt with severely. So force and drugs were the order of the day, for medical treatment, or for fornication and being sodomized. It seemed there was no difference. Now, forty years later, I still have much difficulty accepting the word or stated intentions of people in authority. I struggled for decades to find a way to quit and remain off of antipsychotics, because I had found that rigid compliance was exhausting and diminished my mind and creativity. I was unable to find a doctor who understood me, and those who seemed to do so turned on me and accused me of having sold out for a meager disability check. One MD who had recently taken over my care from another who had left that clinic read my charts quite thoroughly and thought that intensive 50 minute sessions would bring forth a “new view.” There were about half a dozen in all, and they segued from very warm and collegial to (gradually) very harshly interrogating me over every historical psychological trauma event contained in my then twenty-year history; pausing to question the veracity of each of them, limiting my input and never explaining why he had felt the need to do this. Then he would pause to glare at me intently, as if I had failed to pass his methodical, if sadistic questioning. And finally, I asked in parting if he would prescribe enough Zyprexa and Paxil to sustain me in the present course of medication I was self-administering. Furious, he spouted that “…you don’t need it, you never have needed it!!” This may have been technically true, but it was disasterous to leave a patient in a severe psychological uproar, leaving him to fend for himself when the patient (myself) had every reason to hate the psychiatric profession and brand them as sicker than I was. At present, I’ve had over eight years free of anti-psychotics of any kind, though I still find SRI’s helpful. If there is a pattern to these treatment encounters and interventions, engineered by my mother and envious brother; it is one of confrontation leading to my inability to inform them of my needs, due in no small part to their inability to comprehend it, (and to add to it my mother’s advancing senility) leading to misunderstanding and escalation to threats on their part if I do not seek treatment. In 1991, mother’s hysterical rendering of the situation at our home led to my being subdued by surprise in my own bedroom by four armed law officers. I was Tasered and rendered unconscious and disoriented twice when I took too long to comply with an order to march down the stairs with no clothing on to meet the ambulance crew, who also had been called. Threats of force, needless applications of force and endless coerced druggings are what they call treatment in the United States; and how the remedy for mental illness resembles the cause. Now because I can recount these things in retrospect, you will probably adjudge me competent to be self-sustaining and productive. After all, the answer to everything is “a car, a spouse, a job, and a spouse.” I have only one of those four, but indeed, I’m regaining my memory and mental agility, and I’m contributing to society by maintaining myself without assistance concerning four chronic medical conditions at home. Whitaker’s enlightenment mirrors my own experience, as sad as it is; and has worked a small miracle in my life, along with enlightened consumers and ex-patients. I haven’t been hospitalized for twenty years this spring, even though I became psychotic while trying to quit smoking on Chantix and took over a year to fully regain my “right mind.” I decided to ride that one out rather than surrender my neuroleptic sobriety.

  • De

    You need to take amino acid supplements along with SSRIs, or they will deplete you over time. They build up certain things at the expense of others, and this can be bad long-term. See the book “The Mood Cure.”

  • http://www.google.com/profiles/chernavsky Alex Chernavsky

    I’m pleasantly surprised that Robert Whitaker was invited to present at Mass General. Is there a full audio version and/or transcript available anywhere?

    • careyg

      Dear Alex — Mass. General has a full video version but they tell me they’re not set up for linking them externally. Josh Roffman is the chair of MGH grand rounds, and you could try him. Be warned that the acoustics were incredibly difficult, because of the echo of the dome, so am not sure it’ll be usable. But if there’s a transcript, I’d love to link to it! All best — Carey

  • http://www.postcynicalseer.blogspot.com Jaliya

    I write as an adult in my early 50s who has been on a medical leave from work for the last three years, and who has been injured since infancy by C-PTSD, major depression, and chronic sleep disorders (my brain does not go into Stage 3 or 4 sleep). I also worked as a psychotherapist and social worker for 18 years. In relation to the debate about psychotropic medications, I’ve experienced them as both blessing and bane. After witnessing some miraculous symptom amelioration in two clients who had been diagnosed with paranoid schizophrenia and were both prescribed a newly available drug (this would have been the mid-1990s), I finally bit the bullet during a horrific marital rupture and allowed my MD to prescribe me an SSRI. Sixteen days after I took the first pill, I awoke with a pervasive somatic and existential sense of a weight having lifted away; that sense remained for several months as a definite marker of change. Also, a few seemingly intractable, decades-long symptoms of deep injury — uncontrollable rage, self-injury, some compulsions and phobias — abated for the first time in my life.

    I have been on that one drug for over 14 years now, moderating doses as needed (in concert with my MD). During the 2000s I was subject to some extreme, long-term stresses that eroded my health to the point where I was no longer able to work … At my lowest point, I slept in a stupor of nightmares for up to 18 hours a day; my then-husband was taking care of both me and our home.

