A few years ago, while writing an article about the merits of psychiatric medications, I looked at whether the number of adults receiving a federal disability payment due to mental illness had significantly changed since 1987, which was the year that Prozac was introduced. Our society's use of psychiatric medications, of course, has soared since that time, and here's what I discovered: The number of adults, ages 18 to 65, on the federal disability rolls due to mental illness jumped from 1.25 million in 1987 to four million in 2007. Roughly one in every 45 working-age adults is now on government disability due to mental illness.
This epidemic has now struck our nation's children, too. The number of children who receive a federal payment because of a severe mental illness rose from 16,200 in 1987 to 561,569 in 2007, a 35-fold increase.
I wrote Anatomy of an Epidemic to investigate this epidemic, and this pursuit necessarily raises a very uncomfortable question. Although we, as a society, believe that psychiatric medications have "revolutionized" the treatment of mental illness, the disability numbers suggest a very different possibility. Could our drug-based paradigm of care, for some unforeseen reason, be fueling this epidemic?
To answer that question, you need to pore through the scientific literature for the past 50 years and piece together a documented account of how psychiatric drugs affect long-term outcomes. Do the medications help people stay well? Function better? Enjoy good physical health? Or do they, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness? Researchers have studied these questions in a variety of ways, and their results tell a story that is, to the say the least, startling.
Here is just one of many such studies. In the 1980s, Martin Harrow, a psychologist at the University of Illinois, began a long-term study of 64 newly diagnosed schizophrenia patients. Every few years, he assessed how they were doing. Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? The collective fate of the off-med and medicated patients began to diverge after two years, and by the end of 4.5 years, it was the off-medication group that was doing much better. Nearly 40% of the off-med group were "in recovery" and more than 60% were working, whereas only 6% of the medicated patients were "in recovery" and few were working. This divergence in outcomes remained throughout the next ten years, such that at the 15-year follow-up, 40% of those off drugs were in recovery, versus 5% of the medicated group.
As Harrow reported at the 2008 annual meeting of the American Psychiatric Association, "I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics."
This does not mean that antipsychotics don't have a place in psychiatry's toolbox. But it does mean that psychiatry's use of these drugs needs to be rethought, and fortunately, a model of care pioneered by a Finnish group in western Lapland provides us with an example of the benefit that can come from doing so. Twenty years ago, they began using antipsychotics in a selective, cautious manner, and today the long-term outcomes of their first-episode psychotic patients are astonishingly good. At the end of five years, 85% of their patients are either working or back in school, and only 20% are taking antipsychotics.
In Anatomy of an Epidemic, I report on the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness, and also the literature that details outcomes for children treated with psychiatric medications. My hope is that if our society can become informed about these long-term studies, then it could have a reasonable discussion about embracing other models of care--like the one pioneered by the group in Finland--that have proven to help people get better and stay well too.
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