Tuesday, April 18, 2006

Anatomy of An Epidemic:

Psychiatric Drugs and the Astonishing Rise of Mental Illness in America

By Robert Whitaker
Ethical Human Psychology and Psychiatry, Volume 7, Number I , Spring 2005

Some uncritical promoters of psychiatry and its current biological treatment paradigm have declared that the introduction of chlorpromazine (Thorazine) in 1955, was a revolutionary medical “breakthrough” comparable to penicillin (e.g., Edward Shorter, A History of Psychiatry, 1997). Others have sought to legitimize the ADHD "diagnosis" by comparing it to diabetes.
At best, these drugs temporarily reduce psychiatric symptoms with short-term use. Robert Whitaker brings to light empirical evidence demonstrating that currently prescribed psychoactive drugs have shattered patients' mental and physical health. Whitaker examines the unprecedented increase in disabling mental illness in the US since the introduction of those drugs.

The catalyst for this investigation was a book by E. Fuller Torrey, The Invisible Plague (2001), in which Torrey concluded that insanity had risen to the level of an "epidemic." Dr. Torrey is a firm proponent of biological psychiatry who aggressively promotes legislation to force antipsychotic drugs on "non-compliant" patients.

Whitaker examines the "epidemic" from a different perspective: Noting that "this epidemic has unfolded in lockstep with the ever-increasing use of psychiatric drugs, an obvious question arises: Is our drug-based paradigm of care fueling this modem-day plague?"

To answer this question, Whitaker turned to government documents recording the number of patients who received treatment for mental illness and the number of patients disabled by mental illness, and he turned to neuroscientific evidence of how these drugs work.

The first jolting finding is that the number of patients treated for mental illness in 2000 increased fourfold per capita since 1955-- from 1,028 episodes per 100,000 population in 1955 compared to 3,806 per 100,000 population in 2000. (Table 1).
[the US population: 1955…….165, 069.000; 1988………..242,288,918; 2003……..290.788,976. [1]

Whitaker then compares the documented evidence showing dramatic increase in the number of disabled mentally ill persons:
The year 1987 when Prozac was introduced, ushering in the second generation psychotropic drugs. To calculate the number of persons disabled by mental illness in 1987 and 2003, Whitaker counted those receiving disability payments under SSI or SSDI
(Supplemental Security Income or Social Security Disability Insurance).
In 1955 persons disabled by mental illness were institutionalized: the rate of disability was 3.38 per 1,000. In 1987……………………………………………………………………………………………13.75 per 1,000 In 2003…………………………………………………………………………………………… 19.69 per 1,000 (Table 2).

Between 1987 and 2000, the number of disabled mentally ill in the United States increased from 3.331 million people to 5.726 million.
That is an increase of 149,739 people per year, or 410 people newly disabled by mental illness every day (Table 3).

The next issue Whitaker addressed is neuroscientists’ findings that psychoactive drugs induce pathology with long term use. Princeton neuroscientist Barry Jacobs, in 1991 explicitly made the point about SSRIs in Journal of Clinical Psychiatry. These drugs, he said, “alter the level of synaptic transmission beyond the physiologic range achieved under (normal) environmental/biological conditions. Thus, any behavioral or physiologic change produced under these conditions might more appropriately be considered pathologic, rather than reflective of the normal biological role of serotonin.”

Similarly, Harvard neuroscientist Stephen Hyman described the mechanism of action of psychoactive drugs—before his career change from scientist to administrator, first as Director of NIMH, currently, Provost of Harvard. In an article in the American Journal of Psychiatry, Hyman explained that whether abused or prescribed, the mechanisms by which psychoactive drugs work--including stimulants, antidepressants and antipsychotics—is they “create perturbations in neurotransmitter functions." (Hyman & Nestler, 1996)

“Repeated “perturbations” (i.e., chronic use of psychoactive drugs), Hyman noted, “usurp normal homeostatic mechanisms within neurons” (i.e., interfere with normal brain function) “thereby producing adaptations that lead to substantial and long-lasting alterations in neural function." In the case of stimulants, Hyman wrote, the brain’s “adaptation” results in addiction.