    It’s been three years since I first became ill. I am coming through the miasma, slowly … and there are many, many active factors in my situation. They have included already compromised metabolic and immune function, violent neighbours from hell, a devolving baseline of function across all variables, a history of severe trauma, a staunchly devoted husband who ended up breaking down himself and divorcing me, a largely useless hospitalization last year, beloved friends, relatives and former colleagues with whom I share loving relation … and a daily dose of that SSRI that is now appearing to do more harm than good. I have read Robert Whitaker’s book — twice — and am considering his revelations in the context of my own experience and in all that I have witnessed and learned over the years. Ingesting *any* substance daily for 14 years will incur cumulative effects …

    I have been experiencing, over the last decade, symptoms that are novel — that I know instinctively are not related to the original injuries or disorders. I have approached my physician about the possibility that the drug — 14 years’ worth — is causing difficulties that were not extant before I began to take it. These symptoms include marked declines in both executive and practical cognitive functions, a destruction of my appetite and over 20 lb. of lost weight that I cannot seem to recover, deadened affect, empathy and ethical sense (I do believe, as Peter Kramer stated in *Listening to Prozac*, that these drugs can cause shifts in our sense of who we are and what matters to us), and further metabolic and blood disorders that began to emerge two years ago. I experience, daily, dizziness, tinnitus, vertigo and embarrassing lapses in focus, task completion and memory. I have lost muscle tone; new phobias have arisen, and I work very hard to regain a sense of volition and a willingness to be in relation with others and in the world. I don’t know if I will ever again be ‘gainfully employed.’ I experience frightening deficits in sensory integration and tolerance; like an animal I panic in the face of stimuli that many others tend not to notice. I cannot follow conversation for long — sensory / perceptive overwhelm causes all input to become jagged and jarring, like static at high volume and velocity. Composing this comment has taken me over three hours … I come and go with activity, according to my present limits of tolerance and ability.

    So much of neuropsychiatry is a crap shoot, isn’t it … I was very lucky in that the first drug I tried, at its initial dose, worked very well. Beyond several common side effects (some of which have remained), I functioned quite well for about five years. When I look back at the last decade, I am dismayed at the erosion of my health and abilities. At the same time, I know that that one drug was a gift when my very sanity was in question, back when I first began to take it.

    I want to taper off the drug … but at present I survive via a disability pension that would be immediately ended were I to attempt a drug withdrawal. I have medical verification that I am presently unable to work ‘gainfully’. Right now, my work centers on recovering the capacities that have eroded, and taking consistent care of myself, my little home, my two cats, and my close bonds. Being in loving relation with trusted friends, mentors and kin (including my cats!) is the primary pivot around which my well-being turns. I’m relying on the basics to guide me through.

    Believing in neuroplasticity and engaging in mindful practices like walks, baths, writing, yoga — they are of huge help. I have an excellent physician who treats and converses with me with respect. He doesn’t buy Whitaker’s perspective … and he is accepting of my perspective on things, as I am of his; we challenge one another. We’ve been working together for 20 years. He’s prudent, practical, and kind. He also understands — as I do — that there are countless variables operating in each person, in each ‘case.’

    I understand both perspectives — Whitaker’s and Nierenberg’s … and polarized finger-pointing will do none of us any good. Both perspectives have arisen through study, analysis and synthesis of much information. “Anecdotal evidence” — experiential stories from people who know from the inside out what effects various treatments can have — is imperative in the conversation as well.

    Thank you for this post and its comments … all food for thought …

  • Hokaholli

    I have been on several meds. I just got off of klonopin with Neurotransmitter Restoration Therapy or NRT. I was able to go to Tri-Life Health Center in Ft. Collins, CO and was so impressed with their approach and staff. Now I am on Lamictal with no discernable results. This was prescribed by a local doc in Charlotte, NC. My panic and inability to move forward really has me a bit paralyzed. I think that the meds seriously impacted me and made my situation much worse, particularly with Paxil tem years ago. Please continue this work as I think it is valid. The anecdotal evidence is huge. The drug companies and the docs are highly invested in the status quo. The docs don’t want to have us think that didn’t know the right thing to do. It is a sad situation for so many of us that have depended on the system to get better. We have actually turned out to Guinea Pigs, in my opinion.

    • Jeff Kelly

      The Guinea Pig status if FACT not opinion. ALL are Guinea Pigs. Stay away is the best policy.

  • Tifpi92

    Robert Whitaker is a courageous man who is doing our society an incredible service. I pray more and more people have what it takes to boldly address this life-or-death issue that has a profound effect on society.

  • Andrewk1901

    The comment that struck me most was the assertion that we need to know more about the biology of these “diseases.”
    My experience as a patient is that psychiatry has forgotten that it is dealing with conscious human beings and that our conscious chosen responses to the situation we find ourselves in affect our wellbeing profoundly.
    Psychiatry seems to have abandoned psychology nearly entirely and simply been seduced by the medical industrial complex.
    To me most mental illness makes more sense when considered as “faulty software” rather than “faulty hardware”.
    The bottom line is with the modern understandings of mindfulness and neuroplasticity both software and hardware can be rewritten. I personally wasted way too much of my life looking to psychiatry for the answers to my problems.

    • Laurie

      I really like the “software rather than hardware” analogy.

      Please keep up the real thinking and sharing your input. We need to change not only how society things about treating mental illness, but how society perceives the role of a person with a mental illness in guiding and changing his own life and health.

    • pcd0912

      Regarding the use of “disease,” there’s a reason DSM IV refers to all major emotional and mental problems as “disorders.” None of them – not depression, not schizophrenia, bi-polar, anxiety, personality disorders, OCD, etc. – has a scientifically established “pathophysiology.” Unilke diabetes and heart disease (which biopsychiatry is fond of saying mental problems are “just like”)none of these mental/emotional problems has any diagnostic physical diagnostic test. I can prick my finger and learn in seconds that my blood sugar is in the diabetic range; or be tested for artery blockage, or kidney function, or leukemia or cancer. But there is no physical test for any of the major “mental illnesses.” (That term automatically prejudices the issue – if something is an “illness,” then we assume it’s a “disease,” and the medical model must apply).

      The same with the general assumption that these “diseases” are hereditary. Read Jay Joseph’s two books – The Missing Gene, and The Gene Illusion. He’s a PhD psychologist who’s done what almost no authors of psychiatric texts have done – he actually read the twin and adoption studies that purport to show that schizophrenia and other conditions have a “strong hereditary component.” Those studies are amazingly flawed, and if anything, the most reliable of them show how much more important environment is than heredity in serious mental problems.

