With a new review from the University of Southampton urging clinicians to be mindful of the link between prescribed antidepressants and increased risk of Type 2 diabetes, it may be time to persuade psychiatry to seek a ‘check up from the neck up’.
Let me begin by stating that I do not wish to overplay the relevance of this latest study (people taking antidepressant medication often put on weight thereby increasing risk of developing diabetes while antidepressants themselves may yet be shown to be interfering with blood glucose control), but given our increasing over-reliance on antidepressants – 46.7 million scripts for antidepressants were written in the UK in 2011 – the report’s key findings merit careful consideration.
In the US, the increase in antidepressant use is startling. 1 in 10 Americans are now prescribed antidepressant medication. This number leaps to 1 in 4 among women in their 40’s and 50’s.
Such an increase is not a new phenomenon, albeit it’s growth may now be considered exponential. A study of 233,144 adult patient records who made doctor appointments between 1996 and 2007 discovered that the percentage of prescriptions written by non-psychiatrists had more than doubled over the twelve year period, and included close to ten thousand prescriptions for antidepressants given to patients without any diagnosis of depression being present.
Coupled with these findings, we see a marked increase in the use of antidepressants to treat a far wider range of symptoms such as bulimia, panic disorder, generalised anxiety disorder, social anxiety and those conditions considered either to be components of the ‘affective spectrum disorder’ or members of the group known as ‘functional somatic syndromes’ among others.
The insidious expansion of antidepressants as a ‘silver bullet’ to be fired indiscriminately and at will is all the more alarming given that antidepressants have been shown to be shockingly ineffective when it comes to treating depression.
Study after study reveals antidepressants to be no more effective than placebos in all cases other than the most severe conditions of depression. The only reason for the continued approval of new antidepressants by regulatory bodies is that negative tests are not taken into account before approving any new drug.
In fact, only two clinical trials, requiring nothing more than demonstration of effectiveness marginally greater than that of a placebo are needed to gain approval from both the Food and Drugs Administration (FDA) and the Medicines and Healthcare Regulatory Agency (MHRA). This remains the case even if fifteen negative trials provide different results entirely. All negative trials are simply ignored. Even the basis upon which a trial may be classed as positive is less than the standard required by serious scientific study, needing only to demonstrate a one or two point improvement on the Hamilton Scale, where three would normally be required.
An increase as slight as a one or two point increase could be equally attributable to a good night’s sleep, an hour listening to Sam Cooke, or sitting down and popping bubble wrap for five minutes.
So what is responsible for the current upsurge in antidepressant prescription?
The moral wasteland that is the pharmaceutical industry is a key driver, despite it’s protestations to the contrary but allow me to introduce you to the DSM. Or DSM-5, as it is known in it’s current incarnation.
The DSM, or the Diagnostic and Statistical Manual of Mental Disorders was ostensibly, an attempt to standardise the symptoms characteristic of any given mental illness but served first and foremost as an attempt to shield psychiatry from the considerable backlash it experienced in the early 1950’s.
The public perception of psychiatry’s benefits was further eroded twenty years later by an astonishing experiment conducted by Dr. David Rosenhan and a group of eight volunteers. Rosenhan’s team set out individually, arriving at psychiatric hospitals across America with the claim that they heard a voice repeating the word ‘thud’ over and over. They were to respond truthfully to all other questions, and behave entirely normally in all other aspects. Each member of the team was immediately admitted, heavily medicated and diagnosed with severe mental health problems.
The experimenters had naively assumed that they would be held for only a matter of days before they were able to convince their captors of their sanity and be released to reveal their findings. All the experimenters however, were held for weeks and in some cases months. Their attempts to persuade doctors that they were sane fell on deaf ears and their supplications that they were conducting an experiment on the state of psychiatry in America only served to convince those responsible for their care of their madness. Eventually, the only solution left to them was to pretend they were insane and then pretend to get better. When they did finally get out, there was understandable uproar.
When one major hospital challenged Rosenhan to repeat the experiment, confident that they would spot any impostor sent their way, Rosenhan agreed. A month later, after the hospital proudly declared they had spotted 41 fakes Rosenhan revealed he had not sent anybody.
Psychiatry’s inferiority complex may have been the catalyst for the resultant DSM but it’s problems are more deep seated than that alone. Setting aside the organic disorders (epilepsy, Alzheimer’s and Huntington’s), psychiatric disorders have no objective biological cause. Psychiatry then, is based solely on that flimsiest of foundations, consensus.
The problem with consensus is that it offers nothing by way of proof. Consensus is no indication of existence (see Virgin Birth, transubstantiation), and more often than not, consensus comes about through the oppression of one or more dissenting voice in deference to the most indomitable opinion. The publication of the DSM is overseen and undertaken by a DSM task force, usually consisting of twelve or so individuals who sit around a table and argue over definitions until consensus is agreed or will is broken, whichever comes first.
By way of illustration as to the dangers inherent in consensus…
In DSM-II, homosexuality was listed as sexual deviation and placed in same category as ‘paedophilia’. In 1973, the APA (American Psychiatric Association) asked all attending members at an APA convention to vote on whether to remove homosexuality from DSM-III. 5, 854 voted to remove it while an incredible 3,810 voted to retain it.
The current edition of the DSM – while considerably more enlightened than some of it’s predecessors – is fundamentally as flawed. Please follow dx revision watch or read the superb post by Suzy Chapman here. Ms Chapman, in a devastating analysis warns against the lumping of what once were classed as Somatoform disorders under the new catch-all category of Somatic Symptom Disorder (SSD), arguing that by doing so, millions more patients could soon find themselves stigmatised by a mental health diagnosis.
Under the latest revision, Ms. Chapman writes,
a person will meet the criteria for SSD by reporting just one bodily symptom that is distressing and/or disruptive to daily life and having just one of the following three reactions to it that persist for at least six months: 1) ‘disproportionate’ thoughts about the seriousness of their symptom(s); or 2) a high level of anxiety about their health; or, 3) devoting excessive time and energy to symptoms or health concerns.
Chapman goes on to point out that field trials conducted by the DSM-5 Somatic Symptom Disorders Working Group showed ‘one in six cancer and coronary disease patients met the criteria for DSM-5 ‘Somatic Symptom Disorder.’ Further field trials revealed that ‘more than one in four of the irritable bowel and chronic widespread pain patients who comprised the ‘functional somatic’ study group were coded for ‘Somatic Symptom Disorder”.
The additional stress of being stigmatised with a mental health disorder to someone undergoing treatment for cancer brings the inherent failings of the DSM into keen focus.
James Davies’ essential book, ‘Cracked: Why Psychiatry is Doing More Harm Than Good‘, quotes Paula J. Caplan as she compares mental disorders to constellations. There can be no more beautiful and perfect analogy for the DSM. Man’s attempt to find patterns in often unrelated meaninglessness.
The DSM task force do not discover disorders. They create them.
Rather than uncovering new insights and growing our understanding of ourselves, the DSM task force have become architects of misery, serving only to placate the insatiable avarice of a handful of pharmaceutical conglomerates. It is the medicalisation of society and of the human condition. Where our grief, our anxiety, our fears, our joy and our despair are medicalised by the consensus of the few to the absolute detriment of the masses.
Andrew S. Loveland’s, ‘The Sound of Abundance of Rain’, can be purchased from the Kindle store here.