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Are Psychiatric Medications Making Us Sicker?

The views expressed are those of the author and are not necessarily those of Scientific American.

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Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown 2010), by the journalist Robert Whitaker, is one of the most disturbing, consequential works of investigative journalism I’ve read in a long time. Perhaps ever. Whitaker has persuaded me that American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis—harmful medical treatment–in history. I’m even more impressed by Whitaker’s research and reasoning after hearing him speak at my school, Stevens Institute of Technology, on February 29. He is the kind of science journalist who makes me proud to be a science journalist. I’m thus printing here a modified version of an article I wrote about Anatomy last fall for The Chronicle of Higher Education. I also urge you to check out Whitaker’s Psychology Today blog, where he addresses his critics.

I first took a close look at treatments for mental illness in the mid-1990s while researching an article for Scientific American. At the time, sales of a new class of antidepressants, selective serotonin reuptake inhibitors, or SSRIs, were booming. The first SSRI, Prozac, had quickly become the most widely prescribed drug in the world. Many psychiatrists, notably Peter Kramer, author of the bestseller Listening to Prozac (Viking 1993), touted SSRIs as a revolutionary advance in the treatment of mental illness. Prozac, Kramer claimed in a phrase that I hope now haunts him (but probably doesn’t), could make patients “better than well.”

Clinical trials told a different story. SSRIs 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 investigators such as the psychologists Seymour Fisher and Roger Greenberg. According to these and other researchers, 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, published in Scientific American in December 1996, “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.

In retrospect, my critique of modern psychiatry was probably too mild. According to Anatomy of Epidemic by Robert Whitaker, psychiatry has not only failed to progress; it may now be harming many of those it purports to help. Anatomy of an Epidemic has been ignored by most major media. I learned about it only after Marcia Angell, former editor of the New England Journal of Medicine and now a lecturer on public health at Harvard, reviewed Anatomy in The New York Review of Books last year.

As recently as the 1950s, Whitaker contends, the four major mental disorders–depression, anxiety disorder, bipolar disorder and schizophrenia–often manifested as episodic and “self-limiting”; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. Since 1987, the percentage of the population receiving federal disability payments for mental illness has tripled; among children under the age of 18, the percentage has grown by a factor of 35.

This epidemic has coincided, paradoxically, with a surge in prescriptions for psychiatric drugs. Between 1985 and 2008, U.S. sales of antidepressants and antipsychotics multiplied almost fifty-fold, to $24.2 billion. Prescriptions for bipolar disorder and anxiety have also swelled. One in eight Americans, including children and even toddlers, is now taking a psychotropic medication. Whitaker acknowledges that antidepressants and other psychiatric medications often provide short-term relief, which explains why so many physicians and patients believe so fervently in the drugs’ benefits. But over time, Whitaker argues, drugs make many patients sicker than they would have been if they had never been medicated.

Whitaker compiles anecdotal and clinical evidence that when patients stop taking SSRIs, they often experience depression more severe than what drove them to seek treatment. A multi-nation report by the World Health Organization in 1998 associated long-term antidepressant usage with a higher rather than lower risk of long-term depression. SSRIs can cause a wide range of side effects, including insomnia, sexual dysfunction, apathy, suicidal impulses and mania–which may then lead patients to be diagnosed with and treated for bipolar disorder.

Indeed, Whitaker suspects that antidepressants—as well as Ritalin and other stimulants prescribed for attention deficit disorder—have catalyzed the recent spike in bipolar disorder. Relatively rare just a half century ago, reported rates of bipolar disorder have spiked more than 100-fold to one in 40 adults. Side effects attributed to lithium and other common medications for bipolar disorder include deficits in memory, learning ability and fine-motor skills. Similarly, benzodiazepines such as Valium and Xanax, which are among the drugs prescribed for anxiety, are addictive; withdrawal from these sedatives can cause effects ranging from insomnia to seizures, as well as panic attacks.

Whitaker’s analysis of treatments for schizophrenia is especially disturbing. Antipsychotics, from Thorazine to successors like Zyprexa, cause weight gain, physical tremors (called tardive dyskinesia) and, according to some studies, cognitive decline and brain shrinkage. Before the introduction of Thorazine in the 1950s, Whitaker asserts, almost two thirds of the patients hospitalized for an initial episode of schizophrenia were released within a year, and most of this group did not require subsequent hospitalization.

Over the past half century, the rate of schizophrenia-related disability has grown by a factor of four, and schizophrenia has come to be seen as a largely chronic, degenerative disease. A decades-long study by the World Health Organization found that schizophrenic patients fared better in poor nations, such as Nigeria and India, where antipsychotics are sparingly prescribed, than in wealthier regions such as the U.S. and Europe.

