Here, medical journalist and Pulitzer Prize nominee Robert Whitaker discusses the widespread use of psychiatric drugs.
His first book, Mad in America, explains the history of the treatment of those with severe mental illness. His latest book, which was recently released, is Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America.
Depression is a very pervasive health issue today, and it can be a terminal illness. People commit suicide, caused by depression, each and every day. The traditional approaches have sought to use drugs to address this problem, but I believe there are far better alternatives. But before I get into that, what does the scientific literature show, in terms of short- and long-term effectiveness of the conventional drug approach?
In this interview, Robert Whitaker, who is a medical journalist and author of two books on this important topic, shares what he’s found after tremendous amounts of research.
How Effective are Antidepressants in the Short- and Long-Term?
When looking at the research literature, short-term trials show that antidepressants do NOT provide any clinically significant benefits for mild to moderate depression, compared to a placebo.
And as you know, all drugs have benefit-to-risk ratios, so if a drug is as effective as a placebo in relieving symptoms, it really doesn’t make sense to use them as a first line of defense. And yet doctors all over America prescribe them as if they were indeed sugar pills! But what about their long-term effectiveness? According to Whitaker:
“… that’s one of the things I looked at in this book and there are really two things that you find. You find that even with major depression, in the pre-antidepressant era – and this is depression so severe people were hospitalized – they could expect to get better. The episode would eventually pass.
… So when antidepressants were introduced, the thought was okay, we really can hope to improve on this sort of natural recovery, but maybe we can help people recover quicker? So that really was the rationale for the use of antidepressants.
But it’s really interesting if you follow this course through, forward in history. The minute they start using antidepressants in any sort of large numbers, doctors start saying, “Well, you know, my patients may be getting better, the depression maybe lifting faster, but then we’re noticing that they’re also relapsing more frequently than before, back into depression.”
So right away you get this question: Does the drug treatment actually put people on a more chronic course than before?”
Long-term studies now indicate that of people with major depression, only about 15 percent that are treated with an antidepressant go into remission and stay well for a long period of time. The remaining 85 percent start having continuing relapses and become chronically depressed.
“By the 1990s, this change in the long term course of depression was so pronounced that finally it was addressed by researchers,” says Whitaker. “Giovanni Fava from Italy said, “Hey, listen, the course is changing with antidepressants. We’re changing it from an episodic illness to a chronic illness, and we really need to address this.” Not only that, but the depression is sinking into people [on antidepressants] in a deeper way than before.”
According to Whitaker’s research, this tendency to sensitize the brain to long-term depression appears to be the same both for the earlier tricyclic antidepressants and the newer SSRIs (selective serotonin reuptake inhibitors). Another famous psycho pharmacologist named Ross Baldessarini at the Harvard Medical School also began asking whether or not these drugs may in fact be depressogenic (causing depression).
Unfortunately, the evidence points that way, and the long-term prognosis when taking antidepressants is quite bleak, as this type of drug treatment has a whopping 85 percent chronic relapse rate. It’s time for this trend to be broken.
Every year, 230 million prescriptions for antidepressants are filled, making them one of the most-prescribed drugs in the United States. Despite all of these prescription drugs being taken, more than one in 20 Americans are depressed, according to the most recent statistics from the Centers for Disease Control and Prevention (CDC).
The statistics alone should be a strong indication that what we’re doing is simply not working, and that instead, these drugs are contributing to other serious health problems. Fortunately, there are other, safer, more effective ways, and some countries are starting to pay heed to the fact that research is actually showing it to be beneficial, rather than bowing to the will of pharmaceutical companies.
What the Research Says about Alternative Treatments for Depression
One study conducted by Duke University in the late 1990’s divided depressed patients into three treatment groups:
- Exercise only
- Exercise plus antidepressant
- Antidepressant drug only
After six weeks, the drug-only group was doing slightly better than the other two groups. However, after 10 months of follow-up, it was the exercise-only group that had the highest remission and stay-well rate. Some countries are taking these types of research findings seriously, and are starting to base their treatments on the evidence at hand. The UK, for example, does not routinely recommend antidepressants as the first line of therapy for mild to moderate depression anymore, and doctors there can write out a prescription to see an exercise counselor instead.
“With that prescription… you now get either a reduced rate or a free rate at a gym for six months,” Whitaker explains. “Part of the exercise might be “green gyms”… gardening outside, nature walks, repairing trails, hiking trails. And they are finding that people really like this. People comply with it…
People who have gone through this course and have been prescribed exercise, they say that rather than seeing themselves as a victim of depression, and helpless before it -- that they have this sort of biological problem they can’t do anything about -- they say, “Aha, I can make a change, I can do something. It’s in my willpower to do something that will help this problem lift.” So it empowers the patient in a different way that drugs do not.”
Since 2007, when this new program was first introduced, the rate of British doctors prescribing exercise for depression has increased from about 4 percent to about 25 percent. Studies on exercise as a treatment for depression are also showing that there is a strong correlation between improved mood and aerobic capacity. So there’s a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place.
