Have we overdosed?

This at times fractious debate, held at London's Emmanuel Centre, discussed the pros and cons of big pharma within psychiatry. Author Will Self and Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, were among the panellists debating the motion We've overdosed: psychiatrists and the pharmaceutical industry are to blame for the current 'epidemic' of mental disorders. 

Speaking alongside Self, for the motion, was Psychoanalyst and author Darian Leader. Alongside Professor Wessely in the against camp was Dr Declan Doogan, the former Head of Worldwide Development at Pfizer Inc. and current CEO of Portage Biotech. The audience vote prior to the debate was 43 per cent for the motion, 28 per cent unsure and 29 per cent against. How would the arguments, each presented with emotion and conviction, sway the vote?

Will Self – whose two most recent novels, Umbrella and Shark, follow the story of a psychiatrist Zack Busner – raised concerns over the mechanism of action of anti-depressant drugs, saying: 'I've been on a personal journey with this question for many years and it's affected me personally.' He spoke of his experience making a documentary for BBC Radio 4 to mark the 25^th anniversary of Prozac and his concern that the 'assumed' effect of SSRIs in rectifying low serotonin levels had been disproved.

He said: 'The double blind and longitudinal studies of SSRIs show that a good, brisk walk, a talk with a friend, or heroin, are all just as effective in alleviating depression.' Self added that he did believe that SSRIs were prescribed in good faith but that the reason they work is because people believe they work. He added: 'They work because we have faith, we the people have faith, and what we have faith in is medical science.' Self also outlined his concerns about iatrogenisis, or 'doctor created diseases': 'The new edition of DSM contains a lot of diseases that, in my view, are collections of symptoms that have proved to be responsive to certain psychopharmacological compounds.'

Declan Doogan was next to take the stand and argued that drugs used for treatment of psychiatric disorders were, in fact, much more effective than placebos and that the image of big pharma companies as evil-doers was misleading and unfair on patients.  He said: 'Why is talk therapy so much more acceptable than drug therapy?... Depression is a clear disease, at least as toxic as some of the diseases it co-exists with. Anti-depressants do work.'

Dr Doogan went on to speak of the increase in prescribing of psychotropic drugs and said that mental illness was a very prevalent phenomena, citing statistics that 20 per cent of children in the UK would have a mental health disorder in 2014. Is the problem under, rather than over, diagnosis of such problems? Doogan suggested the increases in prescriptions of psychotropic medicine could be due to patients being treated for longer.

Psychoanlyist and author Darian Leader, arguing for the motion, said that around 100 years ago depression was seen as a symptom rather than a disorder in its own right. He added that from the 1960s onwards many new mental health disorders had been emerging. He posed the question, what happened to allow that diagnostic expansion? He suggested this could be due to changes to the legal regulatory landscape of drugs, he said relatively recent changes meant pharmaceutical companies had to specify on new drugs what disease category they aimed to treat, he said that this changed the market in a number of ways, including the shift from marketing illnesses rather than marketing the drugs themselves.

Leader said that over the years there has been a change in the definition of depression. Whereas in the past there had been a number of different, competing descriptions, now the classification of depression has become standardised and reflects how the drugs used to treat it act: 'Rather than finding the pharmacological key that will unlock the illness, it's the other way round, you have the lock and anything that fits it can be defined as the illness.'

Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, started by pointing out that much of his life's work had been concerned with the psychological treatments of mental illness and epidemiology. He said: 'Is there an epidemic of mental disorder? The facts are very clear, there is no such epidemic. Rates of psychiatric disorders have remained the same over the last 20 years.' Although admitting there had been an increase in anxiety problems and eating disorders, Professor Wessely suggested people may believe there is an epidemic because the public and media are much more willing to talk about mental health problems.

He pointed out that, in his work with ex-servicemen and women suffering with PTSD, the rate of people coming forward had increased while the numbers of people with the condition had remained largely stable. However he pointed out that many people were still not coming forward for treatment for lack of services and the remaining stigma around mental health issues. He said three quarters of people with depressive disorders were not being treated: 'If that was cancer or diabetes we would say that was scandalous'.

Questions were then put to the panel and a final vote taken. There had been a large swing against the motion, an increase to 52 per cent, with 46 per cent in favour compared with 43% before the debate. Just 2 per cent remained unsure. For this audience at least, psychiatrists and the pharmaceutical industry are not behind any 'epidemic' of mental disorders.