CARL O'BRIEN

Do the drugs work? The number of antidepressants and drugs being prescribed for mental health problems is increasing – but a growing movement is questioning the true value of the medication

COULD IT be possible that Ireland is experiencing a hidden epidemic of mental illness? It sounds unlikely. There have been no screaming headlines or siren voices on TV warning about it. But judging by the numbers alone, the rise in the number of people suffering from mental ill-health is chilling.

Take illness-benefit payments for mental health problems. They have jumped by more than 80 per cent over the past decade, up from 9,884 in 2001 to 18,173 last year. And look at the use of drugs. Over the past five years, prescriptions for antidepressants, benzodiazepines and sleeping pills on the medical-card scheme increased by more than 25 per cent.

All of this comes with a heavy economic cost. The three-million-plus prescriptions for mental health drugs on the medical-card system and the Drugs Payment Scheme in 2010 cost the State in excess of €100 million. In addition, mental health problems are estimated to cost the Irish economy around €2.5 billion a year through lost employment, absenteeism, lost productivity and early retirement, according to recent research by the Mental Health Commission, the State’s independent watchdog for psychiatric care.

So, what’s going on? Is the prevalence of mental illness really climbing? Or are we simply learning to recognise and diagnose mental disorders that were always in the community? And what about the drugs that play such a prominent role in treatment: do they work? And if they do, shouldn’t we expect the prevalence of mental illness to be falling, not rising?

These are urgent questions that go to the heart of a growing debate on the efficacy of antidepressants, and about whether we are medicalising common distress. They also pose fresh challenges for a mental health system that, for decades, has been built on the foundation of a “medical model” approach to treatment.

The drugs under challenge include many of the main medicines used to treat anxiety, depression and schizophrenia.

Critics – including patients’ groups and some high-profile psychiatrists – say that fresh scrutiny of scientific literature suggests the benefits of many medications have been exaggerated and that in the long term they might even exacerbate a person’s illness. Further, they say, the medicalisation of distress is serving only the interests of drug companies, which don’t care who is prescribed antidepressants as long as they are prescribed in great quantities.

It’s a challenge hotly disputed by the representative groups for the psychiatric profession, who see mental disorders mostly as diseases of the brain that can be treated effectively with medication. They argue that critics make too much out of often minor technical matters and then ignore an overwhelming body of data supporting the effectiveness of medication.

IN THE 1950s, psychoactive drugs transformed the face of psychiatry. The first was Thorazine, which was used widely in mental hospitals as a tranquilliser for psychotic patients. It was followed by a host of other drugs, aimed at tackling anxiety and depression. In the space of a few years, there were tablets to tackle what were regarded as the three main categories of mental illness: psychosis, anxiety and depression.

According to medical card figures for 2010, the medications most prescribed for mental health problems were Valium (500,550 prescriptions) and Xanax (432,000), both of which are benzodiazepines or sedative-type drugs that can be highly addictive, and the antidepressant Effexor (323,000).

There are many who attest to the benefits of these drugs. Many say they couldn’t survive without them, or that they play a vital role in keeping conditions such as schizophrenia or depression at bay. Lisa, a mother of four, is one of them. She says she experienced severe postnatal depression after the birth of her second child, and she didn’t know where to turn. “It was very scary, and I was worrying about harming my baby,” she says. “I was prescribed an SSRI [an antidepressant] and I began to feel better after two weeks. Everyone is different, but for me, I feel they did work. It cleared my head.”

Set against this backdrop, the increase in the numbers taking medication shouldn’t be seen as something alarming, according to the College of Psychiatry of Ireland, the professional representative body for psychiatrists.

“[Prescriptions] are increasing for lots of medicines, such as anticholesterol drugs for heart conditions,” says Dr Anne Jeffers, a spokeswoman for the college. “When it’s to do with the heart, it’s seen as something good. And it’s time we started to see drugs for treating mental illness in similar way . . . We see people every day who benefit hugely from the mental health system. There is a need to ensure that those prescribing drugs are accountable, but it’s also important to get the message out there that medication does work.”

Far from being over-treated, psychiatrists feel that not enough people, especially young people, seek help soon enough, given the benefits that can follow early intervention.

