But the "cows are still loose." These commentaries below that have introduced our journal articles for several decades have filtered into the general water system where they linger long:
| Depression is one of the most prevalent and costly brain diseases. In the last major epidemiology study conducted in the United States, major depression had an overall lifetime prevalence rate of 17.1% (21% in women and 13% in men), and comparable figures have been obtained worldwide. These findings represent an increase of approximately 6% in the 15 years since the previous study… |
| Affective disorders account for considerable psychiatric morbidity (pain and suffering), but also significant disability and consequent loss of productivity. Depression has been estimated to be the second leading cause of disability worldwide, surpassed only by ischemic heart disease. Moreover, depression is often associated with comorbid psychiatric disorders, most notably anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, obsessive−compulsive disorder and post-traumatic stress disorder). The mean age of onset of depression has markedly decreased from the 40- to 50-year-old range noted several years ago to the 25- to 35-year range, and this phenomenon has been observed worldwide. Depression often goes undetected, especially in children, adolescents and the elderly. Mood disorders are associated with a significant risk for suicide, which remains one of the top ten causes of death in the United States and in many countries throughout the world. Depression is a major independent risk factor for the development of coronary artery disease and stroke, and possibly other major medical disorders. |
| Major depression is now recognized as a highly prevalent, chronic, recurrent, and disabling biological disorder with high rates of morbidity and mortality. Indeed, major depression, which is projected to be the second leading cause of disability worldwide by the year 2020, is associated with high rates of mortality secondary to suicide and to the now well-established increased risk of death due to comorbid medical disorders, such as myocardial infarction and stroke. Considerable strides have been made over the past 2 decades in the development of safe and efficacious antidepressants. |
| Depression is an illness that frequently starts early in life, tends to run a chronic course, and produces substantial disability. According to the World Health Organization, depression is the leading global cause of years of life lived with disability and the fourth leading cause of disability-adjusted life-years, a measure that takes premature mortality into account. Depression is not only widespread and common, it may be fatal; an estimated 90% of suicides are associated with mental illness, most commonly depression. There were nearly 30 000 suicides in the United States in 1999, almost twice the number of homicides. Suicide has become the third leading cause of death in individuals aged 15 to 24 years. |
| Despite efficacious and widely available antidepressants and psychotherapeutic interventions, the psychosocial and medical burden of depression is increasing. In fact, the World Health Organization projects that depression will continue to be prevalent, and by the year 2020, will remain a leading cause of disability, second only to cardiovascular disease. Although we do not know with certainty why rates and disability associated with depression are increasing, it is likely that this mood disorder continues to be remarkably under-recognized and under-treated. Depression frequently occurs in the context of chronic medical illness, and it is only relatively recently that the research community has turned its attention to the relationship between depression and chronic medical conditions. However, there is much work yet to be done. |
Four of these paragraphs were written by a paid medical writer, Sally Laden, in industry generated articles ghosted for key opinion leader guest psychiatrist authors. One, however, was written by Dr. Tom Insel, Director of the National Institute of Mental Health. They sound the same whether they’re written as part of a stealth advertising campaign to sell more drugs or by the person in charge of setting our research agenda. I’ve come to believe that this campaign, undertaken primarily for non-medical reasons, has been so inculcated into the current cadre of primary care physicians, psychiatrists, and the population at large, that it’s likely to reverberate there for a very long time.
And from my perspective, I think our patients have become a major independent force in the problem of over·diagnosis and over·medication. They press for the results promised by the roll-down from our own literature, the ads with the beautiful people on television sets, and their doctors quickly responding to reported symptoms with a prescription. It would be naive to think that the massive psycho·pharmaceutical promotions of the drug industry, the third party payers, and psychiatry itself wouldn’t have a profound effect on the general populace, creating a self perpetuating inertia. I think that has already happened to a greater extent than we’d like to admit.
Ghostwriter Sally Laden took her cue from the WHO Global Burden of Disease reports that began to appear in the late 1990s. Unipolar major depression was ranked #4 in 1997, and was projected to go to #2 as a cause of disability by 2020. These numbers were a gift to the marketeers in PhRMA, who naturally took full advantage of them.
