marcia angell


Is There Now A National Debate Over Antidepressants?

Author Robert Whitaker

Tell me if I’m exaggerating. But I think it’s now fair to say that there’s a rising national debate — at least judging by some of the premiere media outlets — over the value of antidepressants.

Just to update you on the latest posts and ripostes: Dr. Marcia Angell, former editor of the New England Journal of Medicine, wrote a provocative two-part series in The New York Review of Books on three recent books that call into question the current drug-heavy style of psychiatry. Then Dr. Peter Kramer, of “Listening to Prozac” fame, responded in defense of antidepressants in The New York Times on Sunday, July 10.

Now the latest gleanings from Twitter: There’s a petition afoot to get the Times to run a response to Peter Kramer’s piece. The response is by Bob Whitaker, author of “Anatomy of an Epidemic,” who challenges current practices of prescribing psychiatric drugs. (CommonHealth wrote about him here.) As of this morning, the petition had nearly 400 signatures.

Here’s Bob responding on Psychology Today’s blog. He challenges Peter’s arguments in his usual data-driven way, and concludes:

As I noted in Anatomy of An Epidemic, the real problem we have in this field of medicine is that academic psychiatry hasn’t been honest in what it tells the public about psychiatric medications. If the medications are to be used wisely, and in an evidence-based manner, we need to have an honest discussion about what science is telling us about the drugs. But on Sunday, in this essay “In Defense of Antidepressants,” the American public has been treated to yet another dose of misinformation.

Dr. Marcia Angell: Off-Label Prescribing Of Psych Drugs Should Be Banned

Dr. Marcia Angell

I appreciate the incisive analysis in the latest installment, fresh off the presses here, of Dr. Marcia Angell’s New York Review of Books piece on the current state of psychiatry. (We wrote about the first installment here.)

But what I particularly appreciate about it is that it doesn’t stop at analysis. Yes, it lays out in sad historical detail how the financial influence of drug companies penetrated psychiatry as the field increasingly shifted from Freudian talk therapy to psychopharmacology. (As the late Harvard psychiatrist Leon Eisenberg put it with characteristic wit, the field shifted from “brainlessness” to “mindlessness.”) And yes, it documents the dangers of over-diagnosis. But then Marcia, former editor of the New England Journal of Medicine, goes on to make actual, succinct policy recommendations. Including this one about prescribing psychiatric drugs “off-label,” beyond the diagnoses the FDA has approved them for:

The original purpose of permitting doctors to prescribe drugs off-label was to enable them to treat patients on the basis of early scientific reports, without having to wait for FDA approval. But that sensible rationale has become a marketing tool. Because of the subjective nature of psychiatric diagnosis, the ease with which diagnostic boundaries can be expanded, the seriousness of the side effects of psychoactive drugs, and the pervasive influence of their manufacturers, I believe doctors should be prohibited from prescribing psychoactive drugs off-label, just as companies are prohibited from marketing them off-label.

And this one: Continue reading

Dr. Marcia Angell On The ‘Mental Illness Epidemic’

Dr. Marcia Angell

I can’t wait for the next issue of The New York Review of Books. It’s slated to carry the second half of a review written by Dr. Marcia Angell of Harvard Medical School, and I’m eager to see how it’s going to come out.

Marcia is the former editor of the New England Journal of Medicine, and from her lofty position at the pinnacle of the medical establishment, she speaks out about the shortcomings of the American health care system and the dangers of financial conflicts of interest in medicine. A 2009 piece of hers in the New York Review of Books, titled “Drug Companies and Doctors: A Story of Corruption,” brought vehement objections in print from Stanford and the American Psychiatric Association, which, in my opinion, she soundly trounced in her response.

Her current review looks at three books, two of which have already been mentioned on CommonHealth: Robert Whitaker’s Anatomy of an Epidemic and Dr. Daniel Carlat’s “Unhinged.” I haven’t read the third yet: Irving Kirsch’s “The Emperor’s New Drugs: Exploding The Antidepressant Myth,” but it sounds like it suggests that antidepressants are largely ineffective, and any positive results they may produce likely stem mainly from the placebo effect.

It’s worth reading the whole review, but here’s a small excerpt:

The authors emphasize different aspects of the epidemic of mental illness. Kirsch is concerned with whether antidepressants work. Whitaker, who has written an angrier book, takes on the entire spectrum of mental illness and asks whether psychoactive drugs create worse problems than they solve. Carlat, who writes more in sorrow than in anger, looks mainly at how his profession has allied itself with, and is manipulated by, the pharmaceutical industry. But despite their differences, all three are in remarkable agreement on some important matters, and they have documented their views well.

First, they agree on the disturbing extent to which the companies that sell psychoactive drugs—through various forms of marketing, both legal and illegal, and what many people would describe as bribery—have come to determine what constitutes a mental illness and how the disorders should be diagnosed and treated. This is a subject to which I’ll return.

Second, none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain.

And the teaser: Continue reading