      For many years I have supervised licensed masters level social workers dealing with seriously disturbed foster children. About 5 years ago Dr. Julie Zito of the University of Maryland did a national study of psychiatric drugs in children and found that foster children were 16 times more likely to be on psychiatric drugs than other children on Medical Assistance. I frequently remind social workers that we’ll be more effective if, instead of asking “what’s wrong with him/her,” we ask what HAPPENED to him/her.” People who have been hurt suffer terribly; the persistence and sometimes violence of their suffering can be terrifying to witness. When we get scared, we feel helpless and we turn to biological explanations and drugs, because they provide a rationale for why we feel so helpless in the face of such suffering. But there are psychosocial ways of dealing with mental/emotional problems that, as Whitaker shows, work better in the long run than do drugs. But there isn’t nearly as much money to be made selling attention and intelligent human interaction, as there is in publicizing the medical model and selling pattentable indistrial products (ie, pills).

  • careyg

    Passing along a comment that just came in by email:
    Robert Whitaker has thrown down a gauntlet before the psychiatric profession and we will learn a great deal by picking it up and considering the issues with the same sophistication and nuance that he exercises. While many benefit from medications, many do not, and some are harmed. Many choose to stop their medications despite our protestations and of those some do poorly and some do very well. I am constantly surprised and humbled by such experiences. The problem is that our default position is to medicate, especially those with psychosis, and we have even shifted to medicating earlier and younger. We do this because we are taught that antipsychotics help most people and the benefits outweigh the risks, because we thought that untreated psychosis damages the brain and because we don’t know what else to do. But it turns out these are not truths. There is conclusive evidence that newer medications are no better than older ones, that medications can cause serious diseases and reduction in lifespan and that they fail to improve social and cognitive deficits that really make the difference in outcomes. The data on psychosis toxicity is seriously flawed, and there is an accumulating evidence base on the effectiveness of non pharmacological approaches (eg CBT, family therapies, supported employment, assertive community treatment, peer support). But there is a durth of research about delaying or reducing medications and most people who discontinue their medications feel they need to do this without the assistance of their prescriber. We would be foolish to ignore and rubbish the data Whitaker presents. For example, the SSD data is important and is neither SSI nor disability data; Harrow’s study is prospective, not retrospective; WHO studies will not be substantially different with newer antipsychotics that are not more effective; clozapine helps SOME treatment resistant patients only. As a psychiatrist I want to help my patients make informed choices about how to manage their illnesses and a partner in decision making. I need to present the facts and acknowledge the doubts. We do ourselves and our patients are injustice if we lobby for meds instead of “first doing no harm.”

    Mark D. Green, MD

    • pcd0912

      Dr. Green – THANK YOU for, as you say “present(ing) the facts and acknowledge(ing) the doubts.” All of us want what’s best for people who are suffering, but few take positions without getting tangled up in recrimination.

    • Jeff Kelly

      Since you are apparently a Psychiatrist who has chosen to be honest with himself AND others, your best contribution for the ends you seek is to leave Psychiatry and help the rest of us banish “The Therapeutic State” as Szasz called it, from the face of this Earth. Your profession lobbies for meds and uses Involuntary Commitment like a SLEDGEHAMMER, and along with the State(whose laws your profession regularly ignore, by the way, and also who regularly commit criminally chargeable acts of averring you examined patients and found they needed to be “HELD” when they never did any such a thing). You are a member of a highly unethical, often criminal, and certainly deceitful and dishonest and fraudulent profession costing $2 Trillion per annum in insurance–mostly public insurance— fraud from bogus hospitalizations. You first do harm in ALL that you do–not just with meds but that is of course a very very big part of it. You do harm because you are like Judge, Jury, and Executioner and are all about social control. Well all this social control has done society exactly overall how much good? I’d like to take a POLL on that one…

  • http://www.tabloidmedicine.com Robert Goldberg

    Another point regarding SSDI… The explosion in mental health treatment for this population was and is linked directly to the fact that this population became eligible under Medicaid. Plain and simple.

    • Been there, done that

      Let me correct you, sir. SSDI only qualifies you for MEDICARE, paying for hospitalization and office visits at a seriously comprimised rate of reimbusement that more and more MD’s are not willing to accept as payment. One has to live in serious poverty, and qualify for SSI, an entirely seperate, needs-based program, to qualify for MEDICAID, which generally covers co-pays in addition to that, which although federally-based, is administered by county social services.

      • Jeff Kelly

        Yes, exactly right. And in the grand scheme of things, those who look down on the poor especially those who have ever seen the abusive mental illness system(which is what it IS–there is no “health” about it!) who had to “go there” because of a true MEDICAL condition called Celiac Sprue(because even though President Kennedy suffered this we still don’t widely recognize this because he was on steroids for some 25 years before his head was blown to bits for his nonexistant “Addison’s Disease” which was really Celiac Sprue, and since the medical profession can NEVER be wrong–especially about a diagnosis of a U.S. President–it seems this will never be widely recognized). Celiac leads to chronic clinical malnutrition. The brain needs adequate nutrition as do other parts of the body to function properly. Therein lies the rub–Celiac, based on this brilliance of JFK’s medical care, almost never today is treated with long term steroid use–oh the long term effects are seen as too dangerous. Thank God we have good gluten free food sources today, that is all I can say. So here is the simple truth:JFK, like his poor sister Rosemary(who was lobotomized and locked away for the rest of her life due to family embarrassment that medicine didn’t have the ANSWER for her mild retardation), would have suffered a great deal more at the hands of Psychiatry had he been poor and had he been without daily steroids for his Celiac. In fact, he likely would have led a life as a total unknown, suffering at the hands of Psychiatry without end due to the long term ignorance of Celiac Sprue by American Physicians(who were taught that, as a religion, no diseases of clinical malnutrition could possibly exist in America due to suficient food supply!), who had less of a family life to speak of than had his killer, Lee Harvey Oswald!!