But recent research is posing a fresh challenge to the notion of how effective these drugs are in the long term, and in the process it is asking unsettling questions about the very foundation of psychiatry.

When Prof Irving Kirsch of the department of psychology at the University of Hull in the UK, and his colleagues in the US and Canada, obtained complete data for all drug trials submitted to licensing authorities in the US, their findings sent a jolt through the medical community. They found that Prozac, Seroxat and other antidepressants of the same class performed no better than dummy pills – or placebos – in the earliest trials. No such analysis had been done before because of the reluctance of the pharmaceutical companies to hand over the full trial results.

In his recent book Anatomy of an Epidemic, investigative journalist Robert Whitaker has found that questioning the efficacy of some psychiatric drugs is not a new phenomenon. He points to an article in the 1976 American Journal of Psychiatry co-authored by Jonathan Cole, regarded as the father of American psycho-pharmacology, titled “Is the Cure Worse Than the Disease?” In the paper, Cole reviewed all the long-term effects the drugs could cause and observed that studies had shown at least 50 per cent of all patients with schizophrenia could fare well without medication. “Every schizophrenic outpatient maintained on antipsychotic medication should have the benefit of an adequate trial without drugs,” Cole wrote at the time.

Whitaker maintains that the psychiatry profession, in effect, shut off further public discussion of this sort. In the 1970s, he says, psychiatry was fighting for survival. The two main classes of drugs – antipsychotics and benzodiazepines such as Valium – were increasingly regarded as harmful, and sales declined.

At the same time, there was a dramatic increase in the number of counsellors and psychologists offering talk therapy and other non-drug-based approaches. “Psychiatry saw itself in competition for patients with these other therapists, and in the late 1970s, the field realised that its advantage in the marketplace was its prescribing powers,” he says. “It consciously sought to tell a public story that would support the use of its medications, and embraced the ‘medical model’ of psychiatric disorders.”

In fact, he goes so far as to argue that the natural history of mental illness is changing. Where once conditions such as schizophrenia and depression were episodic and shorter, now they are more likely to be chronic and lifelong. This, he believes, is due to the damaging long-term effects of some drugs.

However, Kirsch’s and Whitaker’s findings and assertions are challenged by many psychiatrists who say they distort the vast body of wider research which shows these drugs can be very effective, especially in the short term.

This debate over medication and how best to treat mental health problems comes at a time when the voices of patients and advocates, especially those critical of the system, is growing louder. Groups such as Mind Freedom Ireland, Mad Pride and many others are rejecting the labels and language of psychiatry, which views mental ill-health as a bio-medical problem.

Instead, these organisations tend to see mental health problems as forms of emotional distress or an underlying vulnerability, and are demanding a much greater emphasis on choice and on being involved in their route to recovery.

For people such as Dr Terry Lynch, a Limerick-based GP and psychotherapist, it is time our debate on how best to treat mental health problems focused more on developing a genuinely recovery-oriented approach. While he says he is not “anti-medication or anti-psychiatry”, he says the process of recovery requires therapy and time.

“The mental health system doesn’t sufficiently understand the emotional and psychological aspects of mental health problems, nor the importance of exploring in detail the individual’s experiences, whatever they may be.”

This failure, he says, is not due to limited resources, but to an ideological blind spot within the medical approach to mental health problems. In his experience, successful treatment involves becoming an “accompanier” with a person on their journey of life and creating a relationship based on trust, equality, safety, acceptance and positive regard.

Despite the public perception of the psychiatric profession as enthusiastic supporters of a medicine-only approach to care, consultants on the ground say the reality is very different.

For example, Dr Anne Jeffers of the College of Psychiatry says the profession is fully behind the State’s mental health policy, A Vision for Change, which advocates a recovery ethos where psychiatrists work in partnership with patients to support them on their own journey.

The reality on the ground, according to many, is that while this approach is practised in some areas that offer a wide range of services, often due to the influence of individual consultant psychiatrists, many others are still rooted in the more traditional medical approach.

Continuing to invest in the mental health system will be crucial to modernising it. The roll-out of community mental health teams, to be staffed by psychiatrists, therapists and social workers, will be key to giving patients more options.

