Skepticism about science and medicine

In search of disinterested science

Damning psychiatric drugs with very faint praise

Posted by Henry Bauer on 2014/11/13

The effectiveness of psychiatric drugs has been questioned in innumerable books and articles, see for example What’s Wrong with Present-Day Medicine.

It would actually be surprising if psychiatric drugs did work reliably and with high efficacy, since psychiatric diagnosis is itself an art, certainly not a science. Saving Normal by Allen Frances (William Morrow [HarperCollins], 2013) and The Book of Woe by Gary Greenberg (Blue Rider Press [Penguin], 2013)document in exhaustive detail the lack of sound basis for the classification of mental illnesses used in the Diagnostic and Statistical Manual of Mental Disorders (DSM), specifically in its latest version, the DSM-5.

The insurmountable problem is that no distinct cause has been found for any of the peculiar or unusual behaviors and symptoms that are described as mental illness, insanity, craziness, psychosis, or the purportedly more specific labels manic-depression (bipolar), schizophrenia, etc.

Applying the label “mental illness” presupposes an understanding of what is not mental illness. However, human behavior and mentation vary enormously, and there are distinct cultural influences. Some things are regarded as crazy in some societies but not in others, and in a given society what is regarded as crazy may change over time; for example, early DSMs labeled homosexuality a mental illness but recent ones do not.

In absence of identified causes, all mental illnesses are defined on the basis of collections of symptoms that are matters of degree and not specific to any one label. The criteria for the “Inattention” part of attention-deficit disorder (ADHD) (DSM-5, p. 59 ff.) describe behavior quite typical of teenagers, for instance. DSMs are replete with loose criteria that call for satisfying only several of some set of listed symptoms, for more than some specified period of time, to degrees that are judged excessive. Diagnoses are therefore inescapably subjective and thereby arbitrary. A given individual is often given different diagnoses by different psychiatrists.

Treatment can hardly be more specific than diagnosis, and the labeling of psychiatric drugs is no sounder than are the diagnostic labels. It is criminally misleading to describe these medications as anti-anxiety pills, anti-depressants, anti-psychotics, atypical anti-psychotics, mood stabilizers, selective serotonin re-uptake inhibitors (SSRIs), etc., because they do not have the specific influences implied by those labels. Anti-depressants cause suicide in some people; anti-anxiety drugs in one culture are used as anti-depressants elsewhere; SSRIs are not selective in their effects even though they are designed to target a particular neurotransmitter, and so on.

All psychiatric drugs are mind-altering. They are distinguished from “street” drugs like Ecstasy or LSD only in their legality, not in being better understood or more specific in their action.

This not to deny that psychiatric drugs can be useful at times. But so have been insulin-shock and electric-shock treatment and surgical lobotomy. The point is just that these are all purely empirical treatments. Employing them successfully requires a background of experience and good diagnostic intuition; applying them routinely on the basis of formulaic diagnosis à la DSM can be highly damaging. That is perhaps the main theme of Saving Normal, which deserves to be given considerable respect since the author, Allen Frances, is a distinguished psychiatrist who was the lead organizer of DSM-IV (Arabic numeration supersedes Roman numbers with the fifth edition).

Frances’s book attempts a tightrope path, on the one hand acknowledging the lack of scientific basis for labeling and on the other hand not wishing to undercut the authority of the psychiatric profession. One consequence of attempting this impossibility is that he defends the use of psychiatric drugs by asserting that drugs used in general medical practice often have no better record of success than those applied in mental illness. The latter contention cites “Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses” by Stefan Leucht et al., British Journal of Psychiatry, 200 (2012) 97-106.

But that review shows only that many drugs don’t do what they’re claimed to do. It isn’t much incentive to taking an anti-depressive, for example, if you’re told, “Of course it doesn’t work, but then your anti-cholesterol drug doesn’t prevent heart disease either”. The data cited by Leucht et al. report, for example, that blood-pressure-lowering drugs overall reduce mortality by 4% although “significant reduction of mortality has not been shown for all of them”. Aspirin reduced stroke mortality by 1%, but heparin did not. Statins reduced 5-year mortality by 1.2%. Digitalis reduced hospital admission by 8% but did not reduce mortality.
But those numbers don’t even take into account possibly unpleasant “side” effects: for example, some 10% of people taking statins experience muscle weakness within a few years; aspirin causes internal bleeding in some people.
What Leucht et al. have documented is that medications used to prevent illness, by contrast to medications used to treat actual illness, have such a poor record of success as to make their use very doubtfully recommendable.

