For more than 20 years, our country has been conducting an extraordinary
medical
experiment. Ever since
Prozac arrived on the market in 1987, our societal use of
psychiatric medications has gone
up and up, and while the
drugs
generally have been shown to curb a target symptom better than placebo over
the short term, their long-term effects have not been regularly assessed.
Thus, 23 years into this psychopharmacology era, it might be wise for us to
ask: How is this medical
experiment
turning out?
As a society, we naturally would expect that the widespread use of these
medications would have lessened the societal burden of mental illness.
Unfortunately, that has not been the case. From 1987 to 2007, the number of
adults receiving government disability payments due to mental illness more
than tripled, rising from 1.25 million to 4 million.
The disability numbers for children are even more alarming. In 1987, there
were 16,200 children under 18 years of age who received a government payment
because they were disabled by a mental illness. By 2007, there were 561,569
such children on the disability rolls. In the short span of 20 years, during
which time the prescribing of
psychiatric medications to children became common, the number of
disabled mentally ill children rose 35-fold.
These numbers do not tell of a paradigm of care that is working well for us
as a society. But we also need to look at a second question: How is this
paradigm of care working for individuals? Does the scientific literature
tell of medications that alter the long-term course of mental disorders for
the better? Or for the worse?
This is a controversial topic, but suffice to say that the scientific
literature contains one surprise after another. For instance, we all "know"
that people diagnosed with schizophrenia need to be on antipsychotic
medications all their lives. Yet, the National Institute of Mental Health
have been funding a long-term study of schizophrenia outcomes by University
of Illinois researcher Martin Harrow, and in 2007 he reported that at the
end of 15 years, 40 percent of schizophrenia patients off medication were
"recovered," versus 5 percent of those on medication. More than 50 percent
of those off medications were working, including several in "high-level"
professional jobs.
"Our data is overwhelming that not all schizophrenic patients need to be on
antipsychotics all their lives," Harrow told the audience at the 2008 annual
meeting of the American
Psychiatric
Association.
His study -- and many others -- suggests that selective use of
antipsychotics, with some patients given medical support to go off the
medication, would produce much better outcomes than a paradigm of care that
emphasized continual anti-psychotic use for all. The outcomes literature for
the major mood disorders -- major depression and bipolar illness -- also
suggests that there is something amiss with the "
drugs
for life" paradigm.
Forty years ago, major depression and bipolar illness were understood to run
an episodic course, with fairly good long-term outcomes. Today, they run a
chronic course, with the deterioration in modern bipolar outcomes especially
striking. Employment rates for adults so diagnosed have dropped from around
85 percent to 33 percent, and over the long-term, many bipolar patients
today show signs of cognitive decline, which didn't use to be the case.
As Harvard Medical School psychiatrist Ross Baldessarini confessed in a 2007
paper, "Prognosis for bipolar disorder was once considered relatively
favorable, but contemporary findings suggest that disability and poor
outcomes are prevalent."
Our society's grand medical
experiment
with
psychiatric medications is
now entering its third decade, and it is clear we need to have a vigorous
public discussion about its merits. If some patients with schizophrenia can
fare better off antipsychotics, we need to know that, and if mood disorders
have been transformed from episodic illnesses into chronic ones, we need to
know that too.
Fortunately, something of this sort is starting to happen in the Eugene
area.
LaneCare, a provider of mental health services, and MindFreedom, a patients'
rights organization, are focusing attention on this subject, and so perhaps
it is here, in this corner of the United States, that a seed for change can
be planted.
Robert
Whitaker is a medical journalist
and author of the recent book "Anatomy of An Epidemic: Magic Bullets,
Psychiatric
Drugs, and the Astonishing Rise
of Mental Illness in America." He will give a free talk for the public at
the Hilton Eugene at 7 p.m. Aug. 20, 2010.
[On the same day as the above was published, the local weekly newspaper --
Eugene Weekly -- published a column by mental health worker Chuck Areford
challenging the
psychiatric
drug model of the current mental
health system, and mentioning
Whitaker's
and MindFreedom's work. To read Chuck's column,
click here.]