Article The drug-based approach to mental illness has failed. What are alternatives?

[C C]

The drug-based approach to mental illness has Failed. What are alternatives?
https://johnhorgan.org/cross-check/the-d...ternatives

EXCERPTS: I haven’t read a more consequential work of science journalism than Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Robert Whitaker presents evidence that bio-psychiatry, which views mental illness as biochemical disorders best treated with medications, has failed. Whitaker is an award-winning journalist, author of two other books on mental illness and publisher of the website madinamerica.com, which provides informed critiques of mental-health care. Below is an updated Q&A I carried out with him in 2020. I’ve highlighted especially pertinent quotes. —John Horgan

Horgan: Anatomy of an Epidemic argues that medications for mental illness, although they give many people short-term reliefs, cause net harm. Is that a fair summary?

Whitaker: Yes, although my thinking has evolved somewhat since I wrote that book.

I am more convinced than ever that psychiatric medications, over the long term, cause net harm. I wish that weren’t the case, but the evidence just keeps mounting that these drugs, on the whole, worsen long-term outcomes.

However, my thinking has evolved in this way: I am not so sure anymore that the medications provide a short-term benefit for patient populations as a whole. When you look at the short-term studies of antidepressants and antipsychotics, the evidence of efficacy in reducing symptoms compared to placebo is really pretty marginal and fails to rise to the level of a “clinically meaningful” benefit.

Furthermore, the problem with all of this research is that there is no real placebo group in the studies. The placebo group is composed of patients who have been withdrawn from their psychiatric medications and then randomized to placebo. Thus, the placebo group is a drug-withdrawal group, and we know that withdrawal from psychiatric drugs can stir myriad negative effects. A medication-naïve placebo group would likely have much better outcomes, and if that were so, how would that placebo response compare to the drug response?

In short, research on the short-term effects of psychiatric drugs is a scientific mess. In fact, a 2017 paper that was designed to defend the long-term use of antipsychotics nevertheless acknowledged, in an off-hand way, that “no placebo-controlled trials have been reported in first-episode psychosis patients.” Antipsychotics were introduced 65 years ago, and we still don’t have good evidence that they work over the short term in first-episode patients. Which is rather startling, when you think of it.=

[...] You have many alternative programs springing up, even at the governmental level. Norway, for instance, ordered its hospital districts to offer “medication free” treatment for those who want it. In Israel, you have Soteria houses that have sprung up (sometimes they are called stabilizing houses), where use of antipsychotics is optional, and the environment—a supportive residential environment—is seen as the principal “therapy.”

You have the U.N. Special Rapporteur for Health, Dainius Pūras, calling for a “revolution” in mental health, one that would supplant today’s biological paradigm of care with a paradigm that paid more attention to social justice factors—poverty, inequality, etc.—as a source of mental distress.

All of those initiatives tell of an effort to find a new way. But perhaps most important, in terms of “positive trends,” the narrative that was told to us starting in the 1980s has collapsed, which is what presents the opportunity for a new paradigm to take hold... (MORE - missing details)

[Syne]

It seems it will take decades for this simple fact to get through to the public consciousness, much less those who have been convinced of the efficacy of the grift.

[Magical Realist]

I don't believe psychiatric medications have proven a failure over the last century. While there are many mentally ill patients that don't respond to them, generally more benefit from their use than don't. There ARE side effects that occur with most of them like loss of energy, insomnia, sleepiness, tardive diskinesia, emotional blunting, and jitteriness, but the new meds coming out nowadays have less and less of these. I saw my bipolar mother go thru a whole range of meds over the decades suffering awful side effects, but eventually we honed in on a few that worked ok with less side effects. My own experience with antidepressants was fortunate in that I found the one that was right for me right away when I was in the Navy and have benefited from it ever since. Here is a balanced survey of psych meds weighing their benefits against their liabilities.

https://neurowellnessspa.com/pros-and-co...dications/

"In this blog post, we will explore the pros and cons of psychiatric medications to treat depression and other mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other mental health disorders. We will look at the evidence to see if they are effective in treating mental illnesses. We will also discuss some of the potential risks associated with taking them.


