Who says you’re depressed or anxious? Pfizer does

2 April 2018

I’ve been becoming increasingly worried over the years about the creeping medicalisation of human suffering. A frighteningly high percentage of my clients are either taking, or have been prescribed in the past, psychiatric medications including antidepressants, anti-anxiety agents and atypical antipsychotics (disingenuously marketed as ‘mood stabilisers’).

I’ve written before about the total lack of evidence for the ‘biochemical imbalance’ theory as well as the total lack of validity of diagnostic criteria for these so-called mental illnesses such as depression and anxiety.

However, despite the proliferation of books which provide meticulously-researched critiques of psychiatry and its arsenal of drugs, including Peter Breggin’s many titles (start with Toxic Psychiatry, Talking Back to Prozac and The Antidepressant Fact Book), Robert Whitaker’s Anatomy of an Epidemic and Psychiatry Under the Influence; Gary Greenberg’s Manufacturing Depression; Dr Irving Kirsch’s The Emperor’s New Drugs; Dr Peter Gøtzsche’s Deadly Psychiatry and Organised Denial and Dr James Davies’ Cracked, many people are still being diagnosed with ‘illnesses’ that they don’t have, and prescribed ‘treatments’ that can’t possibly help them.

Antidepressants are now the most commonly prescribed class of drugs in Australia; in fact, we have the 2nd-highest rate of antidepressant prescription in the world, lagging behind only Iceland. 10% of adult Australians are currently taking antidepressants, a prescription rate that has more than doubled since 2000.

Despite our profligate use of these medications, there is a constant drum-beat in the media that ‘mental illness’ is underdiagnosed and undertreated, with a periodic cymbal-clash (usually triggered by a tragic mass shooting episode in the US) of calls for population screening for mental health conditions, especially in adolescents.

The idea of population screening has a common-sense appeal to it. After all, surely it would be better to ‘catch’ a condition early in its development when it is easier to treat, rather than allowing it to fully develop? This is the logic behind cancer detection programs such as screening mammography and PSA testing… and unfortunately, neither works: screening mammography doesn’t save women from dying of breast cancer or reduce the death rate overall, and PSA testing doesn’t save men from dying of prostate cancer either.

In the case of depression, aside from the ineffectiveness of the mainstay of treatment, antidepressant drugs, the primary problem with population screening is the question of which screening tool to use.

Physical illnesses are diagnosed through objective signs and symptoms which can be observed and measured. Screening for hypertension or diabetes, for example, is quite simple – just measure people’s blood pressure or fasting blood glucose, and compare it to the cutpoints at which the risk for stroke, cardiovascular disease or diabetes begins to escalate.

But since there are no biomarkers for psychological conditions such as depression and anxiety, the diagnosis of ‘mental illnesses’ is highly subjective. Consequently, various screening tools have been developed to allow clinicians to detect potential cases of depression and anxiety, with two of the most commonly used ones being the PHQ-9 Patient Health Questionnaire for depression, and the GAD-7 Generalised Anxiety Disorder Assessment.

GPs often have charts of these questionnaires in their consultation rooms, and many of my clients have told me they were prescribed psychiatric medications on the basis of their responses to these questionnaires, even though they are not intended to be used as diagnostic tools.

None of these clients were aware that both screening questionnaires were developed by academics funded entirely by the pharmaceutical giant Pfizer, and that Pfizer owns the intellectual property and is responsible for distributing the PHQ-9 and GAD-7 to doctors.

Pfizer just happens to make some of the drugs most widely-prescribed for depression and anxiety, including venlafaxine (Efexor), sertraline (Zoloft), escitalopram (Lexapro) and alprazolam (Xanax).

Do you see the problem? It’s clearly in Pfizer’s financial interest to engage in disease-mongering – that is, expanding the diagnostic boundaries for a condition, to maximise the number of people who ‘qualify’ for diagnosis and treatment.

As Robert Whitaker has pointed out, pharmaceutical treatment of depression has actually turned it into a chronic condition that is far more likely to recur throughout an individual’s lifetime than in the pre-antidepressant era. So it makes perfect business sense for Pfizer to recruit ‘customers’ for this drug at a young age, using busy GPs who aren’t adequately trained and resourced to talk to patients about their psychological issues, as their ‘pushers’.

It shouldn’t come as a surprise then, that the ability of the PHQ-9 to identify depression is low; it has a “positive predictive value of about 50%” which means that half the people that it identifies as potentially depressed are suffering from some other health condition (or perhaps simply the human condition).

Pfizer also funded a GP training program, SPHERE, which claimed to increase GPs’ competence at diagnosing and treating mental health conditions. The result was a significant boost in prescription rates of Pfizer’s flagship antidepressant, Zoloft. Did it improve patient care? Almost certainly not – a study conducted by Monash University researchers on the SPHERE screening tool found that its use would result in large numbers of psychologically healthy people being classified as having a probable mental illness. The authors wrote,

“As a global screen for mental disorder it had a very high false-positive rate, with, in one sample, 83% of patients screening positive while only 27% had a current psychiatric diagnosis, and in the other sample 55% screened positive with only 13% having a current psychiatric diagnosis.”

Pfizer, along with other pharmaceutical companies, doesn’t contain its activities to cultivating doctors. They also provide funding for not-for-profits and establish fake ‘grass roots’ organisations (known as ‘astroturfing’) to push their agenda to government and the public, via the ever-accommodating media.

For example, the non-profit mental illness advocacy group, the Mental Health Council of Australia, receives funding from four different pharmaceutical companies, via the ‘Mental Health Australia/Pharma Collaboration’.

In 2004 they were funded by Pfizer to write a report, which was duly publicised in the media, on young people and depression. The report argued that “young people were dismissive of depression, which was an illness that required professional treatment“. Unfortunately, ‘professional treatment’ almost always entails antidepressant medications, whose efficacy and safety record in young people is particularly abysmal. Perhaps that dismissive attitude that the Mental Health Council frowned upon is reflective of a deeper truth – young people understand that not every form of human suffering is an ‘illness’.

Psychological suffering is real. People do feel anxious, hopeless and unable to enjoy life. There are usually very obvious reasons why they feel that way – they’re lonely, they’ve suffered a significant loss, they experienced childhood trauma, or they’re stuck in a job, relationship or living situation that thwarts their human development. Sometimes they have a physical condition, such as hypothyroidism, that is causing their psychological suffering.

Prescribing psychiatric medications never addresses the cause of a person’s suffering; it simply renders them a helpless victim. And psychiatry and its diagnoses don’t ‘relieve the stigma of mental illness’; they cause suffering people to be stigmatised, as James Davies has pointed out – people are far more likely to be stigmatised when the cause of their aberrant behaviour is believed to be biological than social or psychological.

The bottom line: Screening tools and diagnostic criteria that are set by individuals or corporations with a vested interest in expanding diagnostic boundaries are not to be trusted. If you’re experiencing psychological symptoms such as persistent anxiety, sadness, sleeplessness or oversleeping, loss of interest in activities that you formerly found enjoyable, or a sense of disconnection from others, you should definitely seek help… but that help must address the reasons why you’re feeling the way you do, not just put you in a pharmaceutical straitjacket that blunts your capacity to experience your emotions.

I take a comprehensive mind-body approach to my clients’ psychological issues. See my article Depression: Bringing your black dog to heel for more information.

Struggling with anxiety or depression? Apply for a Roadmap to Optimal Health Consultation today to find out how I can help.