Much of the credit for how we understand ourselves goes to the pharmaceutical companies, even if we don’t take meds, David Healy MD of the University of Wales said in a grand rounds lecture at UCLA on Oct 28 and webcast the same day. Upjohn (since taken over by Pfizer) pioneered the concept of marketing the illness rather than the drug, capitalizing on the DSM-III’s reclassification of anxiety into several disorders to push Xanax for panic disorder. In the mid-eighties, as the benzodiazepines became a focus of concern, the SSRIs in development were first seen as non-habit-forming alternatives to tranquilizers before they were targeted to treat depression. More recently, the SSRIs are returning to their original purpose, with the drug companies spending up to $100 million a year to promote these meds as "anxiolytics" (thereby distinguishing them from the bad associations of tranquilizers).

A thorn in the side of the psychiatric establishment, Dr Healy is the author of "Let Them Eat Prozac"  and a dozen other books, has published articles on the suicidal side effects that some patients can experience on antidepressants, has appeared as an expert witness in legal actions against Prozac and Paxil, and recently sued the University of Toronto for rescinding an employment offer. According to Dr Healy, in order to create new markets for its products, the pharmaceutical industry ghost-writes much of the literature that appears in mainstream psychiatric journals, mobilizes expert opinion, designs its own drug trials, engages in extensive media campaigns, and underwrites (and even establishes) patients’ groups.

Dr Healy stressed to this writer that he is not hostile to the industry, simply stating that its influence needs to be recognized.

During the 1990s, Dr Healy went on to say, we converted cases that would have been treated by Valium and Librium into cases treated by Prozac, Paxil, and Zoloft. Back in the 1960s, an Eli Lilly print ad for a tranquilizer showed a young mom playing with her daughter. Another Lilly ad from the same period, by contrast, displayed the face of depression as an elderly woman. Back then, he reminded his audience, depression was regarded as a rare illness affecting mainly older people. In 1996, when the World Health Organization reported that depression was the second greatest source of disability on the planet, the reaction from psychiatry was not how did society become depressed so fast, but rather "we’re the second most important people in medicine after the cardiologists."

But this trend was far from universal, Dr Healy pointed out. During the nineties, the Japanese did not become depressed the way we did. Prozac is not on the market there, and tranquilizer use remains vastly greater than antidepressant use. Most of the rest of the world, Dr Healy reminded his audience, follows the Japanese model.

Which raises the $64,000 question: Are we better off with antidepressants? The answer may elude us, if we follow Dr Healy’s reasoning. Randomized clinical trials, he says, were never meant to prove a treatment works. Rather, they are designed to show something doesn’t work, as in the case of a charlatan promoting snake oil. It is industry’s "greatest achievement," claims Dr Healy, to turn this around. Although he does prescribe antidepressants in his clinical practice, one senses it is with the confidence of one recommending a Tylenol for unexplained pain than an antibiotic to knock out a particular infection. Indeed, he concluded, if SSRIs worked for depression or anxiety the way antibiotics do for GPI (syphilis), we wouldn’t have the illness around anymore.

Don’t expect this guy to be the guest of honor at any industry-sponsored symposia.

More

In his UCLA grand rounds lecture, and in an internet article, Dr Healy gave several examples of how pharmaceutical companies influence medical and public opinion. One of these involved the company, Current Medical Directives (CMD), which ghost-writes and coordinates medical articles for its clients. As part of a legal action against Pfizer, Dr Healy obtained access to a document that listed the progress of 85 articles on Zoloft. Two articles in preparation related to Zoloft and PTSD, for which Pfizer was seeking a license. The authors were listed as "TBD," for "to be determined." The articles eventually appeared in JAMA and the Archives of General Psychiatry, with several academic psychiatrists credited as the authors. In a study published in the British Journal of Psychiatry, Dr Healy found that the 85 CMD articles were cited three times more often than non-CMD Zoloft articles. One hundred percent of the CMD articles reported favorable results for Zoloft vs 44 percent of the non-CMD articles.

Another example involved six academic articles on pediatric depression, with the authors hailing Paxil as "effective, safe, and well tolerated," despite clear evidence of suicidal thinking and behavior in some patients, greater than those on the placebo and comparison drugs. Since then, citing the same data the academic authors had access to, authorities in the UK have advised against prescribing Paxil to patients under age 18 while the FDA in the US has announced strengthened warnings on product labeling.

