# Are Psychiatrists playing us? Book claims studies show psych meds much less effective than claimed
**URL:** https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597
**Category:** Great Debates
**Created:** [April 28, 2010, 2:57am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597 "2010-04-28T02:57:55Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@astro](https://boards.straightdope.com/u/astro)
#### Post date: [April 28, 2010, 2:57am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/1 "2010-04-28T02:57:55Z")
Interesting book here [Anatomy of an Epidemic](http://www.salon.com/books/nonfiction/index.html?story=/books/feature/2010/04/27/interview_whitaker_anatomy_of_an_epidemic)
Have psychiatrists been playing us?
> [@](#):
>
> Anatomy of an Epidemic" is the first book to investigate the long-term outcomes of patients treated with psychiatric drugs, and Whitaker finds that, overall, the drugs may be doing more harm than good. Adhering to studies published in prominent medical journals, he argues that, over time, patients with schizophrenia do better off medication than on it. Children who take stimulants for ADHD, he writes, are more likely to suffer from mania and bipolar disorder than those who go unmedicated. Intended to challenge the conventional wisdom about psychiatric drugs, “Anatomy” is sure to provoke a hot-tempered response, especially from those inside the psychiatric community.
> [@](#):
>
> But if these studies are so groundbreaking, why have they gone unreported in the media?
>
> Because the NIMH didn’t announce it. Just as they didn’t announce the 2007 outcome study for schizophrenia patients. In that study, the recovery rate was 40 percent for those off meds, but only 5 percent for those on meds. I checked all the NIMH press releases for 2007, and found no release on this study. I found no announcement of it in any American Psychiatric Association publication or textbook. Not a single newspaper published an account of the study. And that’s because the psychiatric establishment – the NIMH, the APA, even the National Alliance on Mental Illness, an advocacy organization – did not put out any press release about it or try to alert the media in any way.
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [April 28, 2010, 3:50am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/2 "2010-04-28T03:50:19Z")
That was an interesting article.
I had a severe psychotic disease when I was a teenager (it was never diagnosed, but met the descriptions of schizophrenia or a disease like it). And I never went on meds. However I did end up more or less fine over time.
I have read studies showing the long term prognosis of some psychiatric disorders like schizophrenia is actually much better than people realize. Studies found over 20+ years, a pretty large number ended up being symptom free or high functioning.
However I’ve also read studies where early intervention with low dose antipsychotics can halt the deterioration from prodromal symptoms into full blown psychosis.
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### Author:  [@E-Sabbath](https://boards.straightdope.com/u/E-Sabbath)
#### Post date: [April 28, 2010, 10:48am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/3 "2010-04-28T10:48:59Z")
I remember the report being discussed in the media in 2007 and again, a similar discussion just this month.
This makes me concerned about the veracity and agenda of this book.
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### Author:  [@astro](https://boards.straightdope.com/u/astro)
#### Post date: [April 28, 2010, 12:56pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/4 "2010-04-28T12:56:20Z")
> [@E-Sabbath](#):
>
> I remember the report being discussed in the media in 2007 and again, a similar discussion just this month.
>
> This makes me concerned about the veracity and agenda of this book.
He seems to be a respected science reporter. A credible study (or studies) showing a relative lack of positive outcomes over time for psychiatric drug use vs no drugs would (I think) be a big, big deal, especially for people taking these drugs. If his charge is true that the major mental health professional associations didn’t even acknowledge the study that’s kind of strange.
As many psychiatric drugs as are prescribed to Americans you’d think this is something that would be of huge interest, but it doesn’t really seem to be rousing any concerns. Are people and doctors vested in their belief that these drugs work better than they do over time regardless of what arms length evaluations show, or is the author full of crap?
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### Author:  [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)
#### Post date: [April 28, 2010, 1:14pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/5 "2010-04-28T13:14:32Z")
I only know that when I was wrongfully hospitalized for being suicidal, it took me 14 hours to get something to eat, 38 hours to get basic toiletrie2, bu within 2 hours they were shoving pills at me. I have a history of being pill addicted, but I was forced to take them with no information about what they were, what they were supposed to do, and any side effects.
