Tuesday, June 07, 2011

Is there an epidemic of mental illness? UPDATE

Marcia Angell, MD, the often critic of the pharmaceutical industry, has reviewed three books that address the status of psychiatry. From the New York Review of Books:

It seems that Americans are in the midst of a raging epidemic of
mental illness, at least as judged by the increase in the numbers treated for
it. The tally of those who are so disabled by mental disorders that they qualify
for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI)
increased nearly two and a half times between 1987 and 2007—from one in 184
Americans to one in seventy-six. For children, the rise is even more startling—a
thirty-five-fold increase in the same two decades. Mental illness is now the
leading cause of disability in children, well ahead of physical disabilities
like cerebral palsy or Down syndrome, for which the federal programs were

Read the whole article. Our society is medicated beyond belief and the efficacy and long term effects of these psychoactive drugs are suspect, especially in children. The conflicts of interests among doctors, patients and industry is examined.


Part two of the 2-part article:

At the very least, we need to stop thinking of psychoactive drugs as the
best, and often the only, treatment for mental illness or emotional distress.
Both psychotherapy and exercise have been shown to be as effective as drugs for
depression, and their effects are longer-lasting, but unfortunately, there is no
industry to push these alternatives and Americans have come to believe that
pills must be more potent. More research is needed to study alternatives to
psychoactive drugs, and the results should be included in medical

In particular, we need to rethink the care of troubled children. Here
the problem is often troubled families in troubled circumstances. Treatment
directed at these environmental conditions—such as one-on-one tutoring to help
parents cope or after-school centers for the children—should be studied and
compared with drug treatment. In the long run, such alternatives would probably
be less expensive. Our reliance on psychoactive drugs, seemingly for all of
life’s discontents, tends to close off other options. In view of the risks and
questionable long-term effectiveness of drugs, we need to do better. Above all,
we should remember the time-honored medical dictum: first, do no harm (primum
non nocere).

So much of medicine is unscientific-- one of the glaring disappointments I've always had with the profession-- but few things are less scientific or more reckless than treating kids with antipsychotics.

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