The New Prozac Nation: Psychiatry Gone to the Dogs

From the L.A. Times:

THEY are the new "Prozac Nation": cats, dogs, birds, horses and an assortment of zoo animals whose behavior has been changed, whose anxieties and fears have been quelled and whose owners' furniture has been spared by the use of antidepressants. Over the last decade, Prozac, Buspar, Amitriptyline, Clomicalm — clomipromine that is marketed expressly for dogs — and other drugs have been used to treat inappropriate, destructive and self-injuring behavior in animals.


It's not a big nation yet. But "over the past five years, use has gone up quite a bit," said veterinarian Richard Martin of the Brentwood Pet Clinic in West Los Angeles. Half a decade ago, no more than 1% of his patients were on antidepressants. Now, Martin estimates that 5% of the 8,000 cats and dogs seen at the clinic are taking drugs for their behavior.

Speaking of canines, I can just see the pharmaceutical companies salivating like Pavlov's dog over this news. Americans have consistently proven that we'll spare no expense for the furry members of our families so the potential income from pet mental health is beyond imagination. I predict that Prozac Puppy Chow is on the horizon. What I want to know is if suicide rates increase among household pets, will PETA intervene?

I couldn't help noticing that the psychiatric treatment of four-legged creatures is superior to that of many of their human counterparts. The article cites one veterinarian who says that dogs are not intended to stay on antidepressants for life. "We don't have specific studies on long-term use." The article goes on to say that most vets prefer to taper their patients' use of the drugs. "We try to use these medications short-term," says another veterinarian, "because they are not without side-effects." If only more physicians exercised the same caution. I'm sure human physiology isn't any better suited to endure sustained treatment with brain-altering medication and, given the fact that the popular class of antidepressants known as selective seorotonin reuptake inhibitors only appeared on the scene in the late 1980's, we have yet to discover what adverse effects accompany long-term use.

An Equal-Opportunity Disorder

The media are abuzz with the findings of a recent study indicating that men are almost as likely (5.5 percent of men) to be compulsive shoppers as women (6 percent of whom engage in the behavior).

The complete findings of the study appear in the current issue of a major national publication. No, not Cosmopolitan or GQ, as you might expect, but the American Journal of Psychiatry. If you're wondering why excessive spending is of interest to medical professionals, it's because, in yet another instance of the medicalizing of life (i.e., reducing all manner of life's problems to illness), the American Psychiatric Association claims that those who frequently experience irresistible and irrational urges to buy things suffer from a condition known as "compulsive buying (or shopping) disorder." According to one account of the study's findings, "Sufferers often rack up thousands of dollars in debt and lie to their loved ones about their purchases. The consequences can be bankruptcy, divorce, embezzlement and even suicide attempts." Researchers conclude that one in 20 adults in the U.S. "suffer" from the "condition."

What is not being as widely broadcast is the fact that this study was funded by an educational grant from Forest Pharmaceuticals Inc. (see small print at the end of the above linked article), whose speaker's bureau includes both the senior author (Lorrin Koran) and co-author (Elias Aboujaoude) of the compulsive shopping study. What makes this connection so interesting is the fact that three years ago another study, also funded by a grant from Forest Labs, reported that a commonly prescribed antidepressant called citalopram (which Forest Labs just happens to manufacture) might be useful in alleviating compulsive shopping disorder. It comes as no surprise that Lorrin Koran was this study's lead researcher as well.

Of course, the fact that those researching a drug's effectiveness are in the employ of the pharmaceutical company that manufactures it does not in itself discredit the research. However, it should at least raise suspicion about just how objective the research is. I've been doing a fair amount of reading lately about the marketing strategies of pharmaceutical companies and it's distressing, to say the least. In their book Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All into Patients, Ray Moynihan and Alan Cassels write:

Psychiatry's intimate relationship with the pharmaceutical industry has become notorious. When the former New England Journal of Medicine editor Dr. Marcia Angell published her famous editorial "Is Academic Medicine for Sale?," it was this group of specialists that she chose to illustrate her point. She wrote that when journal staff were searching for an experienced and independent psychiatrist to write a review article about antidepressants, they had a great difficulty finding one, because only "very few" in the entire United States were free of financial ties to the drug makers (25-26).

Now that it has been "established" that compulsive spending is not just a women's issue, as previously thought, the market for drugs promising to treat the condition has been expanded, much to the pharmaceutical companies' glee, not to mention the relief of those now liberated from any moral evaluation of their insatiable appetites in the name of medical science.

