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Anatomy of an Epidemic by Robert Whitaker

Greetings Bloggers,

I just finished reading Anatomy of an Epidemic: Magic Bullets, psychiatric drugs and the astonishing rise of mental illness in America by Robert Whitaker.

The main theme of this well documented book (over 400 research references) is that Selective Serotonin Reuptake Inhibitors (SSRI’s – anti-depressant medications) ‘may’ work on a short-term basis but they are definitely long-term failures and that psychiatric drugs and their side effects contribute to the alleged epidemic of mental illness in America.

As ‘proof’ of an epidemic, he suggests that if SSRI’s are so effective, the incidence of mental illness should be going down instead of increasing.  He quite rightly points out that more forms of normalcy are being diagnosed as ‘mental illness’ and the bar is being lowered as to what is needed to get a diagnosis.  What Whitaker justifiably points out is that we are experiencing is an epidemic of over-diagnosing, not an epidemic of illness.

We know through the work of Sapolsky (at Stanford University) that with sustained stress or trauma, changes do take place in certain structures of the brain such as a 14% – 16% reduction in the hippocampus (responsible for memory) and the corpus callosum (the bridge of fibers connecting the two hemispheres of the brain) so they can “talk” to each other.

Whitaker points out that brain changes do take place with people on medications and suggests this may be a side effect of certain psychiatric medications.

Not too long ago, kids who were shy, hyperactive, goof-offs and the whole spectrum of types that filled the school yard were considered more or less normal.  Today, these children are diagnosed with mental disorders – mostly ADHD, depression, bipolar illness and children – yes children, are being put into chemical straightjackets (SSRI’s, bipolar medication) to control what may be normal in most kids.

Whitaker rightly distinguishes between two groups – anti-psychiatry groups that deny mental illness exists.  Pro-psychiatry groups represent the other extreme and they believe that almost everything is a mental illness and up to 50% of people have a “diagnosable” mental disorder during their life!!

A middle ground is needed where a common denominator and treatment strategy can be integrated between the two disparate positions.  The author is quite zealous in citing research to support his basic hypothesis that SSRI’s don’t work that well and cites several studies where patients got better with fewer side effects by going off SSRI’s.  However, he did not consider or discuss that those who stayed on their medications may have stayed on because they were sicker.

While Whitaker’s book came through to me as a polemic against the efficacy of SSRI’s and other psychiatric medications, he did a credible job of citing a number of solid research studies that raised serious questions about SSRI’s and anti-psychotics.

His book also reinforced what I frequently hear from several of my clients about the many side effects (sleep dysfunction, sexual dysfunction, low energy, occasional memory problems) that they are experiencing from SSRI’s and anti-psychotics.

The point being – no two people have the same biochemical profile, the same brain wiring, the same hierarchy of beliefs or the same expectations dealing with psychopharmacology – which can contaminate and push research data on efficacy of drugs into mental corners that can affect or negate outcome studies.

I enjoyed the book, felt the author made some very important and thoughtful points about SSRI’s but overlooked the positive benefits – whether they are placebo or actual changes in the biochemistry of negative psychological conditions.

In a similar themed book – The Emperor’s New Drugs by Harvard psychologist Dr. Irving Kirsch, utilizing the Freedom Of Information Act, obtained copies of every single study on SSRI’s conducted by every pharmaceutical company in the United States – including the “file drawer” studies that did not support the efficacy of SSRI’s and were filed away so one could not see or assess them.

I hope you are sitting down.  Using a sophisticated statistical procedure, Meta Analysis, Dr. Kirsch established that the SSRI’s were equivalent to and no better than placebos!  Yet, the sale of the SSRI’s is a multi-billion dollar industry and the cornerstone of psychiatric treatment.  The statistical procedures in assessing SSRI’s were replicated in Sweden and almost identical results were obtained as in the American studies.

Psychology Today in reviewing Dr. Kirsch’s book stated – “The Emperor’s New Drugs absolutely dismantles the case for antidepressants as a pharmacologically effective treatment”.

 

Respectfully,

 

Lee Pulos, Ph.D., ABPP

 

Bibliography

Kirsch, Irving. The Emperor’s New Drugs. Basic Books, New York. 2010

Whitaker, Robert. Anatomy Of An Epidemic. Broadway Paperbacks, New York. 2010

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