Clever marketing

It’s mildly uplifting to find a senior psychiatrist who agrees that a lot of diagnosed depression is just unhappiness. Putting forward this view on this blog tends to spark some angry responses, so I guess Gordon Parker will get a bit of flak for this.
He carried out a a 15 year study of 242 teachers. He found that everyone had periods of unhappiness.

Professor Gordon Parker claims the threshold for clinical depression is too low and risks treating normal emotional states as illness.
Writing in the British Medical Journal, he calls depression a “catch-all” diagnosis driven by clever marketing.

The number of prescriptions for antidepressants in England hit a record high of more than 31 million prescriptions earlier this year – a 6% rise in two years.

A BBC report from July implied that the happy-go-lucky response to prescribing also affects children,

The number of prescriptions handed out to children under 16 for depression and mental health disorders has quadrupled in a decade, official figures indicate.
GPs in England wrote more than 631,000 such prescriptions for children in the last financial year, compared to just 146,000 in the mid-1990s.
But at the same time, figures suggest the rate of mental health problems in the young has not changed markedly.

And, going back into the mists of time, here’s a 2004 news item.

European drug regulators are concerned that Prozac, like its sister antidepressants, is unsafe for children, contrary to UK advice. The Committee for Medicinal Products for Human Use (CHMP) reviewed all of the available data.
It said there was an increased risk of suicidal behaviour and thoughts with all antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRIs). UK regulators say the benefits of Prozac in under 18s outweigh any risk.

Hang on. Greater risk of suicide? Isn’t that why these things are prescribed – to prevent suicides in the severely depressed? Confuses the hell out of me.

Now, that is what I’d call really good marketing to doctors and the public. Are children in the rest of Europe happier than the UK and the USA – two countries where there increasingly large take-ups of anti-depressants and ritalin? Well, yes, actually, according to the UN report last year. So the drugs don’t work, then?

How depressing is this?

There is a story on Health central about the death of a four-year-old girl, who had been prescribed some pretty serious anti-psychotic medication since she was two years old.

Obviously, I don’t know any of the facts here but that won’t stop me commenting on it. There do seem to be some complicating factors – the parents have other kids on the same medication, they have been under the attention of social services before and were warned about giving the child an overdose.

The Health Central post says

… Seroqel, an anti-psychotic; Depakote, which was presumably prescribed for bipolar disorder; and Clonidine, a blood pressure drug that is apparently used “off-label” to calm children…. my jaw dropped when I read this list of drugs, especially as Rebecca had been taking them since she was 2, when she was diagnosed with attention deficit disorder and bipolar disorder. ….prescribing several off-label medications together is even riskier, since their interaction has not been tested.

A two year-old on anti-psychotic medicine? Anyone who has met a two year old knows it’s quite hard to distinguish normality from craziness. Attention deficit disorder and bipolar disorder. Don’t these define two-year-old behaviour?

Taking up a point made a couple of blogs ago and made more strongly in a comment by Chris, we seem to be ever more willing to find medical solutions to problems. And to see psychiatric problems where we might not in the past. Continue reading

The Trap- BBC2

The Trap – on BB2, on Sundays at 9pm for the next few weeks – is well worth watching. It is mainly brilliant. It’s rare to find television that addresses fundamental issues about our current society. If it’s any indication of how good it is, Charlie Brooker’s Screen Burn in Saturday’s Guardian – which introduced it as unmissable – was probably the only totally serious piece Brooker has written in that column.

The programme looks at our ideas about freedom, where they originated and how they serve to cage us. Ian Curtis traces our current views of individuals as totally self-serving to inventions that were necessary to make Rand Corporation cold-war game theory work, through anti-psychiatry’s attack on institutions and Thatcher-inspiring economists to a situation where, as Brooker put it

“conventional human traits such as sadness or irritability are reclassified as aberrant medical conditions, Narcissism and selfishness, however, are normal.”

I can’t say I can go along with all the arguments – I can’t believe that R.D. Laing was truly so influential anywhere, nor that anti-psychiatry can be blamed much for the medicalising of normal behaviours. Curtis’s argument here is that Rosenham’s experiments, by showing that psychiatrists misdiagnosed mental illness, shook the medical establishment and led to the application of non-human computerised automatic diagnoses. When applied to large numbers of non-mental patients, the diagnostic questionnaires showed that half of the US population had a recognised mental disorder. The questionnaires provided an “objective” set of standards of normality that became a model for the population as a whole to judge itself against.

I don’t know where the argument is going with this, yet, but it seems a little far-fetched. I don’t think the detail is really important. Tonight’s programme was very impressive and important. It looks very broadly at the action of ideas in our society, from their origin to their implications.. It should really make you think.