Over the past year, the debate over psychiatric drug use has become increasingly heated. The Journal of the American Medical Association (January 6, 2010) printed a review of a study that demonstrated that for all but the severest cases of depression, there was a negligible difference between antidepressant drugs and placebos. Newsweek (January 29, 2010) picked up the story and did a cover on the study and the value of psychiatric drugs. Concern about the efficacy of psychiatric drugs was also discussed in the New Yorker (August 23, 2010).

Indeed, the percentage of people incapacitated by mental disorders has been increasing dramatically over the last thirty years. This is not an increase in the number of people diagnosed with disorders but due to the medications introduced to treat the illnesses!

Robert Whitaker, an award winning scientific journalist (not a psychiatrist or psychologist) has amassed data and put the numbers and implications together clearly in his book, “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America”. This book has been both timely and relevant. Whitaker covers the history of psychiatry in America in a comprehensive manner, drawing on 50 years of literature and patient interviews. He asks a most important question … if psychiatric wonder drugs are so effective, why have the numbers of people on disability using these drugs increased dramatically?

His critics have horribly attacked him saying that he has been unethical for his reporting, which makes psychiatric medications look bad. After all, say his critics, some patients may hesitate to take the drugs if they know it might have serious negative effects. But the overall statistics are overwhelmingly bad in the long run, and his reporting revealed that despite evidence that medications are helpful in the short run (sometimes dramatically so), the long term story is radically different. In the long run, patients simply become more ‘tolerable’, chronically disabled individuals. Moreover, there seems to be evidence of a dramatic shortening of life, primarily from physical side effects.

When psychoanalysts and psychoanalytic therapists make recommendations that sensible psychoanalytic therapy by trained practitioners can help patients with a wide variety of disorders, it is useful to have books like “Anatomy of an Epidemic” as a reading available for a source of accurate information.

A recent article entitled, “Depressed? Don’t blame your genes” printed in the U.K.’s London Times caught my eye last month. It was published to coincide with January 18th, the day that many psychologists claim is the most depressing of the year. The article, written by Oliver James (author of “Britain on the Couch”) was an expose on the “crippling depression” that appears to be the modern scourge of our modern society.

James noted that many people are in the habit of blaming their genes and he cited the observation that many people continue to invoke the idea of a gene for depression. It turns out this assertion is complete hogwash and that one of the most interesting developments in recent years has been the growing conviction amongst scientists that genes play little or no role in depression. Indeed, James correctly notes that the Human Genome Project, which mapped all our species’ DNA, has not reliably identified a single example of a gene for mental illness whatsoever.

James and I are also in agreement that there is, in contrast, “buckers of evidence” supporting an environmental role in the development of depression. For example, the quality of care you receive in your early years, and the kind of society in which you live are big contributing factors for a person’s risk of developing depression. Hence, if the care a person receives during their first year of life was unresponsive, they are already at greater risk for depression, especially in that as a toddler they will then come to expect the worst.

James and I are also in agreement about what constitutes the ‘best cure’ or best treatment for depression. If you’re going to get better, you are going to have to talk to someone who can effectively find out what is really bothering you.  A major aspect of the work will need to involve some kind of examination of how parental care in the early years of your life affected you. I am in full agreement with James that psychodynamic therapy is usually a better bet for you than the much touted cognitive behavioural therapy (CBT).  James points out that recent studies are beginning to substantiate that the best talking cure, with some modification, is the one invented by Freud. Finally, unless a person is really desperate, they should exercise caution if intending to rely on anti-depressants for a ‘cure’. Apart from having to put up with some challenging and unpleasant side effects, in most cases, even if they do have an effect, it is no better than placebo.