Anatomy of an Epidemic (Part Two)

Psychiatry has now three classes of medications it uses to treat affective disorders – antidepressants, mood stabilizers and atypical antipsychotics – but for whatever reason, an even greater number of people are showing up at Depression and Bipolar Support Alliance meetings around the country, telling of their persistent and enduring struggles with depression and mania. Patients get diagnosed with manic-depressive illness, informed that they suffer from a chemical imbalance in the brain, and put on Haldol and Lithium. Then comes a cocktail of drugs to counteroffer the side effects of the first two.

All of this physiology – 100 billion neurons, the 150 trillion synapses, the various neurotransmitter pathways, tell of a brain that is almost infinitely complex. Yet the chemical imbalance theory of mental disorders boiled this complexity down to a simple disease mechanism, one easy to grasp.

Once again this is a story of neurotransmitter pathways that have been transformed by the medications. After several weeks, their feedback loops are partially disabled, the presynaptic neurons are releasing less dopamine than normal, the drug is thwarting dopamine’s effects by blocking D2 receptors, and the postsynaptic neurons have an abnormally high density of these receptors. The drugs do not normalize brain chemistry, but disturb it, sometimes to a degree that could be considered “pathological”. That is how “create perturbations in neurotransmitter functions”. Knock down a “target symptom”.

The drugs ameliorate anxiety for a short period of time and thus they can provide a depressed person much needed relief. However they work by perturbing a neurotransmitter system, and in response, the brain undergoes a compensatory adaptations, and as a result of this change, the person becomes vulnerable to relapse upon drug withdrawal. That difficulty in turn may lead some to take the drugs indefinitely, and these patients are likely to become more anxious, more depressed, and cognitively impaired.

There is a story that psychiatry doesn’t tell, which shows that our societal delusion about the benefits of psychiatric drugs isn’t entirely an innocent one. It had to grossly exaggerate the value of its new drugs, silence critics, and keep the story of poor long-term outcomes hidden. This is a willful conscious process, and the very fact that psychiatry has had to employ such storytelling methods reveals a great deal about the merits of this paradigm of care, much more than a single study ever could.

Writer suggests full disclosure.

The real question is “When and how psychiatric medications should be used?” The drugs may alleviate symptoms over the short term, and there are some people who may stabilize well over the long term on them, and so clearly there is a place for the drugs in psychiatry’s toolbox. However, a “best” use paradigm of care would require psychiatry, NAMI, and the rest of the psychiatric establishment to think about the medications in a scientifically honest way and to speak honestly about them to the public. Psychiatry would have to acknowledge that the biological causes of mental disorders remain unknown. It would have to admit that the drugs, rather than fix chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways. It would have to stop hiding the results of long-term studies that reveal that the medications are worsening long-term outcomes.

How can we insist that our society’s mental health system be driven by honest science rather than by a partnership that is constantly seeking to expand the market for psychiatric drugs?

From the book “Anatomy of an Epidemic” by Robert Whitaker.


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