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Rave review in Scientific American for Robert Whitaker's Anatomy of an Epidemic


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http://blogs.scientificamerican.com/cross-check/2012/03/05/are-psychiatric-medications-making-us-sicker/

Are Psychiatric Medications Making Us Sicker?

 

By John Horgan Scientific American March 5, 2012

 

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..... 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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Wow!

 

This review could be just the gateway I've sought to induce Dr. Caring to give Anatomy a read and fair hearing.

 

Wow, what a reception. I am seriously affected to see an unbiased journalist give serious, overdue attention to the case. Its not just that i want outsiders to believe the MESS in the bigpicture sense, but that MAYBE outsiders will give deserved understanding and consideration to my MESS which, like nearly all present, I endure, at least in part, every single dang day moreorless all alone but for the Internet...

 

Thanks for posting this, Alto.

 

Alex

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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Agree - In hearing him speak and then briefly talking with Robert myself at ISEPP„ he communicates the overuse of SSRIs and the danger of worsening depression„ but doesn't put them in the category of benzos and antipsychotics regarding dependence and long term dangers aside from worsening the course of depression -

It's very possible that ive missed something in his material „ so please correct me-

I told him that I predict the long term outcomes will show that SSRIs cause more illness due to the many associations being identified - Parkinsons„ diabetes„ frontal lobe dysfunctions/apathy syndrome„ osteoporosis „ etc •

I sensed a strong 'bias' among attendees that antipsychotics are the truly bad drugs based on imaging showing decreased brain mass (but no interpretations of what that translates to) -

SSRIs are still perceived to be safe by many while just the term 'antipsychotic' implies 'serious drug-proceed with caution'

Also„ the withdrawal from SSRIs seems to be downplayed in comparison to benzos - I have not experienced benzo wd and cannot compare but in reading Ashton's manual the wd symptoms appear to be strikingly similar -

I agree that he has done phenomenal work - there was something in the wording of this review about worsening depression that is a can of worms that will open the door to more of 'depression is a lifelong illness needing treatment'-

JMHO after a sleepless nite

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Yes, I think there is an overall perception that antidepressants are less pernicious than the other psychiatric drugs. True, the risk for diabetes and movement disorders is higher with antipsychotics, and benzos are addictive.

 

But -- antidepressants also confer a substantial increase in diabetes risk as well as other health risk, and they have been distributed to far more people.

 

I believe the truth will eventually come out, on a massive scale.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Exactly -

I don't know exact numbers but it seems that SS/NRIs are mentioned as treatment for so many disorders including ones that there is evidence that they cause or worsen - pain syndromes in particular -

I believe it's also important to distinguish between serotonergics and TCAs for starters - I don't trust any of them„ but the profiles are very different and need to be considered as such-

Of course that presents a dilemma because the mechanisms are theoretical -

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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I'm curious about the differences in "addiction" and "dependence". It seems to be that "they" consider dependence to be physical, and addiction the issue is motivation and desire to take the substance?

 

Bubbles

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg

July 2014 Sertraline dropped from 100mg to 75mg, held for six months, slower tapering until 2019 22 Dec 3.2mg

2020 Sertraline 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg, early Nov switched to home made suspension; 29 Nov 1.8mg; approx 25 Dec 1.6mg)

2021 Some time in about Jan/Feb realised my dosing was off and as probably on more like 1.8mg and possible mixing error in making suspension; doses after 10 Feb accurate; 10 Feb 1.6mg; 7 Mar 1.4

 

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/17/

CurrentSertraline: 7 Mar 1.4mg / Armour Thyroid / endless allergy meds, erg

 

 

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  • 6 years later...

Altostrata, thank you for your post. I'm new to this group and a lot of questions about the medications I'm on (and have been on, around 35!) and my "mental illness" have been answered . I never could find answers anywhere else I searched.

 

I remember when Prozac first came out and how the age it was safe to take began increasing. 

 

Just as mentioned, I got sicker than I was before taking that first antidepressant. Worse of all I developed fibromyalgia a few years after starting taking these drugs and I've been the most difficult patient for my doctor to treat. He said all the medications I took could have been the cause for me developing this horrible illness. 

Presently taking all the medications below:

Lamictal 300mgs - September 2008 

Zoloft 100mgs - September 2008

Klonopin 2mgs/3x day - September 2008

Roboxen 750 mgs 3x/day - Jan 2009

Baclofen 20mg - Jan 2009

Buspar 30mg 2x/day ~ Jan 2011

Buprenorphine 1.25mg -January 2017 (dosage has varied from 4mg -1mg)

LDN (low dose naltrexon) - April 2017 (dosage has varied from 3mg - 0.2mg)

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  • 11 months later...

