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The Emperor's New Drugs
July 13, 2006 6:20 PM   Subscribe

It is America's most profitable industry, number one in return on revenues, return on assets, and return on equity. From barbiturates, to benzodiazepines, to everyone's favorite delysid, we come to the new age: SSRI's. There are thousands of studies showing that they work. And very few that question their efficacy. (very informative meta-analysis, a follow-up [pdf]). A quantitative explanation.
posted by dminor (72 comments total) 3 users marked this as a favorite

 
i would argue that it's not only mental illnesses that are made up by Big Pharma. there are a whole host of illnesses that are questionable, at least to my mind.
posted by brandz at 6:33 PM on July 13, 2006


Now all I need to do is get MSS (metafilter snark syndrome) into the DSM-IV. I could find a new drug and make millions - millions, I tell you - ha ha ha ha (evil scientist laugh).
posted by scblackman at 6:35 PM on July 13, 2006


Soma^, baby.
posted by stavrosthewonderchicken at 6:53 PM on July 13, 2006


Oh god do I hate the caret^ wikipedia notation.
posted by delmoi at 7:01 PM on July 13, 2006


brandz : yes, exactly. People say marketing makes them sick, but I bet they never guessed it *literally* made them sick. Even before marketing. Take that Black Death for example, I bet that was a result of nacent big pharma.
posted by ny_scotsman at 7:08 PM on July 13, 2006


But GAD was a little-known ailment; according to a 1989 study, as few as 1.2 percent of the population merited the diagnosis in any given year.

That's 2.5 million people a year. Quite a few.
posted by delmoi at 7:08 PM on July 13, 2006


i hate wikipedia. if someone hauled out the brittanica every other sentence during a conversation you'd punch his face.
posted by quonsar at 7:10 PM on July 13, 2006 [1 favorite]


if Metafilter was a regular conversation I'd be either horrified, or thrilled, depending on how you look at it.
posted by edgeways at 7:12 PM on July 13, 2006 [1 favorite]


This, The idea of characterizing uncomfortable menstrual symptoms as a mental disorder troubles Caplan, who wonders where the medical community will draw the line. "I could say to you, 'Well, your propensity to call people and ask them probing questions is a disorder,'" she says. "'We'll call it intrusive exploratory disorder.'" from the first link, cracked me up.

I don't really care whether people want to medicate themselves to oblivion, as long as it doesn't harm anyone else - alcohol, pot, paxil, whatever. The thing that I worry about is these drugs getting in my drinking water, as apparently there's no filters for these chemicals.
posted by meringue at 7:13 PM on July 13, 2006


Take that Black Death for example, I bet that was a result of nacent big pharma.

at least the causative agent Yersinia pestis was discovered for Black Death. too bad they didn't have antibiotics back then.
posted by brandz at 7:17 PM on July 13, 2006


everyone's favorite delysid

Is that why it's nowhere to be found?

Also, advertising practices play a insidious part in SSRI promotion.
posted by daksya at 7:20 PM on July 13, 2006


too bad they didn't have antibiotics back then.

You're right, I'm sorry.

OK, so let's hear your argument. Why are mental illnesses (as well as a whole host of others) made up by Big Pharma?
posted by ny_scotsman at 7:34 PM on July 13, 2006


i'm specifically referring to the host of others like IBS and ED, just to name two. some might include osteoporosis too. btw, i take prozac and it has worked wonderfully, for me.
posted by brandz at 7:44 PM on July 13, 2006


some might include osteoporosis too

Please DO go on.
posted by thatweirdguy2 at 7:47 PM on July 13, 2006


i also forgot to mention all those smoking cessation gimmicks too. like the patch and the gum and the nasal spray and the lozenge.
posted by brandz at 7:47 PM on July 13, 2006


I suspect that brandz is taking the piss.

That, or s/he needs to have his/her medication adjusted.
posted by dirtynumbangelboy at 7:56 PM on July 13, 2006


Mental illnesses are not made up by big bad pharma, and you're a dope and a (probably unwitting) bigot if you think so.

Take my favorite test case, as I've just been diagnosed with it: ADD (or AD/HD). It's a common cry among the knee-jerk "oh my god, drugs for the brain!" crowd (whose motivations are sundry, but all pretty ignorant) to claim that ADD is way over-diagnosed. Some people used to claim, as recently asa few years ago, that the disease was just a big sham, or even conspiracy (that's all been put to bed, by the way. You can actually find the physical differences in the brains of people with ADD now).

Interestingly, the current best guess on the percentage of the population that has ADD shows that something like only 20% of the people who have ADD even know about it, let alone get any treatment for it. And yet it's an epidemic of "feel good" drugs being doled out needlessly.

Same shit is pedaled with depression drugs. If you've ever experienced clinical depression, you would know to shut up about that one: I'm glad you haven't. I'm not so lucky. Mother Jones has pulled this flippant bullshit before with the "feel good" drugs of SSRIs. I've even fired off an angry missive to them in the past. In their desire to throw big business under the bus, they are hurting a lot of people, which is ironic of a populace-based rag like Mother Jones.

The reality is that many (most?) people are deeply, deeply troubled by the simple fact that your thoughts are just chemistry, and are thus changeable by chemicals.

All the anti-psych drug nonsense ensues.

Don't throw the baby out with the bath water: pharmaceutical companies may do some dubious things: that doesn't make the ailments they treat anywhere close to being "made up." And for every patient that convinces themselves, in error, that they need a new wonder drug, and sees an inept doctor who prescribes it in error, there are probably 10 that get genuine help for that one fuck-up, and another 50 that get no help at all, but that need it.
posted by teece at 7:59 PM on July 13, 2006 [2 favorites]


I suspect that brandz is taking the piss.

