Spending on psych drugs Up 150%, Diagnosis of Depression 25% Inflated"

June 18 2007 at 2:31 PM

Response to APRIL 2007: News on SSRIs, other Psych Drugs and Related Issues

Spending on psych drugs Up 150% Diagnosis of Depression 25% Inflated

According to a new report by the U.S. Agency for Healthcare Research and Quality (AHR&Q), U.S. spending on psychotropic drugs climbed from $7.9 billion in 1997 to $20 billion in 2004--that's an increase of 150% in just seven years. After years of marketing, these drugs now carry the most severe Black Box label warnings.

The sharpest rise in spending was for antipsychotic drugs (a.k.a. neuroleptics) which were approved only for use in managing schizophrenia and bipolar disorder--together these account for 2% of the population. Yet total purchases to treat these conditions more than tripled -- from $1.3 billion to $4.1 billion.

These second generation neuroleptics are the most toxic of all psychotropic drugs: they interfere with normal metabolic, endocrine, and cardiovascular function. Their mechanisms of action induce debilitating chronic disease--including hyperglycemia, insulin-resistant diabetes, stroke and heart attacks.

Antidepressants, the AHR&Q study found, accounted for more than half ($12.1 billion) of the total expenditures for psychotherapies in 2004. These drugs trigger psychosis and antisocial aggressive, violent, manic behavior posing threat of harm to self (suicide) and others (homicide). The drugs have not proven a clinical benefit. Instead, they have worsened the symptoms for which they were initially prescribed, such as stress or difficulty falling asleep. Antidepressants and antipsychotics have been shown to undermine mental and physical health in some persons for whom they were prescribed. The drugs disrupt normal mental and physiological functions and have been shown to induce psychosis, hallucinations, and suicidal behavior.

Why, people may ask, are these drugs so widely prescribed and how did they become blockbuster sellers? The answers are found in the unintended consequence of ill-advised laws that gave drug manufacturers too much influence on government policy
[Link] and in documents unearthed in litigation and in the subjective non-empirical diagnostic criteria. Company documents show that drug companies have engaged in aggressive marketing of these drugs despite knowledge of their hazardous effects--and they have actively influenced the diagnostic prescribing criteria.

A just released report in the Archives of General Psychiatry by investigators from New York University, Columbia University, University of Pennsylvania, and Rutgers, delivers a major blow to the validity of psychiatry's diagnostic criteria. The authors examined the distinctions used for diagnosing "major depression" and found that 25% of those "diagnosed" with "major depression" in accordance with the criteria set forth in psychiatry's diagnostic guide-the DSM -IV--are not clinically depressed. They are responding normally to traumatic life events.

The Washington Post correctly notes, "The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs." The most aggressive of these diagnostic chekclists is TeenScreen with its 84% false-positive misidentification rate.

The DSM-IV is a product under the influence of industry as has been documented by Drs. Lisa Cosgrove and Sheldon Krimsky: [Link] and [Link]

Further evidence of corruption behind the spiraling sales statistics for psychotropic drugs is documented in company reports and memos. Alex Berenson of The New York Times disclosed the content of Eli Lilly Zyprexa documents showing that the company concealed the evidence of harm produced from physicians and the public [Link]. Instead, the airwaves were flooded with false and misleading advertisements whose claims are contradicted by the evidence of the drugs' safety hazards. [Link] The FDA failed to intervene.

Industry, in collaboration (i.e. collusion) with influential mental health professionals and industry funded "advocacy" groups--including the American Psychiatric Association, the National Institute of Mental Health, Mental Health America, the American Academy of Child and Adolescent Psychiatry, the National Alliance for Mental Illness--succeeded in getting these drugs listed as first line treatments in psychiatry's prescribing guidelines hospital formularies.

TMAP--the Texas Medication Algorithm Project--is Big Pharma's psychotropic drug sweepstakes. [Link]

The academic architects of TMAP and TMAP promoters in state government and academia, should be questioned under oath to determine how the flow of cash from industry influenced the formulation and adoption of TMAP by numerous state mental health departments.

Of note: New York Governor Eliot Spitzer appears to have completely reversed his informed legal action in the public interest when, as Attorney General, he filed suit against GlaxoSmithKline to persuade drug companies to disclose the facts about drug safety to the public. As a newly elected governor, he made a political appointment to appease the mental health drug industry cartel.

Eliot Spitzer appointed Michael Hogan, PhD, Commissioner of NYS Office of Mental Health. Dr. Hogan was a pivotal promoter of TMAP and the expanded use of the most expensive psychotropic drugs when he headed the Ohio Office of Mental Health, and chaired the President's New Freedom Commission on Mental Health which gave TMAP a federal seal of approval. Dr. Hogan also serves on the National Advisory Council of TeenScreen, the other market expansion scheme. [Link]

Spending on psychotherapeutic drugs soars
By Joyce Howard Price April 1, 2007

Spending on antidepressants and other prescription drugs to treat mental disorders climbed from $7.9 billion in 1997 to $20 billion in 2004, an increase of more than 150 percent, a new federal report says.

