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Emperor’s new chemicals?

Emperor’s new chemicals?

Neuropsychopharmacology under attack

Some psychologists and psychiatrists now claim that major neuropsychopharmaceuticals are the cause of the precipitous rise of mental disorders in the Western world. It now appears that 50% of the adult populations of major countries are alleged to have suffered from a mental illness at least once in their lifetime. According to the National Institutes of Mental Health in the US, as cited by Marcia Angell in the New York Review, the illnesses fall into the four broad categories of anxiety, mood, impulse control, and substance abuse disorders. Marcia Angell is a Senior Lecturer in Social Medicine at Harvard Medical School and a former editor of the New England Journal of Medicine.

The critics Marcia Angell cites argue that these disorders emerged to fit the drugs that were invented rather than the opposite, i.e., the drugs were not designed to treat the disorders because no one had a clue to how the mind worked in patients with mental disturbances. The pharmacologists who originally discovered the precursors of the major psychoactive drugs meant them to be active against infections. The revolution happened close to 50 years ago when chlorpromazine was discovered incidentally to be effective against psychosis, meprobamate was found to work in anxiety, and iproniazid turned out to relieve some symptoms of depression, although it was a mystery how they worked. These events and their consequences are discussed in the three recent books that Marcia Angell considers in the New York Review, The Emperor’s New Drugs by the psychologist Irving Kirsch, Anatomy of an Epidemic by the journalist Robert Whitaker, and Unhinged: The Trouble with Psychiatry by the psychiatrist Daniel Carlat.

The new drugs and their successors had neurochemical effects, and the authors of the books argue that the effects, including for example the rise of serotonin and noradrenaline in brain tissue, or the blockade of dopamine receptors, were used to invent the causes of the mental disturbances that the drugs were thought to treat, such as noradrenaline and serotonin deficiency in depression, or dopamine excess in schizophrenia. The authors further argue the interesting point that the drugs may not really work as well as reported, and that the efficiency of the treatment greatly has been exaggerated by the pharmaceutical industry.

The authors discovered that a higher number of negative than positive clinical studies had been submitted to the FDA in the cases of the six most popular psychoactive drugs in the US, but only the positive studies had been published. Interestingly, the authors also argue that patients generally used the side-effects rather than any main effects of non-placebo test compounds to infer the nature of the treatment in placebo-controlled and doubly-blinded studies, because placebo drugs with side-effects appeared to be as active as the test drugs. The authors claim that it is this breach of the blinding that explains the positive effects of the test drugs in the minority of trials where test drugs were shown to be more active than placebo drugs with no side-effects. Look for the devil in the details, please.

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