A long-term study by Martin Harrow, a psychologist at the University of Illinois, found an inverse correlation between medication for schizophrenia and positive, long-term outcomes. Beginning in the 1970s, Harrow tracked a group of 64 newly diagnosed schizophrenics. Forty percent of the non-medicated patients recovered—meaning that they could become self-supporting–versus five percent of those who were medicated. Harrow contended that those who were heavily medicated were sicker to begin with, but Whitaker suggests that the medications may be making some patients sicker.

A caveat is in order here. Whitaker does NOT claim that medications have no value and that no one should take them. In his talk at my school, as in his book, Whitaker acknowledged that many people benefit from psychopharmacology, especially over the short term. But he does believe that the drugs should be administered far more sparingly.

Several possible objections to Whitaker’s case against psychiatry come to mind. First of all, the recent surge in mental disability may stem not only from iatrogenic effects of medications but from other factors, notably a decrease in the stigma associated with mental illness, which has spurred more people to seek and obtain taxpayer-supported treatment and assistance. Also, patients who are heavily medicated may not fare as well over the longer term as patients who receive fewer drugs because the former are truly sicker (as Harrow suggested). In her review, Marcia Angell called Whitaker’s book “suggestive, if not conclusive.”

Anatomy has received other recognition. It won the 2010 Investigative Reporters and Editors Award for Investigative Journalism. A review in New Scientist concluded that Whitaker’s arguments seem “far-fetched” at first but on closer examination “are worryingly sane and consistently based on evidence. They amount to a provocative yet reasonable thesis, one whose astonishing intellectual punch is delivered with the gripping vitality of a novel. Whitaker manages to be damning while remaining stubbornly optimistic in this enthralling and frighteningly persuasive book.” At the very least, Whitaker’s claims warrant further investigation. Check out his book and make up your own mind.

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John Horgan About the Author: Every week, hockey-playing science writer John Horgan takes a puckish, provocative look at breaking science. A teacher at Stevens Institute of Technology, Horgan is the author of four books, including The End of Science (Addison Wesley, 1996) and The End of War (McSweeney's, 2012). Follow on Twitter @Horganism.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. Danny Haszard 10:18 am 03/5/2012

    PTSD treatment for Veterans found ineffective.
    I took Zyprexa Olanzapine a powerful Lilly schizophrenic drug for 4 years it was prescribed to me off-label for post traumatic stress disorder was ineffective costly and gave me diabetes.
    *FIVE at FIVE*
    The Zyprexa antipsychotic drug,whose side effects can include weight gain and diabetes, was sold for “children in foster care, people who have trouble sleeping, elderly in nursing homes.
    *Five at Five* was the Zyprexa sales rep slogan, meaning *5mg dispensed at 5pm would keep patients quiet*.
    – Daniel Haszard Zyprexa victim activist

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  2. 2. brynnscott 4:19 pm 03/5/2012

    Anecdotally, I must disagree. “As recently as the 1950s, Whitaker contends, the four major mental disorders–depression, anxiety disorder, bipolar disorder and schizophrenia–often manifested as episodic and “self-limiting”; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare.” My grandmother was hospitalized multiple times over her life for severe depression. Most of my childhood she lived as an agoraphobic and paranoid shut-in. She was not on medication and would not see a doctor again therefore was outside of the official statistics. I wonder if after each hospitalization she was believed to have been “cured?” I wonder if the almost 2 decades she spent in her house she was a statistic for “self-limitation?” or would someone connect the dots and see my Grandmother as chronic? How many others chronic problems were hidden by their families in homes and never documented? How many younger people just self-destructed without ever having been diagnosed? I sought help in college, but having had an extremely distasteful experience with the “talking cure”, toughed it out for years just living with and through my frequent bouts (say about every 6 weeks)of existential despair. Since then I have had some good therapists and some useless therapists (and there in lies the problem with therapy), but have been on medication and functionally stable for 15 years. I have suffered from depression and mania since I was 9 years old–I gave it almost 20 years to correct itself. I’m not going back.

    Is it possible that some of the people who are on anti-depressants shouldn’t be? Sure. No doubt even. But I think it also highly probable that some of the historical data that the author studied suffered from under reporting and other types of bias.

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  3. 3. Bonnie Nordby 12:20 am 03/6/2012

    As an RN working in an inpatient open adult psychiatric unit I saw many people often get better more from being part of a therapeutic community and participating in group and individual therapies than from medication. Simply evident were how people started getting better before the medications were known to take effect. The pharmacist and I even had our inside joke. It ain’t the meds.

