Are Psychiatric Drugs Overused?

Debate over medication vs. talk therapy continues

WASHINGTON, March 24 At 7, Susan was diagnosed with major depression and given antidepressant drugs. At 12, she was tagged with both depression and borderline personality disorder, and more drugs were prescribed.

"At 12, I was on uppers and downers," said Susan, who asked that her real name not be used. At 18 Susan, now 27, took herself off all psychiatric drugs and has been healthy and productive ever since. A miracle cure, thanks to modern psychiatric wonder drugs? Not quite, she insists. "I recovered not because of the mental health system but in spite of it," Susan, a university administrator, writer and poet said in a recent interview. With little fanfare but much passion, a movement has arisen in recent years against what critics regard as a psycho- pharmaceutical industry that has slowly undermined the therapeutic foundations of psychiatry with a drug- and profit-driven model for treatment of illnesses, real and they say imagined.

Psychiatrists say Susan represents a small fraction of those treated with newer classes of psychiatric drugs, many of which have proven highly effective with fewer side effects than older drugs which are potentially addictive or cause drowsiness, disorientation and other serious side effects.

Still, she is not alone in her beliefs. The more radical of these activists say the system serves to enrich psychiatrists, drug makers and insurers while doing little to help those labeled with psychiatric diagnoses.

ANXIETY DISORDERS' DEBATED

Advocates for the mentally ill, including groups like the Anxiety Disorders Association of America, strongly disagree. On its Web site, the ADAA says some 19.1 million Americans suffer from these disorders, which it says costs the United States more than $42 billion a year. 

The group claims some 4 million Americans suffer from generalized anxiety disorder a condition which many anti-psychiatry activists say was invented to sell drugs.

Among the best-selling psychiatric drugs are three that Susan took: Eli Lilly and Co.'s anti-depressant Prozac; Pfizer Inc.'s Zoloft, used to combat depression and anxiety and recently approved to treat social anxiety disorder; and GlaxoSmithKline Plc's , Paxilused for depression and anxiety.

"Both GAD and SAD (social anxiety disorder) are acknowledged and recognized as serious ... health conditions by the APA (AmericanPsychiatric Association)," said Michael Fleming, a spokesman forGlaxoSmithKline.

Are "psychiatric survivors," as many call themselves, just disgruntled individuals, isolated cases in a psychiatric system that has found new pharmaceutical cures for illnesses once deemed untreatable? Perhaps.

But some in the medical profession now also find fault with the rising tide of diagnoses for behaviors once thought of simply as troublesome or odd, and especially the rising number of children andyoung adults labeled "sick" and medicated.

Dr. Lawrence Plumlee was one of about 150 people crammed into a tiny classroom at American University in Washington for a recent seminar called "Fighting Corporate Psychiatry," part of a larger anti-corporate, anti-globalization forum.

Plumlee, 66, a retired toxicologist with the Environmental Protection Agency, was diagnosed with schizophrenia as a troubled young solder in the Army in the 1960s. He believes his personal turmoil in turbulent times was misinterpreted as mental illness because society wasn't prepared to confront the difficult ethical and cultural issues he felt he had to face.

"The reasons we get visions and some delusions when we're coming of age is because we're looking for meaning in life," he told that forum. "When you're having this kind of personal turmoil, you're labeled as schizophrenic."

While some of these critics scorn psychiatry as a pseudo-science of hucksters in an unholy alliance with predatory drug companies, others simply see an overburdened profession that relies too heavily on drugs. But the strand that binds them is a belief that the psychiatric profession is being led astray by an over dependence on drugs at the expense of time-intensive "talk" therapy and intangibles like compassion, societal and family support, meaningful work and creative outlets for troubling thoughts and emotions.

PRESSURE FROM INSURERS

That they find common ground with the anti-globalization movement is little surprise in light of the fact that more than half the new patients of corporate psychiatry are children or young adults.

The drugging of millions of children diagnosed with attention deficit hyperactivity disorder (ADHD) is a rallying point for many who say such children need patience, not drugs.

Susan is among the moderates in this backlash against a system she believes stole more than a decade of her young life. Psychiatric drugs are useful for some, she conceded, "as long as it's with extremely informed consent."

Dr. Paul Applebaum, president of the American Psychiatric Association (APA) and chairman of the psychiatry department at the University of Massachusetts Medical School, said increased reliance on drugs over more expensive and time-consuming therapies stems in part from "pressure" from insurers.

Behavioral health insurers "have made a great deal of money and come to dominate their industries ... by in some cases denying extended care ... and in some cases only agreeing to care if relatively brief and few therapeutic sessions are used and medication is applied," he said.

"The profession as a whole is extremely unhappy about that situation," Applebaum said in a telephone interview. "There are new forms of therapy ... cognitive behavioral approaches that have proven as effective with many forms of anxiety disorders and depression, if not more so than drugs."

Still, Applebaum insists, the new anti-depressant and anti- anxiety drugs are in many cases effective, with fewer side effects and liabilities like addiction than older classes of drugs including sedatives and tranquilizers. The anti-drug activists say the focus on relatively new emotional and psychiatric complaints like GAD and SAD are cynical attempts to apply the disease model to and sell drugs to correct perfectly normal behavior. Applebaum counters that for such disorders to warrant diagnoses as a mental illness, "they must cause significant objective distress and dysfunction in the individual."

POST SEPT. 11 SURGE 

The critics point to a well-documented surge in advertising for anti-anxiety drugs in the post-Sept. 11 world, saying drug companies are capitalizing on widespread fear of further attacks to sell drugs to people who might not need them.

While the APA doesn't have a formal position on direct marketing of psychiatric drugs to consumers, Applebaum said there is "a plus side and a minus side" to the practice.

"The plus side is that consumers are so much better informed as to their choices," he said. "The down side is that people shouldunnecessarily request medications of their physicians that they have a hard time refusing."

Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, said the mass-marketing of psychiatric drugs "is not something that's on the radar screen for us. "However, "direct consumer advertising is closely monitored and regulated" by the Food and Drug Administration, he said, "and the FDA is a rough regulatory task master."

 

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