Types of Mental Health Medications
Mental health medications are designed to treat a specific condition or set of conditions. Some of the more common mental health medications prescribed by psychiatrists include:

Antidepressants
Antidepressants (e.g. selective serotonin reuptake inhibitors or SSRI’s) are the most commonly prescribed type of mental health medication. They are typically used to treat conditions like major depressive disorder, anxiety disorders, and eating disorders. Antidepressant medications work by increasing, decreasing, or managing levels of specific neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain.

Antipsychotics
Antipsychotic medications are the main class of drugs used to treat people with schizophrenia and psychotic disorders. They are also used in people with psychosis which occurs in bipolar disorder, depression, and Alzheimer’s disease. There are two main types of antipsychotics: first-generation antipsychotics and second-generation antipsychotics. First-generation antipsychotics are typically used to treat psychosis. Second-generation antipsychotics are typically used to treat schizophrenia, bipolar disorder, and major depressive disorder.

Mood Stabilizers
Mood stabilizers are typically used to treat bipolar disorder or personality disorders. Mood stabilizers work by evening out the highs and lows associated with bipolar disorder.

Stimulants
Stimulants are typically used to treat attention deficit hyperactivity disorder (ADHD). Stimulants work by increasing levels of dopamine in the brain.

Anxiolytics
Anxiolytics is the technical term for anti-anxiety medications. Anxiolytics are a type of mental health medication that is used to treat anxiety disorders. Anxiolytics typically work by reducing anxiety and promoting relaxation.


The Benefits of Medications

Medication isn’t right for everyone. But for some people with anxiety, depression, and other mental disorders, the results can be profound. Psychiatric medications can be very effective in treating mental illness. They can help to improve symptoms, and they can also help people to function better in their everyday lives. Most medications are convenient and affordable, and easily prescribed by a psychiatrist; they can be taken from the comfort of home with little to no disruption to your daily routine. Some of the benefits associated with mental health medications include:

Relief from Symptoms

Medications can provide relief from the symptoms of mental illness. For example, antidepressants can help to relieve the symptoms of depression, such as sadness, fatigue, and changes in appetite.

Improved Functioning

Medications can also improve functioning in people with mental illness. For example, antipsychotic medication can help people with schizophrenia to think more clearly and function better in their everyday lives.

Increased Quality of Life

Medications can also lead to an increased quality of life. For example, people with depression who take antidepressants may find that their relationships improve, they are able to return to work or school, and they generally feel happier.

The Efficacy of Medications

There is a great deal of evidence to support the efficacy of medications. A meta-analysis of studies found that mental health medications can effectively treat mental disorders. The review looked at data from randomized controlled trials, and they found that mental health medications are effective in treating conditions like depression, anxiety, and schizophrenia..."

[Syne]

Or some people are just more suggestible, in general and to the placebo effect, so it's only a matter of finding an ineffective drug with the least pronounced side effects.

The long term harm is that people never seek out or address the underlying causes or develop better or healthier natural coping mechanisms. Way easier to find a "magic bullet." But same goes for many medical conditions, obesity, etc..

[Magical Realist]

The long term harm is that people never seek out or address the underlying causes or develop better or healthier natural coping mechanisms.

Really? So what are the underlying causes of bipolar disorder or schizophrenia or PTSD that can be resolved with "healthier natural coping mechanisms"? And what is the success record of these natural coping mechanisms that makes them better than medication therapies?

[Syne]

As usual, you don't seem capable of parsing simple English.
Read that again. It doesn't even imply anything can be "resolved" with "healthier natural coping mechanisms." There is an "OR" in there. IOW, finding and addressing underlying causes is independent of developing better coping mechanisms.

For the umpteenth time, please learn to read.

[C C]

I don't believe psychiatric medications have proven a failure over the last century. While there are many mentally ill patients that don't respond to them, generally more benefit from their use than don't. There ARE side effects that occur with most of them like loss of energy, insomnia, sleepiness, tardive diskinesia, emotional blunting, and jitteriness, but the new meds coming out nowadays have less and less of these. I saw my bipolar mother go thru a whole range of meds over the decades suffering awful side effects, but eventually we honed in on a few that worked ok with less side effects. My own experience with antidepressants was fortunate in that I found the one that was right for me right away when I was in the Navy and have benefited from it ever since. Here is a balanced survey of psych meds weighing their benefits against their liabilities. 

https://neurowellnessspa.com/pros-and-co...dications/

[...] The Efficacy of Medications

"There is a great deal of evidence to support the efficacy of medications. A meta-analysis of studies found that mental health medications can effectively treat mental disorders. The review looked at data from randomized controlled trials, and they found that mental health medications are effective in treating conditions like depression, anxiety, and schizophrenia..."