  • http://www.tabloidmedicine.com Robert Goldberg

    Robert Whitaker continues Andrew Wakefield’s lethal legacy by stringing together a myth about the severe mental illness made worse by medicines developed to help those with the disease. He gives aid and comfort to those who believe that there is no biological factors shaping mental illness but who also maintain alien life forces are the principal cause of emotional disturbances. His data dredging reminds me of the fact twisting methodology deployed by Holocaust denialists. The 15 year time line is the oldest trick in the book since it fails to control for medication adherence, changes in cohorts, increasing severity of illness, etc. But beside all that, Whitaker never demonstrates scientifically that other approaches to mental illness improve well-being or that doing nothing is better.

    • http://moodgarden.org/ Moira

      Hi Robert Goldberg, Holocaust denier?!! What alien life force possessed you to throw that in your comment? What you demonstrate is that drug wonks play dirty.

    • Suzb

      Wow. What planet are YOU from? You’re giving me an emotional disturbance.

    • Portland17

      He did too! Did you read the book? His last couple of chapters are devoted to projects like the Soteria House and the Finland “Open Dialog” model, both of which limit medication use and emphasize peer support and psychosocial interventions, and both of which showed BETTER social outcomes for clients in the long run than medication. Medication appears to be better at the short-term reduction of symptoms, but the data suggests that the longer it is used, the less effective and more potentially destructive it becomes.

  • JG

    I appreciate that Mass. General and WBUR are engaging with Bob Whitaker about this epidemic, when so many media outlets and organizations have checked their cohones at the door. When I took my teenage daughter to Mass General in the nineties, at intake we had a wonderful and thorough interview and report done by a social worker, a “structured interview” that was a nightmare of questions hurled at me by graduate students (I think). The psychiatrist met with us for ten minutes. No, she had not received the social work report. No, she had not read the structured interview. Then she saw my daughter alone for five or ten minutes and gave her a prescription. You may think that’s good enough. Not me, not for any member of my family. I hope that people who now go to MGH now get better care, care that is more like one of the psychiatrists described in the original post.

    • Jeff Kelly

      Oh bullshit, all members of the family plop turds over their so called mentally ill family members. That is the most destructive thing you can do “for” them. Keep them FROM the mental illness system at all costs, and it’s the very best and most you can do, rest assured. Go home and read Bill Cosby on why families are insane and then ….get overrrrrrrrrr yourrrrrrselllllllllllllf.

  • Chris Gordon, MD

    To me, as a practicing psychiatrist with a great respect for Robert Whitaker’s journalism, the most important issues he raises are a little more subtle than the “meds good – meds bad” argument, which tends to get very strident and polarized very, very fast. The critical issue for me concerns whether there are people who would do better if given an opportunity — either at the start of their illness or at points after diagnosis — to recover without medications. Whitaker’s journalism illuminates a truth that used to be more widely appreciated, even within mainstream psychiatry: some people really do recover from psychosis, even without medications. The demonstrated truth that people once treated with antipsychotic medications relapse faster when the medications are withdrawn may be obscuring a sub-group of people who would have done better without medication in the first place. Of course, identifying that group prospectively is, for now, not possible. This means that people experiencing first episode psychosis, as well as their doctors and their families, face a difficult choice — to use medications that are demonstrably effective in ameliorating psychotic symptoms in the short term but may unwittingly predispose the person to relapse if they are withdrawn, or take the risks of continuing the psychotic symptoms using methods that, at least in the short run, are demonstrably less effective in remedying the psychosis. These are tough questions, and they complicate the already daunting challenge of informed consent in psychiatric practice. But I think they are very important questions. And I am grateful to Bob Whitaker for stimulating our field in this important way. Chris Gordon, MD

    • AA

      Dr. Gordon, you make some great points.

      However, I did want to throw out something for your consideration. People who come off of medication too quickly have withdrawal symptoms that are mistaken for a relapse. I am not sure it is has anything to do with whether they would have done better without medication in the first place.

      Perhaps, if they were tapered extremely slowly (5 to 10% of current dose every 4 – 6 weeks), their chances of staying off of meds greatly increase which means psychiatry needs to he having a whole new different discussion. Sadly, I am not optimistic about this happening.

      But I do thank you for your great post.

      AA

    • Jeff Kelly

      Now let’s look at this in terms of the fact that Psychiatric diagnosis in the first place is total bullshit. Then you have no decisions you need to make afterward, except read everything that Thomas Szasz, MD has written, accept his diagnosis of the profession, and then try to decide to get a life after recognizing the truth that your chosen profession is total bullshit, harms people left and right, and the monetary fraud PLUS the harm done to PEOPLE just isn’t JUSTIFIABLE with COERCIVE PSYCHIATRIC BULLSHIT.

  • joan

    I began work in a psychiatric unit with little knowledge or opinion about the medications used to treat psychosis, dementia and depression. I will leave my work many years later with a very strong opinion that supports what I consider fact: These medications are toxic and cause just the conditions they are supposed to treat. Would you believe that there is one common factor in all the admissions that have agitation, aggression , psychosis, confusion or a decline in one’s functional ability as a symptom? Psychotropic medication is that common denominator, and you don’t need any fancy studies to prove it. Psychiatrists, and the like, will always defend their use,and anyone who challenges this will likely be ostracized or dismissed as inexperienced. I must applaud those who even make an attempt. It is a relief, a blessing and I thank you for giving it the serious attention it deserves.