The attitude of GPs is also crucial. Many say they feel forced to prescribe drugs as the only solution, because they don’t have access to “talking treatment” such as cognitive behavioural therapy.

Meanwhile, the debate about whether drugs work or not seems set to rumble on. It’s a reminder that, despite all our scientific advances, our basic understanding of how mental illness affects the brain is evolving slowly.

The lack of biological markers – for example, there is no blood test for depression – leads to theories about how various treatments work. And as long as the inner workings of the brain remain a mystery, there are likely to be precious few definitive answers.

Dylan Tighe: ‘Instead of relieving my distress, I felt the drugs were compounding it’  The first time Dylan Tighe, who is 34, attended a psychiatrist was at the age of 18, after experiencing a prolonged bout of depression. “I just felt listless. There was a complete lack of desire and absence of joy that was overwhelming. It was an experience that would be repeated again,” says the award-winning theatre director. After a brief consultation, he was prescribed Seroxat, an antidepressant, for the best part of a year. It was the beginning of several years of being prescribed a range of antidepressants and mood-stabilisers which, he says, had often severe side effects, such as an increased heart rate, short-term memory loss and sexual problems. In the meantime, he felt other options weren’t being made available, such as talk therapy, which might helped him resolve underlying issues. “Drugs were always the first port of call. There was a dismissive attitude towards talk therapy . . . instead of relieving my distress, I felt the drugs were compounding it. “My engagement with the service and lack of choice disempowered me to the point where I’m sure it was a factor in the depression itself. “I found the relationship between the psychiatrist and patient quite patronising. They are the ones with the knowledge and power. Yet, all the assumptions on which I was being prescribed medication were very challengable – but it’s difficult to do so when you’re at a very vulnerable point.” He says he would have liked to have been listened to about what he felt would work in his case – but says there was little leeway outside of the medical approach. After exploring options on his own, he found psychotherapy “infinitely more helpful”. “The most helpful therapists were those with the most empathy. That was almost totally absent from psychiatry, in my experience.” Tighe hasn’t used drugs for about two years. He has serious reservations about psychiatric medication, but accepts that some people find them helpful. “You can’t generalise. Everyone’s different. In my case, I was told I may have to take them for the rest of my life, so I feel an enormous sense of relief now that I made a choice to stop taking them.” Tighe is now putting the finishing touches to an album and stage production called Record, which will draw on his experiences of the mental health system. It will premiere at the Cork Midsummer Festival on June 25th and will go on to tour nationally. “The material uses my starting point of diagnosis and examines the area of emotional distress and ideologies around psychiatry, and looks towards a new way of conceptualising emotional distress . . . I feel I’ve made huge progress in coming to my own understanding of my experiences, which has been very empowering and enlightening.” 

Catherine Mannion: ‘You’re labelled. I was a “manic depressive”. It depersonalises you’  After giving birth to three children in quick succession, Catherine Mannion felt exhausted. The babies were born prematurely and needed extra attention. But she was losing weight and felt physically and mentally drained. “I was burnt out, looking back,” she says. “I just didn’t have any energy.” Her GP advised her that she needed a rest or “deep sleep” to recover, she says, and suggested a brief stay in a psychiatric hospital for a few days. After being discharged, Mannion decided to go for marriage counselling due to the strain her exhaustion was having on the relationship. After explaining how she felt to a psychiatrist, she says she received a diagnosis on the spot: manic depressive psychosis. “It took me completely by surprise. I’d never heard anything like it. When the psychiatrist started describing the symptoms – mood swings, extremes of emotion, indecision – I just didn’t recognise it. It didn’t sound like me.” Mannion says she was told Lithium – a drug used to treat manic depression – was the answer: it would correct the chemical imbalance in her brain. She would receive it under supervision, along with anti-depressants, and be discharged from hospital after a few weeks. Instead of a brief involvement with psychiatric services, she says it was the beginning of a “lost decade” in which she felt ignored by specialists and was given little option other than taking often heavy doses of medication. “It was clear to me that I wasn’t getting better,” she says. “I was just getting worse. The side-effects were just numbing. I started questioning what was happening, but then I’d be told that if I didn’t take them I was in danger of being locked up.” In all, she had four stays as an inpatient, ranging from a few weeks to a few months. At one point, she recalls refusing to take tablets she was prescribed. She says she intravenously injected anti-psychotic drugs and received several doses of electro-shock therapy. “It made be feel that I couldn’t function as a person. If felt like my life was on hold. I didn’t have spontaneity or joy in life. It just desensitised me.” A key moment of validation for her, she says, was reading a letter in a newspaper by Dr Michael Corry, a critic of the forced administration of treatment. Outside the system, she sought independent diagnoses from Dr Corry and a psychologist: both, she says, concluded she did not have a mental illness. “A long time has passed. I don’t think many psychiatrists realise the profound effect they can have on a person’s character. You’re labelled. I was a ‘manic depressive’. It depersonalises you,” she says. “As far as medication is concerned, we need to discuss both sides, the for and against. I don’t doubt they help some people. But in my case, they turned out to be my worst enemy. “And I lost 10 years of my life on medication which I feel I never needed at all.”