It was like being in 12984’s room 101, or under the Taliban–women must be locked up, tortured and stoned.
The doctors did not care if I got addicted again or even if I suffered an allergic reaction and died. They just had to get me to do drugs Fucking pill pushers.
I dare say that more people have gotten addicted to drugs in mental hospitals than from street pushers.
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### Author:  [@Triskadecamus](https://boards.straightdope.com/u/Triskadecamus)
#### Post date: [April 28, 2010, 1:26pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/6 "2010-04-28T13:26:59Z")
The FDA requirements for “effective” in psychoactive drug trials are so low that any placebo response will meet them. In addition, for many such drugs, the condition for which the patient is being treated is so subjective that improvement is pretty much a matter of the opinion of the therapist who prescribes the drug.
On the other hand, those persons with long histories of psychoactive drug prescriptions, and those with none seem to me to be unlikely to be similar in severity of impairment overall. I would like to know what mechanism was used to normalize the sample for that variable.
Tris
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### Author:  [@astro](https://boards.straightdope.com/u/astro)
#### Post date: [April 28, 2010, 2:03pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/7 "2010-04-28T14:03:54Z")
> [@Triskadecamus](#):
>
> The FDA requirements for “effective” in psychoactive drug trials are so low that any placebo response will meet them. In addition, for many such drugs, the condition for which the patient is being treated is so subjective that improvement is pretty much a matter of the opinion of the therapist who prescribes the drug.
>
> Tris
That sounds like a paradigm tailor made for massive over-prescription of drugs with questionable efficacy.
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### Author:  [@Annie-Xmas](https://boards.straightdope.com/u/Annie-Xmas)
#### Post date: [April 28, 2010, 2:06pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/8 "2010-04-28T14:06:57Z")
Right. In my case above, the shrink can say “After three days of taking the medication, the patient improved so much that she was able to be discharged.”
When I told the guy handing me the pink pill in a little cup without giving me any information on what the hell it was, what it was suppose to do, and any side effects that " I don’t do drugs," he replied “This isn’t drugs. It’s medication.”:rolleyes:
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### Author:  [@Marley23](https://boards.straightdope.com/u/Marley23)
#### Post date: [April 28, 2010, 2:10pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/9 "2010-04-28T14:10:38Z")
> [@Triskadecamus](#):
>
> The FDA requirements for “effective” in psychoactive drug trials are so low that any placebo response will meet them.
That’s not right. There are a couple of stages of testing. In the last one, the drugs get compared _to_ a placebo, and the idea is to show that the drug is better by a statistically significant amount. If that doesn’t happen, the drug is essentially no better than a placebo and it’s not going to get approved for whatever disease it’s being tested in. If the trial does work, the FDA doesn’t have to approve the drug.
Which is not to say there are no problems with the system. There are plenty.
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### Author:  [@BrotherCadfael](https://boards.straightdope.com/u/BrotherCadfael)
#### Post date: [April 28, 2010, 2:12pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/10 "2010-04-28T14:12:12Z")
There is a considerable lobbying effort in our state for “parity” between insurance coverage for physical and mental illness. I think if they want parity, then they need to meet the same standards for safety and efficacy.
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### Author:  [@Triskadecamus](https://boards.straightdope.com/u/Triskadecamus)
#### Post date: [April 28, 2010, 2:48pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/11 "2010-04-28T14:48:27Z")
> [@Marley23](#):
>
> Which is not to say there are no problems with the system. There are plenty.
Your correction is accurate. I spoke with a very large amount of imprecise implication.
Yes, the FDA does require placebo comparison. In a strictly mathematical sense, the level of superiority over placebo must be significant. However, there is a lot of dissatisfaction among researchers in independent studies on the level of effectiveness required, and the absence of requirement for comparison with prior treatment modalities proven effectiveness rates, and the comparative improvement over placebo. I happen to agree with that objection, but I was not correct to say that no comparison is required.