  • vburt

    Hearing Radio Boston on this controversy, as I commuted home from work this afternoon, made me worry about my 23 year old daughter, who recently went on Abilify, after being diagnosed with bipolar disorder in May of 2010. She did not consult me, nor even tell me, when this first occurred, so I have no idea who counseled her about the risks vs. the benefits. She is a very independent child who prides herself in her ability to manage things herself. Now I worry that she is either stuck on this for life, or severely hindered in her ability to get better if she goes off meds. Yet I am also amazed at what a positive turn our relationship has taken since she has been on the medicine. This story only makes me worry more. What’s a mother to do?

    • kaj74

      I was about the age of your daughter when I went on lithium for bipolar disorder. I was diagnosed by a psychologist and two psychiatrists. It is likely something I struggled with my whole life. My sister, a social worker also agrees with diagnosis and how effective treatment has been. And yes, I did therapy for years with only minimal improvement. I also had tried other meds to no avail, but the impact of this one was felt within days. My whole life improved. It has stayed better, and I am now 36. I’ve had no side effects other than a bit of excess thirst (knock on wood). It’s an incredibly old and well studied drug and very cheap, so can’t complain there (to all the people saying only expensive new drugs are prescribed). Don’t necessarily assume your daughter made a bad choice. I would make mine again in a heartbeat. I hope it works out as well for her as it has for me.

  • Katherine

    Having read Mr. Whitaker’s book, I think it is definitely thought-provoking, and more research needs to be done on different treatments, drug and non-drug. But it disappoints me that the emphasis is on the extreme cases where people have not been able to recover, have needed to go on SSDI, etc. and doesn’t present stories of those who live successfully with serious psychiatric disorders. We need to study the people who are able to manage their disorders, and see if there are patterns to what treatments (medications, therapy, holistic, lifestyle changes) have worked at different stages of their lives.

    • Patricecampion

      I think the salient feature of Whitaker’s focus is that people are dying and are adversely, permanently affected by these drugs despite the fact that psychiatry tries to convince people that there is a biomedical cause of their emotional turmoil that they call mental illness. To write a book about people who are living successfully with their disorders and the patterns of treatments that have worked at different stages of their lives has already been done, by psychiatry! That is the point of Whitaker’s investigative work!

      • Rwarren

        I would love to read these books. Please provide the titles.

      • Jeff Kelly

        “Living with their disorders” is the operant phrase here. Get RID OF IT. Why? Because it’s NECESSARY to do this, and most certainly Psychiatry never will do this!!

  • J. Oreus

    When looking at the pervasive use of psychotropic drugs in the USA, one has to wonder what is wrong with this society. I do know one of the answers to this question: follow the money.

    The first question the host was supposed to ask Dr Nieremberg is to disclose his earnings from the pharmaceutical industry before I can consider any of his claims to be remotely accurate.

  • Michael

    http://www.boston.com/news/health/specials/Expert_mailbag/
    The link above, particularly economist Lucie Schmidt, gives a good description on why SSI rates are skyrocketing (and no, it’s not the meds). The increase in SSI rates is clearly related to the legal expansion in eligibility requirements, its use as a safety net by families in poverty, limitations placed on other traditional safety nets (i.e. welfare restrictions), and a general increase in mental health awareness. Using SSI rates to declare a mental illness epidemic is like using high unemployment rates to declare a vacation epidemic.
    Furthermore, treatment of serious mental illness is a multi-approach process that involves much more than psycho-pharm. A serious researcher cannot consider mental health outcomes only in relation to a patient’s use of psychotropic meds (while ignoring variations in therapy, family systems, community support, and all other psychosocial/environmental factors… AND how those ignored variations might in turn be related to choices about the prescription of meds). I hope I’m missing something profound from his book, because what I’ve heard so far sounds utterly ridiculous (and more than a little irresponsible).

    • Mary Ann

      It’s unfortunate that discussions of Whitaker’s book almost always lead off with the misleading factoid linking the increase in disabilities (SSI) with the rise in psychotropic med use. That’s not the focus of his book, which is thought provoking, carefully argued, and very well worth reading if you have an interest in the subject matter.

      • Patty

        Mary Ann is right – the disability issue is what got Robert Whitaker looking into this issue initially, but he has many, many lines of evidence for his idea that medication treatments are worsening mental health outcomes in general. You really have to read his book to get the whole picture -there are so many lines of evidence, they can’t all be discussed in a short discussion.

        I will comment that my brother and I were still able to work until we took prozac, and we both went on disability for bipolar disorder soon after, and never recovered. 15 years later and we are still disabled. I suspect that both of us would still be working had we just pushed thru our depression and skipped the newfangled SSRI medication. No way to know for sure.