Well, in combination with the Prozac... that'll do it.
posted by ny_scotsman at 8:01 PM on July 13, 2006


Well said, teece.
posted by dirtynumbangelboy at 8:03 PM on July 13, 2006


mind your apostrophes, children.
posted by moonbird at 8:06 PM on July 13, 2006


some comments from a pharmacology (drug development) grad student:

These drugs work very well for some people and give them a quality of life they never experienced before. How? Fuck if we know. If they worked directly by blocking the re-uptake of seratonin we'd see the effect almost immediately. Instead, antidepressants take about 2-3 weeks to have an effect. This indicates the blocking of seratonin reuptake triggers a secondary modulation of brain function that gives the antidepressent effect. It's very humbling to hear leading researchers tell you they have no idea how one of the most popularly dispensed medications works.

That said, these drugs are way overperscribed. 95 (number pulled out of my ass) percent of people are just looking for an easy way out of their problems nd the drug companies are more than happy to give it to them.

Addiitionally, the whole peer review problem is a huge issue in science these days. The merging of industry and academia is great for the production of new treatments, but only if evaluated in a bias free atmosphere. Unfortunately with this administration the government is never going to play that role.

Finally, know how we find new antidepressants? They take mice and abuse the shit out of them. Shake their cage, wake them up, withhold food, spray them with water, tell them their mother's fat, etc. These mice respond by never leaving the corner and shivering constantly (as would you). Scientists figure these mice are depressed, but who really knows? The mice won't tell us themselves. Anyways, they take these mice and well-treated mice and hang them up by their tails until the stop struggling. "Depressed" mice will generally not struggle that long, while the control mice will struggle for a while. A drug is considered an "antidepressent" if it can make the "depressed" mouse struggle as long as the control while not making the control mouse hyperactive. There are entire warehouses in the midwest full of hanging mice and hopeful scientists.

Ain't science great?
posted by slapshot57 at 8:21 PM on July 13, 2006 [11 favorites]


the simple fact that your thoughts are just chemistry, and are thus changeable by chemicals.

teece, this is a gross oversimplification of the situation. While that may generally be true, any psychologist that deals with brain and behavior worth her/his reputation will tell you that they don't know shit about how the brain works, or why the SSRI's work.

Personally, I hate the way our culture deals with suffering and death. It seems to view them as medical anomalies. When in actuality, health, happiness and life seem to be the accidents. Of course, the first noble truth always seemed like a breath of fresh air to me.
posted by milarepa at 8:23 PM on July 13, 2006


teece

I agree with you for the most part but your numbers are just as made up as mine. It's not whether it's worse for someone who needs meds no to get them than someone who doesn't need them to take them. The focus should be on getting some impartial standard for dispensing these medications.

And unfortunately with all of the wonderdrugs advertised on TV (I mean honestly, Restless Leg Syndrome??) and companies influencing their own trials it's getting harder and harder to know how effective certain drugs really are.
posted by slapshot57 at 8:26 PM on July 13, 2006


I think the basic issue is that nothing about the human brain (and body) is as simple as doctors, patients, and pharmaceutical companies want it to be. The pharmaceutical industry these days is just a slightly more refined version of the ancient practice of trying random herbs until one seems to help. But, that doesnt mean that the things we find out that way are inherently invalid, just that when we DO find drugs, we still don't really know how they work. What this means is that we tend to group disease based on what we can know, which is generally symptoms, and what tends to help them. New drugs will create new diseases, because we now have a better way of differentiating between two diseases that were once considered the same.

A lot of the diseases that are considered to be "made up", like ADHD, came about because scientists and clinicians struggled to identify and group a pre-existing set of symptoms. Because these symptoms are so hard to categorize in the first place, it's inevitable that what we identify as ADHD is actually caused by a large variety of different things. Same for depression. Just because there is no single cause for something, does not mean that a label is necessarily useless or harmful.

The harm comes when people forget that disease is a very nebulous concept. There is no one solution for people with the same labelled disease, because a disease name is a label for a variety of disparate things. Prozac works for my depression, but it may not work for yours. Our depressions are probably significantly different in cause, symptoms, and treatment. However, this doesn't mean that the pattern of depression is made up. The labels may be new, and may be manufactured for marketing concerns, but the symptoms have always been there.
posted by JZig at 8:27 PM on July 13, 2006 [1 favorite]


That said, these drugs are way overperscribed. 95 (number pulled out of my ass) percent of people are just looking for an easy way out of their problems nd the drug companies are more than happy to give it to them.

Correct me if I'm wrong, but aren't these meds typically prescribed by psychiatrists? People can't get these directly, so every "bad" prescription needs to go through a trained professional, and 95% seems like a very high proportion of apathetic or incompetent doctors. Is it the case that if we don't know how they work, then we don't know if they'll work for a given set of symptoms, and the tendency is to give it a shot? I really don't know, and there is a lack of concrete numbers... but I would be surprised if these drugs are dispensed as capriciously or carelessly as you seem to imply. teece seems to me to be more on the money.
posted by ny_scotsman at 8:28 PM on July 13, 2006


Oh yeah, and I definitely agree with many above when they say that the scientific environment in drug research today is making it very difficult to effectively determine which drugs are effective in which circumstances. One of the issues seems to be that in order for a drug to be considered effective, it must be effective on a very large percentage of people with a certain disease. So, in order to get things approved and marketed, a drug is sold as if it will help everyone, when it should be clear to everyone that there is a very good chance it WON'T work for a particular person.
posted by JZig at 8:32 PM on July 13, 2006


Oh god do I hate the caret^ wikipedia notation.

I have a drug for carrot-dislike. It's called cashewsizipinoxil.
posted by Mr. Six at 8:40 PM on July 13, 2006


And yet it's an epidemic of "feel good" drugs being doled out needlessly.

I couldn't care less about the distribution of "feel good" drugs, I just don't like buying them for others.