3 Comments »

Joe Perscriptions are on the increase but that doesen't mean that the actual drug being prescribed is being consumed more. It could be the case that a person on 10mg of drug x has been reduced to 8mg of drug x but has been given three prescriptions per week insted of one. There has been no mention (as usual in Irish media) on the amount of immigrants in this country and how it is changing all our statistics.

Yesterday, 14:08:04

Richard Patterson With articles like this being printed, there is hope for us all yet!! Keep up the good work Carl O'Brien!! For too long medical model psychiatry has had the opportunity to evolve in an environment where the voices of those who dared to question it could effortlessly be silenced and has become a law unto itself and moved beyond the law. Unknowingly or otherwise, it is individual citizens that have released this power to medical model psychiatry and now it is only by the power of individual citizens coming together that this power can be taken back. To Dylan and Catherine, thank you for speaking out. It is TIME FOR CHANGE...... and as an individual citizen it is articles like this that are part of the CHANGE that I want to see happening.......... Again, Carl, Dylan and Catherine, simply... THANK YOU!! Richard Patterson, Co. Leitrim.

Yesterday, 20:59:25

derek doherty Is this not typically symptomatic of the capitalistic profits based economic model? Of course the large soul-less pharma companies will conduct biased research, either directly or indirectly, to justify the consumption of their product.    People may be interested in independently researching St Johns Wort(SSRI) as a viable, much less detrimental, alternative to the synthetic rubbish that the big pharma companies try to force down consumers throats.    St Johns Wort has been found to be just as effective as the Benzo(Valium, Xanax), etc of this world. It is fantastic for insomnia, anxiety, etc, in other words for all the typical symptoms of depression.    Just be aware that you should never take St Johns Wort in conjunction with the commercial options, which is why it is no longer available over the counter in the Republic of Ireland. Of particular interest is the fact that it is pre-dominantly prescribed to adolescents in Germany for depression, primarily because of the lack side-effects associated with the standard commercial alternatives.    I have personally found St Johns to be very effective. At the end of the day, it is well worth looking into this product, at very least because of the lack of side-effects.

Dear Sir,While acknowledging such factors as the opposition of many doctors to the use of electoshock, the national variations and its decline in use, your article 'Shock Therapy' (April 8th) nevertheless conveyed a very sanitised image of the practice. Describing it as "a rather humdrum procedure these days", John Burns and Harry Leech also quoted author Carrie Fisher going in for "a tune up", an image further reinforced by the soothing comments of consultant psychiatrist Anne Jeffers stating that "in practice little actually happens". The reality however, and it must never be glossed over, is that a grand-mal seizure is deliberately provoked in the recipient. Electrodes are attached to the head. A switch is flicked and up to 400 volts of electricity surge through the brain causing an electrical brainstorm which provokes a series of spasmodic outbursts involving the entire nervous system. The recipient's breathing is interrupted, blood pressure rises, stress hormones are released and the muscles go into a rhythmic series of violent contractions. The overseeing psychiatrist keeps the current on until the toe twitches, a sign that despite the muscle-relaxing drugs, a grand-mal seizure is taking place. In normal medicine, such an incident is a cause for major medical concern. In her justification for its use, Dr. Jeffers quotes an 80% positive response without stating specifically either the nature or duration of any such response. In fact, a recent study led by psychiatrist Dr. Harold Sackheim of Columbia University, New York, a lifelong defender and promoter of electroshock, confirmed that it causes permanent brain damage and dysfunction. As reforming American psychiatrist Dr. Peter Breggin states "Psychiatry is the only place where you damage the brain and call it a cure". MindFreedom Ireland calls for a total ban on an archaic and misguided procedure. Yours faithfully, Jim Maddock, MindFreedom Ireland,Cork.