Tris
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### Author:  [@ITR\_champion](https://boards.straightdope.com/u/ITR_champion)
#### Post date: [April 28, 2010, 4:04pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/12 "2010-04-28T16:04:56Z")
> [@astro](#):
>
> He seems to be a respected science reporter. A credible study (or studies) showing a relative lack of positive outcomes over time for psychiatric drug use vs no drugs would (I think) be a big, big deal, especially for people taking these drugs. If his charge is true that the major mental health professional associations didn’t even acknowledge the study that’s kind of strange.
>
> As many psychiatric drugs as are prescribed to Americans you’d think this is something that would be of huge interest, but it doesn’t really seem to be rousing any concerns. Are people and doctors vested in their belief that these drugs work better than they do over time regardless of what arms length evaluations show, or is the author full of crap?
I’ve think there may be a different explanation. Pharmaceutical companies make tens of billions of dollars selling these drugs. Consequently they have an enormous financial interest in having people believe that the drugs are effective. There are countless examples where corporate interests have been able to bury inconvenient facts about their products for a long time; the health effects of lead are one obvious example. Scientists knew that lead could contribute to many physical and mental problems since the 30’s, yet the knowledge was not made available to the public for decades.
Many people believe that in the United States, we have an exhaustive and airtight system which makes sure that drugs must pass rigorous tests before they reach market. We don’t. Certainly the process of clinical trials exists, yet the pharmaceutical companies have ways to work around it. For one, they can do a large number of trials and only report those trials which give the results they want. More significantly, the pharmaceutical industry provides massive funding to many of the academic labs that do the testing, and cynical people might suspect that money can tilt the results a bit.
While I’m not familiar with the background on schizophrenia or ADHD, I do follow the research regarding depression and the story there sounds similar to what’s being described here.
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### Author:  [@Cat\_Whisperer](https://boards.straightdope.com/u/Cat_Whisperer)
#### Post date: [April 28, 2010, 5:45pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/13 "2010-04-28T17:45:38Z")
Anyone with any experience in mental health will be familiar with these phrases; “Well, let’s try this one, and see how it works for you;” and, “It’s normal to experience side effects/experience no results at first. You have to give the drug time to work.” My personal experience taking drugs for an anxiety disorder for 13 years versus five years drug-free, and my experiences as a co-leader of an anxiety support group lead me to believe that the medical industry (including psychiatrists) are failing patients with anxiety disorders. If you feel anything less than good, take a pill. If you have side effects from that pill, take another one. And chances are good that the pills you’re taking won’t actually make you feel any better (except the addictive benzodiazepines - those make you feel _real_ good).
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### Author:  [@Merneith](https://boards.straightdope.com/u/Merneith)
#### Post date: [April 28, 2010, 6:26pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/14 "2010-04-28T18:26:42Z")
1. The study under discussion in the Salon article can be found here:
[http://jama.ama-assn.org/cgi/content/short/303/1/47?home](http://jama.ama-assn.org/cgi/content/short/303/1/47?home) (you’ll need a subscription to JAMA to see the full text.)
From the article description:
> [@](#):
>
> **Conclusions** The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial.
It’s certainly possible that doctors are over-prescribing anti-depressants for people with mild or temporary depression, as the Salon article suggests, but the study in question does not say anti-depressants don’t work, ever.
1. Depression isn’t like diabetes, where you can measure your blood sugar and then know if you need insulin. There’s currently no test for the amount of serotonin in you brain and no guidelines to know if you should or shouldn’t be taking anti-depressants and what type and how much. The medicine just isn’t there yet.
It’s possible that the people in the study with mild depression didn’t need an anti-depressant. It’s also possible they might have been helped if they’d been given a different type of anti-depressant or a different dosage or even a different combo of meds.
It’s frustrating but it’s an evolving field.
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### Author:  [@Marley23](https://boards.straightdope.com/u/Marley23)
#### Post date: [April 28, 2010, 6:34pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/15 "2010-04-28T18:34:33Z")
And on that note here are two threads about this study and issue from earlier this year: [Why antidepressants don’t work…](http://boards.straightdope.com/sdmb/showthread.php?t=550294) and [Antidepressents Don’t Work? Really?](http://boards.straightdope.com/sdmb/showthread.php?t=551419)
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### Author:  [@AHunter3](https://boards.straightdope.com/u/AHunter3)
#### Post date: [April 28, 2010, 6:59pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/16 "2010-04-28T18:59:30Z")
re: the articles & info in the OP — I’ve been saying that for years. On this very board, in fact.
