None of which is meant to diminish the suffering caused by mental illness, or to suggest that the SSRIs should be removed from the market. The drugs can, in fact, work miracles, lifting some patients from the depths of depression and releasing others from the grip of compulsiveness and anxiety. Taking an SSRI has undoubtedly prevented some patients from killing themselves, and even the drugs' most vocal critics prescribe them, albeit with caution. "There is still a place to use [the SSRIs]," says British psychiatrist David Healy, "but we should use them with great care."
That's probably what every physician should have been doing all along. But after more than a decade of companies burying their negative studies, of faulty biological theories, and of psychiatrists ignoring the data, maybe it's time for everybody -- patients, parents, doctors and pharmaceutical companies -- to pause for a moment and take stock.
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Before the antidepressants came along, estimates put the rate of depression at 50 to 100 people per million in the population. Today, we are led to believe that 100,000 Americans per million suffer from the disease. That's one in 10 people, a thousand-fold increase in about 30 years. It's hard to imagine that we are plagued with that much more mental illness than ever before.
What's more likely is that the field of psychiatry, with its shifting, subjective diagnostic categories and its enthusiasm for new drugs, has been acutely vulnerable to "disease mongering." This is the increasingly common practice on the part of the pharmaceutical industry to broaden the perceived market for a drug by persuading doctors and the public that huge numbers of people suffer from this or that disorder. Between disease mongering and some doctors handing out SSRIs like Pez, antidepressant prescriptions for children have surged 27 percent since the mid-1990s. Today, between 1 million and 3 million kids under the age of 19 are on one or more of these drugs for diagnoses ranging from attention deficit disorder to migraines to schizophrenia. Taking SSRIs has become so commonplace that young people talk casually about needing to "adjust their meds" in response to a rough week at school or a bad breakup.
Meanwhile, doctors have been prescribing these medications without knowing until just recently that, according to the FDA, 2 to 3 percent of their young patients could be at risk for drug-induced suicidal thoughts or actions. Maybe that's because academic psychiatry has been too busy performing research with a very different agenda to answer the fundamental questions. In their haste to partake of industry research funds and other perks, academic researchers have focused much of their effort on what Carroll calls "experimercials" -- studies aimed at expanding the drugs' "off-label," or unapproved, markets.
And so doctors still can't tell which patients are most likely to benefit from taking an SSRI. Nor can they predict which ones are most likely to suffer devastating reactions. They still don't have any idea how, biochemically, the drugs might trigger suicide and bipolar disorder. In his book "Let Them Eat Prozac," psychiatrist Healy writes that the story of the SSRIs "reveals a lack of research so complete that academics cannot avoid questions about how well the health science research community serves us."
Aside from the patients who have suffered and died, the other tragedy of the antidepressant era is that some of the brightest minds in academic medicine have spent so much time and money on research that has done so little to elucidate the three-pound universe inside our skulls. Far from being the most studied drugs on the planet, the SSRIs are simply the most heavily marketed, while the mind and its illnesses remain as mysterious as the cosmos.
Author's e-mail:
brownlee@newamerica.net
Shannon Brownlee is Bernard L. Schwartz Senior Fellow at the New America Foundation. She is writing a book on the excesses of American medicine.