"I'm depressed"
"Well, studies show that exercise may be effective in treating depression. Maybe you should try getting out of the house."
"I can't get out of the house. I'm depressed, remember?"
"Well, okay, then, here's my wallet."
posted by Kwantsar at 8:43 PM on July 13, 2006




Teece, this argument has burned through threads here before, to little avail.

I will only say that pharamaceuticals are way, way overprescribed in the West, and that giving anti-psychotics to children and teenagers is a very questionable, if not outright dangerous, practice. Adults can do what they want to themselves, but convincing a child that he or she is inherently broken and needs a lifetime supply of medication to be normalized is downright horrendous and will one day be looked on as a sign of utter barbarism on our part.

That said, there are a lot of points to be made against the pharmaceutical paradigm in place today.

For one, companies that test the products make millions ensuring that a positive result will be concocted without lying.

For another, supposed illnesses like "schizophrenia" have a very unclear diagnostic picture which has changed dramatically over time. Psychotic breaks have always been common in young adults and are usually unique events in one's life, a reaction to the stress and uncertainty of rushing headlong into adulthood. However, most psychiatrists choose to diagnose these breaks as a chemical disorder of the brain, ie schizophrenia. The antipsychotic drugs prescribed to treat schizophrenia were originally called "chemical labotomies" back in the 60s when they were introduced as an alternative means to permanently pacify and send home institutionalized patients, because they alter and suppress the chemical conduits of communication between frontal lobe, which makes the human personality, and the more primitive parts of the brain. When it was revealed that these drugs were actually causing great harm twenty years ago, big pharma introduced "atypical antipsychotics" as a cleaner solution, saying that they more precisely tinkered with the chemicals (dopamine, seratonin, adrenaline, etc) that are supposedly responsible for depression and psychosis. In reality it's like fixing a watch by smashing it with a hammer. These chemicals are responsible for a great many things in the regulation of the body and the psyche of the mind, and to suggest that doctors actually know the long-term effects of what they're doing is ludicrous. Not to mention the unquantifiable loss in the suppression of the human personality.

(The World Health Organization has done several global studies and found, to their surprise, that third world countries that do not rely on pharmaceuticals to treat pateints have much higher success rates and qualitatively better outcomes than in the West. I cannot find the study online, but it is sited in Robert Whitaker's fantastic book, Mad in America.)


The most disturbing aspect of this paradigm is that a society dependent on these kind of mood-suppressing drugs is a society that cannot tolerate the complex and authentic variations in the human personality. It's a systematic means of dealing with anyone who does not adapt to the very narrow capitalist requirements for consciousness (where one's needs and wants are determined by the interests of the corporate State). It's a totalitarian measure, and every bit as violent and hideous as bludgeoning or imprisonment.

I have witnessed first hand the destruction of creative, vibrant, thinking people at the hands of misguided interventionists... usually, alas, the children of psychiatrists, who from 12 on are diagnosed for their intolerable excesses and put on a cocktail of medications. This serves millions as an effective alternative to smart parenting.

Have you ever met a kid who's been pharmed out this way? It's very sad, very unnerving. It's like they have no belief in their own gravity, and they cling desperately to the ground, afraid of falling off of the earth. Nobody ever told them that they have the capacity within them to simply stand up.
posted by bukharin at 8:43 PM on July 13, 2006 [5 favorites]



err, *cited.
posted by bukharin at 8:48 PM on July 13, 2006


bukharin, what's the cutoff point where a kid can actually make a choice to want something like an antidepressant?

It's clear that abuses are definitely possible here. Dosage seems to particularly be an issue. I would support some sort of max dosage for children, if that's possible to quantify.

However, I am 100% sure of the fact that the low dosage of prozac I started taking (as my choice) when I was 11 or 12 had made my life better. I know this because of the two seperate times I went off the drug for a few months, and felt significantly worse in every way.

I suppose it comes down to rather the help things like antidepressants bring to adolescents is worth the risk of abuse by overmedication. I don't know the answer to this one, but I don't think it's the right solution to give up on trying to do it right and just not do it at all.
posted by JZig at 8:57 PM on July 13, 2006


This is a fascinating discussion. My confession: I have prescribed many of the drugs referenced above. I disagree with very little of what has been said so far.

(Except that osteoporosis comment, I mean, C'mon, seriously?)
posted by Slarty Bartfast at 9:10 PM on July 13, 2006


I confess I read the comments just to read the bitches about the caret notation.

I do think that there is a culture in the US of Better Living Through Chemistry that causes huge amounts of drugs to be taken to treat symptoms rather than addressing the root causes.

To be sure there are people who genuinely cannot function at an acceptable level without chemical assistance and to those people I wish nothing but success. It must be asked, however, why it seems that so many people/children seem to suddenly have grave chemical imbalances. Occams razor would tend to indicate that, barring evidence of a massive difference in the chemical functionality in the brains of contemporary Americans compared to historicaly and geographically distinct populations it is more likely that people simply like drugs. Whether that is due to or merely exacerbated by the laziness of doctors, the ineptitude of government oversight and the averice of the pharmacutical industries is up for debate.
posted by Skorgu at 9:17 PM on July 13, 2006


teece, this is a gross oversimplification of the situation.

Unless you ascribe your mind to god and a spirit, no, it's not. It's exactly and precisely true.

Not knowing why an SSRI works does not mean it's not chemistry (which is just physics).

I couldn't care less about the distribution of "feel good" drugs, I just don't like buying them for others.

Really, take that libertarian bullshit elsewhere. You don't have a fucking clue what depression is. It is lethal for some people. Exercise is almost as effective as drugs -- exercise and drugs together are even more effective. Getting exercise when you are depressed is monumentally difficult.

In such situations, you don't fuck around to pinch pennies you; me and society get out our wallets and buy the fucking antidepressants, you anti-social bastard.