There seems to be some anti-capitalist or social justice crusader sentiments driving Robert Whitaker's views (excerpt at bottom). He's a critic of Big Pharma in general, and his position seems extreme IF he is universally denouncing the medications across the board.

But apparently he does acknowledge that the drugs do sometimes perform satisfactorily, but with heavy reservations attached to such: "Whitaker acknowledges that psychiatric medications do sometimes work, but believes that they must be used in a 'selective, cautious manner. It should be understood that they’re not fixing any chemical imbalances. And honestly, they should be used on a short-term basis.'" --Anatomy of an Epidemic

OTOH, psychiatry may be becoming like art, or trend marketing, or philosophy. Always looking for a new narrative when the former phase has gotten stale. So while Whitaker might seem to be a foe of the industry right now, I wouldn't be totally surprised if in the future the psychiatric mainstream diversifies from the meds and begins accommodating some of the alternatives he espouses. As part of its virtue-signaling campaigns for that oncoming era, and especially when it figures out how to profit from those options. 

HORGAN: I fear that American-style capitalism doesn’t produce good health care, including mental-health care. What do you think?

WHITAKER: It’s clear that it doesn’t.

First, we have for-profit health care that is set up to treat “disease.” With mental-health care, that means there is a profit to be made from seeing people as “diseased” and treating them for that “illness.” Take a pill! In other words, American-style capitalism, which works to create markets for products, provides an incentive to create mental patients, and it has done this to great success over the past 35 years.

Second, without a profit to be made, you don’t have as much investment in psychosocial care that can help a person remake his or her life. There is a societal expense, but little corporate profit, in psychosocial care, and American-style capitalism doesn’t lend itself to that equation.

Third, with our American-style capitalism (think neoliberalism), it is the individual that is seen as “ill” and needs to be fixed. Society gets a free pass. This too is a barrier to good “mental health” care, for it prevents us from thinking about what changes we might make to our society that would be more nurturing for us all. With our American-style capitalism, we now have a grossly unequal society, with more and more wealth going to the select few, and more and more people struggling to pay their bills. That is a prescription for psychiatric distress. Good “mental health care” starts with creating a society that is more equal and just.

[Syne]

At best, psych meds may reduce some symptoms. They can perhaps be useful, in the short-term, to facilitate lessening extreme symptoms to an extent that helps allow therapy. But used long-term, they are just a crutch to avoid dealing with the underlying causes. Without any therapy, they are just a life-long dependency.

[Magical Realist]

Seeing that there is no known cure for mental illness, the alleviation of symptoms becomes the primary aim of all treatment of it. There is nothing "shortterm" about it. If you've ever seen a bipolar patient in full blown manic mode rambling nonstop and incoherently you know how tormenting mental illness can be. Medication becomes a welcome relief from its destructive and debilitating effects on one's life, however "dependent" one may be felt to be on it. A diabetic type 1 is dependent on insulin injections for their whole life to maintain normalcy. A severely mentally ill person is no less dependent on meds in order to live a somewhat normal and functional life. If you want to see what its like for the mentally ill to live their lives without medication, just observe the populations of the homeless inhabiting our city streets.

[Syne]

The notion that mental illness is beyond curing is nonsense. As a person who once suffered from depression and substance abuse, I have been free of both for decades... as well as simple addictions to nicotine and caffeine. The mental healthcare industry has a vested interest (on both the pharmaceutical and therapy sides) of keeping people as customers/clients. And while some extreme, chronic conditions can be incurable, due to genetics like most type 1 diabetes, lesser conditions can be treated without medication, like type 2 diabetes.

But the belief that your condition is incurable is always going to be a self-fulfilling prophesy.