Christians and the Psychiatric Culture

Last night I finished reading a book I mentioned here a few weeks ago, Will Medicine Stop the Pain?: Finding God’s Healing for Depression, Anxiety, and Other Troubling Emotions by Elyse Fitzpatrick and another biblical counselor, Laura Hendrickson, a physician who formerly practiced psychiatry. The book targets women since, according to the American Academy of Family Physicians, twice as many women as men will experience depression in their lifetime.Hendrickson not only prescribed antidepressants to her patients but for a period took them herself to treat diagnosed depression and bipolar disorder. She candidly relates her experiences with childhood rejection, subsequent emotional instability, and drug-induced confusion including suicidal and homicidal thoughts. Other first person accounts from Christian women who have struggled with depression appear throughout the book.

The authors explain how modern psychiatry frequently operates on the premise that human beings are reducible to our biochemical components. Intense emotional pain is therefore concluded to be the result of physical disease. They contrast this materialistic perspective with a biblical view of the person as consisting of the uniting of the outer man (the physical body including the brain) and the inner man which is referred to biblically by terms like the heart, mind, spirit, and/or soul. Fitzpatrick and Hendrickson acknowledge that the body can affect and influence the heart and vice versa. They also concede that there are real, empirically verifiable diseases of the brain (as well as brain injuries) that can have negative effects on one’s perception, cognition, and moods. However, they point out that there are no tests for so-called imbalances in brain chemistry for which antidepressants are said to be correctives. They also claim that emotional pain is intended to inform us what is going on in our hearts so that we might avail ourselves of the resources that are ours in Christ to experience heart transformation.

Fitzpatrick and Hendrickson take great pains to caution readers currently on antidepressants against deciding to go off them without medical supervision.  One of the medical professionals frequently cited is Joseph Glenmullen, a psychiatrist who teaches at Harvard Medical School and is also in private practice. I had seen him on ABC's Prime Time Live two years ago and had thought at the time of picking up one of his books but never got around to it. (Dr. Glenmullen's responses to Prime Time viewers' questions about antidepressant side effects and withdrawal are available here.) Glenmullen authored Prozac Backlash and more recently, The Antidepressant Solution which I’m in the midst of reading.

While he prescribes antidepressants on a limited basis, Glenmullen has been a very outspoken critic of the pharmaceutical companies' campaign to market them to physicians and the general public. He believes that the majority of Americans currently taking them are doing so unnecessarily. He is also very concerned that many physicians, who are often reliant upon the drug companies for their information about the drugs and their effects, are ignorant about antidepressant dependence, withdrawal, and how to safely taper patients off them. It’s frightening to learn how misleading pharmaceutical companies have been in their pushing of various medications, many times suppressing evidence of ineffectiveness and/or harmful side effects. According to Glenmullen, ample evidence exists indicating that in some people, antidepressants can create the very symptoms they were prescribed to treat. And in some cases, such a dependence is built that serious symptoms can result from forgetting to take the pills at their proper time. When this happens, patients often think that they are having a relapse when, in actuality, the drug is responsible for their problems.

I can't recommend the above books highly enough to those taking antidepressants (whether male or female) and those who care about someone who is. Readers may also be interested in acquiring a Mars Hill Audio Journal interview with David Healy, a British psychiatrist and author of The Antidpressant Era and more recently Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression on antidepressants and the concept of disease.

When one takes into consideration that the disorders the psychiatric community labels people with, are not scientifically validated, there is much cause for both alarm and caution. I’m especially concerned because I know numerous Christians who have bought the well-publicized line that taking antidepressants is analogous to taking insulin or other medication designed to treat biologically detectable illnesses. In a chapter on biological psychiatry in his book Seeing With New Eyes: Counseling and the Human Condition Through the Lens of Scripture, David Powlison makes what I believe is an accurate observation:

The church typically lags a bit behind the culture's way of thinking. But the ethos and practice of biopsychiatry are deeply affecting the church already. If it's broken, or even just not working optimally, it can be fixed from the outside by a drug: better living through chemistry. In your ministry and in your church you are probably already facing the ethos and the practices. Many people in both pew and pulpit are on mind-, mood-, and behavior-altering drugs. We all increasingly face the ideas and knowledge claims, too. The cover story in Time magazine informs the everyday queries and choices of Christian people. Eventually such ideas make it into the educational system as the received wisdom of the culture with which to disciple the next generation (p. 243)

The more believers uncritically accept the therapeutic ethos that so permeates our culture, the less relevant and precious the gospel will seem.

Related Tags: depression, antidepressants, mental illness, psychiatry, Elyse Fitzpatrick, Laura Hendrickson, Joseph Glenmullen, David Powlison, David Healy, counseling, psychology, biblical counseling