Meds require review, speaker says — (Dartmouth Review)

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Dartmouth Review

By Tom Owen

Published on Thursday, October 6, 2011

Patients who take psychiatric drugs over a long period of time are more likely to relapse than non-medicated patients, according to medical writer Robert Whitaker. Whitaker argued for a shift in the “paradigm of care” currently accepted by the psychiatric community in a Wednesday night lecture in Carpenter Hall.

“With all drugs, there needs to be a risk-benefit analysis,” Whitaker said. “We need a clear benefit to balance the risk.”

Dozens of studies show that long-term use of psychiatric medication changes the brain’s structure and chemistry, making patients more susceptible to the disorders they are trying to treat, according to Whitaker. He cited this change as a possible reason for the twofold increase in the number of Americans receiving government disability benefits for mental illness since 1987.

Whitaker reviewed the history of psychotropic medication, explaining that most drugs were not developed specifically to treat mental disorders but were accidentally “discovered” to be beneficial to patients.

Thorazine, the first antipsychotic drug popularized in the United States, was initially developed to treat worm-borne illnesses, but surgeons noticed that the drug had an effect similar to a “chemical lobotomy” and prescribed it to patients suffering from psychosis, Whitaker said. The first antidepressants were originally introduced as antituberculosis agents, and antianxiety medication developed out of research for treating Gram-negative bacteria.

“These drugs come from serendipitous discoveries,” Whitaker said. “They are not based on biology but on effects that are seen as beneficial for patients.”

Contrary to popular belief, patients have no indication of chemical imbalances before starting a psychotropic drug treatment, according to Whitaker. Although many people believe low serotonin levels are responsible for depression, studies have shown that patients diagnosed with depression do not have low serotonin levels or lack serotonin receptors, Whitaker said.

“There is no clear and compelling evidence that a serotonin deficiency leads to depression,” he said.

When psychotropic medication alters the levels of chemicals in the brain, the brain attempts to compensate for the change. Prozac, for example, increases levels of serotonin in the synaptic cleft, or “press[es] on the accelarator,” as the brain tries to maintain homeostatic equilibrium by producing less serotonin, or “putting on the brake,” Whitaker said.

“Do you see at all the possible irony here?” Whitaker asked. “After you go on medication, in fact you do have a chemical imbalance. It caused the opposite of the intention.”

Whitaker said that because the brain is fundamentally changed after a long-term course of psychiatric medication, the nature of mental disorders has changed drastically in the last 50 years, with significantly more patients experiencing chronic symptoms.

“In the anti-depression era, we are gradually understanding that depression is shifting from an episodic to a chronic disorder,” Whitaker said.

Whitaker said he was disappointed that pharmaceutical companies often obscure important studies that find negative consequences of the long-term use of psychiatric medications. He also acknowledged that doctors are in a difficult position when deciding how best to treat patients suffering from psychic distress due to the conflict between conventional wisdom and more controversial studies.

“In the United States, it’s considered unethical not to immediately treat disorders with drugs or to take someone off them prematurely,” Whitaker said. “I am not strictly anti-drug. I think they have a place, because according to the data, they help in the short term. But the paradigm we’ve accecpted as a society ­ long term for all ­ is not an evidence-based conclusion.”

Whitaker, who has won numerous awards for medical writing and was a finalist for the Pulitzer Prize in 1999, outlined key points from his 2010 book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.” Whitaker said the book is the first comprehensive and scientific study of the long-term effects of psychotropic medication, and that he hopes his research will lead to greater “discussions” about conventional wisdom.

The lecture, “50 Years of Psychotropics: A Medical Advance or Doing More Harm than Good?” was sponsored by the Ethics Institute and the Special Needs Support Center of the Upper Valley.