For free online issues of McMan's Depression and Bipolar Weekly, email me and put "Sample" in the heading and your email address in the body.

Dec 15, 2003

Issues and Advocacy articles   All articles

Grantasaurus (Jan 21, 2004):  An excellent article.  Psychopharmacologists have redefined depression so that it fits in with some fairly shaky theories on Serotonin depletion in the brain.  This then requires SSRIs and the like.  I used these drugs until they lost their effect.  The solution my psychiatrist used was to increase the dose and to combine more than one.  This made me sick.  I have now decided that my mild depression is easier to live with than the drug induced sickness brought on by antidepressants.  The problem with these drugs is that they are often only partially effective, they often make you ill in their own right, they can stop working and no one knows the long term effects.  I suspect that these drugs are dangerous when used long term and should only be used where other options for treatment of the depression have been exhausted.  Where they are used it should be for short term treatment only.  The drug companies are in it for the money and are total bastards only interested in their bottom line, profits.  Unfortunately the US government gives them almost free rein to disinform the public. I think slowly though the public are starting to lose faith in doctors and psychiatrists in respect to the treatment of depression.  It seems to be that while average Joe Public is no Einstein their sense of smell is fine and this business stinks like yesterday's diapers.

Mark (March 4, 2004):  There is an inherent need for more research into natural remedy, and I do not mean simply from plants such as St John's Wort or Valeriana, etc, but rathermore on diet, exercise and the accumulative exposure to the thousands of chemicals we come into contact with daily.

Sedentary lifestyles and metabolites of the chemicals and derivatives that are now already in or added to the food chain at source or during the food production process, need financial backing and investigation.  The issue at fault is the endemic lack of commercial interest to do so in both cases.  Therefore investigation is mostly limited, and outcomes criticised by those waving the larger wallets.  

The old adage you are what you eat should not be forgotten;

-Soil Depletion due to overuse of fertilizers means vegetables lack vital trace elements that cannot be remedied with a simple vitamin pill.  Their effects on the body and brain function remain insufficiently investigated.
-Vegetables contain pesticides, which I cannot find any benefit for in my body to date.  Neither can I find which ones have been used on the food I eat.  Regarding food production, there are surpluses everywhere.  There is a distribution problem only.
-Parts of pesticide compounds are now being add to genetically modified organisms, and being ingested in pollen as well as food, the pollen recently being linked to sickness in some recently released reports.
-Meat contains hormones and accumulated toxins from the pesticides and other toxins in the feed they eat.
-Some articles suggest metabolites of additives such as artificial sweeteners can lead to depression, after prolonged exposure.

Lacking micronutrients, with a lifelong accumulation of chemicals we are exposed to daily, some voluntarily, others involuntarily may contribute to our functioning, not only physically but mentally.  This may be a direct influence of a specific chemical, or interactions between them, or due to the effects of their breakdown products.  It is known for example that both lead and mercury affect brain function and make us "mad as a hatter".

Not everything we ingest can be controlled, but there are some things that can be done as a matter of choice.

If you are on a down period, eat well, walk, do exercise of any description.  Go outdoors, get some direct daylight on your face.  Remember how unnatural your life is to how you would live in an undeveloped society.  The lives we lead are no longer as nature intended.

I am convinced that unnatural lifestyles can be a trigger to depression. Increasingly sedentary, indoor lifestyles, with a rich carb/fat/sugar diet hold no benefits that I can log.  Incidentally on the latter, these are the 3 cheapest base ingredients, marketed and pushed on us all through a plethora of products of little or no nutritional value and capable of inducing mood swings in themselves. 

There is a lucrative industry in marketing cheap unhealthy food at us, just as there is for antidepressants for the pharmaceutical industry.  The dependency that they create may one day be shunned as we shun nicotine today.  It is the perfection in marketing; cutstomers are for life.  Smoking is a great example, customers are with you til they expire.  New generation of customers is necessary.  Not much else is.  It is very often the same with treatment for depression with many current treatments.  There are bonuses and freebies to be had for getting the new customers.  These customers will often remain with the company for life on a reduced continual dose, just as the nicotine addict, who fails to stop using the product, learns to wean the dose in an attempt to 'save' their health.  The same is beginning to happen to food.  Increased yields, but "Hey, no seeds.  Sorry 'bout that.  Come back next year.  We'll have generated a new batch." 

