During the past six months, I have traveled to a number of English speaking countries to speak about my book Anatomy of an Epidemic, and everywhere -- Canada, the U.K., Ireland, New Zealand (and Iceland) -- I find the same questions being asked. Why, everyone wants to know, is mental illness becoming such a big problem in their society? And what are they to make of psychiatric drugs, which are being so frequently used?
And so I am now starting to look at disability numbers in those countries, and as might be expected, they are all telling a similar story.
In the United States, the number of adults on government disability due to mental illness rose from 1.25 million in 1987 to 3.97 million in 2007. On a per-capita basis, the disability rate rose from 1 in every 184 Americans in 1987 to 1 in every 76 Americans over that 20-year period. (Total population divided by number of working-age adults on disability.) At the same time, societal spending on psychiatric drugs soared, from less than $1 billion in 1987 to more than $40 billion annually today.
Now, I recently spent a week in New Zealand speaking on this topic. The United States and New Zealand are the only two Western countries that allow pharmaceutical companies to directly market their products to consumers, and perhaps not surprisingly, the prescribing of antidepressants in that country has soared over the past 15 years. And now here is its disability data.
New Zealand's Numbers
In 2000, there were 23,142 adults 18 to 64 years old on government disability (sickness or invalid benefits) in New Zealand due to psychiatric conditions. In 2010, there were 48,899 adults on government disability due to psychiatric disorders. On a per capita basis (total population divided by number of working-age adults on disability), that is an increase in disability from 1 in every 168 to 1 in every 90.
It is also notable that in 2000, disability due to psychiatric conditions represented 26% of the total disability pie, and that by 2010, this percentage had jumped to 34%. In other words, it is mental illness that is driving the country's disability numbers upward. Between 2000 and 2010, the total disability count rose by 56,161 adults in New Zealand, and 46% of that increase was due to psychiatric conditions.
Finally, World Health Organization researchers recently published their findings on the prevalence of "bipolar spectrum disorder" in eleven countries. The United States led the list, while New Zealand was second. In the United States, the WHO investigators reported, the lifetime prevalence of bipolar spectrum disorder is 4.4% of the population; in New Zealand, it is 3.9%. At the bottom of the 11-country list were India, at .1%, and Bulgaria, .3%. Although I don't have the prescribing data for antidepressants in those latter two countries, I feel confident in stating that antidepressant usage in those two countries much be much less than it is in the United States and New Zealand.
You might conclude, from this report, that a dramatic increase in the prevalance of bipolar disorder is one of the societal costs of allowing direct-to-consumer advertising of prescription drugs.
While Australia doesn't allow direct-to-consumer advertising, use of antidepressants and other psychotropics is quite popular in that country. Psychiatry in that country has adopted a drug-based paradigm of care similar to ours. There, the number of adults on disability due a psychiatric disorder rose from 140,965 in 2001 to 227,420 in 2010. That is an increase in the disability rate from 1 in every 137 to 1 in every 98 (Total population divided by adults of working age on disability.)
Moreover, as is the case in New Zealand, psychiatric disorders are composing an ever-greater percentage of the disability pie in Australia, increasing from 22.6% in 2001 to 28.7% in 2010. Between 2001 and 2010, 51% of the increase in total number of disability beneficiaries in Australia was due to psychiatric disorders.
Researchers in Iceland, which also has embraced the use of antidepressants, recently provided an update on disability numbers in that country. There, the number of new cases of disability annually due to mental and behavioral disorders rose from 84 per 100,000 population in 1992 to 217 per 100,000 population in 2007.
Where there's smoke . . .
One common criticism of Anatomy of an Epidemic has been that I mistake "correlation for causation." The fact that disability numbers have soared during a time of sharply increased usage of psychiatric drugs doesn't prove that the drugs are causing the rise in disability, the critcs say. I agree, but in fact, in my book, I used the disability data merely as a starting point for questioning our drug-based paradigm of care. However, as I now find the same correlation occurring in country after country, I would say this is a case of more and more "smoke" appearing, and at some point, you have to ask when such correlational data provides evidence of a "fire."
The drug-based paradigm of care that we have adopted in the United States, which took off in 1987 with the arrival of Prozac on the market, has taken hold in many Western countries. I wish that a researcher could take the time to chart usage of psychiatric drugs in fifteen "developed" countries over the past 20 years, and chart the number of people on government disability due to mental illness during that period (and the prevalence of bipolar spectrum disorder in those countries.) If that could be done, I think that the pattern that shows up in the United States, Australia, New Zealand, and Iceland would, quite unfortunately, be found again and again.
And if that fact were documented, I wonder whether the defenders of our current paradigm of care would once again shout: Correlation is not causation! Or would it be taken as evidence that something is quite amiss with this paradigm of care?