We’re going crazy

If you measure craziness by the number of people who because of a mental disorder qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), then the number more than doubled from 1987 to 2007.  Some studies have shown that 46% of us meet the criteria for mental illness as defined by the American Psychiatric  Association. Why is that? Are we better able to detect mental illness? Most mental illness is now treated with drugs. But why has the number of sick people increased so dramatically if these drugs are working? These are questions Marcia Angell discusses in her latest NY Review article.

Angell attributes much of the problem to the theory that mental illness is caused by a chemical imbalance in the brain. She doesn’t think much of the theory. First of all, the early drugs that were used to treat mental illness, such as Thorazine or Miltown, were initially intended to treat infections; it was only by chance that they were found to be effective against some forms of mental illness. It was when they tried to discover why these drugs worked, that strange conclusions were drawn. “For example, because Thorazine was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine.”  A similar logic was used for antidepressants: because these drugs, e.g. Prozac, increased the levels of serotonin, depression was caused by too little serotonin. Even today, the theory remains just that; no proof has been forthcoming.

Did you know that the FDA approves drugs that have had two trials where the drug is more effective than a placebo?  There could be twenty trials that do not show such effectiveness. One analysis of the approval process for six antidepressants considered the 42 trials submitted to the FDA. Most were negative. Furthermore, the placebos in these trials were 82% as effective as the drug.

Another point Angell considers is the possibility of side effects slanting the trial. While these trials are double-blind” (neither doctor nor patient knows whether the patient is given the drug or a placebo), the patient may be able to make an educated guess as to which he has been given because of the side effects. Human nature being what it is the patient would be inclined to believe the drug has improved his condition. This whole question of placebos is an interesting one. An active placebo (one that has side effects) in some cases produces the same reaction as the drug.

Angell’s article is the first of two. I’ll let you know what she says next month.