December 18, 2012

Mass Producing Maniacs in America

Prozac was introduced to the market by Eli Lilly in 1987.  It quickly gained favor among psychiatrists, or psychopharmacologists as they are often called these days, given their preference for treating all mental illness with psychotropic drugs, since it allowed the profession "to do something" about depression besides try to talk the patient into feeling better.  The mechanism of Prozac, generically called fluoxetine, was to "selectively" inhibit the re-uptake of the neurotransmitter serotonin in the brain's neurons.  Neurotransmitters do what their name suggests: they transfer energy from neuron to neuron across the synapses of brain cells.  Serotonin is essential to the maintenance of mood stability.

Since depressed patients taking Prozac began to "feel better" after an induction period on the drug, researchers (anxious to sell Prozac) backed into a diagnostic analysis: since readings of spinal fluid indicated that patients taking Prozac had increased levels of serotonin in the brain, the depression must have been caused by a "chemical imbalance" resulting in too little serotonin before administration of the drug.  This is similar to claiming, as Daniel Carlat notes in Unhinged - The Trouble With Psychiatry, that “By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.”

In fact, there is practically no scientific evidence for the "chemical imbalance" theory of depression.  All three books reviewed in an excellent piece by Marcia Angell in the New York Times Review of Books ( make this point: psychopharmacology needed a theory which would fit the action of the drug, so the industry made one up.  Depression is caused by too little "natural" serotonin.  It certainly was a profitable way of thinking about the problem.  Prozac was followed by Paxil, Zoloft, Serzone, Celexa and similar anti-depressants, and we're now at the point where 10% (or about 30 million people) over the age of 6 years old in America are taking anti-depressants.

As Robert Whitaker notes most forcefully among the three writers, the problem with Prozac and its ilk is that messing around with the brain's delicate chemical transmission mechanisms has nasty effects, which Eli Lilly and the rest of Big Pharma of course call "side effects," although there is nothing incidental about them.  Artificially pumping up the level of serotonin in the brain (above the preexisting baseline which was, as noted, probably completely normal) naturally produces a "high" or euphoria, and depending on the metabolic idiosyncrasies of a given patient (can they metabolize all this serotonin flooding the synapse because of the presence of the drug), the patient may go all the way into depression's opposite pole, mania.  In other words, Prozac and other drugs acting on serotonin can produce maniacs.

It's worse than that, however, because the effects of anti-depressants (and other psychotropic drugs acting on other neurotransmitters, such as dopamine and norepinephrine) tend to continue even when the patient attempts to withdraw from the drug.  Marcia Angell summarizes this effect very neatly:

Getting off the drugs is exceedingly difficult, according to Whitaker, because when they are withdrawn the compensatory mechanisms are left unopposed. When Celexa is withdrawn, serotonin levels fall precipitously because the presynaptic neurons are not releasing normal amounts and the postsynaptic neurons no longer have enough receptors for it. Similarly, when an antipsychotic is withdrawn, dopamine levels may skyrocket. The symptoms produced by withdrawing psychoactive drugs are often confused with relapses of the original disorder, which can lead psychiatrists to resume drug treatment, perhaps at higher doses.
The brain cells, in other words, having adapted to the presence of a synthetic chemical which was interrupting natural function (re-uptake of serotonin), remain "stuck" in an up-regulated or down-regulated condition.  Thus, while conditions such as depression used to be, in the great majority of cases, self-limiting and brief in duration, we have, through the miracle of psychopharmacology, created an epidemic of people who are bummed out for good.

Or: become suicidal or totally psychotic, maybe even violently so.  Correlation is not causation, but it is highly suggestive, to say the least, that prevalence of anti-depressant use tracks more or less exactly the rise in school and public place massacres.  More soon.

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