        • Malinchief

          Patty- yes I too am on disability because of major depression, anxiety, PTSD, and chronic fatigue.
          I really want to read Whitaker’s book, because I believe the gauntlet needs to be thrown down, now only to the traditionalists but society in general.
          I believe that each person is unique and therefore no cookie-cutter treatment will work. I agree with others that meds seems to be the prodominate path. I no longer-take meds, which was Celexa ( the only one I could take, being drug-resistant) and Klonopin.There is no doubt in my mind that due to my trauma, my brain had chemical changes and needed to be balanced. There were two main things that help me and none of them were doctors. I researched alternative supplements, so I could ease myself off meds and began to take 5HydroxTrytophan to keep the seratonin levels higher. There is no doubt that I am seratonin deficient. However, Celexa helped me sleep, but I felt tired in the morning. To get me up, since I could not drink coffee for a long time due to anxiety, I took SAM-E, which helped me have more energy and also helped my liver. Having been diagnosed as Bi-Polar at one time, I was reluctant to take SAM-E, starting at 100 mg only,now take 200mg. I too could not take Prozac, only titrated doses such as 2.5 mg per day. This helped only for awhile and I was told that that dosage was not a therapeutic one.

          The second thing I did was to begin a program, self-taught to captured all my negative thoughts, which tended to be around 300 per day. I followed Ashkok Gupta’s protocol for people suffering from post-viral chronic fatigue. After going through the 6 month program,I could get out of bed, leave the house, feel happy, participate in life.Possibly this could be used for anything, including all mental illnesses.

          Why does the profession of mental health want to ignore that most people who have break-downs or become burned out on life, work, family, lack of sleep etc>>>>??? It is truly common sense, do you know that a person needs to talk about these traumas and peer-counseling is a lot cheaper than professional therapy, which many people cannot afford. Bottom line, a simple connection with another human being, understanding of one’s worldview, mutuality, and moving on instead of away from- toward hopes, dreams and positive visions for life is a way out of chronic mental illness!! Amen.

          • http://www.postcynicalseer.blogspot.com Jaliya

            “… a simple connection with another human being”, as you write, is the pivot around which our wellbeing turns. We’re all in this together …

  • Leowers

    I been taking psychotropic meds – ssris for years, had useless results until welbutrin but it no longer works after 5 years.

  • Hana

    The biggest problem is that not only is it drugs first, it is usually drugs ONLY. especially for kids. It is true, drugs make kids often worst. Why not mandate to include Cognitive Behavior Therapy as part of the treatment?

    • pcd0912

      Hanna, please keep in mind that about 80% of drug studies are funded by the drug companies themselves, who stand to make tens of billions of dollars if the studies support use of the drugs. And the other 20% are mostly sponsored by NIMH, which is heavily influenced by the drug companies’ political clout (they have one lobyist for each member of congress). Drug companies spend 50% more on promotion than they do on research. And most drug studies are designed and controlled by the drug companies – study results are owned by the companies, so they generally don’t even release information that doesn’t favor their own drugs.

      These facts explain why drug studies tend to show that drugs plus therapy outperform therapy alone. It seems logical, but there’s a catch, as exemplified by a major study done by Brown University. They compared antidepressant alone versus psychotherapy alone, finding no statistically significant difference between the two. Then they compared both groups to drugs + therapy, and found the combination to be modestly better.

      The catch: they SHOULD have included a fourth group – therapy + placebo (sugar pill). The placebo effect is powerful – see Irving KIrsch’s 2010 book The Emperor’s New Drugs: his meta-analysis of all antidepressant drug studies submitted in the past 30 years to the FDA shows that overall, placebo comparison groups performed as well as the drug groups. So it is more than likely that a therapy + placebo group in the Brown study would have worked just as well as therapy + antidepressant.

      This is the kind of study design and interpretation you get when those controlling the study stand to make billions on the study results. Oh yes – one more tidbit about the Brown study: the school’s Department of Psychiatry was/is headed by Dr. Martin Keller, who, according to the Boston Globe, made $800,000 in personal income in just 2 years from various drug companies, including many manufacturers of antidepressants. Coincidence?

      Hana, the drug companies can live with people feeling as you do, as long as you accept the drugs in combination with therapy. They know psychiatrists and primary care docs will continue to prescribe at about the same rate; and to avoid liability, psychologists, social workers and counselors will refer patients for psychiatric evaluation (which almost invariably results in prescriptions).

      The question we need to ask, over and over, is whether there is unbiased scientific evidence that clearly shows these drugs work signficantly better than psychosocial interventions; and if so, do the drugs’ benefits outweigh an honest assessment of their short and long term adverse effects. There is scant real evidence to support the drugs, yet non-psychiatrist mental health professionals risk their licenses if they avoid exposing their clients to these drugs.

  • Leswp

    I work in primary care. The # of patients whoapply for ssi is exponentially increasing. It would be inacurate to use the #s of ssi disabilty pts as a marker. 20 yrs ago I never got requests to fill out these forms. Now,even if I know the pt is not disbled the ssi screener willscreen them inside

  • Rachel

    As a student and researcher, the importance of looking at the data for one’s self has been a foundation of my education. I do not feel you have done Dr. Nierenberg’s argument due diligence by providing links to only those arguments which Mr. Whitaker cites. Please find links to these additional articles below:

    http://bjp.rcpsych.org/cgi/reprint/178/2/154
    http://ajp.psychiatryonline.org.ezp-prod1.hul.harvard.edu/cgi/reprint/160/4/727
    http://ajp.psychiatryonline.org.ezp-prod1.hul.harvard.edu/cgi/content/abstract/152/8/1124

    • careyg

      Thank you, Rachel — I’d invited Dr. Nierenberg — just as I did Bob Whitaker — to provide links to any studies, and he hadn’t — at least, not yet. I’ll check these with him and insert them if he approves — Thanks so much for this contribution, and all best — Carey

  • Ronpies

    from Ronald Pies MD: Claims that schizophrenic patients in the U.S. fare worse than those in so-called “developing” cultures must be placed in context. First, many of the World Health Organization data supporting these claims were obtained in the late 70s through the early 90s, before the use of newer, “atypical antipsychotics”, such as clozapine. These newer medications are known to improve outcome in schizophrenia. Second, some recent cross-cultural data show that the particular cite studied can influence outcome. For example, in one study by Craig and colleagues (British Journal of Psychiatry 1997; 170:229-33), two centers in developed countries—Nottingham and Prague—showed schizophrenia outcomes similar to those found in less industrialized, “developing” countries. Finally, lower recovery rates in the U.S. should not be used as a blanket indictment of American psychiatric treatment of schizophrenia. The role of the family in the U.S. versus in developing countries may be a critical variable. In many developing countries, families provide more supportive care for their schizophrenic family members than do families in the U.S., and may have more realistic expectations about outcome

    • Andrew Kinsella

      We need also to be aware that the idea of “schizophrenia” as a distinct unified condition is highly questionable- and even being challenged by many mainstream psychiatrists.