The claim that psychiatric drugs are no less effective compares apples and oranges: the data given for the psychiatric drugs is for treatment, not for prevention. In general medicine, of course there are conditions for which there is simply no really good treatment, namely, conditions brought on by aging — cardiovascular disease, cancer, organ failures — and it is hardly worth pointing out that drugs attempting to treat those don’t do a very good job; but that is no reason to use psychiatric drugs that are no better.

The authors’ Declaration of Interest is worth noting:
“In the past 3 years S.L. has received fees for consulting and/ or lectures from the following companies: Bristol-Myers Squibb, Actelion, Sanofi-Aventis, Eli Lilly, Essex Pharma, AstraZeneca, MedAvante, Alkermes, Janssen/Johnson & Johnson, Lundbeck Institute and Pfizer, and grant support from Eli Lilly. W.K. has received fees for consulting and/or lectures from Janssen-Cilag, Sanofi-Aventis, Johnson & Johnson, Pfizer, Bristol-Myers Squibb, AstraZeneca, Lundbeck, Novartis and Eli Lilly. All authors work in psychiatry.”

The authors have a clear bias toward the use of drugs to treat mental illness, and that alone already brands their article as biased. This is hardly a reliable assessment of the efficacy of psychiatric drugs or a recommendation for their use.

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4 Responses to “Damning psychiatric drugs with very faint praise”

  1. I think you are being overly optimistic, Henry. 🙂

  2. nitpicker077 said

    I say the scientific papers that Scholar.Google.com shows for GcMAF oleic acid demonstrate that there is now a good treatment for cancer. You can buy it at GcMAF.EU for a fraction of the cost of conventional cancer treatments.

    The only cholesterol that matters for atherosclerosis it oxidized cholesterol. We have no convenient test for that, but the fact that drunks die with pristine clear arteries shows that those who prevent methanol from being converted into formaldehyde have avoided oxidizing their cholesterol successfully. http://whilesciencesleeps.com/files/(749)International%20Health%20News%20June,%202012.pdf says a whole lot about this in a dozen easy to read pages.

    Substantial support for Bauer’s complaints in this blog can be found in Lawrence Lessig’s lecture at https://www.youtube.com/watch?v=FPXNgsClxNE

    • dondeg said

      Just watched the video. It is excellent. Thanks for the link. My only complaint is his fall back on “behavioral ethics”. I’m too much of a “soul brother” to buy into this viewpoint. But otherwise a lot of great information. -Don

  3. dondeg said

    Nice article Henry. This stuff needs to be said – over and over and over.

    To me, what is ironic about the rise of psychiatry as a profession of “drug pushers” is rejection of the serious medical work in the 1950s and 60s with LSD from people like Humphry Osmund. (http://en.wikipedia.org/wiki/Humphry_Osmond). Patients were showing massive “recovery” rates from things now classed as mental diseases in the DSM, such as alcoholism, criminal behavior, and so on. LSD seems to allow a type of “self reprogramming” for such people, allowing them to naturally overcome psychological weaknesses that manifest as such self-destructive behaviors. This was all rejected. Instead today, we have drugs that facilitate suicide being handed out like candy (e.g. Prozac: http://www.drugwatch.com/ssri/suicide/).

    Just another nail in the coffin for the legitimacy of institutionalized medicine.

    Also, just to underline your observation of the empirical nature of these drugs. We do not even know the anatomy of the neural pathways targeted by psycho-active drugs, which generally are the brain regions called the “reticular formation”. What are we going to do? Dissect medical students? The methods used to map these neural pathways (tract tracing methods) require intact living animals in which tracer substances are injected in the site of interest. The substance moves along the axons to upstream and downstream connection sites. The animal is then killed and the tracer locations determined. Again, medical students are unlikely to volunteer to be subjects in such studies. And it is highly questionable if these pathways are the same in primates even. Our brain is so unique, even among primates, that to assume the same pathways exist in us is simply untenable.

    So, when people say a drug is a “dopamine antagonist” or a “serotonin re-uptake inhibitor” this is all hand waving, and comes from studying rats or some other nonhuman species.

    Further, even if we knew the anatomy, that doesn’t mean we would understand the physiology. These drugs cause changes in the network dynamics of the brain, and this paradigm is just starting to gain traction in the neurosciences, let alone in medical specialties related to the brain.

    Anyway, thanks for stimulating the discussion of this very serious issue, Henry.

    Best wishes as always,

    Don

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