Across the developing world there is an explosion in the use of drugs to treat mental illness. But is there really an increase in mental ill health and do these drugs work?
These are huge issues with implications for how we view modern society, for public health, for state spending and for our trust in pharmaceutical firms, some of which are amongst the world’s most powerful global corporations.
On the grounds of fairness I have to declare a personal interest. In response to my general tendency towards gloominess and low level anxiety I did try out one drug myself. It didn't work but I’m not suggesting this is of any relevance (it may have been the wrong drug for me and perhaps I didn't stick with it long enough). My own experience did however get me interested in the growing literature about the mental illness epidemic and the burgeoning global industry in psychoactive drugs.
If the issue interests you then you really must read this article from the current New York Review of Books. It summarises three new books which argue that:
Despite the growth in diagnosis and treatment, there is no evidence of an underlying increase in mental health morbidity. Neither - in relation to the fastest rising disease diagnoses - is there any evidence of chemical imbalances in the brains of patients. In other words, the problem the drugs are supposed to solve is an illusion.
There is similarly very little evidence of the efficacy of psychotropic drugs. ‘Active placebos’ work just as well (or as badly depending how you look at it). But there is growing evidence that psychotropic drugs may create chemical imbalances leading to more and more patients having to take a cocktail of drugs as one counteracts the effects of the others (or the effects of trying to come off the others).
One reason this evidence is doing nothing to stem the tide of prescription and state and private spending on these drugs is that the big pharma has managed to rig the process of drug assessment. Remarkably, while the occasional trials which find positive outcomes are published the much more frequent ones that don’t are routinely suppressed. This system is kept in place is probably not unrelated to the huge monies invested by pharma in lobbying the medical establishment, media and politicians.
Many people have been trying for years to raise awareness of these profound issues and in this blog I am just riding on their coat tails. But if the evidence in the NYRB article is true this is one the great mass delusions and corporate scandals of our time. So why hasn’t the issue become an urgent public debate?
My theory is that the tide of public and professional concern is held back by a dam comprising:
The massive power of big pharma
The commendable desire of doctors to want to offer their patients a simple solution to genuine difficulties in their lives
The deep craving among the public for such solutions
Confirmation bias and the difficulty we all have in distinguishing between anecdotal and statistical evidence
And something which is less obvious, the predisposition of the political left (the people you might expect to spearhead a critique) to embrace the idea that modern consumer capitalism drives people to depression and madness.
So here are my questions:
Do readers share my view that this is potentially one of the biggest social and public policy issues of our time?
Are the concerns I raise real or is just that I have only heard one side of the debate?
If the issues are real and important should the RSA be using its capacity to reach a global audience to highlight them? Should we perhaps be seeking to convene a short sharp commission of experts to try to make an independent and authoritative statement about what is really happening to our mental health and drug budgets?
This is all very heavy stuff so I should end with today's pathetic joke (in tests seven out of ten of my blog readers say my jokes are better for their well-being than anti-depressants). I’m afraid this is an aural joke and only succeeds if you know who is the MP for Richmond Park and North Kingston…
What is the difference between a leading anti-depressant brand and the diligent Parliamentary Assistant to the MP for Richmond Park and North Kensington?
They are both pro-Zac but - allegedly - only one of them really works.