  • Ronpies

    Many of Mr. Whitaker’s claims are based on statistics derived from disability determinations for mental disorders. But such determinations are susceptible to all kinds of economic pressures and influences, since they involve often desperate people seeking assistance. As Dr. Nierenberg notes, well-designed
    epidemiological studies of major mental illnesses have not shown evidence of increasing rates over the past 50 years. –Ronald Pies MD, SUNY Upstate Medical U., and Tufts University

  • Robert B Whitaker

    This is the beginning of a much-needed discussion. As such, I think it is worthwhile to provide more information about the disability data and studies alluded to here.

    1. The disability data

    The number of people receiving SSI or SSDI due to mental illness rose from 1.25 million in 1987 to 4 million in 2007. That is a hard number, and it tells of the number of adults 18 to 65 years old who receive government support because they are “disabled” due to mental illness.

    Dr. Nierenberg stated, during his presentation, that there had been no rise in disability, over this time, and to support this claim, he cited surveys that looked at the number of people with disabilities of all types—physical, mental, etc.—and said this percentage hadn’t risen. But this was data that included people with physical handicaps, neurological ailments (Alzheimer’s disease, etc.) This is not data that isolates the number of people with “disabilities” due to mental illness. Equally important, this is data that tells of people with disabilities, and not of people who are receiving government support because they are, in government terms, “disabled.”

    So, our society needs to ask: Why the extraordinary rise in the number of people on SSI and SSDI due to mental illness?

    2. The rise in treatment and the rise in disability numbers from 1990 to 2003.

    You quote Dr. Nierenberg stating that disability rates have remained the same even as far more people sought treatment. But, in fact, as the SSI/SSDI data shows, the number of people on disability due to mental illness actually soared during the past 20 years. And after I got home from the Grand Rounds, I realized that Dr. Nierenberg had unwittingly presented data that showed a direct correlation with increased treatment and increased disability.

    If you were to look at his slides, you would find that he reported that 29.4% of the American adult population had a psychiatric disorder from 1990-1992, and that 30.5% did in 2001-2003. The prevalence of psychiatric disorders remained the same. What changed was that in 1990-1992 only 20.3% of those with a psychiatric disorder were treated, whereas in 2001-2003, 32.7% were treated. Now if you look up census data for the number of adults in 1990 and 2003, and do the relevant math, you find that the number of people treated rose from 11.16 million adults in 1990 to 21.77 million in 2003.

    And what happened to the number of adults receiving SSI or SSDI due to mental illness during that period of increased treatment? It rose from 1.47 million people in 1990 to 3.25 million in 2003.

    3. The Harrow Study

    I would encourage anyone interested in this topic to really look at the data in this study, and to go beyond the spin that has been put on it. This is the most important long-term outcomes study for schizophrenia that has ever been done, and it is the only study that charts long-term outcomes for medicated and unmedicated patients. As a society, we really need to look at this NIMH-funded study closely.

    Martin Harrow is a psychologist at the University of Illinois College of Medicine. From 1975 to 1983, he enrolled 64 adults diagnosed with schizophrenia into the study, recruiting them from two Chicago hospitals, one public and one private. This was a young cohort of patients (median age 22.9 years), and for two-thirds, this was either their first or second hospitalization. In addition, he enrolled 81 others with milder psychotic disorders into his study.

    Now, for the next 15 years, Harrow followed the patients and charted their outcomes. He assessed how they were doing at regular intervals (2 years, 4.5 years, 7.5 years, 10 years, and 15 years), and whether they were taking antipsychotic medications. If you dig into the data he reported, in his various tables, and read the study closely, you find that here were the outcomes:

    • At end of 15 years, 40% of the schizophrenic patients off antipsychotics (25 of the 64 patients) were in recovery, versus 5% of those on medication. This stark divergence in outcomes appeared by the 4.5 year followup, and remained throughout the study.

    • At the 10-year and 15-year follow-ups, only 28% of those off meds suffered from psychotic symptoms, while around 70% of those on drugs remained actively symptomatic.

    • At the outset, Harrow also divided his schizophrenia patients into those with a “good prognosis,” based on their internal sense of self, and those with a “bad prognosis.” Starting with the 4.5-year followup and continuing through the 15-year followup, the good prognosis schizophrenia patients off medication had better global outcomes than good prognosis schizophrenia patients on medication, and the bad prognosis schizophrenia patients off medication had better global outcomes than bad prognosis schizophrenia patients on medication.

    • Among those with milder psychotic disorders, those off medication—close to half of the cohort of 81 patients– did much better long-term.

    • In terms of all patients, the global outcomes for the patients lined up like this, from best to worst: milder disorders off medication, schizophrenia off medication, milder disorders on medication, schizophrenia on medication.

