Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker

An epidemic is raging in the United States of America, an epidemic of crippling and sometimes deadly disease. The disease is bipolar disorder, and the chief cause is the pharmaceutical industry.

That’s an astonishing charge, but author Robert Whitaker drives the point home with a vengeance. After reading this book, you will never look at our Medical-Industrial Complex the same way again.

The phrase “bipolar disorder” was invented only recently, but episodes of mania alternating with depression have been described as far back as Hippocrates. But the condition has morphed into a new and much more pernicious form. Since the introduction of psychotropic medications, the number of patients disabled by this condition has soared.

The year 1955 saw the introduction of Thorazine, the first drug touted specifically as a treatment for mental illness. That year, only about 50,000 individuals were confined to state and county hospitals for affective disorders – major depression and bipolar disorder, or “Manic depression,” as it was called then. An estimated one-fourth of those belonged to the latter category, exhibiting alternating episodes of both depression and mania. Today, after a dizzying variety of psych medications have been made available, a staggering 1.4 million Americans are receiving SSDI or SSI disability payments for these conditions.

Note this is not just an epidemic of overdiagnosis, although no doubt that is occurring as well. We’re not talking about the number of people labeled bipolar – we’re talking about the number of people who are disabled by that condition.

The explosion of bipolar disorder is clearly related to the use of psychotropic drugs. As far back as 1993, the American Psychiatric Association acknowledged that “All antidepressant treatments, including ECT, may provoke manic or hypomanic episodes.” A survey of the members of the Depressive and Manic Depressive Association found that 60% of them became bipolar after being diagnosed with depression.

Moreover, in the pre-psych meds era, manic-depression was largely a self-limiting condition. The majority of people with this condition had only one episode. Few had more than three, with long symptom-free periods in between. Something like 70-90% of them returned to their former social roles as parents, spouses, workers, homemakers.

Today, while the number of people disabled by bipolar disorder has skyrocketed, their long-term outcome has gotten almost immeasurably worse. Today doctors are seeing more and more rapid cycling between depression and mania, slower recovery, shorter symptom-free episodes, and progressive long-term decline. In the pre-psych meds era, one of the hallmarks of manic-depression was that patients’ cognitive abilities remained intact. Today, bipolar patients are exhibiting the same long-term cognitive decline characteristic of patients with schizophrenia – the most severe form of mental illness there is. Today only about one-third or fewer bipolar patients return to their former social roles. A study of bipolar patients found their social lives were nearly as impoverished as those with schizophrenia.

The convergence in outcomes between schizophrenic and bipolar patients began at the same time the members of both groups began to be treated with the same “drug cocktails,” often including so-called “antipsychotic” drugs. Well-documented side effects of these include not just cognitive decline but also cardiovascular problems, diabetes, obesity, and thyroid dysfunction – all of which are now plaguing bipolar patients.

All this led Harvard psychiatrists Huxley and Baldessarini to comment:

“Prognosis for bipolar disorder was once considered relatively favorable, but contemporary findings suggest that disability and poor outcomes are prevalent, despite major therapeutic advances.”

Advances???

The epidemic has even spread to children. In the pre-psych meds era, bipolar disorder was diagnosed in children so rarely that most clinicians believed that juvenile bipolar disorder simply did not exist. Today estimates of the number of children suffering from this disorder are as high as one out of fifty.

Whitaker details the history of this epidemic, as well. In the 1970’s, doctors began prescribing Ritalin to large number of children labeled “hyperactive,” children who, in previous decades, might have been considered merely “naughty” or “fidgety.” (No other nation in the world does this, by the way – certainly not on the scale we do. The United States, with less than five percent of the world’s population, accounts for a staggering 75% of the stimulants consumed by children.) Ritalin is a drug similar to amphetamines in its chemical structure and to cocaine in its mode of action. Mania and psychotic symptoms were already well-known side effects of both cocaine and amphetamines.

In 1976, an article appeared in the American Journal of Diseases of Childhood describing five children suffering from this hitherto unheard-of condition. Three of the five had been treated with either Ritalin or antidepressants. Two years later, another article appeared, documenting bipolar disorder in nine children, seven of whom had been previously treated with psych meds. In 1982, Strober and Carlsson reported that twelve of sixty adolescents treated with antidepressants became bipolar. Instead of concluding that antidepressants caused their illness, they argued, bizarrely, that the antidepressants had merely unmasked a pre-existing condition. 

This “unmasking” proceeded apace. The late 1980’s and the 1990’s saw an explosion in the number of prescriptions for stimulants and antidepressants given to children, and along with that was an explosion in the number of angry, out-of-control children admitted to hospital psychiatric wards.

Just how big is this epidemic? Whitaker provides us with some sobering figures. Doctor Joseph Biederman of Harvard Medical College and Massachusetts General Hospital reported that after four years, 12% of children treated for Attention-Deficit-Hyperactivity Disorder displayed symptoms of bipolar disorder that were not present when the initial diagnosis of ADHD was made. Today an estimated 3.5 million children are being given stimulants for ADHD. Assuming 12% of them become bipolar, that’s four hundred and fifty thousand bipolar youth.

It gets worse. Barbara Gellar of the University of Washington found that nearly half of prepubertal children treated for depression had become bipolar during a ten-year follow-up period. Since 2 million children currently are being treated with SSRI’s for depression, this works out to something like one million bipolar youth.

In 2008, the General Accounting Office reported that over 600,000 young adults between 18 and 26 were suffering from bipolar disorder. This figure was surely a lowball estimate, since it didn’t include young people who were homeless, incarcerated, or institutionalized.

This is not about curing mental illness. It’s about creating mental illness, on an industrial scale.

We have already noted that the long-term prognosis for bipolar adults had gotten almost unimaginably worse since psych meds were introduced. The outlook for this new, iatrogenically manufactured juvenile bipolar disorder is similarly grim. One study found that 87% of juvenile bipolar cases exhibited “ultra-rapid cycling,” switching constantly back and forth between mania and depression.

In a previous post, I mentioned how the aforementioned Joseph Biederman oversaw the creation at Mass General of the Center for Pediatric Psychopathology, which he described as a “strategic collaboration” that would “move forward the commercial goals of J & J.” The purpose of the center was to develop screening tests for juvenile bipolar disorder and “alert physicians to the existence of a large group of children who might benefit from treatment with Risperidal,” which is marketed by J & J.

Biederman stated that that “[P]ediatric mania evolves into what some have called mixed or atypical mania in adulthood, [which] will provide further support for chronic use of Risperidal from childhood through adulthood.”

Oh, by the way, since the publication of Anatomy of an Epidemic, a review paper in CNS Neurosciences and Therapeutics appeared which noted that atypical antipsychotics, the class of drugs to which Risperidal belongs, increase the rate of suicide in bipolar patients.

Where do we go from here? Bipolar disorder was once a largely self-limiting condition.  However, it remains to be seen whether this new iatrogenically created version is as well. For some reason, the drug companies don’t seem very interested in funding research on this matter. But at the very least, we ought to stop manufacturing new cases. When you find yourself in a hole, the first thing to do is stop digging.