Dependent marketing cycles are great for the producer.  Be careful, before buying in to one.

For some, treatment with pharmaceutical drugs is indesputably necessary.  For many, a chain of unexpected dramatic events are the trigger. This should not be doubted.  For many it is not, and alternatives are not effectively investigated.  The cheapest solution is a box of pills.  Quick fix solutions are however rarely the best. 

Sometimes we have no option but to dig deeper ourselves for to find solutions directly pertainable to us individually, or for those that we care for around us.  Do not underestimate constant self-evaluation.  Being aware of yourself and your feelings is not only useful but, before reaching a critical point, vital.  Knowing your limits, and not those societal pressures appear to impose on you, is  also of the utmost importance.

To summarise eat well, keep active, learn to know yourself better and do not buy or eat junk.  Both you, those around you and your environment will be a better place for it.

Bipolar in New Jersey (March 4, 2004):  I viewed Dr. Healy's webcast and found it very interesting. As a former psychology major who has finally given in to the "bipolar" diagnosis (though I only take small amounts of lithium--much prefer therapy), I'm very saddened to see how drug companies seem to be determining what is "normal" human behavior in a way that seems to be making us all crazy trying to figure out just what exactly it is we should be or feel.

StrataFire (March 7, 2004):  Its Very disconcerting when the people with the  Medical Certificates & physiological certificates (I am purposely refraining from calling them a "Degree") say that people have a "disorder" and therefore must be drugged to become "productive" to the general population (I suppose the grants and monetary value have nothing to do with it ?)

I can recall moments in my history where some may have considered it a form of ADD, yet I have a father who was more supportive of my "differentiation" in mental processing and recognized the need to allow my mind to roam the veritable "wastelands" of understanding (referred to as knowledge) and provided me with moral values to work by (even if I did not understand them at that age) books that where more advanced then a 4 year old needed and mechanical toys that required building in order to work.

If I screwed up, I was as afraid as any child at that age that I would be in trouble, and learned many things the hard-way yet I am here today with a complete understanding that no future is written for you nor are there any real boundaries set upon you other then what you place there in the first place by your own admission or  allowing of the lack thereof.

The point of this little "raving" , is to  simply say that :

No future is written by man for you nor is there a destiny set upon you. You can achieve many things if you simply find a way to channel your thoughts toward a goal or a set of goals "WITHOUT" the need for a crutch (drugs) to cause your "unique" abilities to become numbed just to fit into a very narrow and very opinionated form of "normal".

"A Child's action is always the end results of the failings or successes of parental observation and involvement, and society "be damned" if it believes otherwise."

Squiggles (March 9, 2004):  I am happy to see Dr. Healy presenting
a case similar to one I fought on the net a couple of years ago.  It is the
perennial problem of spurious psychiatric diagnosis due to the inability to distinguish first, cause from effect, and secondly, to turn that uncertainty into an entrepreneurial advantage by the drug companies.

I still don't know the cause of my original diagnosis, and my doctor cannot be sure either. However, I am sure of the cause of my chronic, and escalating panic attacks. It was believed that Xanax was necessary to be prescribed indefinitely at the same dose for breakthrough anxiety.  Gradually, I got panic attacks, which I never had  before Xanax.  They got worse and worse. I smelled tolerance and said so.  I was weaned off (fortunately it was a small dose) and I have never had a panic attack since.

All psychiatric drugs have effects which are undesirable to some extent, and given  the name 'side effects'.  Often, other drugs  are given to combat the side effects.  If this is recognized, the doctors are ahead of the
game.  But if it is not, and the onus is placed on endogenous disorder, then what we get is yet another sub-category on the DSM and yet another opportunity to manufacture and prescribe a totally unnecessary drug.

Is it depression or is it the drug? Is it anxiety or is it the thyroid level or hormone substitute?  Well, it seems to me that an old-fashioned differential diagnosis by a general practitioner, is all we need to answer such questions.  We don't need no stinkin' MRIs - not for this stuff.

Catherine (March 18, 2004):  I am of the belief that many of our impressions of mental illness do come from the pharmaceutical companies. I believe that any form of advertising always succumbs to the purpose for which it was made, which is to sell.

