Who Shares The Blame for the Mental Health Epidemic? - Will Self [2014] | Intelligence Squared

I am quite a competitive person as as people probably realize but I'm also a person and I'm an emotional person I have feelings and I feel very very strongly about this issue and I want to speak to you tonight from the heart which is why I have only cursory notes and I don't even particularly want to refer to them I've been on a journey with this question for many many years and it's affected me vitally and personally and I suspect it's affected a lot of people in this Hall vitally and personally as well uh what I want to talk about first is a documentary I made for Radio 4 last year to Mark the the 25th anniversary of proac a selective serotonin reuptake inhibitor uh most of you will be familiar with this category of neuropharmacology uh statistically a substantial number of you in this Hall tonight will be taking an SSRI it's just a fact something like 20 million prescriptions for these drugs are written every year in this country when I went into making the documentary for Radio 4 I really tried to keep an open mind on the subject but my background view was that the selective serotonin reuptake Inhibitors were overprescribed my feeling was because I come from that kind of place and generation was that these drugs were mostly often being prescribed for what used to be called exogamous depression in other words depressions that are caused by things like your partner leaving you losing a job an illness rather than for endogamous depressions depressions that are caused by a chemical imbalance but beyond that I didn't really have any strong views about ssris or at least I didn't think I did and what I discovered as I researched for this program and as I talked to people was that what I had assumed to be the causal mechanism for these drugs which was that they rectified the low serotonin levels uh in people's brains that caused them to be depressed that this causal mechanism had long since been disproved by Medical Science and indeed when I interviewed for the program the head of marketing and Eli Lily the pharmaceutical company that produced proac he conceded that there was only a statistical correlation between taking proac and the alleviation of depression in other words the man responsible for marketing this drug didn't know how it worked okay I think that's kind of astonishing actually not only that but the double blind and longitudinal studies of selective serotonin reuptake Inhibitors show to my satisfaction at least that a good brisk walk a talk with a friend or heroine are all just as effective in alleviating depression as a selective serotonin reuptake inhibitor actually heroin's rather better however I do believe that ssris work one of the people who I interviewed for the program was my own GP who at one point had offered me an SSRI in order to help me give up smoking and I asked him why he prescribed them and he said I prescribe them because they work I am not interested in a medical as a medical practitioner in how they work what matters to me is that they work fair enough I think that they are prescribed by the medical profession in good faith I actually think a lot of the people in at Eli Lily who make the drugs make them in good faith and make a whole range of other psycho pharmacological preparations so in a way I'm slightly challenging the terms of the debate I don't think that there is some evil cabble of big farmer types sitting there plotting to create new drugs they don't know how they work and flog them to an unsuspecting public what I think the crisis that we now face and I do think we Face a crisis in Psychiatry and in the Mental Health Professions generally in relation to these compounds is we're all in it together and the reason why they work is because of something that we don't usually like to talk about in scientific discourse they work because of Faith they work because we have faith we the people have faith and what we have faith in is Medical Science boy do we have faith in it we really believe in it and why wouldn't we believe in it the advances in medical science since 1950 it is not hyperbole to describe them as miraculous now if you consider that in the days when we lived in the kind of societies that are exemplified by This Magnificent sacral building you you could believe in a sky spirit and you could believe that a man in a dress was capable as of acting as an intercessor between you and the sky spirit for your entire lifetime while never seeing anything as miraculous as what a doctor can do for you in 10 or 15 minutes is it any surprise that we have faith in medical science is it any surprise that when you go to a doctor and you're feeling depressed and that doctor gives you a pill and tells you it's an anti-depressant and you go home and take it and it makes you feel a bit funny because I don't know if anybody has read the side effects on ssris on proac or sorac but they run to several volumes and include every conceivable minor ailment in the book from erectile dysfunction to constipation and Back Again taking in the peran along the way and you start to feel a little constipated and you start to have a bit of a erectile dysfunction you start to stop experiencing an orgasm but actually you never had one anyway um you think oh I must be feeling better from my depression now it's called a no sibo effect and it works it works the ssris work because we have faith in them they work because we have faith in them and we pay for them and the big pharmaceutical companies get bigger and bigger and the big pharmaceutical companies now fund scientific and academic papers in some instances they ghost write them they fund the FDA board in the states that is responsible for approving psycho pharmacological preparations and they also do is participate in the origination and collation of the diseases that go into the diagnostic statistical Manual of mental disorders that is put together by the American Psychiatric association and which is the Bible that sits on every psychiatrist's desk and again I don't think this is done in bad faith but there's one word I want to plant in your mind now and it's a complex term iatrogenic and it simply means a doctor created disease and that's what we're facing the new edition of DSM dsm5 contains a lot of diseases that in my view are collections of symptoms that have proved to be responsive to certain psychopharmacological compounds and what is happening now in medicine is that pathologies are being constructed around Bunches of symptoms that respond to drugs it's gone that direction round the drug is