Anne Harrington Explores the Role of Drug Marketing in Mental Illness: Shots

Anne Harrington, historian and professor at Harvard, believes that pharmaceutical companies have played an excessive role in determining the treatment of mental illness in the United States, which has resulted in an increase in the use of antidepressants.

Harrington's new book, Fixers of the mind: the troubled research of psychiatry on the biology of mental illness, describes the history of psychopharmaceuticals, such as Prozac and Xanax, which have been used to treat depression and anxiety, as well as lithium, the first drug to treat what is now called bipolar disorder.

According to Harrington, prior to the 1970s, the company tended to distinguish forms of depression that should be medically treated from depressions caused by "bad things in your life," which we thought would be best treated by therapy. the speech.

But when pharmaceutical companies started marketing antidepressants, the treatment of many people deviated from speech therapy. Harrington says this change has not always served patients well.

"We do not know enough about the biology of these mental disorders to know if some of the reasons are biological – in the sense that medicine likes to consider these things as illnesses – and if that's just because they have problems, "says Harrington. "I would like to see a wider and more pluralistic set of options."

Interview highlights

Why did the patient pool for anti-anxiety drugs increase so much in the late 1970s?

There was a huge market for anti-anxiety drugs. … In 1978, I think about 2.2 billion Valium tablets were sold in a year. It was the best-selling prescription drug of all time in the 1970s. And it was an anti-anxiety medication, but then it turned out that it was an addiction and people could not get out of it. The market for benzodiazepine pellets. But where are these people – what are we going to do for this type of patients?

Well, we've known for a long time that one of the symptoms of depression was often anxiety. And so, it became possible to think, "Well, maybe those patients who had already been diagnosed with anxiety actually suffer from depression with a presentation of acute anxiety, and maybe that antidepressants will help. "And they did it.And so you have the growing pelvis of people suffering from" depression. "We have the appearance of depression in the way we think now – the colds of psychiatry.

You have also experienced an evolution in which an earlier distinction erased by the field had been erased: forms of depression to be treated medically and forms of depression considered neurotic or reactive and caused by bad experiences in your life, and It has been widely accepted that treatment with speech therapy is necessary. But if drugs help everyone, then maybe these distinctions, they say, are not so important; Perhaps more important is the severity of the symptoms. And at some point, the symptoms are serious enough [that] the medications can then be what you choose to prescribe to the patient.

Why has Prozac changed the game in psychiatry?

The irony of the resounding success of Prozac is that its manufacturer, Eli Lilly, did not expect much. The Prozac is put on the market, and because it was designed to be safer [than previously available antidepressants]people are starting to prescribe it. General practitioners and psychiatrists prescribe Prozac to other brands and also prescribe it to patients who may have already hesitated to prescribe what would be perceived as a more dangerous tricyclic antidepressant.

The market for this antidepressant is therefore growing in part because the pool of patients to whom it is prescribed is increasing dramatically.

Why is the antidepressant market at a standstill?

The enormous developments that occur in the history of depression and antidepressants occur in the late 1990s, when various studies seemed to increasingly suggest that these antidepressants – even if they helped many people – compared to placebo versions of themselves, do not seem to do much better. And this is not because they do not help people, but because placebos also help people. I think that just taking Prozac can have a powerful effect on your depressive state. However, for a drug to be put on the market, it must beat the placebo. If he can not beat the placebo, the drug fails.

On lithium, the first drug to treat bipolar disorder

The first thing to know about lithium to understand its strange place in the history of psychiatry is that unlike all other drugs, it was not invented in a laboratory. It's an element. It is found in the natural world. And we find, for example, in some types of spas in Europe, which once boasted of the high lithium content of their drinking water. And so he had his place in the spa culture. There was a place like a tonic of well-being. It was for a while an ingredient in a new lemon-lime soft drink that became very popular in the 1950s and was renamed 7UP. [which doesn’t contain lithium today].

But there was this earlier history of lithium. And then lithium … is used in all kinds of other things that have nothing to do with the health industry. But his fortune as a product in the health care sector is on the rise when a lithium compound is used as a base for a salt substitute that is believed to end up causing heart problems and even death. . And so, there is a warning sent by the AMA and then by the FDA, according to which these salt substitutes – "remove them from the market.This is a dangerous drug". Thus, the emergence of lithium in psychiatry emerges in the context of two relevant facts: the first, it has a reputation [all of a sudden] to be dangerous and, secondly, it will not bring much money back to a pharmaceutical company because it can not patent. … I think a lot of people say that it is a very good medicine. And there are people who still take lithium. The problem with lithium [for drugmakers] it is that it was not profitable.

Why pharmaceutical companies leave the psychiatric field

Since the 1960s, no good idea has been found for finding new biomarkers or targets. The only exception is ketamine, which targets a different set of biochemical systems. But R & D is very expensive. These drugs are now, for the most part, off patent. … [The pharmaceutical companies’] Efforts to introduce new drugs in this proven way – with a handyman here and a handyman out there – are facing generally unexplained but unmistakable problems with the placebo effect.

But that does not mean that the drugs do not work. It simply means that the placebo effect is really strong. But the logic of clinical trials is that the placebo effect is nothing and that you have to be better than nothing. But, of course, if the placebo effect is not just nothing, then you may need to rethink what it means to test a drug. Now, this sort of thing goes beyond what historians should talk about, but it seems that the pharmaceutical company has a big problem with placebo.

Sam Briger and Mooj Zadie produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin have adapted it for the Web.