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Bob Livingstone, LCSWBob Livingstone, LCSW
Healing Emotional Pain and Loss

New Book Challenges Usage of Psychiatric Drugs

Bob Livingstone, LCSW Updated: Nov 1st 2010

A new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker (Crown Publishers, April 2010) should be creating an upheaval in the world of mental health clients, providers and the pharmaceutical industry.

pills pouring out of a prescription bottleRobert Whitaker has impeccable credentials and it will be difficult to label him as an extremist or one that has an ax to grind. He is a reporter for the Boston Globe, he won a George Polk Award for medical writing, a National Association of Science Writers Award for best magazine article, and was a finalist for a Pulitzer Prize.

In his book, he wonders why the number of disabled mentally ill in the United States has tripled over the past two decades. He poses the question as to why every day 1,100 adults and children are added to the government disability rolls because they have become disabled by mental illness. He states that this epidemic is increasing the most quickly among our country's children.

During a recent Alternet.com interview, Whitaker states, "What I then did was look at what the scientific literature -- a literature that now extends over 50 years -- has to say about those questions. And the literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness. In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug-- say have a manic episode after taking an antidepressant -- and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic pathway [physician-caused illness] that is helping to fuel the increase in the disability numbers. Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature -- and this really is a tragic story -- clearly shows that our drug-based paradigm of care is a primary cause."

He continues, "When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children. But once psychiatrists started putting "hyperactive" children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants. Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature. And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up "rapid cyclers," which means they have severe "bipolar" symptoms, and that they can now be expected to be chronically ill throughout their lives."

As a psychotherapist (I am a clinical social worker and don't prescribe medication. I do work with several psychiatrists who I work collaboratively with), reading this material is overwhelming and frightening. I am reading it in a state of shock. I wonder if the interpretation of the research is accurate. Perhaps the increase in the use of psychiatric medication didn't create an increase in mental health disorders. Maybe the awareness and subsequent reporting systems of mental illness in the United States are so thorough; that may explain the spike in numbers of the mentally disabled.

Could it be that over the years, entitlement programs have increased the coverage for those suffering from mental illness as Neuropsychologist and blogger The MacGuffin points out? I also speculate if the unrelenting stress of living in America is a factor in the increasing numbers of the mentally disordered.

My mind is not made up yet and I'm not ready to advocate for the total non-use of psychiatric medications. I will have to study Anatomy of an Epidemic and those writers who oppose Whitaker's views. I also want to have intense conversations with my colleagues and clients about this book and the issues it raises. I have witnessed medication being a positive, integral part of a client's treatment plan. I have seen adults dramatically improve their lives with anti-depressants. I have worked with children whose acting out behavior led them to a path of school suspensions and detention. Once these children were in therapy and on medication; their behavior and attitudes improved greatly.

I have also worked with adults and children where medication was not helpful and sometimes made their conditions worse.

How do you feel about this? Have you or your child ever been on psychiatric medication? Please share your experience.

 

Bob Livingstone, LCSWBob Livingstone, LCSW, has been a psychotherapist in private practice for twenty-two years. He works with adults, teenagers and children who have experienced traumas such as family violence, neglect and divorce. He works with men around anger issues and with adults in recovery from child abuse. He is the author of two critically acclaimed books: Redemption of the Shattered: A Teenager's Healing Journey Through Sandtray Therapy and Body Mind Soul Solution: Healing Emotional Pain Through Exercise and his newly released book Unchain the Pain: How to be Your Own Therapist. For more information visit www.boblivingstone.com.

    Reader Comments
    Discuss this issue below or in our forums.

    Psychotropic Medications & Their Dangers - Nancy - Nov 12th 2010

    I found this article to be very interesting and informative.  I have finally found something that supports my thinking about my particular situation.  My husband also shares my thinking and is the one person who presented this idea to me, and I realize he is right.

    I have always been a "high strung" person.  I remember my stepmother telling me that when I was a teenager, but I did not understand what she meant by that, nor did I try to find out.  Years later (15 years to be exact), after being on several anti-depressants, I am re-evaluating my life.  I have a sneaky suspicion, as well as does my husband, about how anti-depressants have changed me into a "sicker" person.  It makes me wish I had never taken those pills.  My greatest regret is taking Paxil for years and years under the auspices of my psychiatrist.  Not only did I become totally addicted to it, it also changed my personality.  I was free of it for about one month, when I became quite sick with panic attacks and severe anxiety to the point where I was anorexic, suicidal, sleep-deprived, etc.  I was hospitalized for the insomnia, hoping to be helped with yet more psychotropic medications such as Klonopin and Ambien, and you guessed it, Paxil.  I didn't know whether or not I was in withdrawal from Paxil and the other medications (since I tried withdrawing from Klonopin almost immediately, taking 6 months to do so).  Now I am to the point where I have stopped all medications except for yet another anti-depressant Nortriptyline, which is what enabled me to wean off those other horrible meds.  I am still experiencing problems, problems I never remember having just 15 years ago.  I still have anxiety, I still feel depressed, and I still cannot sleep on my own.  I am desperate to get off of this medication, but because it's only been 3 weeks since I have been Paxil-free, I feel now is not the time since I just recently had to "up" the dosage on the Nortriptyline because I began having symptoms again.  What a mess my life is in.  I want to be free.  My fear of being free is that I'll never sleep and will be forced to take the drugs again.  My life certainly has not been successfully helped by using drugs.  I just don't know how to undo the damage.  I need some help, I need something.  I have had many, many counseling sessions with many different providers.  I have spent a lot of money and am no further ahead.   

    The Swing of the Pendulum - John Mertes, MSW - Nov 2nd 2010

    I am also a clinical social worker and primarily work in a concurrent disorder setting.  I believe that as we have advances in medicine some problems are resolved while other problems are created.  I still believe that psychiatry is in its infancy and psychiatrists are treating very complex mental health issues with the best options that are available.  It is not an exact science and many issues still remain.  I have witnessed the life changing changes my clients have made while using psychotropic medications.  I have also worked with clients whose prognoses have worsened as a result of the medications they have been prescribed.  Having said this, I most definitely would not be recommending a moratorium on psychiatric medication.I do however believe that in time, pharmacotherapy will continue to evolve with more specific medications that have fewer side effects and fewer negative outcomes.

    Children and Medication. - Mark Adams - Nov 2nd 2010

    I seem to recall Frontline doing a story on the problems of diagnosing children, and the problem many doctors have distinguishing between ADHD and bipolar.  Trying to come up with a correct dosage of medication for children was also a serious problem as children are different sizes as they grow and will need the amount of their medication changed more often.

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