Yeah, that's over the top. But I absolutely hate this petulant, third-grade, selfish bullshit libertarian streak that I see in so many Americans.
posted by teece at 9:19 PM on July 13, 2006


The thing that gets me is, even if all these "trendy" conditions (social anxiety disorder, etc) are real, and the number of people who have them is not grossly exaggerated, why is the answer always a drug?

I mean, I understand it from a Capitalist Pharmaceutical Corporation perspective; but why are people so eager to diagnose themselves and then immediately treat their condition with pills?
posted by meringue at 9:25 PM on July 13, 2006


It must be asked, however, why it seems that so many people/children seem to suddenly have grave chemical imbalances.

This is classic question begging, Skorgu. It's not even remotely clear that some people "suddenly have grave chemical imbalances."

So, no, it must not necessarily be asked. First, you must ask do people "suddenly" have grave chemical imbalances. I'm very certain you'll find the answer is no, people have had them all along.

They've just lived lives of with a bit more quiet desperation (at best), or misery and incarceration (at worst).

The "mental health problems are way over-diagnosed" argument is a canard. You don't ever hear layman saying, "hey: don't you think FinkelSteimer's disease is way overdiagnosed?" It's not a coincidence. It all goes back to the stigma that still exists around mental health issues.

What real problems in mental health diagnosis and treatment do exist are sadly given short-shrift by that, too, in addition to such talk furthering the stigma of mental health treatment.
posted by teece at 9:28 PM on July 13, 2006 [1 favorite]


The thing that gets me is, even if all these "trendy" conditions (social anxiety disorder, etc) are real, and the number of people who have them is not grossly exaggerated, why is the answer always a drug?

Do you folks even think about this tripe before you write it? Change the phrase "social anxiety disorder" to "high blood pressure" and rethink your statement.

Why is the answer always a drug? First, question-begging again -- the answer is not always a drug. In some mental health issues, drugs aren't very effective, in others they as are effective as some non-drug treatments, with the best approach being a combination (depression is in this camp); for some issues, drugs are the single best treatment, even if non-drug approaches also help (ADD is is this camp).

You're letting your blinkered thinking about mental health foul up the works. Diet and exercise can go a long way to helping lower high blood pressure: why don't you just do that? Why take a pill? Well, because high blood pressure can kill you. Ditto mental health issues.

But aside from that, why a drug? Because they fucking work. Why is it so hard for people to accept that without the bullshit moral condemnation and stigma we see here? Why is taking a drug to fix a problem in your brain any different that taking a drug to fix a problem in your liver?

Why is it only OK to take a drug for mental health if it gets by at an "acceptable level," as mentioned above, but taking a drug that makes you much better, even if you were "acceptable" to begin with, is somehow sinful?

Y'all are pissing me off, I better go to bed.
posted by teece at 9:41 PM on July 13, 2006 [2 favorites]


Exercise is almost as effective as drugs -- exercise and drugs together are even more effective.

And diet has no effect?
posted by rough ashlar at 9:44 PM on July 13, 2006


I mean, I understand it from a Capitalist Pharmaceutical Corporation perspective; but why are people so eager to diagnose themselves and then immediately treat their condition with pills?

Because sometimes nothing else has worked or is practical. Or because sometimes giving control of the situation to someone else and taking the pill they prescribe is easier.

Or because sometimes a person is conditioned to think that if they don't feel well, they should seek the advice of a doctor. The doctor recognizes that the person is suffering but cannot change the person's crappy life, cannot convince the person to have a positive attitude, cannot see to it that the person exercises regularly, or stops drinking, or gets a job. But the doctor can prescribe a pill and he or she has read a body of evidence that suggests there is some value to taking the pill.

(The doctor may do this all the while recognizing that the reall problem is that the patient has bad parents or a crappy life or lacks financial security or whatever.)
posted by Slarty Bartfast at 9:48 PM on July 13, 2006 [2 favorites]



Exercise is almost as effective as drugs -- exercise and drugs together are even more effective.

And diet has no effect?


I'm not aware of a study that looks at this, I do not think this has been done. The exercise study is well known.
posted by Slarty Bartfast at 9:51 PM on July 13, 2006


Y'all are pissing me off, I better go to bed.

Teece, it seems like you were pretty pissed before you even came in here.

I understand your points. However, you were over simplifying.

Our thoughts seem to be produced from chemical interactions, granted. But to my knowledge, there is not one scientist that can tell you how those chemical reaction create thoughts, why those chemicals create thoughts or what chemicals exactly make those thoughts. It's mystery. So your assumption "thoughts = chemicals" is over simplified, given the current state of knowledge.
posted by milarepa at 9:55 PM on July 13, 2006


I'm with teece on this one, but I don't have to go to bed, so.

It's a totalitarian measure, and every bit as violent and hideous as bludgeoning or imprisonment.

Is this statement hyperbolic, repugnant, or both? You decide!

If you really buy this, I think that you should occupy yourself with more important concerns like the fluoridation of our water supply.

I have witnessed first hand the destruction of creative, vibrant, thinking people at the hands of misguided interventionists... usually, alas, the children of psychiatrists, who from 12 on are diagnosed for their intolerable excesses and put on a cocktail of medications. This serves millions as an effective alternative to smart parenting.

My aunt used to give my cousins antibiotics (serious antibiotics) for every single ailment they got, and unsurprisingly, by the time they were teenagers, their immune systems were absolutely fucked as a result.

But that doesn't mean I advocate getting rid of antibiotics. This is an instance of bad parenting -- consulting a doctor or even a family member would have made plain what a bad idea this was, but she didn't.

Now, while you may not believe it, because you obviously don't have the first fucking clue what you're talking about, your argument really is tantamount to claiming that antibiotics are a product of the evil capitalist system, simply because you have anecdotal evidence that it was overprescribed or misused in a few isolated instances. Indeed, there are even academic articles about the problems with over-prescribing antibiotics and improper supervision -- do a quick search on drug-resistant TB, if you're interested. News flash: most drug treatments are not perfect. Most treatments require proper use in order to be effective.

