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SAMHSA, Alternatives, and a Psychiatrist’s Despair Over the State of American Science

Medication, Long-term Outcomes, and Untrustworthy Research

In my last post, I told of my experience speaking at the Alternatives conference in Anaheim, and my frustration -- despair really -- over whether our society could ever have an honest discussion about the merits of psychiatric medications (and particularly their long-term merits.) That blog triggered a rather remarkable number of comments from readers, with many voicing similar thoughts about whether such a conversation was possible. And one of those who posted a comment was Dr. Mark Ragins, the psychiatrist who spoke at Alternatives in response to my talk. His words were thoughtful and important (and gracious too), and it would be a shame if they got lost in the flurry of reader comments.

To understand the importance of his comments, let me first set the scientific context.

In Anatomy of an Epidemic, I ask this question: How do psychiatric medications affect the long-term course of psychiatric disorders? What does the outcomes literature show?

Now, as you investigate that literature, following it over a span of 50 years, you find repeated instances where researchers, in response to their findings, worry that the medications are worsening the long-term course of psychiatric disorders. In addition, they have put forth biological explanations for why this may be so.

For instance, in the late 1970s and early 1980s, two physicians at McGill University, Guy Chouinard and Barry Jones, argued that antipsychotics induce changes in the brain that cause it to become "supersensitive" to dopamine, and that this supersensitivity may then lead to psychotic "symptoms of greater severity."

Similar concerns were raised about the benzodiazepines in the 1980s. Next, in the 1990s, an Italian psychiatrist, Giovanni Fava, worried that antidepressants "worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression . . . Use of antidepressant drugs may propel the illness to a more malignant and treatment unresponsive course." He then raised this broader question:

"Within the field of psychopharmacology, practitioners have been cautious, if not fearful, of opening a debate on whether the treatment is more damaging [than helpful] . . . I wonder if time has come for debating and initiating research into the likelihood that psychotropic drugs actually worsen, at least in some cases, the progression of the illness which they are supposed to treat."

In response to Fava's articles, Harvard Medical School psychiatrist Ross Baldessarini, who has been one of the most prominent researchers in the field for more than 30 years, wrote this: "His question and the several related matters . . . are not pleasant to contemplate and may seem paradoxical, but they now require open-minded and serious clinical and research consideration."

And now let's return to the comment written by Dr. Ragins, in response to my first blog. After noting that he "too felt discouraged by the events at the Alternatives conference," Dr. Ragins briefly describes his experience there. He then moves onto the main theme of my book, which is that psychiatric medications do indeed worsen the long-term course of mental disorders. He writes:

"My main disappointment, however, goes beyond Alternatives, and is that I don't think we'll ever have an honest, comprehensive scientific evaluation of your most startling assertion -- That medications induce a feedback response from the brain that worsens mental illnesses. I'd really like to know more about that, but I've lost all faith in our research system to inform me -- for the reasons you detail in your book.

"For me the last straw with drug companies was when I found out that they knew about diabetes and Zyprexa all along and intentionally hid it from doctors leading us to put people at risk without knowing it. That felt like a terrible betrayal to me. (though, of course, not in the same league as what the people who got diabetes or even died went through.) I don't know of any other field where the producers of something are so untrustworthy that the retailers regularly ban them from their offices). Although I'm sure that I've helped many people with medications, the drug companies are extraordinarily dangerous partners. I can't believe anything they say and no one else has enough money and independence to do a full scientific study instead of a journalistic study."

So let us now all think about this. In the 1970s and 1980s, prominent researchers worried that antipsychotics might be causing changes in the brain that led to psychotic "symptoms of greater severity." Researchers then began worrying about similar problems with other classes of psychiatric medications (such as the benzodiazepines), and in the mid 1990s, Giovanna Fava urged psychiatry to investigate whether antidepressants and other psychiatric medications worsen the long-term course of mental disorders. A leading American psychiatrist agreed that Fava's concern was legitimate and needed to be investigated. Yet, what happened? This concern was never communicated to the public or ever investigated. Instead, the public was told again and again about how these medications fix chemical imbalances in the brain, and need to be taken forever, with tens of millions of Americans having followed this advice (and millions of children prescribed the pills as well.)

And here is the source of Dr. Ragin's despair: He doesn't believe that a research enterprise even exists in the United States that can honestly investigate this question of whether psychiatric medications "induce a feedback response from the brain that worsens mental illnesses." The reason, he writes, is that research in this country is financed by pharmaceutical firms that can't be trusted to conduct honest science.

What, then, are we -- as a society -- to do about this?

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