"It is quite an increase. It is an important thing to take note of," said Marie N. Stagnitti, the report's author and a senior survey statistician with the U.S. Agency for Healthcare Research and Quality. The agency is part of the Department of Health and Human Services.
Purchases of psychotherapeutic drugs rose from 141.9 million to 244.3 million during the seven-year period. The number of people who reported buying these drugs increased from 21 million to 32.6 million during that time.
The study found that antidepressants accounted for more than half ($12.1 billion) of the total expenditures for psychotherapies in 2004. Spending for those drugs, which include commonly prescribed medicines such as Prozac, Paxil and Zoloft, more than doubled from $5.1 billion in 1997.

The total number of antidepressant purchases skyrocketed from 88.3 million in 1997 to 161.2 million in 2004, and the number of people who reported making such purchases increased from 15.3 million to 24.8 million.
The study found that the sharpest rise in spending was for antipsychotic agents, or medications used to manage schizophrenia, bipolar disorder and other psychotic disorders. Total purchases to treat these conditions more than tripled -- from $1.3 billion to $4.1 billion.
Likewise, total expenditures for central nervous system stimulants to treat pain and control seizures nearly tripled during the seven years --from $600 million to $1.7 billion. The number of people who said they bought at least one of these drugs increased from 2.1 million to 3.3 million, and the total number of purchases of such prescriptions swelled from 11.8 million to 19.7 million.
Meanwhile, purchases of sedatives, hypnotics and medicines to ease anxiety nearly doubled from $900 million to $2.1 billion. Total purchases of those drugs climbed from 24.5 million to 39 million, and the number of people who said they bought at least one of those drugs surged from 5.4 million to nearly 8 million.
Ms. Stagnitti said she is interested in doing more research in this area to determine factors involved in the increase. She thinks it is important to determine how socioeconomic background and insurance coverage influence access to drugs to improve mental health.
Attempts to get reactions Friday from professional or advocacy organizations such as the American Psychiatric Association and Mental Health America were unsuccessful.
But the National Institutes of Mental Health (NIMH) said on its Web site the "burden of psychiatric conditions has been heavily underestimated."
It said a massive study called the "Global Burden of Diseases" found that mental illness accounts for more than 15 percent of the disease burden in established market economies, such as the United States. "This is more than the disease burden caused by all cancers," NIMH said.

[Link]Washington Post
Criteria for Depression Are Too Broad, Researchers Say Guidelines May Encompass Many Who Are Just Sad

By Shankar Vedantam
Tuesday, April 3, 2007; A02

Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are used.

The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs.

Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says.

The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.

The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful -- but normal -- responses to life's stresses. Supportive therapy, on the other hand, may be useful -- and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression.

The researchers -- including Michael B. First of Columbia University, the editor of the authoritative diagnostic manual -- based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said.

An estimated one in six Americans suffer depression at some point in their lives. Under the more limited criteria the researchers urged, that number would be 25 percent lower.

"The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous," said lead author Jerome Wakefield, a New York University researcher who studies the conceptual foundations of psychiatry. "There is a trend to treat people in this somewhat mechanized way."

Said First: "One issue this would play out at is at the level of medication. If someone has a normal grief reaction, you wouldn't give that person an antidepressant, you would favor counseling. If someone has major depression you would be more likely to medicate. So this could influence how clinicians think about medications or psychotherapy."

Drawing the line between normal and abnormal suffering has long been controversial in psychiatry, because people who have no disorders often experience the same symptoms as those who do, but their reactions typically are less prolonged and intense. Where to draw the line involves a degree of subjective judgment: If the criteria are too strict, some people who are depressed may not receive help.

After First oversaw the writing of the current edition of the manual, for example, a number of doctors contacted him about difficulties they had in applying the diagnosis, First said. One described a patient who was feeling acute grief after the death of her dog. The manual says doctors need not diagnose depression if symptoms follow the death of a loved one, and the doctor wanted to know whether the death of a pet met the criterion.

That question, First said, illustrated how difficult it was to establish a set of criteria that could encompass the complexity of human sorrow: The death of a spouse or a family member, he said, was only one of many things that could cause an acute grief reaction.

But he warned that people who are in pain after a divorce or other stressful event should not conclude that they simply ought to "buck up." They should seek the counsel of clinicians who would take the time to explore what caused the symptoms and whether they need treatment.

Still, Wakefield and Allan Horwitz, a researcher at Rutgers University who studies the sociology of mental disorders, said their study, which was published in this month's issue of the Archives of General Psychiatry, pointed out that sadness has increasingly come to be seen as pathological in the United States. They have written a book called "The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder."

Pharmaceutical companies, the psychiatric profession and patient advocacy groups have all contributed to the phenomenon, Horwitz added. Companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease makes it easier to do studies, and psychiatry has come to think of itself as "the arbiter of normality," he said.

Patient groups, Horwitz added, think that the stigma attached to mental illnesses would be reduced if they were shown to be more common.

"The way in which people interpret their emotions is changing," Horwitz said. "People are starting to think that any sort of negative emotion is unnatural, that they can take medication and feel better. What that can also do is . . . make it less likely for people to make real changes in their lives that might be better than medications."

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