The Psychiatric Times (November 2016) honors Robert Whitaker on the front page. Well, not directly. The lead article, written by Ronald Pies MD is entitled, “The Astonishing Non-Epidemic of Mental Illness.” The article is an attempt to refute a central premise of Whitaker’s well-known book, Anatomy of an Epidemic, that mental illness is on the rise because of adverse medication effects.
The article makes an argument that rates of mental illness have been unchanged over the last decade, and argues against Whitaker’s assertion that more people are ill with mental illness due to misguided and harmful psychiatric treatment.
Assessing actual rates of mental illness in the population is difficult, but for the sake of argument I want to agree with Pies that the rates of mental illness have been constant over time. Unaddressed in Pies’ article are the well-known statistics on the dramatic increases in the percentage of the population that are taking a psychiatric medication.
If the incidence of mental illness has remained the same, but there is an ever-increasing percentage of the population that take psychiatric medications, then these drugs are being over-prescribed to people without mental illness.
I am surprised that Dr. Pies and the Psychiatric Times would want to headline the issue with this article. While I realize that Whitaker and Pies have had their disagreements, this article seems inappropriate for a leading psychiatric publication. Anatomy of an Epidemic, while popular among the public, is not popular at all with psychiatrists, many of whom make their living by doing the overprescribing.
Who is the intended audience? I can’t know exactly why this article was written, but obviously, Dr. Pies has been affected by Robert Whitaker’s well-written book and the entire Mad in America movement. My guess is that he needed to write the article for himself, because the psychiatric epidemic spawned by overprescribing and prescribing without concerns for side effects is so obvious. Congratulations, Bob.
Meanwhile, there is another epidemic of mental illness. It is the epidemic of people trying to stop SSRI antidepressants that they have taken for many years. Put on a SSRI 20 years ago, often for trivial problems, the patient believes that they can stop the drug whenever they want. When they do stop, the depression and akathisia are crippling, and reinstatement sometimes makes it all worse. In my practice I am seeing people with severe tardive akathisia after stopping their SSRI and they don’t know that it is a side-effect of withdrawal. Such patients must be commonly showing up in every psychiatrist’s practice. Unfortunately, the long-term withdrawal effects of SSRIs are not recognized by organized psychiatry.
On the other hand, I have a strong suspicion that the pharmaceutical industry is looking to capitalize on SSRI withdrawal. The FDA has just approved a drug to treat pseudobulbar affect. There is a push to declare pseudobulbar affect a common and often unrecognized condition. Pseudobulbar affect is a state where the patient’s mood is very labile, and they are easily moved to tears or laughter. It is an uncommon clinical finding, best known as a result of strokes or other neurological conditions. It is pretty rare and it is difficult to see why the profit driven pharmaceutical companies would focus on this. However, it is a very common symptom in patients who are withdrawing from SSRIs. Education courses are showing up, to teach the doctor to recognize what is described as a common and under diagnosed problem. So, when the patient who doesn’t realize that they are in withdrawal shows up with pseudobulbar affect, the psychiatrist is going to be able to make a diagnosis and prescribe another drug – anything as long as the withdrawal syndrome remains disguised as new illnesses.
The good news is that Mad in America is widely circulated and the message has been entering the collective unconscious. Even Dr. Pies’.
