My colleague Jeff Kaye PhD recommended that I read Robert Whitaker's The Making of an Epidemic (pictured above) for insight into the scientific evidence concerning the effects of psychiatric medication. I read the entire book in one day and feel it is the most important work I've read in years. This and the following two posts will summarize Whitaker's most important findings but I recommend that you read this book if you're at all interested in or concerned about these drugs and what they actually do.  Although some sections of the book discuss neurological processes and there's a fair amount of statistical data to support his arguments, you don't need to be a psychologist or a physician to understand the material. For me, the experience was like reading a well-written legal thriller: I found it riveting.   As a clinician, I've always doubted the effectiveness claims associated with Prozac and the other so-called "anti-depressants", viewing them as propaganda that drives profits for Big Pharma, as I've discussed elsewhere.  The full truth is far more disturbing.

Whitaker began as a newspaper reporter, then co-founded his own publishing company that reported on the business aspects of clinical testing for new drugs; his readers worked at pharmaceutical companies, medical schools and private medical practices, so he did not come to his subject area with an ax to grind.  He began his research for Anatomy when he discovered that as a whole, schizophrenic patients in poor countries, only 16 percent of whom were regularly given antipsychotic medication, had much better long-term outcomes than patients in developed countries who received such drugs. He set out to understand this puzzle, not to launch a crusade.  Before writing his book, he "believed that psychiatric researchers were discovering the biological causes of mental illness and that this knowledge had led to the development of a new generation of psychiatric drugs that helped 'balance' brain chemistry." Many of you may believe the very same thing -- not surprising, since it's the story that has been given to us by the medical profession and regularly repeated in the media.

After painstaking research, Whitaker found that there is absolutely no scientific evidence to support the theory that mental illness is a result of an imbalance in brain chemistry. Let me repeat that: there is absolutely no scientific evidence to support the theory that mental illness is a result of an imbalance in brain chemistry.  As an example, let's take the best known theory, that depression is caused by low serotonin levels in the neural synapses.  An entire class of drugs -- the "selective serotonin reuptake inhibitors" (SSRIs) inhibits the removal of serotonin from those synapses and thus ( in theory) restores normal serotonin levels.  So, if this theory is true, depressed people should have below-normal levels of 5-HIAA (serotonin is matabolized into 5-HIAA) in their cerebrospinal fluid.

Study after study has failed to find any significant difference in the 5-HIAA levels of depressed and non-depressed patients.   No correlation has been found between 5-HIAA levels and severity of depressive symptoms.  Whitaker is thorough and devastating on this particular point, exposing flawed research designs and statistical analysis in the very few studies that purport to show even a very small link between serotonin levels and depressive symptoms.  Furthermore, no correlation has been found between levels of 5-HIAA in cerebrospinal fluid and degree of response to anti-depressants.  This widely accepted theory has absolutely no basis in fact:

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