A serious conversation is under way in the United States on the subject of psychiatric drugs. The debate consists of three fundamental issues: first, whether antidepressants actually treat depression; second, the vast, growing body of evidence that psychotropic medications alter the brain permanently; and third, the pharmaceutical industry’s continuing, decades-old corruption of American psychiatrists, many of whom have been made by drug companies’ shenanigans into little more than handsomely paid industry shills.

A careful questioning of these issues written by the spectacularly decorated Harvard Medical School lecturer Dr. Marcia Angell appeared as a two-part essay published earlier this summer in The New York Review of Books. In addition to holding a medical degree from Boston University School of Medicine and undergraduate diplomas in both chemistry and mathematics, Angell is a Fulbright Scholar, a board-certified pathologist, author of two books, a member of numerous professional health care associations and a retired 20-year staffer at the New England Journal of Medicine, which she ultimately left as editor-in-chief.

The recent publication of three books, each of which takes up one of the issues raised above, provided the occasion for Angell’s essay. In it, she argues convincingly that antidepressants are not known to do what drug companies and many psychiatrists say they do. It is this claim that drew the attention of practicing psychiatrist and Brown University professor Dr. Peter D. Kramer, who in a New York Times commentary published last Sunday questioned some but not all of what Dr. Angell wrote.

Both articles deserve to be read, but there is a crucial difference between them. While Kramer points to much data that must be taken seriously, his wandering defense of the utility of antidepressants does not undo the diligent, methodical inquiry one would expect from someone with Angell’s credentials—and which she delivers. Otherwise, he too is a critic of Big Pharma’s shady dealings. Kramer nods with genuine concern toward the dangers associated with the prolonged use of psychotropics and, in his conclusion, expresses support for treatment via effective alternatives. Both professionals agree that serious research needs to be done to understand exactly what these drugs are doing. –ARK

Marcia Angell in The New York Review of Books:

Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from “talk therapy” to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain. The number of people treated for depression tripled in the following ten years, and about 10 percent of Americans over age six now take antidepressants. The increased use of drugs to treat psychosis is even more dramatic. The new generation of antipsychotics, such as Risperdal, Zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the US.

Read Part 1: The Epidemic of Mental Illness: Why?

Read Part 2: The Illusions of Psychiatry

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