Psycho-Pharmaceutical Industrial Complex: Profiting from drugging women and children
by Dr. Bruce E. Levine
Postpartum depression among women in the United States occurs at a rate of between 10 to 20 percent, but it is rare in several cultures where new mothers routinely receive structured social support following childbirth. Yet, currently Congress is legislating increased medical treatment for postpartum depression rather than confronting its societal roots.
In the United States, one in three doctor’s visits by women involves an antidepressant prescription, 11 percent of women take antidepressants, and a 2007 study of pregnant women enrolled in Tennessee Medicaid revealed that antidepressant use during pregnancy increased from 5.7 percent in 1999 to 13.4 percent in 2003.
With respect to children not “fitting” into standardized schools, U.S. doctors have been heavily encouraged since the early 1980s to diagnose them with attention deficit hyperactivity disorder (ADHD)-and to prescribe Ritalin, Adderall, and other amphetamines. Today the practice of drugging “difficult-to-manage” children continues, augmented with more serious psychiatric diagnoses and more powerful drugs. The diagnosing of children with bipolar disorder in the U.S. has increased 40-fold from 1994 to 2003 and bipolar-labeled children are now the fastest-growing part of the approximately $12 billion U.S. market for antipsychotic tranquilizing drugs such as Zyprexa and Risperdal.
In 2008 Congressional investigators began paying attention to the financial relationships that drug companies have with both individual psychiatrists and the American Psychiatric Association. Though this Congressional investigation has been covered by the corporate press, they do not make clear that Big Pharma has virtually annexed every major mental health institution from which U.S. doctors and the general public receive their mental health information. The corporate press most certainly does not report why increasing numbers of Americans are having emotional difficulties.
Postpartum Depression: Cultural Disorder?
Official American psychiatry repeatedly states that postpartum depression occurs in 10 to 20 percent of new mothers. The truth is that postpartum depression occurs in 10 to 20 percent of American mothers-not all mothers. A 2004 cross-cultural review in BMJ (formerly the British Medical Journal) reported that postpartum depression is rare in Fiji and in traditional African and Chinese populations. BMJ authors concluded that “structured social supports after childbirth are described in groups of women with low rates of postpartum depression.”
Medical anthropologists Ann Becker and Dominic Lee in “Indigenous Models for Attenuation of Post Partum Depression” (a chapter in the World Mental Health Casebook, 2002) report that postpartum depression occurs at a rate of 1 percent. For Fiji women after childbirth, there is mandated extended relief from domestic responsibilities such as laundry and cooking (for three to four months) as well as relief from work on the family farm (for one year). Given that a Fiji woman’s daily life consist of exhausting physical labor, this relief represents a serious commitment by the household and the culture to the new mother’s well being. In addition to this extended relief, a caretaker (often the woman’s mother or sister-in-law) is designated to assist in the caring of both the new mother and her infant.
In traditional Chinese culture there is the postpartum custom called peiyue, which means attending. Peiyue requires an elder female relative to help the new mother with domestic duties for a month. Becker and Lee report that in one Hong Kong study, women who did not observe peiyue were four times more likely to suffer postpartum depression than women who observed peiyue.
Structured social supports for women after childbirth are decidedly missing from U.S. culture. On a modest level, social supports would mean universal paid maternity and paternity leave. On a deeper level, it would mean rethinking our cultural priorities. However, the U.S. Congress and psychiatry officialdom have chosen a different kind of assault on postpartum depression.
In 2007 the U.S. House of Representatives passed the Melanie Blocker-Stokes Postpartum Depression Research and Care Act and sent it to the U.S. Senate, which renamed it the Mothers Act. In 2008 the Mother’s Act was included in the omnibus bill “Advancing America’s Priorities Act” (that has not yet passed).
In the “Findings” section of the Mothers Act we are told that postpartum depression is a “devastating mood disorder” and that “postpartum depression is a treatable disorder if promptly diagnosed by a trained provider.” The stated goal of the Mothers Act is to “ensure that new mothers and their families are educated about postpartum depression, screened for symptoms and provided with essential services and to increase research at the National Institutes of Health on postpartum depression.” Critics of the Mothers Act, such as those at the International Center for the Study of Psychiatry and Psychology (not funded by Big Pharma), believe that the Mothers Act will merely ensure that federal dollars are used to increasingly diagnose, often unreliably, depression in pregnant and postpartum women-and then convince them that antidepressants are safe and effective.
