that may seem like part of the depression—not a result of the drugs. Rather than examining the sources of her postpartum plight, Kate found herself in dangerously unfamiliar territory in the name of treatment. If only she had known the whole story before deciding to fill that prescription.
The ease with which these medications are dispensed is partly why so many take them: 11 percent of all Americans, 25 percent of whom are women in their forties and fifties. The use of antidepressants has increased almost 400 percent from 1998 to 2008, making them the third most commonly prescribed drugs across all ages. The sharp increase does not necessarily signify a depression epidemic. Through the early 2000s pharmaceutical companies aggressively tested antidepressants for a variety of disorders, which led to an explosion of FDA-approved uses, from depression to premature ejaculation.1 Believe it or not, we are spending more on antidepressants than the gross national product of more than half of the world’s countries. Sixty percent of people on antidepressants stay on them for more than two years, and 14 percent do so for more than a decade. By a conservative estimate, 15 percent of pregnant women take psychiatric medication today, a rate that has tripled in just the last couple of years.
The medical industry isn’t selling a cure. They are selling sickness.
SELLING SICKNESS2
Is there a connection between the profligate use of antidepressants and increasing rates of disability? Before antidepressants became so widely used, the National Institute of Mental Health (NIMH) assured people that recovering from a depressive episode was common and that experiencing a second episode was uncommon.3 But then how do we explain soaring rates of disability and escalating prescriptions?
Robert Whitaker, a notable critic of modern psychiatry and author of Anatomy of an Epidemic and Mad in America, has compiled and analyzed data showing that days of work lost are not decreased by medication treatment.4 Much to the contrary, they are increased by drug treatment, and so is long-term disability. He also has reported on studies showing that people treated for the illness are three times more likely than the untreated individuals to suffer a “cessation” of their “principal social role,” meaning that they function less optimally. And they were nearly seven times more likely to become “incapacitated.” Moreover, 85 percent of unmedicated patients recover in a year, with 67 percent doing so by six months.5 From my perspective, that’s an enviable statistic.
What’s going on here? In the past half century, the Diagnostic and Statistical Manual—the DSM, the bible of diagnosable disorders in psychiatry—has lengthened to more than three hundred diagnoses in its fifth edition. In 1952 the DSM was a slim 130 pages and outlined 106 illnesses. Today’s version is a colossal 886 pages and includes 374 diagnoses. It encompasses a general consensus by a committee consisting of practitioners with profound conflicts of interest and pharmaceutical enmeshments.6 As Dr. Allen Frances of Columbia University and author of Saving Normal states: “Wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment—a bonanza for the pharmaceutical industry but at a huge cost to the new false positive patients caught in the excessively wide DSM-V net.”7 Dr. Frances is the psychiatrist who chaired the task force that produced the fourth edition of the DSM and has been critical of the latest tome. In 2013, Frances rightfully said that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests.”8
When you look at the impossibly long list of symptoms and maladies for which antidepressants can be prescribed, it’s practically farcical. These drugs are indicated for classic signs of depression as well as all of the following: premenstrual syndrome, anxiety, obsessive-compulsive disorder (OCD), bipolar disorder, anorexia and binge eating, pain, irritable bowel, and explosive disorders fit for anger management class. Some doctors prescribe them for arthritis, hot flashes, migraine, irritable bowel syndrome, and panic disorder. The fact that antidepressants can be prescribed to treat arthritis, an inflammatory disease of the joints, undermines any beliefs about their ability to precisely correct a chemical imbalance at the root of everything from phobias to bulimia and melancholic depression. The condemning 2015 paper by researchers at Johns Hopkins Bloomberg School of Public Health that I discussed in the previous chapter clearly states that antidepressants are used willy-nilly.9 In their study, the authors conclude that most people who take antidepressants never meet the medical criteria for a bona fide diagnosis of major depression, and many who are given antidepressants for conditions like OCD, panic disorder, social phobia, and anxiety don’t actually have these conditions.
Let’s not forget the use of these medications in young children. And they are prescribed not only for depression but behavioral issues such as inattention, temper tantrums, tics, autism, and impaired thinking. How did we ever come to think that this could be a safe and effective treatment for two-year-olds still in diapers who don’t even speak in full sentences yet? For starters, consider Study 329, which cost GlaxoSmithKlein $3 billion for their efforts to promote antidepressants to youngsters.10 This drug company manipulated data that hid signs of increased risk of suicide. The company also falsely represented Paxil as outperforming a placebo.11
Among the most celebrated and respected thought leaders in my field is Joanna Moncrieff. She is a senior lecturer in psychiatry at University College London and co-chair of the Critical Psychiatry Network, a group of psychiatrists who dispute the generally accepted model of depression and seek alternative approaches to psychiatry. In a seminal 2006 paper, “Do Antidepressants Cure or Create Abnormal Brain States?” Moncrieff and her coauthor write: “Our analysis indicates that there are no specific antidepressant drugs, that most of the short-term effects of antidepressants are shared by many other drugs, and that long-term drug treatment with antidepressants or any other drugs has not been shown to lead to long-term elevation of mood. We suggest that the term ‘antidepressant’ should be abandoned.”12
At this point, you might be wondering: Where did antidepressants come from and how did they get so popular?
A MEME IS BORN13
The predominant theory behind modern antidepressants (SSRIs, or selective serotonin reuptake inhibitors) is that they work by increasing the availability of serotonin, a neurotransmitter famously associated with mood, in the gaps between cells of the brain. In fact, if you were to quiz someone on the street about the biology of depression, they would likely parrot “chemical imbalance” in the brain and go so far as to say a “serotonin deficiency.” This hypothesis, referred to as the monoamine hypothesis, grew primarily out of two main observations made in the 1950s and ’60s.14 One was seen in patients being treated for tuberculosis who experienced mood-related side effects from the antitubercular drug iproniazid, which can change the levels of serotonin in the brain. Another was the claim that reserpine, a medication introduced for seizures and high blood pressure, depleted these chemicals and caused depression—that is, until there was a fifty-four person study that demonstrated that it resolved depression.15
From these preliminary and largely inconsistent observations a theory was born, crystallized by the work and writings of the late Dr. Joseph Schildkraut, who threw fairy dust into the field in 1965 with his speculative manifesto “The Catecholamine Hypothesis of Affective Disorders.”16 Dr. Schildkraut was a prominent psychiatrist at Harvard who studied catecholamines, a class of naturally occurring compounds that act as chemical messengers, or neurotransmitters, within the brain. He looked at one neurochemical in particular, norepinephrine, in people before and during treatment with antidepressants and found that depression suppressed its effectiveness as a chemical messenger. Based on his findings, he theorized broadly about the biochemical underpinnings of mental illnesses. In a field struggling to establish legitimacy (beyond the therapeutic lobotomy!), psychiatry was desperate for a rebranding, and the pharmaceutical industry was all too happy to partner in the effort.
This
