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Sunday, October 2, 2011

Are Psychiatric Medications Making Us Sicker?

Three years ago, I was reminded in dramatic fashion of the chasm between psychiatry and more-effective branches of medicine. My 14-year-old son, Mac, while playing lacrosse, emerged from a collision with his right arm askew. I drove him to a local hospital, where an orthopedic surgeon on duty immediately diagnosed the injury: dislocated elbow. He gave Mac an oral and local anesthetic and put him in a portable X-ray machine that showed Mac's elbow joint on a screen, in real time. Watching the screen, the doctor quickly snapped Mac's elbow back into place.

Overcome with gratitude to the doctor, I was leading my groggy son out of the hospital when my cellphone rang. An old friend, whom I'll call Phil, was on the line. He was in the psychiatric ward of a New York hospital, to which his 16-year-old son had been committed. The boy, who was taking antidepressants for depression, had threatened to commit suicide, not for the first time. The doctors were recommending electroconvulsive therapy, or ECT. Knowing that I had written about shock therapy and other psychiatric treatments, Phil asked my opinion. The fact that Phil had called me, a mere journalist, for advice in such a dire situation spoke volumes about the troubles of modern psychiatry.

I first took a close look at treatments for mental illness 15 years ago while researching an article for Scientific American. At the time, sales of a new class of antidepressants, selective serotonin reuptake inhibitors, or SSRI's, were booming. The first SSRI, Prozac, had quickly become the most widely prescribed drug in the world. Many psychiatrists, notably Peter D. Kramer, author of the best seller Listening to Prozac, touted SSRI's as a revolutionary advance in the treatment of mental illness. Prozac, Kramer said in a phrase that I hope now haunts him, could make patients "better than well."

Clinical trials told a different story. SSRI's are no more effective than two older classes of antidepressants, tricyclics and monoamine oxidase inhibitors. What was even more surprising to me—given the rave reviews Prozac had received from Kramer and others—was that antidepressants as a whole were not more effective than so-called talking cures, whether cognitive behavioral therapy or even old-fashioned Freudian psychoanalysis. According to some investigators, treatments for depression and other common ailments work—if they do work—by harnessing the placebo effect, the tendency of a patient's expectation of improvement to become self-fulfilling. I titled my article "Why Freud Isn't Dead." Far from defending psychoanalysis, my point was that psychiatry has made disturbingly little progress since the heyday of Freudian theory.

The entire story can be read here.

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