In the Mothers Act official findings, several inconvenient truths about postpartum depression are omitted. Not many in Congress would vote for legislation that stated the U.S. could eliminate much of postpartum depression by transforming American values, culture, and economics. The Mothers Act findings neglect to mention, for example, a 1996 British Journal of Psychiatry article that reported postpartum depression is associated with unemployment of the mother (no job to return to), unemployment of the head of the household, not breast-feeding, and unplanned pregnancies. The Mothers Act findings also omit relevant truths about Blocker-Stokes, the woman for whom the initial House bill was named. Blocker-Stokes was a pharmaceutical sales manager who began suffering severe symptoms of depression after the birth of her child. She was hospitalized three times in seven weeks, given four combinations of antipsychotic, anti-anxiety, and antidepressant medications, and underwent electro-convulsive therapy (electroshock). But despite her psychiatric treatment-or because of it-Melanie Blocker-Stokes jumped to her death from the 12th floor of a Chicago hotel.
Pregnant Women on Antidepressants
A study “Increasing Use of Antidepressants in Pregnancy,” published in the American Journal of Obstetrics and Gynecology in 2007, is an analysis of the medical records of 105,335 pregnant women enrolled in Tennessee Medicaid from 1999 to 2003. Among the group of 13.4 percent women who took antidepressants at some time during pregnancy in 2003, 10 percent took antidepressants during the first trimester, 6.4 percent used them during the second trimester, and 5.9 percent used them during the third; white women were four times more likely than nonwhite women to have used antidepressants during pregnancy.
In June 2007 the CDC issued a press release stating “New Study Finds Few Risks of Birth Defects from Antidepressant Use During Pregnancy.” CDC epidemiologist Jennita Reefhuis concluded, “Overall, our results are generally reassuring with respect to the use of antidepressants during pregnancy.” This CDC press release was reported in 2007 by U.S. newspapers with headlines such as “Reassurance on Antidepressants in Pregnancy” (Wall Street Journal). However, the actual research findings are the opposite of reassuring.
In 2006 the Archives of Pediatric & Adolescent Medicine reported that 30 percent of infants who had prenatal exposure to antidepressants experience some withdrawal symptoms, with 13 percent of them experiencing severe ones, most notably tremors, respiratory distress, gastrointestinal problems, sleep disturbances, and high-pitched crying. Other withdrawal symptoms include rapid heartbeat, irritability, feeding difficulties, and profuse sweating. While Big Pharma and establishment psychiatry want Americans to hear about “crack babies,” they’d prefer they not know about “Paxil babies.”
There are several other serious problems that newborns are more likely to suffer when exposed in utero to antidepressants such as Prozac, Paxil, Zoloft, and other selective serotonin reuptake inhibitors (SSRIs). A 2006 U.S. Food and Drug Administration (FDA) alert stated, “A recently published case-control study has shown that infants born to mothers who took selective serotonin reuptake inhibitors (SSRIs) after the 20th week of pregnancy were 6 times more likely to have persistent pulmonary hypertension (PPHN) than infants born to mothers who did not take antidepressants during pregnancy.” In persistent pulmonary hypertension of the newborn, the newborn’s arteries to the lungs are constricted, limiting the amount of blood flow to the lungs and therefore the amount of oxygen into the bloodstream. The FDA alert also noted, “Neonatal PPHN is associated with significant morbidity and mortality.”
The CDC, it turns out, based its approval of antidepressant use during pregnancy on studies in which women were taking antidepressants the month before they became pregnant or in the first three months of pregnancy. However, the New England Journal of Medicine in 2007 reported that SSRI antidepressant use in first trimester was associated with more than double the risk of anencephaly (birth without forebrain), omphalocele (the child’s abdomen does not close properly allowing intestines and other organs to protrude outside the body), and craniosynostosis (premature closure of the joints between the bones of the skull before brain growth is complete).
What then is the rationale of those medical authorities who encourage antidepressant use among depressed pregnant mothers? Their claim is that while antidepressants might present some risks, the stress of not receiving medication for depression is more risky for the newborn and mother. In reality, the research simply does not back up this claim. Two major studies (American Journal of Psychiatry, 2007; Archives of General Psychiatry, 2006) comparing the health of newborns from depressed mothers who took antidepressants versus newborns of depressed mothers who did not take antidepressants show that newborns are better off with mothers not taking antidepressants. Plus, a 2002 Prevention & Treatment analysis of 47 depression studies on Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone revealed that in the majority of the trials, the antidepressant failed to outperform a sugar pill placebo.
The Assault on Children
Joseph Biederman is a towering figure in America’s child psychiatry establishment, which was rocked on June 8, 2008 when the New York Times reported the following about Biederman: “A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007, but for years did not report much of this income to university officials, according to information given Congressional investigators.”
Pediatrician Lawrence Diller, author of Running on Ritalin (1998), notes about Biederman, “He single-handedly put pediatric bipolar disorder on the map.” Biederman convinced many doctors to diagnose bipolar disorder in children and to medicate them with antipsychotic drugs. In addition to being a professor at Harvard, Biederman is also chief of research in pediatric psychopharmacology at Massachusetts General Hospital, which publishes more than 30 papers yearly on psychiatric disorders. Biederman himself has authored and co-authored approximately 500 articles, 70 book chapters, and more than 450 scientific abstracts, as well as being on the editorial board of many professional journals.