In fact, I could surely come up with a brilliant argument about how Big Pharma actually wants antibiotics to be overprescribed in order to create dependency, more drug-resistant strains, more need for drugs! And if I were talking about something as vague and poorly-understood as the mind, that argument would probably be even more palatable to my fellow paranoiacs.

But that wouldn't make the argument less dumb.

It's really simple: just because antidepressants or ADHD medications are sometimes mis-prescribed -- or god forbid overprescribed -- doesn't mean that it's a big capitalist conspiracy, or that they don't work, or that the disorder they're intended to treat doesn't exist. It means that -- unsurprisingly -- we don't fully understand these disorders yet, but we're working towards it. Just like antibiotics, the challenge is to use our tools intelligently and consistently, and people like you are just as much a part of the problem as these hypothetical Big Pharma agents that you're afraid of, because you prevent a rational inquiry into the problems by lumping everything in under the aegis of a 'big conspiracy.'

If you're going to make a criticism, make it substantive. This is a waste of time, and your position is, frankly, dangerous. I fear for your kids.
posted by spiderwire at 10:02 PM on July 13, 2006


milarepa - But to my knowledge, there is not one scientist that can tell you how those chemical reaction create thoughts, why those chemicals create thoughts or what chemicals exactly make those thoughts

Which is irrelevant. The promotion of drugs as a treatment for psychpathology endorses the paradigm that "thoughts = chemicals". The observation that the mechanics are uneludicated plays a small role in tempering that public perception, since most of the public are laymen who wouldn't bother with the details and philosophy anyway.
posted by daksya at 10:06 PM on July 13, 2006


The "mental health problems are way over-diagnosed" argument is a canard. You don't ever hear layman saying, "hey: don't you think FinkelSteimer's disease is way overdiagnosed?" It's not a coincidence. It all goes back to the stigma that still exists around mental health issues.

There is another possibility. Mental health is a serious topic, and there are plenty of people who need treatment to help them survive - as you say, depression can literally be lethal.
I have no beef whatsoever with drugs being used by professionals to treat sufferers of mental illness. A friend of mine is bipolar, and her treatment is no different in principle than that for any other chronic condition.

That said, I also believe the West, and America in particular over-subscribe medication in general, and that especially includes the medication of mental health.

It's like the over-use of antibiotics. They're in everything, and we take them at the slightest need for them. Now we have MRSA, and who-knows what other multi-drug resistant bacterial infections coming in the future.

Mental health drugs too; take depression. Depression is a serious illness, that can be caused by ill-balanced brain chemistry. Drugs can be used to treat that, and in true sufferers, it is pretty much the only choice.

Everyone suffers from depression (small d) sometimes though. It's a sign of unhappiness. We can either medicate that away, or tackle the underlying case of that depression.
By using drugs as a front-line method of treatment, rather than reserving them for cases which require them, we cheapen the whole field of mental health and can actually make the problem worse in the long term for those with mild and/or non-chemical reasons.

What real problems in mental health diagnosis and treatment do exist are sadly given short-shrift by that, too, in addition to such talk furthering the stigma of mental health treatment.

So rather that just trying to pretend there's not a problem with over-diagnosis, wouldn't we be better to actually fix the problem? Pharmacology giants have a vested interest in getting as many people on their pills as possible, especially in the US.

Mental illness is a serious problem, that sufferers need professional help and probably medication to help solve, just like any other disease. With time and drugs budgets being wasted on people that frankly don't need it, those who do need it are being short-changed.
posted by ArkhanJG at 10:11 PM on July 13, 2006 [1 favorite]


It's easy to poke fun at these "so called" disorders, until you or a relative are affected. Be careful you aren't just poking fun at the kids riding the short bus.
posted by caddis at 10:16 PM on July 13, 2006


There's a fascinating and useful book for young people considering suicide called Hello Cruel World.

I do know one person involved in the book's publication; and I do knowthatmany school counselors/libriarians might have a hard time promoting this book...it talks about the s_x word in a positive light, and the author is...differnt, like a lot of kids this book is aimed after.

Frank talk about gay sex versus suicide. Hmmmm. Your call. (Although a lot of the book would apply to, say, straight band geeks as well.)
posted by kozad at 10:21 PM on July 13, 2006


The only authority that should control how we feel is the government. And mother.
posted by squirrel at 10:36 PM on July 13, 2006


teece I don't have statistics handy so this is all basically intellectual masturbation but that's OK.

First of all, there are people with all of these disorders who need medication to live happy, 'productive' lives. No question there.

There are also people who do not need medication to lead happy lives. I hope there is no disagreement here.

What I believe (and observe) is that the first instinct of many Americans is to treat any divergence from happiness as a Big Problem that needs Fixing. Fixing almost always involves drugs.

My opinion is that drugs fuck with systems that are designed to regulate themselves and should not be used unless they are needed. What I observe happening (admittedly only in an anecdotal sense) is the use of pharmacological sledgehammers to treat pushpin-scale problems.

Antibiotics are generally agreed to be grossly overperscribed and I see no compelling reason to assume that other classes of drugs do not fall victim to the same condition. Diet and exercise are contenders, as are lifestyle changes to remove or mitigate the causes of unhappiness.

For example: ADHD. Like any other disorder it runs the gamut from barely detectable to debilitating. How many kids are being perscribed Ritalin for mild forms of ADHD? There are non-drug treatments for ADHD that can be as simple as allowing the kid to sit on a ball instead of a chair or chew gum in class. Do all kids respond to these options? Of course not. Will there always be a need for drugs in some cases? Absolutely.