Two Side Effects of Antidepressants You Need to Be Aware of
“There are two side effects or risks that really need to be addressed, and that everybody should be thinking about, that show up in the scientific literature,” Whitaker says. “The first risk is that you’ll convert from unipolar depression to bipolar depression. One of the things we’ve seen with the use of the SSRIs is this incredible, extraordinary boom in bipolar diagnoses, and that is definitely tied to the widespread use of antidepressants. Now, in kids, something like 25 to 50 percent of all kids placed on an antidepressant, who stay on that antidepressant for five years, will convert to bipolar illness. With adults, it seems like about 25 percent of long term of users that begin with a diagnosis of unipolar depression will convert to bipolar.
Bipolar used to be a fairly rare disorder but now it’s becoming much more common. Why is this so bad? Well, when you convert from depression to bipolar, now you’re in a category where you’re often treated with a cocktail of medications including an antipsychotic medication, and long-term bipolar outcomes are really problematic in this country. Only about 35 percent of bipolar patients are employed. So you see this risk of disability.
So my point is this, when you go on an antidepressant, you do have a risk of having a manic episode and that is a risk of becoming “a bipolar patient,” and at that moment you’re into a much more long-term problematic disorder that does not have a good outcome today. The second real risk is that there is a lot of evidence compiling [showing] that if you stay on antidepressants for five, ten, fifteen years, there is some real worry with cognitive decline associated with that long term use.”
Most of you have probably heard that depression is due to a “chemical imbalance in your brain,” which these drugs are designed to correct. Unfortunately for anyone who has ever swallowed this marketing ploy, this is NOT a scientific statement.
“The low serotonin theory arose because they understood how the drugs acted on the brain,” Whitaker explains. “But it was just a hypothesis borne to try to explain why the drug might be fixing something. They investigated whether people had low serotonin…[But] in 1983, NIMH concluded that there is no evidence that there is anything wrong in the serotonergic system of depressed patients. And this was in 1983 before Prozac was released.
So there was never evidence that people with depression characteristically had low levels of serotonin. As one doctor I interviewed about this who did some of this research said, “The serotonin theory of depression is comparable to the masturbatory theory of insanity.” It’s just not a scientific statement.”
Making matters worse, if you do not have low serotonin levels when you’re depressed, but you start taking an SSRI drug that blocks the normal reuptake of serotonin, you end up with the very physiological problem the drug is designed to treat –low serotonin levels. Which, ironically, is the state hypothesized to bring on depression in the first place. In 1996, neuroscientist Steven Hyman, who was head of the NIMH at the time, and is today Provost of Harvard University, published the paper Initiation and Adaptation: A Paradigm for Understanding Psychotropic Drugs, in which he explains this chain of events. According to Dr. Hyman, once your brain has undergone these compensatory adaptations to the drug, your brain operates in a manner that is “both qualitatively and quantitatively different than normal.”
“So these are not normalizing agents, from a scientific point of view,” Whitaker says. Really they are abnormalizing agents, and once you understand that, you can understand why maybe they might provoke a manic episode; why they might be associated with sexual dysfunction or violence, acathisia, etcetera. It’s because they in fact are abnormalizing agents.”
Whitaker discusses numerous other areas of confusion and shares many additional facts about the treatments for depression in this interview, so please, if you or anyone you know suffers from depression, do listen to the entire interview, or read through the transcript. This is vital information that could very well save your life, or the life of someone close to your heart. Finding an effective treatment for depression is not something to approach lightly, and having the facts about what actually works, and what doesn’t, is imperative. In addition, below you will find the four cornerstones of healthy living that would be part of any successful treatment plan.
Other Key Factors to Overcoming Depression
Address your stress -- Depression is a very serious condition, however it is not a “disease.” Rather, it’s a sign that your body and your life are out of balance. This is so important to remember, because as soon as you start to view depression as an “illness,” you think you need to take a drug to fix it. In reality, all you need to do is return balance to your life, and one of the key ways to doing this is addressing stress.
Meditation or yoga can help. Sometimes all you need to do is get outside for a walk. But in addition to that, I also recommend using a system that can help you address emotional issues that you may not even be consciously aware of. For this, my favorite is Emotional Freedom Technique (EFT). However, if you have depression or serious stress, I believe it would be best to consult with a mental health professional who is also an EFT practitioner to guide you.
Eat a healthy diet -- Another factor that cannot be overlooked is your diet. Foods have an immense impact on your mood and ability to cope and be happy, and eating whole foods as described in my nutrition plan will best support your mental health. Avoiding sugar and grains will help normalize your insulin and leptin levels, which is another powerful tool in addressing depression.
Support optimal brain functioning with essential fats -- I also strongly recommend supplementing your diet with a high-quality, animal-based omega-3 fat, like krill oil. This may be the single most important nutrient to battle depression.
Get plenty of sunshine – Making sure you’re getting enough sunlight exposure to have healthy vitamin D levels is also a crucial factor in treating depression or keeping it at bay. One previous study found that people with the lowest levels of vitamin D were 11 times more prone to be depressed than those who had normal levels. Vitamin D deficiency is actually more the norm than the exception, and has previously been implicated in both psychiatric and neurological disorders.