Biederman, along with and two of his colleagues in the psychiatry department at Harvard Medical School (who received an additional $2.6 million from drug companies from 2000 to 2007), failed to report income from drug companies while receiving federal funds from the National Institutes of Health (NIH), which violated rules designed to police conflicts of interest, according to Congressional investigators. In one example, Biederman neglected to report his 2001 income from Johnson & Johnson (makers of the antipsychotic drug Risperdal), which Johnson & Johnson reported to Congressional investigators was $58,169.
While there is no law against being on the take from drug companies, there are rules against greed. NIH states that researchers cannot take more than $20,000 in payments from a drug company whose drug they are funded by NIH to research and that researchers must disclose any payment received from a drug company of $10,000 or more.
In addition to his popularization of bipolar disorder for children, Biederman is one of the most significant forces behind the commonplace diagnosis and drug treatment of attention deficit hyperactivity disorder (ADHD). Congressional investigators also found that Biederman conducted studies of Eli Lilly’s attention deficit hyperactivity disorder drug Strattera that were funded by NIH at the same time he was receiving money from Lilly that exceeded the maximum amount permitted.
While the extent of the drug-company loot accumulated by Biederman and his Harvard colleagues is exceptional, it is common practice for psychiatrists to have financial relationships with drug companies. Most states do require disclosure, but Vermont and Minnesota are exceptions. So we know that drug company payments to psychiatrists in Vermont more than doubled in 2006 from 2005 to an average of $45,692 each; and psychiatrists earned on aggregate the most in Minnesota, with payments ranging from $51 to $689,000. That was reported in the New York Times on June 27, 2007, which also pointed out, “Psychiatrists who took the most money from makers of antipsychotic drugs tended to prescribe the drugs to children the most often.” A 2007 analysis of Minnesota psychiatrists revealed that psychiatrists who received at least $5,000 from makers of newer-generation antipsychotic drugs wrote, on average, three times as many prescriptions to children for these drugs as psychiatrists who received less money or none.
Unraveling the Psycho-Pharmaceutical Complex
On July 12, 2008, the New York Times reported the following about the American Psychiatric Association: “In 2006, the latest year for which numbers are available, the drug industry accounted for about 30 percent of the association’s $62.5 million in financing. About half of that money went to drug advertisements in psychiatric journals and exhibits at the annual meeting, and the other half to sponsor fellowships, conferences, and industry symposiums at the annual meeting.” Congressional investigators also discovered that the president-elect of the American Psychiatric Association (Alan Schatzberg of Stanford University) has $4.8 million stock holdings in a drug development company.
In addition to psychiatrists, universities, hospitals, and the American Psychiatric Association, Big Pharma also throws money at so-called consumer groups, the most influential of which is the National Alliance for the Mentally Ill (NAMI). In 2007, for example, Eli Lilly (manufacturers of Prozac, Zyprexa, Strattera, and other psychiatric drugs) provided NAMI with a grant of $450,000 for NAMI’s “Campaign for the Mind of America 2007.”
The government-industry revolving door of employment, a staple of industrial complexes, most definitely exists in the psycho-pharmaceutical industrial complex. A recent egregious example involves Daniel Troy, former chief counsel for the U.S. Food and Drug Administration (FDA). In July 2008 Troy was appointed senior vice president and general counsel for the giant pharmaceutical corporation GlaxoSmithKline, which counts the antidepressant Paxil as one of its many drugs. The revolving-door of employment is also used by Big Pharma to maintain influence over the National Institute of Mental Health (NIMH). One example is Lewis Judd, a former NIMH director who in 2001 joined the scientific advisory board of Roche Pharmaceutical (manufacturer of Valium, Klonopin, and other psychiatric drugs). NIMH routinely funds researchers who are financially connected with drug companies.
Prior to the Prozac marketing blitz that began in the late 1980s, the total annual sales for all antidepressant and antipsychotic drugs in the United States was approximately $500 million. Today, these two classes of psychiatric drugs are grossing over $20 billion annually. A single antidepressant such as Zoloft has grossed more than $3 billion a year, as has been the case with the single antipsychotic Zyprexa (the majority of which is purchased via government agencies such as Medicaid).
Mental health treatment in the U.S. has become a major industry and all the rules of industrial complexes apply. Virtually every institution from which doctors, the press, and the general public receive their mental health information is financially interconnected with Big Pharma. In such a system, U.S. doctors and the general public get bombarded with antidepressant pitches rather than getting clued in to the battle to make the United States a less dehumanizing and depressing society.
Bruce E. Levine, a clinical psychologist, is author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, & Community in a World Gone Crazy.