The only way WHO could come up with such estimates was through accepting the broad definition of depression we met in DSM-III (1980). Trouble is, the undifferentiated disorder called major depression was never a scientific description of a disorder with coherent construct validity. The result was an epistemologic quagmire from which we are still trying to extricate ourselves.
Can Thomas Insel deliver us? Not with RDoC he can’t.
Pharma’s ability to influence even a closed system is highlighted in this link:
http://brodyhooked.blogspot.com/2013/10/controlling-channels-va-and-diabetes.html
Today pharma is in every corner of our lives. We should feel no pain, there is a pill for that, never have a disability, there is a device for that, and never wait, and there is an open CT machine for that. Pharma has pushed and succeeded in achieving a society that is focused on medical care with no cost controls.
Doctors become complicit when they use the system for their financial gain. The question was posed some time ago about the highest use of a medical practice. A number of doctors replied the highest use was to provide them with the income they desire, because without that income they would not stay in medicine.
“the clamor is coming from people who have been lead to believe that unhappiness itself is a disease with a chemical solution. It’s not. And that’s a notion that psychiatry and industry helped to create…”
Now if we can only convince people life happens, and doctors their financial future does not hinge on medicating everyone in their panel.
Steve Lucas
Steve–
I could offer pages of substantiation and opinion. I will add a simple “AMEN.”
Eur Neuropsychopharmacol. 2011 Sep;21(9):655-79.
The size and burden of mental disorders and other disorders of the brain in Europe 2010.
Wittchen, et al.
Source
Institute of Clinical Psychology and Psychotherapy, Center of Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.
Abstract at http://www.ncbi.nlm.nih.gov/pubmed/21896369. Full text http://www.mediafire.com/?3mv68ejlnz59ck4
This study, finding nearly 40% of Europe suffers from “brain disorder” was funded by Lundbeck, according to this press release (PDF: http://www.globalmentalhealth.org/binary_data/651_the_size___burden_on_mental_disorders_in_europe.pdf ). Lundbeck says its “key focus areas” are depression, schizophrenia, Alzheimer’s, Parkinson’s, and sleep disorders http://www.lundbeck.com/products/default.asp
The European College of Neuropsychopharmacology is using this study as a scare tactic to get government backing to protect pharma from injury lawsuits.
God, with all this legal documentation going on, can’t just 1 slick or resourceful lawyer find a way to drag in big pharma as a whole for a RICO charge, and then equally drag in the APA as an accessory?
Yes, it will take years, and much discovery and cost, but, if you are in it for the big payout, while it is longer than Powerball or Megamillions, the amount at the end makes those payoffs on Tuesdays or Fridays look like Keno instead! And you know what, the defendants will want to settle for a lesser amount as the Discovery process will be painful in their revelations, but, I believe the plaintiffs will demand some kind of admission as part of the settlement, as the defendants are so narrow minded and limited, they just think saving money and saying “I’m sorry” is fine for today and that is all the public will remember.
Oops, they might be right on that assessment. Sure damn well see that every day of late both in the office and on the news.
The push to prescribe is enormous. The notion that these drugs are safe and effective runs deep.
I find your blog a welcome counter-point to many of the messages I am getting in my psychiatry residency. A few months ago, a co-reisdent and I were hearing about the overnight admissions and there was a geriatric admission with lots of medical problems who was having anxiety attacks (who I picked up as a patient). Without ever meeting the patient, he turns to me and starts telling me which drugs I should try with the patient. I told him that I needed to meet the patient first, and come up with a differential diagnosis, and that my usual gero-psych strategy has been to see what medications I can discontinue, rather than add more medications. As it turned out, the man was maxed out on multiple classes of meds and was delirious from poly-pharmacy. Our strategy turned out to be to try to reduce his medications, but the patient had become so conditioned to the idea that he needed to take a pill whenever he felt uncomfortable, that he couldn’t tolerate the changes. I think that the instant gratification/placebo effect/over-diangosis issue is a real problem, but unfortunately the risks and side effects of the treatments are very real!
See SurvivingAntidepressants.org http://tinyurl.com/3o4k3j5