2 Reports: Spending on psych drugs Up 150%_Diagnosis of Depression 25% Inflated
VERACARE
Promoting Openness, Full Disclosure, and Accountability
http://www.ahrp.org <http://www.ahrp.org/> and http://ahrp.blogspot.com
<http://ahrp.blogspot.com/>
FYI
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.
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
http://ahrp.blogspot.com/2007/03/damaging-impact-of-pdufa-and-conflicts.html
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:
http://www.tufts.edu/~skrimsky/PDF/DSM%20COI.PDF and
http://www.ahrp.org/cms/content/view/144/27/
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 th ecompany concealed the evidence of harm produced from
physicians and the public.
http://ahrp.blogspot.com/2006/12/eli-lilly-documents-show-risks-of.html
Instead, the airwaves were flooded with false and misleading advertisements
whose claims are contradicted by the evidence of the drugs' safety hazards.
http://ahrp.blogspot.com/2006/12/eli-lilly-documents-show-lilly.html 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. http://www.ahrp.org/cms/content/view/411/29/
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 appointed 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. http://www.teenscreen.org/cms/content/view/19/47/
Contact: Vera Hassner Sharav
212-595-8974
vera...@ahrp.org <mailto:vera...@ahrp.org>
http://www.washingtontimes.com/national/20070401-120128-5227r.htm
THE WASHINGTON TIMES
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.
~~~~~~~~~~~~
http://www.washingtonpost.com/wp-dyn/content/article/2007/04/02/AR2007040201
693.html
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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