FEAR FORCE FRAUD

    I, like so many others, was a victim of fear, force and fraud at the hands of institutional psychiatry. I encountered psychiatry for the first time two days after the birth of my first child. Having received nitrous oxide and a neuroleptic called Sparine in labour, both of which I was allergic to and more drugs immediately after the birth, I was whisked off two days later at high speed to a psychiatric hospital where I got my first electroshock the next day. I subsequently received twelve more shocks with multi neuroleptic torture over a six week period. I often received the neuroleptics in forced injection form. I can remember the pain even though due to the electroshocks and multidrugs, I would have known very little about it at all but managed to acquire my records many years later. All of this was without consent. I didn't sign any forms and I knew nothing about this medical induced harm which was done in the name of 'help'.

I only found out all of this more than three decades after the severe damage and trauma I endured as a first time mother. I had become a long-term psychiatric slave enduring horrific real effects from psychotropic drugs which I thought was a 'mental illness' I inherited due to a chemical imbalance in my brain. I thought I had become a different person in need of lifelong 'treatment'. This is the outrageous fraud and deception most psychiatrists sing from their hymn sheet (out of tune!!). This is the reason why so many people like me are being brain damaged by people who have no cure! When so called doctors can perform brain damage so easily, when they can even do it forcefully, when they are protected legally, when they are aided by governments and insurance companies, then it is no wonder that those labelled by psychiatry often live in constant fear. Then fear is the root cause of a troubled mind and a shattered spirit. Is it any surprise that people with real psycho/social difficulties fail miserably to find true peace of mind, body and spirit! Where there is no choice there is tyranny. Bio psychiatry offers little or no choice. It only has tunnel vision. It sees people as objects to be fixed. Yet it breaks, destroys and multiplies these 'objects' in need of more fixing! It is bribed, wined and dined by unscientific Big Pharma, which is only motivated by enormous profit and greed and covers up its damage. It hires fraudulent ghost writers. It has short contrived trials. It bribes the FDA, referred to as the Fraudulent Deception Association by Dr Robert Rowen. In spite of this monopoly, it is amazing that many people have survived/thrived and recovered from the destructive and coercive harm institutional bio psychiatry has left in its wake. They are exceptional people. They are today's prophets. They are writers, poets. artists, musicians and true scientists They are caring, compassionate, emphatic and above all heartfelt people. It is thanks to them and the people who understand them that there will be choice and freedom to heal in the future. I have recovered/thrived and become a stronger and happier person because I finally found out that many psychiatrists are doctors of deception who destroy people like me. I also found some true doctors such as Dr Terry Lynch, Dr Peter Breggin, Dr Michael Corry, Dr Thomas Szasz and Dr Pat Bracken to name but a few. Then I became an activist for reform and enlightenment. I joined MindFreedom International and today I am proud to be a board member. I joined other organizations such as ENUSP (European Network of ex/Users and Survivors of Psychiatry) of which I was a board member and INTAR. I discovered and practice daily mindfulness which brought me to my SENSES and I rediscovered my love for music and dancing. Music is indeed our universal emotional language. I, like Abba. say everyday 'THANK YOU FOR THE MUSIC'!

RECORD: Friday 9 March, Theatre Development Centre, Triskel Arts Centre, Tobin Street, Cork at 6pm.