Here is a great lecture of Anatomy of an Epidemic by his author Robert Whitaker, it could be taken as a summary of his book, if anyone does not have enough time for reading the whole book, you can watch this video that has the lecture of it, (book tour) which has great comprehensive scientific facts and studies about the effects of psychiatric drugs used in short and long terms. He explains very clearly how psychiatric drugs work. This valuable evidence-based information in this video should get viral and everyone that has to do with these drugs have to know this info.

 

https://www.c-span.org/video/?293935-1/anatomy-epidemic

 

Nov/30/17 started quetiapine IR tablets 100mg 0-0-1. Dec/1/17 started pristiq (desvenlafaxine) 50mg tablets 1-0-0. Jan/14/18 started with 1.5mg melatonin 0-0-1

Tramadol: 2 year well done (slow and gradual) taper: from Mar/12/18 to Feb/11/20 

Pristiq taper: Jun/15/20 Converted from pristiq 50mg to efexor xr 75mg for 57 days (felt very good).  Aug/11/20 weaned to efexor 37.5mg and stayed there for 2 months with 26 days (felt very good). Nov/6/20  CT 0mg of efexor xr (felt very good).

Total time in tapering pristiq 50mg by converting to efexor xr 75mg: 4 months with 22 days: Jun/15/20 to Nov/6/20. (felt very good)

35 days  in efexor 0mg and in quetiapine 100mg (Nov/6/20 to Dic/11/20) to start tapering quetiapine (felt very good being without effexor and taking 100mg quetiapine)

Dic/11/20 weaned quetiapine from 100mg to 75mg, so 75mg from Dic/11/20 to Jan/4/21  25 days

Jan/5/21 weaned from 75mg to 50mg (1 day in 50mg). Jan/6/21 1st CT of quetiapine from 50mg to 0mg 

Between Jan/6/21 to Mar/24/21 tried different herbs. Feb/16/21 CT melatonin 1.5mg. Feb/22/21 Reinstated melatonin. Mar/1/21 CT melatonin. Mar/25/21 reinstated 100mg quetiapine. 

100mg quetiapine 19 days (Mar/25/21 - Apr/13/21) Felt very good while in quetiapine 100mg. 75mg quetiapine 55 days (Apr/14/21 - Jun/8/21) the only day that I felt bad while in 75mg was the 55th day (Jun/8/21) in which just for a few minutes felt hellish anxiety so I CT'd quetiapine for a 2nd time on Jun/9/21.

Jun/9/21 - Aug/8/21 tested 2 different cbd's and dosages. Aug/9/21 discovered the cbd and it's dosage that made me feel and sleep good. Aug/16/21 Felt very good (7th day of taking same cbd and same dosage). Aug/26/21 Felt even better (17th day of same cbd & dosage). Sep/9/21 Felt even better (31st day of same cbd & dosage). Sep/12-15/21 stopped taking ginkgo because it blocks cbd's antiepileptic effect and to let cbd heal back spasm which I've had it since many years ago but CT'ing quetiapine made back spasm pain worse (made me feel horrible not taking ginkgo). Sep/16/21 reinstated ginkgo. Had to wait for my body to stabilize and because of feeling very bad and impatient, I didn't wait for my body to stabilize so I started taking kalanchoe (herb for panic disorder and muscle relaxant) on Sep/19/21 and felt very good since the 1st day of taking it. I was feeling very good with cbd and kalanchoe. The only thing that was bothering me was the back spasm and because of being intolerable, I tried other herbs, changed kalanchoe's dosage and tried detox herbs (all of these changes made me feel horrible). Stopped taking the spasm and detox herbs and because of feeling horrible, reinstated quetiapine 75mg Nov/17/21, immediately after taking it, I had severe heart palpitations, so Nov/18/21 back to kalanchoe (herb) and cbd and no quetiapine. Kept feeling bad so Nov/20/21 reinstated 75mg quetiapine and stopped cbd & kalanchoe, Nov/20/21 or Nov/21/21 couldn't breathe for 5 seconds after taking quetiapine so Nov/23/21 started quetiapine 50mg. Nov/27/21 Felt hellish so at PM took a herb & cbd, didn't made me fall asleep so then reinstated 50mg quetiapine @6:45am of Nov/28/21 and REINSTATED/STARTED QUETIAPINE 50 MG @10 PM ON NOV/28/21. (STOPPED HERBS AND CBD). 

 

 

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