The rate of prescriptions for drugs to treat mental disorders is doubling every decade. Psychiatric drugs are being handed out in ever-increasing numbers to treat the supposed epidemic of depression, anxiety, hyperactivity, schizophrenia, stress and psychoses.
It is a pattern that is being reported in every developed country in the world. In the UK, for example, more than 57 million prescriptions for anti-depressants were handed out in 2014 alone, which was up seven per cent from the previous year and a fivefold increase since 1992. Similar rises have been seen with other psychiatric drugs in that same year: 10.5 million prescriptions were written in the UK to treat psychosis (where people lose touch with reality), making it an eight per cent rise on the previous year, while the prescribing of stimulants to treat hyperactivity in children rose by a similar rate.
In the US, anti-depressant prescriptions doubled between 1996 and 2005, and similar patterns have been seen across western Europe and New Zealand (Br. J. Psychiatry, 2016). However, there is an extraordinary paradox relating to this growing mountain of prescription pills; there has been no reciprocal increase in cases of mental problems.
Rates of depression have been flat over the same 10 years, anti-depressant prescriptions doubled and the incidence of people with a mental disability hasn’t risen since the 1950s. Yet the percentage of people affected has increased sixfold over the past 60 years, which suggests that either the drugs are not effective and the same people are taking them over their whole lifetime, or the drugs are actually making the problem even worse. Or medicine simply doesn’t understand what mental illness is and what causes it.
In fact, all three possibilities are playing some part in the paradox, and they can be summarised as: the drugs don’t work or, if they do, it’s not for long. Jurgen Margraf and Silvia Schneider, professors of clinical psychology at Ruhr-University, Bochum in Germany, say the drugs are having only short-term effects and not curing the problem. If patients stop taking the drugs, the symptoms return. However, if they continue to take them, their symptoms are likely to get worse. This is certainly true of the drugs that treat anxiety disorders, depression and ADHD (attention-deficit/hyperactivity disorder), and they suspect it is also the case for schizophrenia treatments. (EMBO Mol. Med., 2016).
Rates of depression have been flat over the same 10 years, anti-depressant prescriptions doubled and the incidence of people with a mental disability hasn’t risen since the 1950s. Yet the percentage of people affected has increased sixfold over the past 60 years
The story of the rise of mental disease is an interesting one, categorised by year:
1900 – There were just seven mental disorders, including insanity, manic depression, schizophrenia, delirium and paranoia, referred for psychiatric help.
1920 – The number of mental disorders had risen to 59.
1960 – The number had risen to 130.
2010 – The number of mental disorders ‘discovered’ were 374.
2013 – A further 13 ‘new’ conditions had been added to the latest edition of the DSM, bringing the total to 387.
Leading psychiatrist Allen Frances, who led the task force that defines mental disease for psychiatry’s bible, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, says that psychiatry has abandoned its legacy and become just another delivery system for the drugs industry.
Today, he is telling the world about the medicalisation of psychiatry and its close ties to the drugs industry. By the time he left the editorial board of the DSM-IV, 69 per cent of them had ties with the industry and unusual mental disorders had suddenly become major social problems needing drug therapy.
One example from DSM-5, published in 2003 after Frances had resigned, was the elevation of ‘oppositional defiant disorder’ (ODD) to an antisocial problem that could be treated with antipsychotic drugs. ODD is characterised by ‘an ongoing pattern of disobedient, hostile and defiant behaviour’ and symptoms include questioning authority, negativity, defiance, argumentativeness and being easily annoyed. Not surprisingly, that pretty much sums up most teenagers and, indeed, the DSM sees ODD as often going hand in hand with a diagnosis of ADHD.
Previous editions of DSM had already elevated arrogance, narcissism, above-average creativity, cynicism and antisocial behaviours to the ranks of psychiatric disorders requiring drug therapy.
However, mental disorders such as depression and schizophrenia are real enough. Margraf and Schneider believe the problem comes from applying the standard medical model of disease to psychiatric problems. The latter is in the mode of ‘come and go’, and there may be a range of causes including environmental and psychological ones. Whereas a heart problem, for example, is always there. Margraf and Schneider feel that the most important causes are what they call ‘psychosocial factors’ such as having a sense of control, pursuing mental activities and delaying gratification. As such, ‘talking cures’ such as cognitive behavioural therapy (CBT) are far more effective than any drugs could be. CBT has been proven to be effective across a range of psychiatric conditions, and when tested alongside antidepressants were just as effective, but without the side effects of the drugs. (BMJ, 2015).
However, proof of efficacy isn’t the issue, say Margraf and Schneider, it is the lack of resources. More therapists need to be trained in CBT techniques and the current medical model relegated to a secondary role, because the drugs just aren’t working.
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