More Money for Drug Companies, You Say? The Disastrous Stigma Against Mental Illness
I will start by saying Prozac is not an anti-psychotic drug as Dr. Lind suggests in his article. Yes, it's psychoactive. Yes, it's an antidepressant. No it is not an anti-psychotic.
While this may seem like a captious point, it exemplifies the author's understanding of the subject area. It is clear that Dr. Lind knows a thing or two about the human body, as his suggestion that mental illness may have its roots in advanced catabolic disintegration reflects a knowledge of human physiology. In addition, his request for physiological evidence for mental illness is a valid one - the knowledge of the biological basis for mental illness has been increasingly recognized in the mental health community over the past thirty years and this recognition has benefited those with mental illness.
But it is clear that Dr. Lind's understanding of the mental health field is elementary. If this ignorance were my only concern I'd go on my merry way and think little of this article.
Unfortunately, I sense a far more sinister motive at work in this article - that of the stigma against mental illness and mental health treatment.
Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense.
Treatment of depression includes medication, it's true. But Dr. Lind claims that there "is no money in non-drug treatment" - is he unaware of "counselors," "therapists," and "psychologists?" Last I checked there were no drugs administered in a session with a Marriage and Family Therapist. Were Dr. Lind's intent to encourage his readers to seek treatment using what non-drug methods are available, therapy would be an excellent suggestion.
Instead Dr. Lind argues that the increase in diagnoses in as reflected in the DSM-V (and seems to insinuate that most if not all diagnoses in the various DSM editions) are "bullshit." And yet in a country whose health care is almost entirely dependent on insurance a diagnosis is the difference between affordable treatment and astronomical out-of-pocket expense.
And why might an individual want treatment?
Because untreated depression is the number one cause for suicide, according to Suicide.org.
Dr. Lind seems to be suggesting that Prozac itself is dangerous. His focus on Prozac is entirely on how it causes suicidal thoughts. Well, let's take another look at that, shall we?
According to the drugs.com report of the side-effects of Prozac (otherwise known as fluoxetine), "The 1991 meta-analysis of controlled trials (which was sponsored by the manufacturer of fluoxetine) reported six suicidal acts occurring in a total of 1763 patients treated with fluoxetine. The frequency of suicidal acts was 0.3% and was similar to the frequency reported for placebo (0.2%) and tricyclic antidepressant therapy (0.4%)."
For those in the world that did not love statistics class, this means that when researchers looked at several well-designed studies and averaged them out, there was 1 more case of a suicide attempt (which are far more common than completed suicides) in 1000 for those who took Prozac than for those who took no drugs at all.
(If you are thinking that the drug companies have a reason to report so low a percentage reflect that the same page reports that 12% of participants experienced diarrhea. What benefit could possibly come from that?)
Dr. Lind spends three of fifteen paragraphs in his article describing the increased risk of suicidal behavior in those taking antidepressants when the difference is 0.1%. 1 in 1000.
My question - why are we ignoring the 999 in 1000 over that 1?
Does Prozac work for every person that tries it? No. But if an individual with diagnosable Major Depressive Disorder keeps at it and tries more than one medication, he or she is more than likely going to find one that works.
Also, the more severe the case, the more effective antidepressants are. Why is this important?
Suicide is the tenth leading cause of death among Americans in 2012 according to the Center for Disease Control and Prevention.
The treatment of depression is effective 60 to 80% of the time, according to the American Association of Suicidology.
What this means is that, literally, by encouraging individuals not to take antidepressants when they have diagnosable depression he is encouraging them not to take actions that could save their lives.
He may not have to deal directly with the consequences of reinforcing the stigma against seeking help for mental illness, but I do. I volunteer at the Suicide Prevention Center in Los Angeles and take calls every week from people that suffer from major depression. I can't tell you how many people I've spoken to who think antidepressants are a hoax and are at the same time taking steps toward their own suicide. I've been on the phone with individuals in the last moments before their self-delivered death and had to live with the thought that if this person had had treatment for their severe depression, they might still be here today.
So here is the question I pose: Is Dr. Lind's quarrel with drug companies worth tens of thousands of lives?
Bibliography:
http://www.mayoclinic.com/health/mental-health/MH00076
http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-157.pdf
http://www.suicide.org/suicide-causes.html
http://www.drugs.com/prozac.html
http://articles.washingtonpost.com/2013-05-02/national/38974326_1_suicide-rate-12-suicides-prevention
http://www.cdc.gov/nchs/fastats/lcod.htm
http://www.webmd.com/depression/features/are-antidepressants-effective
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