In our own lives, I think that it is paramount that we educate ourselves on our conditions, and educate ourselves about medications. In conjunction with a psychiatrist who is enlightened, empowering and non-judgmental, we might be able to find a medication which suits our needs without having to give in to the rhetoric given to us by the drug companies.

My opinion of mental health recovery is a very eclectic one, that there are several factors which shape our recovery, which are: proper nutrition, proper exercise,  psychological stability as worked through by talk and/or group therapy, emotional wellbeing as produced by doing things that we enjoy, and spiritual growth as manifested by our willingness to depend on a higher power to help guide us, be it simple meditation to a generic higher power, or any of the world's faiths--the spiritual can help us with deeper questions.

Each case of  mental conditions is individual and must be investigated with an eye towards an individual's needs, be they emotional, psychological, medical or environmental. Some people with a milder condition may not need medication, while others with more severe conditions may need some medication. Some people may need more therapy than others; some people may need to get out of the environment that they are in, others may need to go inwardly to change, and some people may need a combination of environmental change AND inward investigation.

Medication is a tool that has been abused by the pharmaceutical companies as the end all and cure all of mental health conditions. Some medications do work, and that's fine, but some medications are dangerous. Sometimes, people are given too much of one type of medication or the psychiatrist does not think to see what combinations might be lethal to the client; some psychiatrists blindly prescribe and they do not check with the client to see if there are concerns of  toxicity, severe side effects or discomforts.

In my opinion, the pharmaceutical companies should be required by law to realistically market their medications and to comply with a rigid code of ethics given to doctors and other MH professionals who dispense medications. The mentally ill are human beings, not machines. Sometimes medications do help; sometimes, research and the DSM-IV serve as guides to help form a baseline for what to expect generally in a condition. However,  individuals manifest different strengths, weaknesses, abilities, insights, and shortcomings-and individuals are as variant as snowflakes are in design. This is what the pharmaceutical companies ignore, and many medical professionals have forgotten.

Thank you for your website. It is very informative.

Janee (March 22, 2004):  I don't trust a single psychiatrist out there.  I was only 18 when I started playing their medication game.  I've had every diagnosis under the sun.  I've been on SSRI's, Tricyclics, MAOI's, Lithium, more mood stabilizers than I can count.  Antipsychotics, mood elevators and of course Aricept because I got so sick from the lethal combination my last idiot of a doctor gave me.  I've lost my job due to all this.  I had a really good job as a nurse.  But I trusted my doctor who decided that once a week ECT was a good idea.  I lost my job and the psychiatrist who decided to retire in the middle of my treatments.  Then I got my last idiot.  He only had three patients I should have known better.  He stuffed me with pills and decided to take them away one day.  That was fun because I started to hallucinate.  Then his job became mine because he knew I was a nurse he wouldn't get off his lazy butt.  I could go on forever.  All I know is my current creep is getting this article.

Jane (May 23, 2004):  Janee, you hit some strident chords that I can resonate with, certainly.  However, I am very grateful that for the most part I have been fortunate in the psychiatrists that I have seen over these 18-20 years.  Of course, up until this year, I had excellent health insurance or a decent income with which to self-pay, and thus to be very meticulous and 'choosy' in regard to my head-doctor.  After all, it is my brain that they are messing with, with DRUGS no less!

I maintain, just because it's prescription, doesn't mean that it's not dangerous to your/my brain!  Especially over the long term use of these psychoactive drugs.  I mean, geesh, 20 years of 'doing drugs'?  Come on, this isn't insulin, folks!

So, I just wanted to say here that I know that you are a nurse, intelligent and knowledgeable.  We make ourselves knowledgeable, ask tough questions, and they resent our intelligence. I'm not a nicely-compliant patient, either.

Of course, I cannot do that now, as I am rendered unto dire straits circumstances financially, and am w/o insurance.  But, I still have enough brain cells intact to know that prescribed drugs helped me to get over-the-edge, and I still ask tough questions that they really don't want to be bothered with nor have the time.  In fact, now one doesn't even get to see the staff psychiatrists in this state's outpatient mental health centers; RNPs are one's only access.  Unfortunately, they as well don't seem to want to be bothered.  (I keep asserting upon first meeting: "You need to know first that I'm not from around here, I didn't grow up here, this is not my culture. So please don't talk to me as if I were an uneducated hillbilly, please, and thank you. "