    So what do you see in this data? You see that no matter how you group the patients, those off medication did much better over the long-term. And most startling of all, you see that schizophrenia patients off meds did better longer term than those with milder disorders on meds.

    Now, the way that this data has been spun—and frankly, the published articles contains this spin—is that a number of good prognosis patients, having stabilized well on the medication, then were able to get off. That’s the official explanation: the better outcomes reflect a better prognosis, and Dr. Nierenberg, in his quote above, was saying that I had it “backward” to suggest otherwise.

    But what I did at the Grand Rounds was report the data, not the spin. And everywhere you look in this study, it was the unmedicated patients who did better. And those with a much more severe diagnosis at the start—the schizophrenia patients—who then got off antipsychotics had a better long-term outcome than those with a milder psychotic disorder who stayed on psychiatric medications. And that is data that needs to be known and its implications discussed.

    4. The Chinese Study

    As a rebuttal to the many NIMH-funded studies I presented at the Grand Rounds, all of which contradicted the conventional wisdom that people diagnosed with schizophrenia need to be on antipsychotics all their lives, Dr. Nierenberg cited a 1994 study, which looked at patients in a Chinese community with schizophrenia symptoms who had never been treated. (Ran, Br. J of Psychiatry 2001, 178:154-58.)

    Here was the design of that study. The researchers went into the community, and identified 510 people with psychotic symptoms. Now 156 of that group had never been treated for their symptoms. This never-treated group had a median age of 48 years, and had been ill for 13 years. And here’s the first important point: This study identified people who had never been treated and who had remained ill. People who had suffered psychotic symptoms in the past and then recovered (without treatment) would not likely have been included in this study.

    Now, at that moment of identification, the researchers found that there were 30 people who were on antipsychotic medications and had been taking the drugs regularly. This cohort was younger (35.9 years), and had been ill for a shorter time (7.8 years.) The researchers assessed how these two cohorts were doing at that one snapshot in time, and concluded that those on medications were doing better, on the whole, than the never treated group. They were less likely to have active symptoms, etc.

    The researchers then followed the untreated group for two years. They didn’t follow the treated group, and so there is no time comparison at all. And sure enough, this untreated group that had been psychotic for a long time tended to stay psychotic.

    You can see the difference between the Harrow study and this study. In the Harrow study, Harrow began following a large sample of patients from early in the course of their illness, and charted their medication use and outcomes. The Chinese study simply reports that a group of chronic, elderly patients who had never been treated stayed chronic. And one final note: 77.6 percent of the chronic patients in the Chinese study were able to do part-time or full-time work. That work rate is far, far above what we see here in the United States.

    5. The NIMH’s Long-term Study of Depression

    In the article above, Dr. Nierenberg is quoted as stating that in a longitudinal study of depression, those who got treatment virtually doubled their odds of getting better. The study he is referring to is known as the National Institute of Mental Health Collaborative Depression Study, which began in 1998, and it showed no such thing.

    In his talk at Grand Rounds, Dr. Nierenberg cited one of the many spin-off studies that have been published form this long-running study of depression. This particular study looked at people who had been treated for an initial episode of depression and then relapsed. The researchers then found that those who were treated for this recurrent episode with a high dose of an antidepressant were more likely to recover from that episode than those treated with a low dose or no drug at all. As much as anything, it was a study designed to assess dosage of antidepressant to be used when people suffer a recurrent episode of depression. (Leon, Am J Psychiatry, 2003, 160:727-33.)

    But the key spin-off study from that larger long-running study, which I cite in Anatomy of an Epidemic, is one that looked at the six-year outcomes for depressed patients who were either treated for the disorder, and those who weren’t treated at all. And in that study, 32.3% of those who got treated suffered a “cessation of role function” and 8.6% “became incapacitated,” while only 9.8% of those who didn’t get treated suffered a “cessation of role function,” and only 1.3% became incapacitated. (Coryell, Am J Psychiatry, 1995, 152:1124-29.)

    A Need for Discussion

    I have posted this long comment because I do truly hope it can be a beginning for a larger societal discussion we need to have. Psychiatric medications can often help over the short-term, and there are people who stabilize well on them for the long term. But in terms of how their long-term use affects long-term outcomes in the aggregate, well, that is a different story indeed. And the soaring SSI and SSDI numbers tell us that we need to look at this “epidemic”, and think what might be done differently.

    –Robert Whitaker

    • Stuart

      I am bipolar have taken meds since 1994 when I had my first manic episode. For the 1st few years the drugs didn’t help, but I kept at it with the help of doctors and the bipolar clinic at MGH.
      I think the study basis of using SSI and SSDI results is grossly flawed. For example: I didn’t apply for SSDI until I had the support of meds to get me out of bed or off the high of mania. Since 7 years ago I have had the right cocktal and have been far more successful in a new career. While I don’t want to give the Rx companies more money, I think it is dangerous to implicate them in mental health improvement.

      • Patricecampion

        Hi Stuart, so glad to hear about your reported success while on the drugs. Just wanted to know, Stuart, can you attribute any environmental factors to your reported success, or is this strictly down to the drugs prescribed by doctors? For example, were there any instrumental people in your life, such as a parent, community leader, close friend or distant relative who may have played a role in helping you see your world in a more successful way, and thereby may have influenced your road to success? I ask this because I think it is fair to measure all of the factors in your success, and would like to know what you think of this.

        About Whitaker’s research, he would have used figures reported by governing bodies, institutions, and the like.. the fact that Robert Whitaker did not report about those who did not apply for SSDI until they had the support of drugs to get them out of bed may not have been part of the numbers collected by the governing bodies or institutions from which his figures are taken. Just a thought.