Anatomy of an epidemic

Whitaker begins his study with a reminder that the effects of antipsychotics , benzodiazepines and antidepressants were discovered as side effects during studies of antihistamines ( promethazine ), gram-negative antibiotics (mefenesin) and anti-TB drugs . At that time, the psychotropic mechanisms of action of these drugs were not known, and they were first called strong tranquilizers (now this group of drugs is called antipsychotics) because of their ability to cause “euphoric calm”, weak tranquilizers (now benzodiazepines) and stimulants (now antidepressants ) due to the ability to cause in patients the effect of "dancing in the wards" ^[6] . These drugs were developed during the boom of the pharmaceutical industry , triggered by the adoption of the Durham-Humphrey Amendment of 1951 , which gave doctors a monopoly on prescribing drugs, thus effectively merging the interests of doctors and pharmaceutical companies. In addition, during this period, pharmacists invented the so-called “magic pills”, which were unusually effective for certain symptoms of diseases such as diabetes , which gave reason to advertise psychotropic drugs according to a similar scheme. Only many years later, the mechanisms of action of psychotropic drugs were discovered, and based on these findings, the serotonin hypothesis of depression and the dopamine hypothesis of schizophrenia were developed.

According to Whitaker’s primary literature analysis, reduced serotonin and increased dopamine levels were observed in patients only after taking antidepressants and antipsychotics, but not before ^{[7] [8] [9] [10] [11] [12] [13] [ 14] [15] [16] [17] [18] [19] [20] [21] [22] [23]} .

There is still no clear and convincing evidence that monoamine deficiency causes depression; that is, there is no such real mental problem as the "deficiency of monoamines."

Original text

So far there is no clear and convincing evidence that monoamine deficiency accounts for depression; that is, there is no "real" monoamine deficit.

- Stephen Stahl Essential Psychopharmacology ^[24]

Whitaker also refutes the theory of “magic pills” in another way: he demonstrates the mythical nature of the widespread belief that the invention of chlorpromazine (chlorpromazine) made it possible to practically free psychiatric clinics from patients ^[25] . He begins by pointing out that in the late 1940s and 1950s, approximately 75% of those who had a first episode of schizophrenia completed treatment for no more than three years (chlorpromazine was released in 1955 ) ^{[26] [27] [28]} . It is further noted that the appearance of chlorpromazine did not improve recovery rates among patients who were first diagnosed with schizophrenia. In fact, according to Whitaker, the release of psychiatric clinics from patients was not facilitated by the emergence of antipsychotic drugs , but by the launch in 1965 of the state programs Medicare and Medicaid , which provided funding for nursing homes , but did not provide funding for psychiatric clinics, which naturally entailed a massive referral of patients from psychiatric clinics to nursing homes.

The author supports the idea of ​​using psychotropic drugs for mental disorders, but advocates their cautious prescription, rejection of the opinion that they “correct the chemical imbalance in the body” and for their short-term use ^[29] .

According to Whitaker, the mass prescription of psychotropic drugs to patients acquires the features of an iatrogenic epidemic: the cause of impaired functioning of the patient’s brain is actually the medications prescribed to him ^[30] .

The author believes that the aura of glory of “miracle drugs”, which at first accompanied psychotropic medicines, has long disappeared. He considers the active advertising of popular atypical antipsychotics “one of the most outrageous pages in the history of psychiatry, since one scientific study after another shows that their effectiveness is not at all higher than the effectiveness of first-generation antipsychotics” ^[31] .

Whitaker gives an example of the method of Professor Jaakko Seikkula from the hospital in Tornio ( Finland ), which prescribes medicines to patients in limited quantities, which leads to positive results ^[32] . Whitaker also believes that patients with a diagnosis of depression should exercise. For example, in the UK, exercise was so effective in depression that a doctor can prescribe exercise as a treatment. Studies have shown significant effectiveness of exercise, even in the short term ^{[33] [34] [35]} .

Whitaker warns against prescribing medications to children. The author notes that a child can be prescribed a whole “cocktail” of drugs in order to adjust his behavior, but as a result of such a careless attitude, after a few years the child can be turned into a disabled person ^[36] .

Whitaker spent one and a half years studying the materials for this book ^[30] . Some of the most important studies are available on the author’s website ^[37] .

• Controversy surrounding biopsychiatry
• Conflict of Interest and Clinical Research in Psychiatry
• The myth of mental illness
• The whole truth about drugs: a global conspiracy of pharmaceutical companies
• Breggin, Peter Roger

• Whitaker, Robert. Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. - Crown (Random House), April 13, 2010 .-- ISBN 978-0-307-45241-2 .

• Book home page at author's site, Mad in America
• Author keynote at Alternatives 2010 (funded by the Substance Abuse & Mental Health Services Administration of the US Department of Health and Human Services)

• Part one
• Part two
• Part three
• Part four