Drugs to the rescue

Drugs to the rescue
  • Spain is a leader in the use of antidepressants and sleeping pills. They are necessary for serious disorders but do not always work, create addiction and have side effects. “They're not perfect, but they are the best alternative available”

Psychotropic drugs don't work and they kill people. That is the message from Danish biologist and doctor Peter Goetzsche, who has written books and given talks on the subject and was recently at a conference organised by the Institute of Nutrition Sciences and Health in Madrid.

The idea that anxiolytics, antidepressants and sleeping pills are prescribed too easily without taking into account their side effects nor their limited effectiveness is not new. However the negative voices have recently got louder for two reasons: one, the use of this type of drug is rapidly growing - Spain is one of the biggest consumers in Europe - and two, there is an increase in chemophobia (an irrational aversion to chemical products), as well as growing enthusiasm for 'alternative' medicines. And then there is the conspiracy theory that suggests that the pharmaceutical industry makes sure people remain sick in order to make more money.

In an article to promote one of his books, Goetzsche said that the consumption of psychotropics is the third cause of death in Britain, after heart problems and cancer. He attributes this to their side effects: patients with dementia being treated with drugs which increase the risk of heart attacks, strokes and diabetes, relapses caused by sleeping pills and suicides provoked by antidepressants.

Peter Goetzsche goes even further and says these drugs are useless. “The industry invents mental disorders so that people become addicted to its products,” he has insisted. He believes only some extreme cases should be treated with medication.

For example, he says selective seratonin reuptake inhibitors (SSRI), the most popular antidepressants, base their effectiveness on correcting a chemical imbalance in the brain whose existence, he says, has never been proven. The Attention Deficit and Hyperactivity Disorder (ADHD) for which thousands of children are given medication is not, in his opinion, a mental disorder but a label given to active or intellectually curious children. He also says the severe psychosis suffered by patients with schizophrenia, bipolar disorder or serious depression should be treated with “psychotherapy, empathy and love”.

Chemistry or words

Is this, then, a new battle between defenders of two different ways of looking at mental health, those who want to restore 'normality' to patients' brains through chemical substances and those who want to cure them by talking to them and getting them to change their behaviour and negative thinking?

Criticism of psychiatry is not new. In the 19th century there was strong opposition to degrading treatment in mental institutions, and in the 20th century to electro-shock treatment and lobotomy.

The development of modern pharmaceutical products and the humanisation of psychiatric attention helped, but some still question non-pathological patients being given medication, paternalism towards patients and the conflicts of interest between doctors and the industry.

“Self-criticism exists within psychiatry, but there is nothing similar in the field of psychotherapies,” says psychiatrist Pablo Malo, the Spanish author of a blog called 'Evolución y neurociencias' (Evolution and Neurosciences). He says that different meta-analyses (systematic reviews of scientific studies on the same theme) agree that psychotherapies are no more effective than drugs, that there are economic interests behind certain therapies (the sale of books, courses and mobile apps, for example) and that psychology is not exempt from adverse effects, including a worsening of the disorder being treated or suicidal ideas.

Malo refers to mindfulness, “an industry which moves millions”, as an example even though its effectiveness has never been sufficiently proven, and the controversial regression therapy, which uses hypnosis to create false episodes in the memory and has destroyed families and resulted in parents and carers being charged with sexual abuse or ill-treatment which they have not committed.

Malo says Dr Goetzsche “looks for data which conveniently fits his ideology” and ignores the fact that some psychoses may respond spontaneously to psychotherapies, benzodiazopines (a sedative) or simply a placebo, but there are also psychoses which become chronic and do not respond to any treatment known so far. And in the middle of these two extremes is “a majority in which it is impossible to prevent the use of anti-psychotics, especially in the acute phases of decompensation”.

Saying that schizophrenia can be cured with “empathy and love” is, in his opinion, “an insult, not just to psychiatrists but also to science, intelligence, history, the patients and their families”.

The underlying problem, he says, is that Goetzsche “doesn't believe that serious mental illness exists, a mental disorder which the patient cannot control, which produces great suffering and justifies the use of medications which do undoubtedly have side effects, but are still the best alternative available”.

Peter Goetzsche shields himself with the prestige of the organisation to which he belongs, and whose Scandinavian branch he runs: Cochrane, an international network of researchers, professionals and patients dedicated to checking scientific research in order to offer “credible, accessible health information which is free from commercial sponsorship and other conflicts of interest”.

Nevertheless, in 2015 the parent company distanced itself from his statements: “The views expressed by Professor Goetzsche are not those of the organisation,” it said.

In reality, psychiatry and psychology are complementary and the majority of patients receive both types of treatment, according to the president of the Spanish Psychiatry Society (SEP), Julio Bobes.

A meta-analysis of the 21 most common antidepressants, published in The Lancet in February, concluded that they are all more effective for serious depression than placebos, the fake drug which is administered to a control group to see whether people's illnesses change simply because they believe they are being treated.

The work, which looked at 522 trials in which over 100,000 adults took part, confirms the incredible power of suggestion, because about 30 per cent of patients improve within two months when they have been given sugar tablets. However, this percentage rises to 60 per cent among those who are given the actual treatment.

“Antidepressants have been improved and they are not only more effective, they also have fewer side effects and are tolerated better,” explains Bobes. He says we live in a society in which many people believe they are ill when they are not.

“There are patients with slight depression, as a result of adaptive situations: the person who has lost their job, the mother who is upset because her son and his partner have separated, the grandmother who never sees her grandchildren.... these are problems of everyday life. Then there is serious depression, an endogenous illness which is genetically conditioned. There are people who go to bed and can't get up, or wash or do anything at all,” he explains. They, he insists, need medication.

The discomfort of life

His view coincides with that of José Manuel García Montes, spokesman for the Spanish Society of Clinical Psychology and Health. “Psychologist Hans Eysenck said in the last century that 70 per cent of mental health problems cure themselves with time. In the long term, psychotherapy is a little more effective than antidepressants, but that isn't saying much,” says this lecturer at Almeria university. “In fact, nearly any 'treatment' is effective for depression: going to the gym, going for a walk, being with friends, reading a book or adopting a dog. You have to ask yourself what depression is, so that almost anything meaningful that you do works.”

The problem, he stresses, is that in our society we want to get rid of difficulties quickly. “Society is psychologised and psychiatrised. Problems which we use to call 'feeling sad' or 'going through a bad time' are now medicalised. There are hard situations in life and people can be worried, anxious, or sad. What is wrong is that we insist that we need to be happy and think positively all the time,” he says.

The biggest consumers

It is a fact that the use of psychopharmaceuticals is increasing. The consumption of antidepressants tripled in Spain between 2000 and 2013, from 26.5 to 79.5 doses per thousand inhabitants. The use of other drugs such as anxiolytics rose from 38.1 doses per thousand inhabitants in 2000 to 56.3 in 2015, and hypnotics and sedatives from 17.9 to 30.9.

“It's worrying,” says GP Juan Simó, the author of a comparative study into the use of drugs in Europe. He believes the economic crisis has played a part - although not noticeably in Greece, which was particularly badly affected - but says the biggest problem is dependence on these drugs. “It's not that more are being prescribed than are necessary; it's that some people start taking them and find it hard to stop. In general people aren't aware that you can get hooked on these drugs,” he says.