Thursday, September 5, 2013

Is Psychiatry Going Off Its Meds?

Paradoxically, as psychiatric patients are increasingly relying on medication to treat their mental health issues, pharmaceutical companies are shutting down their research into psychoactive medication.

Gary Greenberg reports in The New Yorker:

In the past few years, one pharmaceutical giant after another—GlaxoSmithKline, AstraZeneca, Novartis, Pfizer, Merck, Sanofi—has shrunk or shuttered its neuroscience research facilities. Clinical trials have been halted, lines of research abandoned, and the new drug pipeline has been allowed to run dry.

What does it mean? Greenberg suggests that the manufacturers are losing faith in the power of medicine to cure mental illness. Or, as he puts it, they have recognized that all mental illness cannot be reduced to a chemical imbalance:

But the dry pipeline of new drugs … is an indication that the drug industry has begun to lose faith in the myth it did so much to create…. Bedazzled by the prospect of unraveling the mysteries of psychic suffering, researchers have spent recent decades on a fool’s errand—chasing down chemical imbalances that don’t exist.

It isn’t because they are not making money off of these meds. Greenberg continues:

It’s been just over twenty-five years since Prozac came to market, and more than twenty per cent of Americans now regularly take mind-altering drugs prescribed by their doctors. Almost as familiar as brands like Zoloft and Lexapro is the worry about what it means that the daily routine in many households, for parents and children alike, includes a dose of medications that are poorly understood and whose long-term effects on the body are unknown. Despite our ambivalence, sales of psychiatric drugs amounted to more than seventy billion dollars in 2010. They have become yet another commodity that consumers have learned to live with or even enjoy, like S.U.V.s or Cheetos.

One might say that someone is very good at marketing drugs, but it is also fair to say that, considering how ineffective most therapy is, it is not crazy to take meds. In many cases medication is the best that a psychiatrist can offer.

Of course, psychiatrists do not quite put it in these terms. They insist that their patients are suffering from a “chemical imbalance” and that it can best be remedied by another chemical.

This argument works well to persuade patients to take their meds—which is a good thing, since stopping or starting them at whim can be dangerous—but it also tells them that they are suffering from an illness and that they can do little to treat it without medication.

Greenberg adds that it makes for a good story:

Despite their continued failure to understand how psychiatric drugs work, doctors continue to tell patients that their troubles are the result of chemical imbalances in their brains. As Frank Ayd pointed out, this explanation helps reassure patients even as it encourages them to take their medicine, and it fits in perfectly with our expectation that doctors will seek out and destroy the chemical villains responsible for all of our suffering, both physical and mental. The theory may not work as science, but it is a devastatingly effective myth.

Yet, the story misses a larger and more important philosophical point. Dr. Richard Friedman stated it succinctly in The New York Times:

Also, knowing how a drug works in the brain doesn’t necessarily reveal the cause of the illness. For example, just because an S.S.R.I. antidepressant increases serotonin in the brain and improves mood, that does not mean that serotonin deficiency is the cause of the disease; many depressed patients get better with medications that have no effect on serotonin.

And many patients get better while taking no medications at all. Many patients are helped by aerobic exercise, meditation and better social connections.

Of course, in many cases psychoactive medication does not work very well at all.

Greenberg noted:

By 1960, the major classes of psychiatric drugs—among them, mood stabilizers, antipsychotics, antidepressants, and anti-anxiety drugs, known as anxiolytics—had been discovered and were on their way to becoming a seventy-billion-dollar market. Having been discovered by accident, however, they lacked one important element: a theory that accounted for why they worked (or, in many cases, did not).

For the record, we ought to notice that psychiatry has developed the unfortunate habit of lumping together illnesses that seem clearly to have a physiological cause—like schizophrenia and bipolar illness—with more benign everyday problems surrounding depression and anxiety.

Worse yet, if your emotions and your moods are trying to tell you something, anyone who tells you that they are biochemical static is inducing you to ignore what they are saying. And anyone who tells you that the problem is all in your brain is suggesting that you not bother to try other ways to treat the problems.

It is important to note the shrinking pipeline for new psychiatric medication, though it would be a better sign if we saw more people stop pathologizing their emotions.

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