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  4. 4. dawson54 5:11 am 03/6/2012

    A good review, John, and it sounds as if Whitaker’s book is filled with worthy food for thought. I suspect that the questions he’s dealing with are far too nuanced to be reduced to simple cause-and-effect statistics.

    What if, for instance, SSRI’s somehow produce the same changes in neurochemistry as the placebo effect? It’s possible. If one looks at the same data from a different viewpoint, it’s even likely.

    And why does Prozac (and similar SSRIs) produce profound changes in the behavior of dogs? Are they subject to the placebo effect? How can a dog with a severe phobia of thunderstorms be calmed into sleep by administering a Valium? Placebo again?

    I doubt it. Common sense is a variable that should — in fact, must — be factored into any statistical equation, especially those dealing with human behavior.

    My own anecdotal evidence: my mother was hospitalized repeatedly for severe depression during the 1950s and 1960s. She received electroshock therapy and medication, and was able to come home after several weeks. Rather than a “self-limiting” condition, hers was chronic. As soon as she stopped taking her medication — which consisted of both MAOs and tricyclic antidepressants (not at the same time) — she would relapse and be forced to return to the hospital. This pattern continued until last year, when she died after suffering from a sustained period of 15 years of depression that degenerated into full-scale dementia.

    I can well imagine the horror that she suffered, for I have suffered it myself. Beginning in the mid-1970s, during my early 20s, I began to suffer from debilitating panic attacks that kept me housebound much of the time, and terrified of venturing far from home when I did muster the ability to leave home. I tried classic psychoanalysis for two years with a kind, elderly analyst who had studied in Austria and Switzerland not long after Freud had left the scene. I tried gestalt therapy, cognitive-behavioral therapy, rational-emotive therapy (same difference as CBT), humanist therapy, and pastoral counseling.

    After some ten years of panic disorder that devolved into full-blown depression, I decided to try the dreaded “drug treatment” that I had grown up hearing my mother rail against. I found a psychiatrist who prescribed Xanax (which was at the time uniquely effective in blocking the worst symptoms of panic disorder) and a tricyclic antidepressant.

    Although much improved, I still couldn’t shake the anxiety symptoms altogether. Until, that is, I tried a mixture of SSRI and SNRI (which inhibits the reuptake of norepinephrine). After a mere week on this medication, my symptoms disappeared. Completely. I have not had a panic attack — or even a significant spell of anxiety — in nearly 15 years.

    Is it possible that I have succumbed to a placebo every day for 15 years? I doubt it. Like our inability to tickle ourselves, I would suggest that it’s extremely unlikely that we could fool ourselves into a placebo effect for this amount of time.

    While I’m sure that “being part of a therapeutic community and participating in group and individual therapies” can have a dramatic effect, from my experience I would have to take issue with Bonnie Nordby’s conclusion. In my case (and that of my mother), it really has been the meds.

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  5. 5. HaroldAMaiio 4:08 pm 03/6/2012

    notably a decrease in the stigma (I) associated with mental illness

    I first took a close look at treatments for mental illness –are they not plural?

    psychiatry has not only failed to progress; it may now be harming many of those it purports to help. –when was this not true?

    diagnosed with mental illness –diagnose means to name the illness, or diagnosed with a mental illness.

    schizophrenic patients –is politely, people with schizophrenia.

    a decrease in the stigma associated with mental illness –by whom? You, above. I have never seen it quantified or qualified.

    Harold A. Maio, retired mental health editor

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  6. 6. dawson54 8:04 pm 03/6/2012

    Footnote to my overlong comments above — when I singled out Bonnie Nordby in the final sentence, I meant to make this somehow humorous. Not laugh-out-loud funny, but worth a wry smile. Looking back I see it now as quite snide, something I certainly did not intend. So, please accept all apologies. Despite my experience with psychiatric medications, I remain fascinated by this subject (when I’m not in the throes of a panic attack!), and I think both the article and the comments shed light on what a difficult and amazing topic this is.

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  7. 7. JeffreyC 1:48 pm 03/12/2012

    “And why does Prozac (and similar SSRIs) produce profound changes in the behavior of dogs? Are they subject to the placebo effect? How can a dog with a severe phobia of thunderstorms be calmed into sleep by administering a Valium? Placebo again?”

    No, not because SSRI’s may produce placebo effect hence be useful for treating depression. Nobody is calling AD’s a “placebo”, they are in fact psycotropic drugs but what is being claimed is that there psycotropic, mind-bending method of action is not specific to the organic cause of depression. Alcohol and cocaine could be called “antidepressants” by the same logic that AD’s would be called them, if AD’s actually worked.

