Whether the “chemical imbalance” theory is true or not, the real question is, Do antidepressants work better than placebos? Psychologist Irving Kirsch, one of the authors reviewed by Angell, used the Freedom of Information Act to obtain drug companies’ records of their negative studies from the FDA. Unlike the positive results, negative results are normally not published. (Incredibly to this writer, negative results are considered proprietary and therefore confidential.) Taking both positive and negative results into consideration, Kirsch discovered that six popular drugs — Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor — scored unimpressively when compared with placebos. Yet, as Angell writes, “because the positive studies were extensively publicized, while the negative ones were hidden, the public and the medical profession came to believe that these drugs were highly effective antidepressants.” It gets more surreal. When depressed patients were prescribed drugs such as opiates, sedatives, stimulants and even herbal remedies, Kirsch and others found their symptoms were relieved to about the same degree as with SSRI-type antidepressants.
I first took a close look at treatments for mental illness 15 years ago while researching an article for Scientific American. At the time, sales of a new class of antidepressants, selective serotonin reuptake inhibitors, or SSRI’s, were booming. The first SSRI, Prozac, had quickly become the most widely prescribed drug in the world. Many psychiatrists, notably Peter D. Kramer, author of the best seller Listening to Prozac, touted SSRI’s as a revolutionary advance in the treatment of mental illness. Prozac, Kramer said in a phrase that I hope now haunts him, could make patients “better than well.”
Clinical trials told a different story. SSRI’s are no more effective than two older classes of antidepressants, tricyclics and monoamine oxidase inhibitors. What was even more surprising to me—given the rave reviews Prozac had received from Kramer and others—was that antidepressants as a whole were not more effective than so-called talking cures, whether cognitive behavioral therapy or even old-fashioned Freudian psychoanalysis. According to some investigators, treatments for depression and other common ailments work—if they do work—by harnessing the placebo effect, the tendency of a patient’s expectation of improvement to become self-fulfilling. I titled my article “Why Freud Isn’t Dead.” Far from defending psychoanalysis, my point was that psychiatry has made disturbingly little progress since the heyday of Freudian theory.
For any mental illness or passing mood swing that may trouble a person, the Diagnostic and Statistical Manual of Mental Disorders — better known as the DSM — has a label and a code. Recurring bad dreams? That may be a Nightmare Disorder, or 307.47. Narcolepsy uses the same digits in a different order: 347.00. Fancy feather ticklers? That sounds like Fetishism, or 302.81. Then there’s the ultimate catch-all for vague sadness or uneasiness, General Anxiety Disorder, or 300.02. That’s a label almost everyone can lay claim to.Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.
Is America truly stricken with widespread mental illness? Do tens of millions need mind-altering drugs? A recent flurry of media articles lead readers to a realization that Big Pharma and the “mental health” industry have deceived Americans on a grand scale.
The “New York Review of Books” two-part article by Dr. Marcia Angell, Senior Lecturer at Harvard Medical School and former Editor in Chief of The New England Journal of Medicine, summarizes it extremely well. She analyzes three books by authors Irving Kirsch, Robert Whitaker, and Daniel Carlat. Each deconstructs the apparent mental illness epidemic and theory that mental disorders stem from brain chemical imbalances which can be corrected by drugs.
Dr. Angell’s review has sparked a host of other journalists to applaud her and fuel the fire. An article in Forbes even concludes, “psychopharma is looking like an idea whose time has passed.”
In this corner: Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, senior lecturer in social medicine at Harvard Medical School, and frequent critic of the pharmaceutical industry. In the opposite corner: Dr. Peter Kramer, Brown University psychiatry professor and author of the mega-selling “Listening to Prozac,’’ a book that helped convince thousands of Americans to live better, chemically.
At issue: a two-part article by Angell, published in The New York Review of Books, that assails psychiatrists and their pharmaceutical helpmeets, mainly antidepressants, on several fronts.
Item: Angell, quoting, among others, Tufts University psychiatrist Dr. Daniel Carlat, attacks the widely held belief that depression and other mental disorders result from chemical imbalances in the brain. Item: Citing the research of British psychologist Irving Kirsch, Angell writes that some of the most widely used antidepressants, including Prozac, Paxil, Zoloft, Celexa, and Effexor, performed only marginally better than placeItem: Angell uses a book by journalist Robert Whitaker to suggest that newly minted antipsychotic drugs may be causing “an epidemic of brain dysfunction.’’