Drugs get used a lot because they are easy and because they are a one-size-fits-all solution. I would much rather drugs only be used as a last resort instead of the spray and pray methodology that much of American medicine subscribes to.
posted by Skorgu at 10:38 PM on July 13, 2006 [1 favorite]


I've been psychotic before, was told I was schizophrenic, and placed on haldol and cogentin. I had terrible extrapyramidal reactions (the thorazine shuffle) and was still completely out of my mind, regardless. Then the good doctors tried lithium, and shit if I wasn't fine in two days. Now, instead of being paranoid schizophrenic, I magically morphed into having bipolar disorder. I didn't change, the drug did. One is diagnosed not by symptoms, but by the drug which alliviates the symptoms.

Well, lithium sucks: made me fat and slow and dull and dry mouthed and moodless. I never really felt that I was bipolar or schizophrenic, but rather that I went through a rough patch including dropping out of college, a near-fatal car crash, and too much marijuana. I was told of the horrible things that would happen to me if I ever stopped taking lithium. I have not taken any psych med since 1999, nor have I suffered any relapse of manic or majorly depressive symptoms.

I empathize deeply with those who really can't go off their meds, who find life tolerable with them and impossible without. However, I am not one of those people. Just as my choice to not take med should not effect theirs', nor should anyone make that choice for me. The one thing that pulled me through this time is having a large, supportive, similarly- insane family who were on my side: "It's a rough patch, kid, you'll pull through it. You're not crazy, and we love you." Not everyone has the luxury of that kind of support.

Also, shamanic soul retrieval helped. Literally, paying someone to shake a rattle over me and go into a trance worked wonders in my life. Go figure.
posted by eegphalanges at 11:10 PM on July 13, 2006


teece,


You are getting far too defensive about this subject. No one is saying that people who are clinically aren't depressed aren't really mentally ill, nor is anyone speaking directly to you. Some people are *truly* depressed, yes, but not everyone that is prescribed antidepressants fits in that category and I would venture most definitely that not all of them would do just as well if not better on alternative treatment methods.

You are not the only one who has mental problems, has experienced real depression or has in other ways been near to mental illness--remember this when you feel personally attacked.
posted by nonmerci at 11:19 PM on July 13, 2006


teece, spiderwire, skorgu, et al. - you should really read the latter links. granted, the first one is a bit lop-sided, but hey, you need a hook, right? the last few are heavy on the reading, but they really do contain some fascinating information.

the point being made here has nothing to do necessarily with the reality of some people's suffering - the title of the first link is misleading. it is more about the industry that exists to gleefully support this suffering and basically squash any attempts at criticism. i think the study linked last says it best. there is no question that this is the most powerful industry in this country, which is, at least to me, disconcerting.

derail for the caret haters: the caret is a simple, *arbitrary*, upfront way to let you know that a wiki article is being linked. haters of all kinds: don't click on them.
posted by dminor at 11:22 PM on July 13, 2006


Yeah, that's over the top. But I absolutely hate this petulant, third-grade, selfish bullshit libertarian streak that I see in so many Americans.

Teece, you mean like the people who wrote the Constitution?

Trying to build a fence between companies like Pfizer and our government isn't something we do to protect our own wallets. It's to protect all of us from getting bilked wholesale, as a society. There's a trend: business and government make friends, and we pay billions a week to defense contractors for wars we don't want.

I'd agree with you that in many cases individuals and society would both be better off sharing the costs of healthcare, but therein are deals with all sorts of devils (drug companies, drug patent reform), and we have to tread carefully.

It's the petulance and third-grade selfishness of pharma corporations that concern me...
posted by kid ichorous at 11:43 PM on July 13, 2006


daksya, I don't see why what I said is irrelevant and our description of why it's irrelevant only convinced me more of its importance.
posted by milarepa at 11:49 PM on July 13, 2006


um...

our = your
posted by milarepa at 11:52 PM on July 13, 2006


teece, spiderwire, skorgu, et al. - you should really read the latter links. granted, the first one is a bit lop-sided, but hey, you need a hook, right? the last few are heavy on the reading, but they really do contain some fascinating information.

"Heavy on the reading?" Please. Do you find childish, backhanded jabs at people's reading abilities funny? I did read them, thanks -- incidentally, your characterization of the last link is wrong. At any rate, I don't think anyone's arguing that mental illnesses are now nor ever have been diagnosed perfectly. I thought I was pretty clearly admitting that treatment is still somewhat touchy.

Getting passive-aggressive about this is highly disingenuous. As you imply, the first link is an inflammatory crock, "hook" or no. I wasn't aware that we were trying to market our FPPs here, as opposed to presenting useful information (although I guess all the wikipedia links make it pretty clear that you don't subscribe to that theory). Even the title of the post makes it clear that this is flamebait. Are you really that surprised by the reaction? Were you expecting different? This is a debate that we've had here many times, and no, I don't think that this post adds anything substantive to the argument at all. Sorry.

All that said, I thought it was clear that I was speaking to the morons that you predictably drew out of the woodwork -- bukharin, notably -- not the post, but if you really wanted an opinion on the FPP, that's it.
posted by spiderwire at 11:59 PM on July 13, 2006


I do sometimes wonder if what I would call my ADD tendencies isn't actually just that people aren't meant to sit in a fluorescently-lit office all day long.

I do sometimes wonder if what I would call my social anxiety tendencies aren't actually just that people aren't meant to have to rebuild their entire social group from scratch every 2-3 years as they (as I) move around the country from college, to first job, to grad school, etc.