When Dr. Hyman was asked how, in light of his scientific findings, he could support an unethical NIMH experiment—Preschool ADHD Treatment Study—that exposes preschool children to a psychostimulant drug that he knew to be addictive, and potentially permanently altering these children’s brain function?
He replied, “the article referred to research in a Petrie dish…”

Whitaker found empirical evidence validating the applicability of Hyman’s Petrie dish research. For instance, “Prozac and other SSRI antidepressants block the reuptake of serotonin. In order to cope with this hindrance of normal function, the brain tones down its whole serotonergic system. Neurons both release less serotonin and down-regulate (or decrease) their number of serotonin receptors . The density of serotonin receptors in the brain may decrease by 50% or more. As part of this adaptation process, Hyman noted, there are also changes in intracellular signaling pathways and gene __expression. After a few weeks, Hyman concluded, the patient's brain is functioning in a manner that is "qualitatively as well as quantitatively different from the normal state" ( p . 161).

Contrary to the assertions of the profession and the mental health drug lobbyists, psychoactive drugs--in particular the atypical antipsychotics and SSRI antidepressants--have not only failed as therapies for the mentally ill—these irresponsibly prescribed drugs have led to an epidemic of chronic, incapacitating mental illness. Inasmuch as the drugs induce mania and akathisia, patients are at increased risk of violent, aggressive, and suicidal behavior.

As psychiatrist Fava wrote: "Antidepressant-induced mania is not simply a temporary and reversible phenomenon, but a complex biochemical mechanism of illness deterioration." (See: Fava, G. Can long-term treatment with antidepressant drugs worsen the course of depression? Journal of Clinical Psychiatry, 2003, 64, 123-133).

An excellent review and analysis of the SSRI evidence by Peter Breggin, published in International Journal of Risk & Safety in Medicine 16 (2003/2004) 31–49, includes case reports, epidemiological studies and clinical trials as well as studies related to SSRI-induced suicide, violence, mania, and extreme abnormal behavior in children.

How many violent crimes are committed by the estimated 500,000 Americans who experience antidepressant induced mania each year?
The evidence from government sources demonstrates that--instead of improving patient recovery rates, hundreds of thousands of patients treated with these drugs have been rendered incapable of recovery. Patients on the drugs have been condemned to become permanently disabled.
The empirical evidence pulls the foundation out from under psychiatry's scientifically invalid belief system: First, its faith-based claim that mental disorders are caused by "a chemical imbalance" in the brain, and that psychoactive drugs are curatives that restore the brain's normal chemistry. Second, the claim that psychoactive drugs are "safe and effective" and that they improve patients' chances for recovery from mental illness.

Third, the claim that early detection--i.e., mental health screening--and early drug intervention prevent future disability.
From an immoral business perspective, these drugs’ adverse effects are ensuring a stream of lifelong customers for the drug industry. Whitaker notes:
The combined sales of antidepressants and antipsychotics jumped from around $500 million in 1986 to nearly $20 billion in 2004--a 40-fold increase.

Furthermore, these drugs have produced abnormal metabolic effects resulting in chronic physical illnesses that require additional drugs. The drugs increase cholesterol levels and high blood pressure, cause hormonal and cardiac abnormalities, and diabetes. Indeed, as Psychiatric Times reports, "comparative data are emerging on the metabolic effects of second-generation antipsychotics (SGAs) used in treating children and adolescents suffering from psychotic, mood and disruptive behavior disorders."
The data shows life-threatening drug-induced effects:
"Increased insulin resistance in young people after three months of treatment with olanzapine, risperidone or quetiapine ... is of considerable concern." [2]
Psychiatry and its financial backers in the pharmaceutical industry have determined--without our knowledge or informed consent--that the temporary, short-term relief from psychiatric symptoms--which the drugs provide for some patients--is worth the price of chronic disability and the risk of death.

Ultimately, the documented evidence is a devastating indictment of public policies that undermine the health and mental health of the American people.
These policies are misinformed by the psychiatric establishment whose financial and professional investments in psychotropic drugs necessarily taints their recommendations.
The public has been decieved about the irreversible damaging effects of currently used psychoactive drugs. Whitaker presents the devastating consequences of that deception.

Whitaker’s CONCLUSION:
A century ago, fewer than two people per 1,000 were considered to be "disabled" by mental illness and in need of hospitalization. By 1955, that number had jumped to 3 .38 people per 1,000, and during the past 50 years, a period when psychiatric drugs have been the cornerstone of care, the disability rate has climbed steadily, and has now reached around 20 people per 1,000. (Table 2). As with any epidemic, one would suspect that an outside agent of some type-a virus, a bacterial infection, or an environmental toxin was causing this rise in illness. That is indeed the case here. There is an outside agent fueling this epidemic of mental illness, only it is to be found in the medicine cabinet. Psychiatric drugs perturb normal neurotransmitter function, and while that perturbation may curb symptoms over a short term, over the long run it increases the likelihood that a person will become chronically ill, or ill with new and more severe symptoms. A review of the scientific literature shows quite clearly that it is our drug-based paradigm of care that is fueling this modem-day plague.