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### Author:  [@Squink](https://boards.straightdope.com/u/Squink)
#### Post date: [April 28, 2010, 7:32pm UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/17 "2010-04-28T19:32:22Z")
[Pharmaceutical giant AstraZeneca will pay $520 million to settle allegations that the company illegally marketed an antipsychotic drug and paid kickbacks to physicians](http://www.washingtonpost.com/wp-dyn/content/article/2010/04/27/AR2010042705360.html)
[In 2004, Warner-Lambert agreed to plead guilty and pay $430 million in fines to settle civil and criminal charges regarding the illegal marketing of Neurontin for off-label purposes, and further legal action is pending.](http://en.wikipedia.org/wiki/Gabapentin#Recreational_use)
[A Senate committee report showing that a vagus nerve stimulation device was approved for treatment-resistant depression over the objections of “more than 20 [Food and Drug Administration] scientists, medical officers, and management staff” could add to the difficulties patients and psychiatrists have reportedly had in securing insurance coverage for the device.](http://www.clinicalpsychiatrynews.com/article/S0270-6644%2806%2971221-8/preview)
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### Author:  [@Marley23](https://boards.straightdope.com/u/Marley23)
#### Post date: [April 29, 2010, 12:53am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/18 "2010-04-29T00:53:57Z")
The sad thing is that **Squink** missed a couple of recent fines that were even bigger than the quoted ones.
> [@Triskadecamus](#):
>
> Yes, the FDA does require placebo comparison. In a strictly mathematical sense, the level of superiority over placebo must be significant. However, there is a lot of dissatisfaction among researchers in independent studies on the level of effectiveness required, and the absence of requirement for comparison with prior treatment modalities proven effectiveness rates, and the comparative improvement over placebo.
These are all good points, and I think new antidepressants should definitely be compared to current ones and not just sugar pills. That’s done with cancer drugs and other treatments.
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### Author:  [@Zoe](https://boards.straightdope.com/u/Zoe)
#### Post date: [April 29, 2010, 4:28am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/19 "2010-04-29T04:28:37Z")
I don’t think it’s anything new that medication alone doesn’t work for a large segment of the population. And it wasn’t until prozac came on the market that I had reliable relief from severe depression. (I have chronic low grade depression that is always with me.)
It’s so frustrating for me to read these articles that say how minor the effects are, when I know that prozac saved my life.
(I will add that I know nothing about medications for schizophrenia except that once when I was misdiagnosed and given medications for schizophrenia by a very unethical doctor, I got as sick as I’ve ever been. That was forty-five years ago.
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### Author:  [@Zoe](https://boards.straightdope.com/u/Zoe)
#### Post date: [April 29, 2010, 6:44am UTC](https://boards.straightdope.com/t/are-psychiatrists-playing-us-book-claims-studies-show-psych-meds-much-less-effective-than-claimed/537597/20 "2010-04-29T06:44:21Z")
> [@](#):
>
> **BrotherCadfel** : There is a considerable lobbying effort in our state for “parity” between insurance coverage for physical and mental illness. I think if they want parity, then they need to meet the same standards for safety and efficacy.
I don’t know of anyone who lobbied harder than the patients who were denied parity. They were often limited in the amount of time that they could be hospitalized. Their visits to their psychiatrists were limited to a certain number per year. And the expenses were not covered at the same rate. It was almost as if the insurance companies were saying, “Mental illness isn’t a _real_ illness.”
But that fight is over now. Patrick Kennedy was successful in getting his bill through Congress. I don’t remember who saw to it that it went through on the Senate side. It was part of the eighty-seven billion dollar stimulus bill.
With some insurance companies it went into effect in October. With other companies it went into effect in January. I think all companies are supposed to be in compliance by now.
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