Depressed or anxious?
Switching pills for your ills a dangerous practice by Alan Cassels
The story of benzodiazepines is of awesome proportions… a national scandal. The impact is so large that it is too big for governments, regulatory authorities and the pharmaceutical industry to address head-on, so the scandal has been swept under the carpet. – Phil Woolas MP, British House of Commons, December 7, 1999.
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n Selling Sickness, Ray Moynihan and I discussed how the pharmaceutical industry, ever vigilant to expand new markets for its products, has worked in tandem with the medical profession to widen the boundaries of illness. We described a world where “new” conditions are painted as “dire,” and where risk factors in our bones or blood are promoted to fullfledged diseases, in and of themselves, hence becoming prime targets for pharmaceutical intervention. In pa i nt i ng t his pic t u re, however, we touched only brief ly on a ver y impor tant aspect of
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selling sickness: the methodologies used to shift patients from older, cheaper, of f-patented drugs to newer and more expensive patented products. The best example to demonstrate this phenomenon is the recharacterization of anxiety into depression and the wholesale switching of older, anti-anxiety drugs, largely benzodiazepines – drugs like Ativan, Valium and Xanax – to newer SSRIs, selective serotonin reuptake inhibitors, such as Paxil, Zoloft or Prozac. The switch to newer treatments is partially due to the “newer is better” thinking that permeates so much of our consumer culture. The fact that older drugs tend to carry more baggage also has a lot to do with it. We have learned about those drugs and their warts and blemishes simply because we have had more experience with them. Shif ting patients f rom more established and better understood therapies to newer ones that we have less knowledge about may sometimes have a strong medical rationale. It may be because there is a clearer understanding of the condition. An older drug’s side effects may be intolerable, with the newer one marketed as being “safer.” Any extra cost involved may seem justified. But switching patients’ drugs is a potentially dangerous practice,
THEN Dominant disease . . Drug of choice . . . . . Problem . . . . . . . . . Costs . . . . . . . . . . . . Side effects . . . . . . . Suicide risk . . . . . . .
Anxiety Alprazolam (benzodiazepine) Known to be addictive Non-patented and cheap Well-known Overdose could cause suicide
NOW Dominant disease . . Drug of choice . . . . . Problem . . . . . . . . . . Costs . . . . . . . . . . . . Side effects . . . . . . . Suicide risk . . . . . . .
Depression Effexor (SSRI / SSNI) Growing evidence of addiction Patented and expensive Not yet fully understood Prescribed use could cause suicide
which may accomplish nothing more than exchanging one set of problems for another. According to the British Medical Journal, “The growing search for blockbusters in the 1970s resulted in a trend to rubbish earlier drugs in order to put new patent-protected drug classes on the market.” The BMJ points out that, in the case of treatments for mood and anxiety disorders, “Despite clear evidence that benzodiazepines were effective, they were dismissed as drugs for neurotic women, who then become
addicted.” After a brief f lirtation with tricyclic antidepressants, which were also quickly considered to have too many adverse effects, the world bent to embrace the brave new world of the SSRI antidepressants. In the 1960s, drug companies were not at all interested in depression; they didn’t think it was marketable. (David Healy’s books, including Let Them Eat Prozac, lay this out in fine detail). Depression was considered an easily self-cured problem, so the real market was always anxiety. With the rise of the SSRIs in the mid ‘80s, depression
APRIL 2006
3/28/06 6:54:39 PM