The article is available at: http://psychrights.org/Articles/EHPPPsychDrugEpidemic(Whitaker).pdf

The following may be viewed as a drug market expansion scheme masquerading as science. If allowed to go forward, it will likely magnify the number of drug-induced mentally and physically disabled young persons in the US:
At Yale University, HEALTHY children as young as 12 are being exposed to Eli Lilly's antipsychotic blockbuster drug, Zyprexa, for non-approved uses.
The experiment is being conducted on the basis of the speculative, unsubstantiated premise that Zyprexa (or any drug) might prevent schizophrenia.

In April, 2000, AHRP filed a complaint about the experiment, with the Office of Human Research Protection--see:

However, it is unclear whether the federal regulations apply to the excperiment which is privately funded. Five years after the experiment commenced, the psychiatrists admit that: "Many people with prodromal symptoms develop other psychiatric illness or no illness at all."
And they admit: "The symptoms that are considered prodromal are generally not specific to schizophrenia and that causes the wide variation of outcome."

Nevertheless, healthy children are being put at high risk of harm from exposure to this powerful antipsychotic with severe, irreversible adverse side effects--
Based on the available evidence, some of the children are likely to develop diabetes, possibly insulin-resistant diabetes.
The drug has never been approved as a "preventive" intervention for any psychiatric condition.
The vague rationale given five years later fails to justify the documented risks: "schizophrenia is a devastating disease. There are several points in the development of the syndrome when one can be brought to clinical attention."
The goal is: "to pick up on symptoms that are causing difficulty but have not led to the full syndrome and a conclusive diagnosis of schizophrenia…." "it is important to begin to understand who might benefit from treatment at an earlier stage and who might never need full schizophrenia treatment."

The speculative nature of this dubious experiment on adolescents --who are legally non-consensual human subjects--is revealed in the vague attributes which not even psychiatry's diagnostic Bible identifies as "symptoms" of schizophrenia:
The investigators merely say they are "...looking at impaired attention as a predictor of future outcome. Using particular markers of attention, there have been findings that show that differences as early as 12 years old can be used to predict outcome." [3]

The funding sources for the Yale experiment reveal who the stakeholders of such pseudo-scientific marketing pitches are.

1.Forstall, Richard L. Population of States and Counties of the United States: 1790 to 1990. U.S. Bureau of the Census, Washington, DC, 1996. http://www.tsl.state.tx.us/ref/abouttx/census.html
2. Correll CU, Olshanskiy V, Mughal T et al. (2005), Prospective study of second-generation antipsychotic-induced insulin resistant in antipsychotic-naive children and adolescents. Presented at the XX International Congress on Schizophrenia Research. Savannah, Ga.; April 2-6.
3. See: Prevention of Schizophrenia - Can it Be Achieved? Cheng Lee, Thomas H. McGlashan and Scott W. Woods CNS Drugs 2005; 19 (3): 193-206
"Supported by grants to Dr McGlashan from the National Alliance for Schizophrenia and Affective Disorders (NARSAD) and from the UK National Institute of Mental Health (MH01654). Dr McGlashan has also received research support from Eli Lilly Company. Supported by grants to Dr Woods from the Donaghue Foundation and MH61282 from the US National Institutes of Health. Dr Woods has also received research support from pharmaceutical companies including Eli Lilly, Janssen and Bristol-Myers Squibb."
See also, soon to be posted on the AHRP website: Graham Aldred's IMR (Investigative Medication Routine) calculations for SSRI-induced suicides in the US (1988--2002) and the UK (1989--2004)

1 comment:

Anonymous said...

This such an important topic, Pat, and it sounds like Whitaker addresses it well.

The rise in the diagnoses of mental illness has corresponded with a rise in violence, mind-altering psychiatric drugs, and more people being diagnosed as mentally ill. Whenever we don't solve a problem, but bring a problem and call it a solution, we of course get much bigger problems. No one in psychiatry or psychology should be ignoring the question of the harm caused by their fields.

Thanks for another good blog.

Jim Shackelford