We’re Only Hearing About the Quick Fix
“Does your life have signs of persistent anxiety?” the ad asks. “Should you see your doctor? . . . Ask your doctor about a nonhabit-forming medicine.”
People constantly are being encouraged to see their doctors for help with their fears, phobias and worries. (In fact, National Anxiety Disorders Screening Day was Thursday). I have a friend who has had a fear of cats all her life; another who has panic attacks if she drives on a freeway. If my friends went to a physician or psychiatrist, chances are that they would come away with a prescription for medication or possibly spend several years trying to find the origins of their fears. They would learn nothing at all about a proved nonmedical kind of psychotherapy that would be far more likely to help them.
The drug companies have succeeded brilliantly in persuading the public that antidepressants are the treatment of choice for feelings that range from the mild blues to severe depression. Now, they are launching a campaign to persuade everyone with feelings from mild anxiety to severe panic disorder to use them, too. SmithKline Beecham is awaiting clearance to market its antidepressant, Paxil, for “social phobias” and extreme shyness. Ads soon will tout Paxil as a solution for people who are “allergic to people.”
And yet, dozens of studies have shown conclusively that the effectiveness of any antidepressant, including the much-heralded Prozac, is far more modest than consumers have been led to believe. The public is largely unaware of the contradictory and disconfirmatory evidence about antidepressants and, more important, of why they are unaware of it.
The massive economic power of the pharmaceutical industry now controls much of the basic research on mental disorders, sexual problems and psychological functioning conducted in this country. Drug companies may embargo that research, deciding whether, when, and where it may be published, if at all. They set up their own research institutes, sponsor professional conferences and fund scientists. They can thereby direct the kinds of questions scientists investigate--and the kinds of answers they find. Sex researchers can get thousands of dollars from Pfizer, which manufactures Viagra, to study medical theories of sexual dysfunction, but not a cent for the study of kissing, coercion or communication.
The influence of drug companies is sometimes buried under layers of corporate structure. In his book, “Blaming the Brain,” neuropsychologist Elliot Valenstein offers the example of PCS Health Systems, an agency that provides information to physicians, pharmacies and health care managers on ways to “improve patient care and lower health care costs.” PCS informed its constituents that Prozac is the antidepressant of choice, being cheaper than Zoloft or Paxil and more effective. It did not report any of the considerable evidence disputing this claim. PCS Health Systems is totally owned by Eli Lilly, which manufactures Prozac.
But antidepressants have serious limitations. First, a large part of the effectiveness of any new drug for emotional problems is a result of the enthusiasm surrounding it and the expectation of a quick cure. When these “placebo effects” decline, many drugs turn out to be neither as effective as promised nor as widely applicable. Findings like this are well-known to research psychologists, such as Irving Kirsch and Guy Saperstein. In their analysis of 19 studies involving more than 2,000 depressed patients, they found that 75% of the drugs’ effectiveness was due entirely to the placebo effect or other nonchemical factors.
Second, little or no research has been done on the effects of taking antidepressants (or many other drugs) for many years. Already there are suspicions that antidepressants, including Prozac, may cause cardiovascular problems in some vulnerable people after long-term use. Most new drugs are often tested on only a few hundred people for only a few weeks, even when the drug is one that patients might take for many years. For example, the Food and Drug Administration warned that “Because clomipramine [for obsessive-compulsive disorder] has not been systematically evaluated for long-term use (more than 10 weeks), physicians should periodically reevaluate the long-term usefulness of the drug for individual patients.” In an era of managed care, how many of them will do so?
Third, because antidepressants have unpleasant side effects--including dry mouth, headaches, constipation, nausea, restlessness, gastrointestinal problems, weight gain and, in many patients, decreased sexual desire and blocked or delayed orgasm--the large majority of people given these medications stop taking them. Such individuals are likely to relapse as soon as they do.
The alternative to medication is not some generic form of “talk therapy.” My friend with the cat phobia spent years with psychiatrists, and they all agreed that it was a traumatic nightmare in her childhood that first generated her fear. Unfortunately, insight about the origins of one’s fears or blues does little or nothing to alleviate them.
However, a specific kind of psychotherapy repeatedly has been found to be beneficial for emotional and behavioral disorders such as depression, anger, anxiety, panic attacks, stress-related illnesses, and obsessive-compulsive disorder: cognitive-behavior therapy, a program that helps people identify and change the thoughts and actions that are keeping them unhappy or fearful.
In hundreds of studies involving thousands of people, cognitive-behavior therapy has been shown either to be more effective than medication or as effective, without side effects and high relapse rates.
Obviously, some people benefit from medication. It would be as foolish to claim that cognitive-behavior therapy helps everyone as it is to claim that drugs do. And, unfortunately, many therapists are uninformed about the benefits of cognitive and behavioral procedures and unskilled in their application. A person suffering from panic disorder would do better to take an antidepressant than spend months or years with a psychotherapist who is ignorant of these procedures.
But in this biomedical age, consumers must protect themselves against the one-sided story they will hear from drug companies, ads and physicians. We must ask about side effects, long-term risks and alternative therapies that might be just as effective. We must be alert to any financial interests that researchers may have in a product or finding. And we must try to resist the allure of the next miracle cure for the next everyday problem. If hope could be bottled, its sales would leave those of Viagra in the dust.