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  8. 8. Jmosies 2:44 pm 03/13/2012

    I am currently being drugged against my will with Clozapine.

    That the effects of such formulations have, in my experience, been exceedingly unpleasant, it seems reasonable that those who are intended to receive them may affirm or deny their receipt.

    This has not been the case.

    That people may be medicated against their will, seems to suggest an infringement of civil liberties.

    Insofar as a person may wish to receive antipsychotics, that is entirely up to them.

    I prefer alternative avenues towards improving health and wellbeing.

    The following message may shed some light on the matter:

    I was released from New Hampshire Hospital on February 16, 2012, and I’ve reiterated on numerous occasions, both during my confinement and following my release, that antipsychotics are, in my experience, harmful.

    Such indications were largely disregarded by the staff.

    Under the influences of these substances, I find that cognition is crippled.

    I much prefer the experience of life without them.

    A filing for Legal Guardianship was approved following a hearing on July 20, 2011, and amongst the various rights that have been revoked, is the right to approve, decline, or otherwise modify the proposed treatment plans devised by the medical staff.

    That a person may be medicated against their will, with pills whose effects have been expressly indicated to be harmful by those who are intended to receive them, seems to merit something in the way of a public discussion.

    In regard to my captivity at New Hampshire Hospital, I was detained beginning May 28, 2011, under the tenets of an Involuntary Emergency Admission.

    Once one has been confined in such a manner, one may change one’s status to voluntary. Such a change in status may reduce one’s stay to a handful of days, whereas, if one continues to be held involuntarily, one’s stay may extend to a number of years.

    Being released from the hospital seems to become more a matter of leaving the hospital as soon as possible, rather than promoting health or allowing people the freedom to pursue avenues of their choice towards health and wellbeing.

    I’ve devised two petitions in regard to this matter, and I pray that they may touch your heart.

    The petitions may be found at the following addresses:

    US Citizens Are Being Confined Without Having Been Charged with a Crime.
    Guardianship Granted to Those Who Are Shown to Be Abusive Influences

    Additionally, the contents of the tab that reads “About this Petition” may offer some clarification.

    Please offer your support in regard to this matter.

    God bless,
    take care and
    be well,


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  9. 9. benjcoff 7:21 pm 12/4/2012

    I agree that this is making us sicker. If not the actual patients, it’s affecting the way we deal with our patients. I would like to start seeing more Minneapolis psychiatrist
    suggest, recommend, and offer patients more enthusiasm and insight into their lives. These people are coming to us in a last ditch effort and we handing the giant pill bottles and sending them on their merry way. Thanks for posting.

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  10. 10. TheTruthIsTheLight 9:49 am 09/2/2014

    Really? Well from personal experience with neighbors, loved ones and myself medications do in fact work.

    Mixed with good talk therapy (and lets face it far too many therapists should NOT be in the business. This is an epidemic in and of itself) medications work just fine.

    This article should be ashamed of itself. By the way most cannot afford good talk therapy. Have you ever attempted seeing a therapist regularly? The expense is unheard of! So we’re (the economically depressed) left to below average therapy at best.

    It’s a complex situation that only those who have experienced it personally could possibly understand.

    Allow me to throw out a few sentences to show how complex it really is:

    1. Co-Dependent, narcissistic and disconnected therapists ,at the state level, so common in the business it’s frightening.

    2. Control freaks involved in the business simply to exert control over those suffering (easy prey right?). Feeling slightly better about themselves in the process through what they perceive as being ‘downward social comparison’. SICK!

    3. Therapists who are actually far more emotionally/mentally disturbed than the patients themselves.

    4. Exorbitant fees charged by psychiatrists and psychologists limiting mental/emotional healing to the the wealthy, upper middle class or those who can afford astronomically expensive insurance policies.

    Shall I continue?

    This publication is obviously geared toward the 2%. The other 98% are left to struggle, suffer and continue the cycle despite seeking help.

    Medication works.

    A crock of inexperienced, disconnected trash this article turned out to be. Before spewing more vile, uninformed, ridiculously unwise advice try having some real life experience under your belt.

    The author is presenting as a hack. Yes I’m calling you out sir! Do us all a favor before you strut back to your isolated world and tap out more drivel on an I-pad, inbetween Starbucks lattes and having someone polish the rims on your overpriced BMW for the third time this month … We highly suggest gaining some REAL WORLD experience.

    Unfortunately, the author has proven himself to be a motley fool of epic proportions. This article covers half the story AT BEST.

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