Not to take anything away from those who truly suffer or criticize the use of drugs in those cases. Just that when I hear statistics about the wave of mental health problems, I turn to social critique.
posted by salvia at 12:13 AM on July 14, 2006


Oops. Subject-verb agreement. I swear I proofread three times.
posted by salvia at 12:14 AM on July 14, 2006


spiderwire :

the point is not to "market" an FPP, but rather to make you want to look a little deeper, read the rest, do your own research, etc. like rational people do, you know?

the point is also to present - by way of scientific analysis - an objective view of a situation that is not the status quo and potential reasons for why it is not so common. if i wanted to start a flame war, believe you me, i would not link to any kind of peer reviewed journal.

the title of the post, by the way, is the title of the study which you claim to have read in full. come on, man.. that's just sad.

again, the wikipedia links are marked as such for a reason. that is the point. in fact, you know, the whole thing is optional - don't forget that.

the last link is what the whole post is about. it is a study of the correlation between efficacy results of anti-depressants and the source of funding for the labs where the studies were conducted. you really should read it instead of getting angry.
posted by dminor at 12:18 AM on July 14, 2006


Correct me if I'm wrong, but aren't these meds typically prescribed by psychiatrists? People can't get these directly, so every "bad" prescription needs to go through a trained professional, and 95% seems like a very high proportion of apathetic or incompetent doctors.

While there are qualified, knowledgeable psychiatrists out there prescribing meds, they're hardly the only ones doing it. I'd say you're just as likely to get samples of entry-level SSRIs (Prozac, Zoloft) from your GP. Since they are by definition not specialists, it leaves the door wide open for overprescribing, or prescribing the wrong stuff. Speaking strictly from personal experience, the wrong meds are almost worse than no meds at all. I'd much rather have doctors immediately referring patients who needed psychiatric meds to a specalist, since if you're dealing with depression strong enough to require medication, you really want someone at the wheel who knows what they're doing.

No one is saying that people who are clinically depressed aren't really mentally ill

I don't think it's that so much as the palpable feeling that depression isn't a real illness, but a character flaw. Personally, I've been dealing with clinical depression for nearly 15 years. And while objectively I know damn well it's not some kind of personal failing, it is still incredibly difficult to ignore the usually-unspoken conventional wisdom, which goes something like this: "Buck up, little camper! Only weak and lazy people need those drugs. Just pull yourself up by the bootstraps and go for a jog." Great. When you hear it from enough people who haven't been to the place where you can't eat, can't get out of bed, can't think, can't stop crying and can't imagine that things will never not be as bad as they are right now--and trust me, you do--it gets old, fast. Almost as quickly as the attempt to explain to your flip listener how real and fucking awful depression truly is.

Mad props to teece and spiderwire, too.
posted by Vervain at 12:34 AM on July 14, 2006


milarepa - your(sic) description of why it's irrelevant only convinced me more of its importance

It convinced you, but then you're someone posting in this thread at Metafilter.

To elaborate on my argument

1)Folk wisdom is that there's a mind-body duality. Mind over matter. Free will. Immaterial soul..etc etc

2)Scientist says "Nope. Matter is entirely responsible for your thought. Hey, I notice that you just lost your job and your wife. Here, pop this pill."*

3)The layman, because he doesn't understand how matter gives rise to thought, is skeptical & resentful** of the notion that a pill could 'solve' something mentally dissonant.


*Apologies for the phrasing. Just trying to get the dualist perspective.
**Take note that 85% of the US population is religious in some sense; and that 46% believe in literal Creationism alongside 36% who believe in God-guided evolution. So you have to consider that many of these folk, certainly the 46%, don't want to actively ponder the possibility of a material universe.
posted by daksya at 2:10 AM on July 14, 2006


It's so wonderful to read the chicken/egg arguments of people who've never had their arm hairs spell out accurate prophetic messages. Chicken. Egg. At some point, mere belief in anything will not suffice. Your ideas about life and free will and freedom will be completely quashed, if you're lucky. Otherwise, when things really do fall apart, you will not have had the practice in how to deal. You'll still be arguing if it's really happening or not.

There is great power in the word of diagnosis. Naming something makes it understandable, but it's dangerous and potentially life-destroying. If I had bought the original diagnosis given me in 1993 of schizophrenia, I would not have ever moved out of my parent's home, got an education and career, or lived an independent life. I most likely would have killed myself, and I tried, because Haldol is a bad, bad drug. Chemical straightjacket. Everyone who prescribes that shit should have to do six weeks on it, just to dig the freezing hell of stiff limbs and ataxia. Your thoughts freeze just like your body does. Neuroleptics like Haldol, Prolixin, and Thorazine are used on political prisoners for a reason. (Not that I was a political prisoner. I was a raving fucking nut.)

You want to argue about free will, thought, and chemicals: did I will myself out of schizophrenia, then bipolar disorder, too? Or are my years of stability just a crapshoot? Or did the elders of the church who anointed me with oil have something to do with it? Or should the Harner Method Shaman who blew my soul back into my head and chest take the credit?

No doctor has the right to give me unalterable prognosis along with his damning diagnosis. When I was in the hospital, and 85 year old man who'd just come through a mild stroke and who had a bit of dementia was watching Letterman with me one night. He said, "This guy goes nuts on TV every night and gets paid for it. You and me are in here."

Sanity is a construct of predictability and safeness, all based on our fears. Even though I look sane, act sane, am sane, the crazies still call me out. The other week, there was a guy across the street from me, a half a block ahead, who was cawing like a raven and doing some kind of bird dance. He hadn't seen me yet, but I was like "Oh, shit, lunatic! Hide!" because they know I'm one of them, too. And wouldn't you know, the bastard zones in on me and ends up following me to the supermarket. He was really harmless, you have to participate with them like children and send them on their way.

Your mind can be easily broken, don't doubt it. But I found soul behind that, even in mindless madness, abject quaking horror and fear, yes, there is free will enough to abide with that which you can't control. Argue about it. You've never been there. Cheers.
posted by eegphalanges at 2:49 AM on July 14, 2006 [3 favorites]


the caret is a simple, *arbitrary*, upfront way to let you know that a wiki article is being linked

i already read my status bar, thank you very much. i know the url being linked before i click. also, why would i give a fuck about knowing a wiki article is being linked anyway?
posted by quonsar at 4:34 AM on July 14, 2006


The layman, because he doesn't understand how matter gives rise to thought

daksya
My point is that "laymen," and scientists alike all don't understand how matter gives rise to thought. Thus, teece's assertion that thoughts = chemicals, while generally true, is an oversimplification.
posted by milarepa at 4:42 AM on July 14, 2006


Really, take that libertarian bullshit elsewhere. You don't have a fucking clue what depression is. It is lethal for some people.

