America’s real drug epidemic (2)

Robert Whitaker, author of ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, was a believer in the benefits of psychiatric drugs until he came across a study by the World Health Organization that showed that schizophrenia outcomes were much better for patients in poor countries such as India and Nigeria than in rich countries such as the United States.  What was the reason, he wondered, why mental illness was so much worse in the United States when treatment was so much more advanced.

He said that another study that made him a skeptic was a 1994 study by Harvard Medical School which showed that outcomes for schizophrenia patients had worsened in the previous 20 years, and were no better than they were a century before.  Surely, he thought, with all the wondrous psychiatric drugs available, the trend out to be in the opposite direction.

The number of people receiving Social Security Disability Income or Supplemental Security Income because of mental disabilities has increased eight-fold in the past 20 years.  We don’t know how much is due to an actual increase in disability, and how much to the widening definition of disability.

Marcia Angell, in the New York Review of Books, said that for many low-income families, applying for SSI payments on the grounds of mental disability is a way to survive.  It is more generous than welfare and guarantees eligibility for Medicaid.  But to qualify requires the applicants, including children, to take psychiatric drugs.

She told about four-year-old Rebecca Riley, who died of a combination of Clomidine and Depakote, which has been prescribed when she was two years old [!!] along with Seroquel to treat ADHD (attention deficit hyperactivity disorder) and bipolar disorder.  Her two older siblings were also taking psychiatric drugs.  The parents had obtained SSI benefits for themselves and the siblings, and were applying for SSI benefits for Rebecca when she died.  The family’s total SSI income, Angell reported, was $30,000 a year.

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Correlation is not causation, but if psychiatric drugs aren’t a cause of the epidemic of mental illness among children and youth, they clearly aren’t the solution.

This chart is based on a study by Martin Harrow, a psychologist at the University of Illinois College of Medicine, of 64 young schizophrenic patients from two Chicago hospitals, one private and one public, whom he followed over a period of 15 years.

The ones who weren’t medicated did better than the ones who were, but Harrow said this wasn’t proof that the drugs worsened the outcomes, as Robert Whitaker suggested.  Harrow thought that the un-medicated patients simply had stronger personalities to begin with.  But at the very least, his study shows that not all schizophrenia patients need or benefit from medications.

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This is a typical study of drug dependency from Whitaker’s book.  Patients who took Xanax, an anti-anxiety drug, received some benefit, but once they stopped taking it, they were worse off than those who never took it at all.

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This study shows the benefits of healthy exercise as compared with drugs.  Whitaker in the last chapter of his book described seemingly successful therapies for mental illness that did not involve drugs.  He does not absolutely oppose the use of psychiatric drugs, but he said they should be used as a last resort, not a first resort.

Click on Anatomy of an Epidemic for Robert Whitaker’s home page and links to the scientific studies he cites in his book.

Click on Antipsychotic drugs and chronic illness for Robert Whitaker’s list of studies for his earlier book, Mad in America.

Click on Mad in America for Robert Whitaker’s web log for Psychology Today.

Click on Robert Whitaker’s Anatomy of an Epidemic: the Carlat Take and The Carlat Take Part 2 for an thoughtful critique of Whitaker’s book by a psychiatrist named Daniel Carlat.  Both his mini-essays and their comment threads are well worth reading.

Click on Do Psych Drugs Do More Harm Than Good? for an account of a confrontation between Whitaker and Andrew Nierenberg, a psychiatrist who directs Massachusetts General Hospital’s bipolar research program.

Click on The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry  for a two-part series by Marcia Angell in the New York Review of Books.  The Rebecca Riley story is told in the second article in the series.

Here are two more charts which are not in Whitaker’s book, but which throw light on the administration of psychiatric drugs to children.

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What the chart above shows is that psychiatric drugs are used more commonly for less serious conditions when Medicaid pays for the drugs.  The chart below, from the Wall Street Journal, shows the number of American children being given psychiatric drugs.  Asthma is the most common condition for which drugs are prescribed, but ADHD medications run a close second.

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My earlier post on this subject was a review of Robert Whitaker’s book, and my next post will embed videos of Robert Whitaker lecturing on psychiatric drugs.

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