A Pill is Not Enough

Psychologist Michael Browne on the failures of antidepressants

You wouldn't know it from reading local newspapers, but the antidepressant revolution is in trouble. Last year, the British government concluded that for children, the popular antidepressant Paxil carried a host of troubling side effects (including an increased risk of suicide) that outweighed potential benefits. The warnings were soon broadened to include most major antidepressants, and sparked a flood of concern in this country. The U.S. Food and Drug Administration waffled for months, but was finally forced in March to ask the manufacturers of 10 antidepressants to warn doctors and patients that both adults and children taking the drugs should be closely monitored for worsening depression and thoughts of suicide.

The bad news opened a Pandora's box of sorts, and in recent months medical journals, the Washington Post, Los Angeles Times, and Wall Street Journal have carried a steady stream of horrifying disclosures: that clinical drug trials resulting in negative findings are routinely ignored; that the existence of these "file-drawer studies" is well-known among researchers, psychiatrists, and FDA policymakers; that the bulk of the studies concerning children show no benefit whatsoever from antidepressants; and that studies involving adults aren't much more convincing. Perhaps most shocking of all, FDA honchos even conceded that for some time they opposed adding warning labels to antidepressants because they feared it would expose the pharmaceutical industry to liability.

So far none of this seems to have had much effect on the sales of antidepressants in this country. According to a study published in the April issue of Psychiatric Services, use of these drugs by children and adolescents is growing by 10 percent a year; the fastest-growing user group is preschoolers. In 2003, sales of central nervous system drugs totaled $37 billion, $9 billion more than the combined total for all drugs that treat the heart, arteries, and blood pressure, according to the New York Times.

Michael Browne: "I really began to wonder if medication helped any of my patients."
Craig Lassig
Michael Browne: "I really began to wonder if medication helped any of my patients."

Dr. Michael Browne is a psychologist who has spent 25 years in private practice in Minneapolis and an adjunct University of Minnesota faculty member who supervises psychiatric residents learning to conduct therapy. About five years ago, he was asked to give a talk about mental health issues to residents training to be family practice doctors. In preparation, he started reading research on antidepressants. "I was just completely astounded by what I found," he explains. "The claims for the effectiveness of antidepressants were greatly exaggerated. I looked closely at the evidence, and it's not there."

Trained as an experimental psychologist at Indiana University, Browne went on to write and lecture critically about the mental health industry's growing dependence on antidepressants. His most recent paper, "The Medicalization of Emotional Distress and the Future of Psychotherapy," argues that the mental health profession needs to kick its drug habit, and lays out half a dozen reasons why that will be tough.

Browne presented the paper in April at the Minnesota Psychological Association's annual conference, held at the Bloomington Holiday Inn Select. As if to punctuate his thesis, attendees had to thread their way through a foyer where drug companies and other vendors were creating good will and handing out goodies. Groups of students wearing "Itasca Community College Psychology" sweatshirts snapped up GlaxoSmithKline's facial tissue, hand lotion, and some large turquoise clocks emblazoned with the Paxil logo. Apparently oblivious to the irony, several clinicians took notes with light-up pens courtesy of Seroquel.

Following his presentation, Browne sat down with City Pages to discuss his work. What follows are excerpts from that conversation.

City Pages: Before you started your research, had you been sympathetic toward the idea of antidepressants?

Michael Browne: I had always believed that they must be effective. Everyone said they were. It was disorienting for a while. Probably the biggest impact was that I really began to wonder if medication helped any of my patients.

I wrote a couple of papers about the subject, and I just kept pulling in more information. And I found that the evidence was exaggerated not just for antidepressants, but for virtually every single psychiatric medication. I talked to colleagues, and their reaction was, "Well, it can't be that bad. They wouldn't be giving out all of these drugs if they didn't work."

CP: All of a sudden the questions you've been asking are au courant. There's bad news out of the FDA, reports of negative studies. How do you hear about this stuff?

Browne: You know where psychiatrists get their information? They get their information from the drug companies. I think psychologists tend to get their information from psychiatrists. I think psychologists tend not to read and study the research on medication. They think it's the psychiatrists' responsibility.

Psychologists tend to have a couple of psychiatrists they have a good working relationship with. When somebody wants an antidepressant, they can say, "Go see Dr. Jones." But it goes the other way, too. "I saw this woman and she's on medication, but she also needs psychotherapy." So it certainly is an I'll-scratch-your-back-if-you'll-scratch-mine kind of relationship. I know psychiatrists here who do all psychotherapeutic work and not medication. But they are very much in the minority.

CP: When antidepressants came on the market, did you envision them becoming as popular as they are?

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