Following the recent CNN Democratic debate, the internet practically exploded with interest in Marianne Williamson and her views. Google trends showed that she appeared in the most searches after the debate in 49 of the 50 states. This increased interest immediately led to a mad scramble by mainstream journalists and opinion writers to try to drive a stake through the heart of Williamson’s quixotic campaign before it gained any more traction. Articles such as that by Brian Boyle of the LA Times darkly predicted that “we’re all probably doomed” if Williamson were to succeed in her quest to drive Trump’s “dark psychic forces” from the White House.
On August 1, CNN’s Anderson Cooper had Williamson on his show in what could have been a very informative discussion on the massive overprescription of antidepressants in the United States, possibly the most severe drug crisis facing the country today — with the possible exception of the opioid crisis. Instead, Cooper seemed intent on totally trashing Williamson’s legitimate message regarding the dangers of overuse of antidepressant and psychotropic prescription medications by focusing on one or two perhaps ill-advised statements that Williamson had regretted making in the past, including a reference to clinical depression as a “scam” and a statement referring to antidepressants as merely “numbing our pain.” Cooper also dredged up her promotion of an article on the death of Robin Williams that had been written by a group affiliated with the Church of Scientology, which strongly opposed psychiatry in general and almost all medications in particular. However, what Williamson was agreeing with in the article was the relatively non-controversial position that antidepressants are “helpful for some, but harmful for others.”
To be sure, Cooper started the segment by noting that Williamson has been outspoken regarding the “legitimate” issues of overprescription of antidepressants, the aggressive marketing by pharmaceutical companies, and their potential harmful side effects. However, he then spent the balance of the segment taking Williamson to task for suggesting that antidepressants may cause harm by “numbing” or “masking” emotions. Williamson denied promoting that message, but did articulate her core message that too many doctors are treating the “normal spectrum of human despair” with antidepressants, adding that, in her view, “we have lost our sense that there are times when sadness is part of life.”
Instead of blindly attacking and dismissing Williamson’s views as “kooky” or so outside the mainstream that they should not be taken seriously, it should be noted that there is growing recognition in the psychology and psychiatric fields that psychotherapists and other mental health professionals have been far too quick to view patients from a purely psycho-pharmacological perspective. Several reputable studies have confirmed what experts have long suspected, which is that powerful antidepressants and psychotropic medications are often prescribed far too quickly, without a proper diagnosis and without taking into full consideration the potential dangerous negative side effects and addictive qualities of such drugs.
In 2002, researchers at the Rand Corp. surveyed close to 700 adults who were taking antidepressants, but fewer than 20% met the criteria for clinical depression, and fewer than 30% of those receiving medication had any symptoms of depression at all. Put another way, more than 70% of patients in the survey presented no medical need for antidepressant treatment, and an additional 10% had insufficient symptoms to warrant the American Psychiatric Association’s official DSM diagnosis of depression.
In June 2012, an article in the American Psychological Association noted that a study by the Center for Disease Control and Prevention (CDC) found that “patients often receive psychotropic medications without being evaluated by mental health professionals,” and that many Americans are being prescribed powerful antidepressants and other medications without a proper diagnosis. These patients are often unaware of other non-drug treatments, such as cognitive behavioral therapy, that might work better for them without the risk of dangerous side effects. In 2016, the prestigious Journal of the American Medical Association (JAMA) published a study based on a review of 100,000 prescriptions for antidepressants written by about 160 doctors for 20,000 people, reaching the conclusion that the massive increase in the use of antidepressants over the past two decades is due, at least in part, to the fact that primary care physicians are prescribing antidepressants for non-depressive indications, including the unapproved and off-label use for non-depression related indications that have not been evaluated by the FDA and other regulatory agencies.
Despite the sharp upward trend in antidepressant prescriptions, there are a relatively small number of physicians, therapists, members of the clergy who provide counseling services, and spiritual advisors (such as Ms. Williamson) who believe that non-drug related therapy, including Dialectical Behavior Therapy (DBT) or “talk therapy” as it is often referred to, is the most effective and least dangerous tool to provide treatment to their clients or patients. As Ms. Williamson and others have often repeated, if an individual is benefitting from the use of antidepressants, they are delighted, but they do not believe that the use of such prescription drugs is the appropriate course of treatment for everyone who seeks counseling or is coping with serious unhappiness, anxiety or depressive symptoms. However, these “non-drug” therapists are the exception, rather than the rule, and, as Williamson stated in the CNN interview, “We’re living in a society now where somebody is going through just a normal breakup, and somebody says, ‘You should be on something.’”
In one medical malpractice case that I handled for the family of their deceased son, the young man of college age was prescribed nearly two dozen antidepressant and psychotropic medications, even though the medical providers who were prescribing these medications to him never conducted any psychological testing to determine whether, in fact, he was clinically depressed. It was later discovered through a comprehensive battery of psychological testing that he did not have any mental problems but, rather, may have had some organic and neurocognitive problem related to a bout with Lyme’s Disease that he suffered from as a young child. In other words, the massive doses and chemical cocktails that he was forced to take during several hospitalizations were wholly inappropriate and unnecessary, and caused classic side effects, such as extreme agitation and severe akathisia (literally, inability to sit), extreme mental anguish, self-violence, suicidal ideation and, eventually, attempted suicide.
Two of the drugs the patient was required to take — Celexa and Zoloft — carried a “black box warning” on the label as required by the FDA. This warning cautioned that, based upon various studies, the drugs may increase suicidal thoughts and behaviors in children and adolescents (under 25). Nevertheless, the medical providers insisted that the young man continue to take these and other prescription medications with dangerous side effects. When the patient began making progress with a therapist who specialized in talk therapy that did not rely upon any prescription medications, the other doctors who were prescribing the antidepressants for him ordered that such drug-free therapy cease since it was supposedly interfering with his pharmacologically-based treatment.
Eventually, the young man’s downward spiral resulted in him dousing himself with gasoline and lighting himself on fire, resulting in severe burns over 90% of his body. He lingered near death for six months in a hospital ward before he eventually died.
Tragically, this case that I worked on is not an isolated incident, and although some of Marianne Williamson’s rhetoric on the subject of the overuse of prescription medications may be over the top, the topic deserves much more public attention and debate, since it is a crisis throughout our country as real as the opioid epidemic.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.