Vatican Conference: Revisiting Psychiatric Treatment of Children (Part 2)

Long-term use of psychiatric medication increases the risk of becoming chronically symptomatic, says Robert Whitaker, a journalist and key note speaker at a Vatican conference on child health care.

"The Child as a Person and as a Patient: Therapeutic Approaches Compared" was sponsored last weekend by the Pontifical Council for Health Care Ministry and focused on the needs of children suffering from medical and psychiatric care.

Whitaker has written extensively on the subject of psychiatric treatment, and the use of medications to treat mental illness. He has published books on the subject called Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, in 2002, and Anatomy of an Epidemic, 2010.

In this second part of his interview with ZENIT, Whitaker addressed the effects which psychiatric medications have had on people suffering from mental and emotional illnesses.

Part 1 was published Monday.

ZENIT: What are some of the long-term effects of psychotropic drugs, both for the person taking them, and potentially for society as a whole?

Whitaker: If you look at the scientific evidence, you find that psychiatric drugs increase the chronicity of major mental disorders over the long term. This is what I wrote about in my book Anatomy of an Epidemic.

For instance, prior to the arrival of antidepressants, depression was seen as an episodic illness, with a fairly benign long-term course. Today, in the Prozac era, it runs a much more chronic course. Giovanni Fava, a professor of psychology at the University of Bologna in Italy, for years has been raising the question in medical journals: do antidepressants, over the long-term, induce changes in the brain that make people more biologically vulnerable to depression? 

You also find that experts in bipolar disorder acknowledge that outcomes are worse today than they were 40 years ago. People so diagnosed suffer more acute bipolar episodes, and much more low-level depression between acute episodes than they used to. In particular, functional outcomes -- that is to say employment rates -- have worsened over the past 40 years. The U.S. experts who have written about this decline in outcomes -- Ross Baldessarini, Carlos Zarate, and Frederick Goodwin -- have different explanations for it, but one thought is that it is due to prescribing antidepressants and antipsychotics to bipolar patients, and how these drugs may worsen their long-term outcomes.

The scientific story of the long-term effects of antipsychotics on people with schizophrenia and psychotic disorders may be more complicated, and certainly more controversial. But you do find, in the research literature, worries that antipsychotics worsen long-term outcomes, at least in the aggregate. That was the finding in the one long-term study conducted in the U.S., which was funded by the National Institute of Mental Health. The patients diagnosed with schizophrenia who got off antipsychotics, as a group, had much better long-term outcomes than those who stayed on antipsychotics. As the lead researcher, Martin Harrow, stated at a meeting of the American Psychiatric Association in 2008, "I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics."

So, I think one worry about taking psychiatric drugs is that, over the long term, you run the risk of becoming more chronically symptomatic. The drugs also have many side effects -- emotional, physical, and cognitive. 

As for their effect on society, it's clear that their widespread use increases the burden of mental illness in that society. For instance, in the United States, the number of adults receiving a disability payment due to mental illness has increased from 1.25 million in 1987 to more than 4.5 million today. Numerous other countries have reported similar increases in disability -- Iceland, Ireland, the United Kingdom, Denmark, Germany, Sweden, New Zealand, Australia, and so on. That is the bottom line for societies: the widespread use of psychiatric drugs leads to mental illness becoming an ever greater problem in their society. 

ZENIT: What, in your opinion, has caused medical practitioners to rely excessively on drugs to treat emotional and behavioral disorders? 

Whitaker: It's a combination of factors. One is that the drugs do generally work over the short term, in the sense that they may relieve distressing symptoms better than placebo, and that gives medical practitioners a reason to prescribe them. The second is that the prescribing of drugs is quick; the doctor doesn't have to invest much time in the healing process. Alternative therapies may take more time, and the recovery process may take place more slowly (but may be more enduring.) And the third reason is this: there is a commercial force at work. 

During the 1980s, pharmaceutical companies in the United States began paying academic psychiatrists to serve as speakers, advisors, and consultants. As a result, leading American psychiatrists vigorously touted a drug-based paradigm of care, and because the United States is such a big market, with such outsized influence, their statements had a big effect on global psychiatric practices. In addition, the makers of these medications often employed the same marketing method in other countries; they knew that if they could funnel money to the academic psychiatrists in those countries, it would help build a market for their drugs.

I should also note that the paradoxical long-term effects of psychiatric drugs are not so easily seen. That is a perspective that arises from a careful review of the scientific literature, across many decades of research. Short term studies may tell us the drugs work; the doctors who prescribe them may see that they often work; and academic psychiatrists tell us that they work. The story about their negative long-term effects is not so immediately evident, and thus is easily ignored or missed when psychiatrists develop their treatments.

--- --- ---

On ZENIT's Web page:

Part 1 of this interview: 

http://www.zenit.org/en/articles/vatican-conference-revisiting-psychiatric-treatment-of-children-part-1