A lot of things are lethal. How effective are drugs in reducing the death rate? Can you cite a cost-benefit analysis?

In such situations, you don't fuck around to pinch pennies you; me and society get out our wallets and buy the fucking antidepressants, you anti-social bastard.

Why can't those suffering from depression get out their own wallets? I have a slow metabolism, and I have to exercise to stay fit. Obesity is lethal! Should I demand that you pay for my gym membership? Cigarettes keep me from fidgeting and relieve my anxiety. Maybe you should buy those for me.

And what percent of new depression cases skip the fluoxetine and go straight for the expensive stuff? I don't merely object to paying for your pills, I object to the pharma-industrial-government complex that sees to it that incentives are removbed, and that the cost structure is as byzantine and intermediated as possible.
posted by Kwantsar at 6:03 AM on July 14, 2006


What most people don't realize here is that the wide genetic variation in humans is probably responsible for the way antidepressants look really close to placebo in clinical trials-- and yet some people find them miracle drugs whilst others find them toxic hell.

Same is even true for opioids like heroin-- clinical trials of opioids in humans sometimes find that they are not painkillers, in fact this happens about half of the time!

This doesn't mean that they aren't painkillers-- it means that genetic variation messes up the trial. When you match the right drug to the right person, the difference between placebo is astonishing; but when you get the match wrong, you wind up with people who end up crusading against these evil mind-killing drugs.

I wrote about this problem and about the failure of people to recognize the agenda of antidepressant opponent therapists (um, maybe their jobs are at risk if the drugs work?) for Reason here...
posted by Maias at 7:25 AM on July 14, 2006


Maias, that was one of the few Reason articles about a relatively complex topic that wasn't immediately slagged by the H&R peanut gallery. It really was quite good; I remember thinking so when I first read it last year.
posted by Kwantsar at 8:36 AM on July 14, 2006


For the record teece (et. al.),
Regarding mental health exceptionalism;
A lot of work remains to be done to completely eliminate the stigma around mental illness but I don't think you could find a reputable source that would argue that antibiotics have not been overprescribed. Among the leading causes of death in America (and other western industrialized countries) is cardiovascular disease, a condition for which I believe that drugs are vastly overprescribed. If we as Americans (and as a fat guy I include myself) got off our collective duffs, exercised and ate halfway decent meals, the need for drugs would be nearly eliminated. I'm sure other can think of other types of disease for which this is true. Mental health is not exceptional, the problem is systemic.
posted by Octaviuz at 9:09 AM on July 14, 2006


milarepa - Thus, teece's assertion that thoughts = chemicals, while generally true, is an oversimplification.

Which is besides the point. teece's statement was

"The reality is that many (most?) people are deeply, deeply troubled by the simple fact that your thoughts are just chemistry, and are thus changeable by chemicals."

Whether this is actually true or not, and if so, how, is irrelevant. The layman gets the impression from the pharmaceutical industry that the gist is true. That perception is what matters, and causes the resentment. For most of the population, the current state of the philosophical problem and the scientific gap in understanding is irrelevant.
posted by daksya at 11:18 AM on July 14, 2006


I see what you mean...finally. I can be a bit slow.

But it also works in reverse. The pharmaceutical companies/scientific communities give off the air that they know what's going on, people trust it, label themselves "chemically imbalanced" and medicate accordingly, often through negligent healthcare.

I think it builds resentment, as you're saying, on the one hand, but the simplification also results in overmedication, and a justified mistrust of the pharmaceutical companies/scientific communities because they are not being completely forward about what they don't know.

I really think the oversimplification of chemicals = thoughts, and the inability to admit legitimate ignorance, is what leads to much of the debate.
posted by milarepa at 11:34 AM on July 14, 2006


people are just looking for an easy way out of their problems nd the drug companies are more than happy to give it to them.


Those crazy people are always trying to take the easy way out!
posted by Kloryne at 2:26 PM on July 14, 2006


I don't even know if this is worth mentioning at this point but there's an extremely interesting opinion piece that compares the chemical vs. system theories of depression available here (pdf). It explores the question of the function of antidepressants and the causes of depression from within a biochemical/neuroscience framework.

Abstract: The chemical hypothesis of depression suggests that mood disorders are caused by a chemical imbalance in the brain, which can be corrected by antidepressant drugs. However, recent evidence indicates that problems in information processing within neural networks, rather than changes in chemical balance, might underlie depression, and that antidepressant drugs induce plastic changes in neuronal connectivity, which gradually lead to improvements in neuronal information processing and recovery of mood.p
posted by nTeleKy at 3:09 PM on July 14, 2006 [1 favorite]


The problem with "depression" is that in most people it's self-limiting and not very deep; they just get "a little blue" sometimes. Those people don't really need prescriptions for those occasions. I wouldn't forbid it, I'd just point out that there's bound to be a cloudy day in the most perfect resort.

As for what "depression" is, I don't know enough about neurology and all the relevant fields to know what to think. I don't care mch either: whether my brain is chemically imbalaced or broken in some other way (I've had dozens of literal hard knocks to the head, e.g.), or whether I'm just an idiot who can't retrain himself or find the right guru (excuse me, "therapist") or what, I feel (and behave) much better with pharmaceuticals. (For example, I quit failing to kill myself, I quit laying in bed for six months whining on the phone to people I barely know, I quit having sex with strangers, etc. etc.) And my previous experiences with "self-medication" (blotter, PCP, crank, heroin, etc.) had far worse side-effects (among them illegality).
posted by davy at 9:04 PM on July 14, 2006


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