Posted: September 23, 2010 08:00 AM
Remember not so long ago when Prozac became the world's largest selling medication of any kind, and then for years how Prozac, Paxil and Zoloft took over many of the top 10 spots? Remember the explanations at the time–that they were wonder drugs and that 15-50 percent or more of Americans would need them some time in their lives? To many people this seemed like a scientific breakthrough when in reality it was … a triumph of marketing. Some studies suggest that the antidepressants are little or no more effective than a sugar pill and a lot more dangerous. Recent research examined all antidepressant studies submitted in recent years to FDA in regard to antidepressant efficacy and found that the drug performed no better than placebo except in "severely depressed patients," reaching "clinical significance" only "at the upper end of the very severely depressed category." Even then, the difference between the antidepressant and the placebo was "relatively small."
In addition to being largely ineffective, the antidepressants can be very distressing to withdraw from, which keeps the market artificially inflated by people who would desperately like to stop but find the process too emotionally or physically painful. Often these individuals fail to realize that they are undergoing withdrawal and instead mistakenly conclude that they "need" the medication to control their original psychiatric problems.
Now look what have become the new top selling drugs in the world: antipsychotic drugs like Risperdal, Zyprexa, Abilify, Seroquel, Geodon and Invega. Although the FDA has been expanding the approved use of some of these drugs to some cases of autism, Tourettes and a variety of other problems, their original purpose and their main use in psychiatry until now has been largely confined to psychosis and acute mania. Psychosis and acute mania afflict a very small portion of the the population. Yet these drugs are now at the top of the list of most widely prescribed medications worldwide. How did these incredibly toxic chemicals become daily pharmacological mainstays for so many millions of children and adults? It's time to face the truth that the prescription of psychiatric drugs is driven by marketing trends–and now for the first time by something even more dreadful and insidious than mere marketing.
To begin their market campaigns for the newer antipsychotic agents, the drug companies created the myth that these products were not as dangerous as the old antipsychotic drugs, which were becoming recognized as highly toxic. Especially hard to ignore, it was demonstrated that the old antipsychotics cause tardive dyskinesia, a disfiguring and sometimes disabling array of abnormal movements in 5-8 percent per year cumulative of otherwise healthy patients and more than 20 percent of older patients. But even the unproven and ultimately false claim that the newer drugs were safer could not make a huge market for them. Even if these were wonder drugs, they were wonderful for a relatively tiny percent of the population. The drug companies had to create a new patient population market and that market became "bipolar disorder."
Once much rarer than schizophrenia, bipolar disorder would soon become one of the most common diagnoses made in medicine and psychiatry. Indeed, while ordinary folks used to talk about their biochemical imbalances and depression, now they've upgraded to having bipolar disorder.
Lithium, once the magic bullet without side effects for bipolar disorder–then called manic-depressive disorder–had turned out to be a severe central nervous system toxin that over the years ruins mental function while also producing thyroid disorders, kidney failure and a host of other serious problems. The discrediting of lithium created a new niche for antipsychotic drugs–to be used as "mood stabilizers" for people with severe ups and downs. But it was a relatively smalll niche to begin with.
Where would all the new bipolar patients come from? Many of them would come from the fertile imagination of drug company sponsored psychiatrists who found bipolar disorder in everything from toddlers with temper tantrums to adults with bursts of energy followed by a natural period of feeling fatigued. Leaders in child psychiatry like Harvard's Joseph Biederman were literally paid under the table to push antipsychotic medications for bipolar disorder in children. A recent study showed that children labeled bipolar actually receive more adult antipsychotic drugs than adults labeled bipolar . Another recent study covering 200-2002 showed that 18 percent of child visits to a psychiatrist included antipsychotic treatment, and 92 percent of those were for the newer so-called second generation drugs. It took a great deal of marketing to convince physicians that these relatively untried and highly toxic antipsychotic drugs are that safe and effective in children.
But even marketing bipolar disorder to the professions and the public was insufficient to create a huge enough market to satisfy the drug companies. Here's where the irony of ironies came into play. The newer antidepressants–once the leading drugs in the world–frequently cause mania. They do so in millions of patients, children and adults alike, every year. These once most popular drugs in the world by causing mania made and continue to make the market for the next wave of most popular drugs–the antipsychotic drugs being used as mood stabilizers.
How common is antidepressant-induced mania? Very common. Several studies have found that 6 to 8 percent of patients exposed to antidepressants will develop a manic disorder. One research study, for example, found in a retrospective study that Paxil produced mania in 8.6 percent of patients exposed. Other studies find the rates as high as 17 percent And if a person has already shown a manic tendency or has experienced a manic-like episode, antidepressants will pu
sh one-quarter to one-third into new manias (For a review, see P. Breggin, Brain-Disabling Treatments in Psychiatry, 2008, pp. 157-165) . Yet misguided psychiatrists commonly give antidepressants to patients diagnosed with bipolar disorder. The result? Millions of people suffer from medication-induced mania and other expressions of what I call "medication madness."
When I took my psychiatric residency at Harvard in Boston and at SUNY in Syracuse in the early 1960s, we never saw or diagnosed bipolar disorder in children. In my four years of training, I saw one 19-year-old in a manic state and a few adults. When a person was admitted in a manic condition talking a mile a minute, imagining grand things about themselves, making outrageous plans, bursting with anger and energy, unable to sleep and otherwise euphoric, the condition was so unusual that we would hold grand rounds, a medical show-and-tell, to discuss the patient.
Now psychiatric wards are filled with patients having their second and third or umpteenth manic episode and every psychiatrist's day is filled with patients diagnosed bipolar. It's mostly about antidepressant-induced mania. Every single child I have evaluated who has suffered what looks like a manic episode has been taking stimulants or antidepressants, both of which cause mania. At least 9 out of 10 adults I've seen in the last two decades who have suffered emotional episodes that could be diagnosed as mania had them in direct response to stimulants or antidepressants–mostly the newer antidepressants starting with Prozac.
In the official diagnostic system, these are not cases of bipolar mania but cases of medication induced mood disorder with manic features; but they are almost always mistakenly called bipolar disorder in order to avoid identifying the drug and the prescriber as the causative agents.