To reduce the rising burden of mental disorders around the world, the Lancet Commission on Global Mental Health and Sustainable Development has declared a need to increase psychiatric services globally, which should include an effort to “reduce the cost and improve the supply of effective psychotropic drugs for mental, neurological, and substance use disorders.”
While reducing the burden of mental disorders is certainly a laudable goal, we believe that implementing this plan will increase the global burden of mental disorders rather than decrease it.
Following the American Psychiatric Association’s publication of the third edition of its “Diagnostic and Statistical Manual” (DSM III) in 1980, there has been a remarkable expansion of the psychiatric enterprise in the United States and other developed countries. That expansion, which included dramatically increasing the use of psychiatric drugs, offers a lesson from the past that helps predict the effect of a planned “global” expansion of psychiatric services.
After DSM III was published, the main models of depression and other major mental disorders held that they were brain illnesses caused by chemical imbalances, and that psychiatric drugs could help fix these imbalances. The antidepressant Prozac, the first serotonin-specific reuptake inhibitor (SSRI), hit the market in 1988. It was touted as a wonder drug, and our society’s use of antidepressants and other psychiatric drugs soared. Today in the United States, more than one in five adults — and more than one in 20 children and adolescents — take a psychiatric drug on a daily basis.
Yet even as more and more people have been getting medical treatment for psychiatric disorders, the number of adults on government disability due to these disorders has more than tripled since 1987. The number of children so disabled by psychiatric disorders has increased more than 30-fold during this period.
The same correlation is seen in country after country that has adopted widespread use of psychiatric drugs and, in particular, the regular use of antidepressants. These countries have all seen sharp increases in disability due to mental disorders.
While this rise in disability may be due to many factors, there are two ways that increased use of antidepressants can contribute to it. Although antidepressants may provide a small benefit over placebo over the short term, there have now been a number of studies concluding that these drugs increase the risk that a person will become chronically depressed over the long term. Researchers have dubbed this drug-induced worsening “tardive dysphoria,” meaning that SSRIs are causing a biological change that often leads to persistent dysphoria, a state of profound unease or dissatisfaction.
In addition, one of the risks of taking an antidepressant is that it can trigger a manic reaction. When this occurs, the individual may be diagnosed with bipolar disorder, which is seen as a more serious illness than depression. A large study done by Yale investigators found that taking an SSRI antidepressant more than doubles the risk that a depressed person will convert to bipolar disorder.