Dylan Tighe has been doing a development week at the Triskel this week and will be having a work in progress of the above. It would be really great if you were able to attend the work in progress on Friday evening. RECORD, which is devised, composed and performed by acclaimed young Irish theatre-maker Dylan Tighe, is a multi-platform theatre project exploring depression and 'mental illness' through a combination of album release, theatre performance and related events, which will receive its premiere during the 2012 Festival in June. The project aims to explore and shift consciousness around the representation of mental health and will use as its starting point Dylan Tigheʼs personal history and archive of mental health treatment and experience, along with on-going research being undertaken through a research and development award from Create: the national development agency for collaborative arts.

While the album focuses on the past, the theatre performance looks to the future and asks: How can we re-conceptualise 'mental illness' and use the experience to positively shape our future, rather than seeing emotional distress as a defect to be eliminated, contained and suppressed?

The eventual performance will be directed, performed and sung by Dylan Tighe along with an actor and dancer and drummer Conor Murray, with lighting and design by Aedín Cosgrove, original 16mm film by Paul Prendergast and Dylan Tighe, and video design by Killian Waters. Advisor to the project is Dr Pat Bracken, psychiatrist, author and Director of the West Cork Mental Health Service. The showing will include some ideas in progress which will feed into the full production in June, as well as a discussion about the project and the representation of mental health in performance.

Kath Gorman, Associate Producer, Cork Midsummer Festival, 00353 868810747

Warnings that some prescription drugs cause violent thoughts

By Jennifer Hough

Tuesday, March 06, 2012

When it comes to cocaine, crystal meth or LSD, there is no difficulty believing a drug could drive a person to commit a crime.

However, in the case of prescription drugs, the drug is always innocent and the person guilty, a psychiatrist has said. David Healy, an Irish-born professor based in the UK, has been an expert witness in homicide and suicide trials involving psychotropic drugs. He believes selectove serotonin re-uptake inhibitor (SSRIs) anti-depressants can cause a delirium that leads to violent behaviour. "They can also cause entirely normal people to start thinking aggressively and have violent thoughts they had never had before, as they did to some drug trial volunteers in Leeds in the 1980s. "And they can switch off anxiety so that someone coldly starts to plan something they would be too scared to do ordinarily — so there can be pre-meditation. The problems can happen within 48 hours, or build up over two to three weeks, as in Shane Clancy’s case." Prof Healy gave expert evidence at the inquest of Mr Clancy, who killed a man before taking his own life. This view is strongly disputed by the College of Psychiatry of Ireland, which maintains there is no evidence anti-depressants can cause harm. The college believes discussion of suicide and homicide as potential adverse effects of antidepressant medications, particularly SSRI anti-depressants, is speculative. "Clearly, suicide and homicide are events of the utmost gravity and any possible role of any treatment in precipitating such tragedies warrants the most thorough investigation," according to the college. "However, discussion of the risks involved must be based on evidence rather than conjecture or unfounded personal opinion." Former deputy state pathologist Declan Gilsenan warned in this newspaper yesterday that he had seen too many suicides of people who had recently started taking powerful anti-depressants. He said he would be willing to sit down and share his concerns with Kathleen Lynch, the minister with responsibility for mental health. On suicide, Dr Gilsenan said that while there were a lot of people trying to solve the problem, nobody — including psychiatrists — had and it was getting worse. "I worked in the Midlands in the 1980s and saw about five cases of suicide a year. In 2010, I was seeing 25-30 in that one area alone with a population of about 200,000. That is a huge increase. I think people are not observed and monitored the way they used to be in the past and perhaps that is part of the problem." Ms Lynch congratulated Dr Gilsenan for speaking out in public as it was such a difficult issue to tackle. She said the former coroner could have picked any issue but the fact that he picked this one was significant. "When someone of this stature speaks out, we have to take notice," she said. "GPs have found themselves in a position where there is nothing else to do but prescribe pills. There needs to be alternatives for people. It can’t just be medication, and we need a system where people are reviewed on a continuous basis." Ms Lynch said work was in progress to close gaps in psychology and counselling services in the community, and that people in emotional difficult needed to be treated with the upmost care. Dr Gilsenan called for a national survey of suicides to see how many people had begun taking SSRIs shortly before taking their life. He said toxicology reports were vital in this regard but were expensive tests which were sometimes not carried out.