arrived at the symptoms that it will alleviate are identified and then the disease disease is created and makes its appearance in DSM and just quickly because I haven't got much time the pathos of somebody who has a non-existent disease being treated by a drug that makes them feel sick I see these people in my office where I teach at the University every day my students prescrib these preparations deeply unhappy and trapped it needs to stop thank [Applause] you thank you will so our first Speaker against the motion is no doubt relieved that will is not suggesting that there are evil big farmer types because he is uh a veteran of the pharmaceutical industry Declan Dugan was formerly head of worldwide development at fisa Inc which developed the popular anti-depressant zolof he is currently CEO of Portage biotech and executive chairman of bioh Haven a technology startup which is working on a radically new form of anti-depressant based on ketamin please welcome Dr deand Dugan Mr chairman ladies and gentlemen good evening I've been called a lot of things in my time and coming from glasgo hey you was one in Japan Dr Viagra and tonight an international drug Peddler my mother would be so proud however I find it slightly ironic that we are having this debate in this building of worship and the two gentlemen on my right The High Priestess Priests of no treatment would have you believe that well researched drugs are no more effective than Placebo in fact as Mr self said they are no sios they're no damn good but they cause side effects and it's pharmer that's a cynical purveyor of these I'd like to say this does a disservice to our patients and I as a physician care about patients I also care about the science behind drug development so the ssris are Placebo what is psychotherapy why is talkx therapy so much more acceptable than drug therapy is this the Zeitgeist or Zeitgeist that we're in just now and why is it that Psychotherapy is actually lost ground to pharmacotherapy or drug therapy ah simple it's just the power of Pharma we spend loads of money advertising putting reps out there on the street to to beguile unsuspecting GPS prescribers and indeed patients with in the US Direct to Consumer advertising I don't think it's quite like that depression ladies and gentlemen is a killer disease at least as toxic as some of the diseases it coexists with with cardiovascular disease cancer arthritis anti-depressants do work I will expand on this in a bit later studies over the past 30 years actually show that they do there has been a huge increase in psychotropic drug prescribing that's anti-depressants anti-anxiety agents drugs for psychosis and it's not just down to far marketing it's far more complex than that and I think it does a disservice not only to the medical profession but also to the patient population of which I'm sure many of you are or have been a part mental illness is a prevalent phenomenon one in four Europeans and probably up to a half of patients will meet the criteria for a mental health disorder in their life a staggering statistic is 20% of children in the UK will have a mental health disorder in the current year this is not Pharma going out and say diagnose more patients we need the money it's nothing to do with that depression and schizophrenia are malignant conditions and attract with them more than a doubling of the mortality the death rate just associated with the diagnosis and counter to the discussion that we are overdiagnosing I think we're actually under diagnosing serious mental disorder and I think it requires not just the minute it's diagnosed treated with a drug not at all diagnose it first and treat it appropriately and also the economic consequences to the country are ridiculous apparently it's costing up to 90 billion pound a year not just in patients loss of uh cost cost of quality of care but also cost to the economy I don't really understand why there is such an opposition to detecting mental disease you may also hear and have read writings of Mr self which talks about the placebos that we're purveying in the pharmaceutical industry and we will quote meta analyses these large L analysis of many many studies which when you run the numbers say they're not much better these anti-depressants and Placebo well there are limitations to the way those studies are put together and the interpretations put in them but I would say that wouldn't I but I can go into further detail about it there are eloquent um protagonists for drug therapy which actually say it's as good as Psychotherapy not it's as good as Placebo it's as good as Psychotherapy over the first 3 months of treatment I did a study some years ago in the UK looking at patients who were put on a drug you might know as zolof or lustro called caline we treated them for 8 weeks and after 8 weeks those that responded to anti the anti-depressant we we allocated one sord of them to Placebo there was a substantial relapse on Placebo whereas the P patients maintained an active drug maintained themselves in a non-press state if that is a placebo what was Placebo I don't understand what the accusation is I'm not against Psychotherapy I think what we have to advocate for is the right drug for the right patient at the right time I'm not against adequate research but what I am against is a biased view of the world which misleads there's no blood test for depression and nobody said we've found the cause for it we don't actually mean that if we give an SSRI your problem is serotonin deficiency that was a naive and simplistic view put forward many years ago what we are saying is we don't understand the cause of depression and we don't fully understand the mechanism of action of anti-depressants but we do know that the modern anti-depressants are substantially safer and better tolerated than the older ones such as the tricyclic amitryptiline prot tripoline ETC these drugs do work the GPS are overprescribing that's the problem blame them blame them because they go to drug lunches and they have a rep in the door who says I'll give you a pen if you prescribe that does a hell of a disservice to our GP colleagues it's not like that there has been an increase in prescribing and that can also be due to the fact that there are smaller prescription sizes and patients are being treated for longer so there is an amplification of the number of prescriptions given out but there is also I would call it a societal drift I think there's a demand from the patient population to go to the GP and get a treatment we go for to the GP for a treatment for a sore throat if we don't get an antibiotic we're actually not very happy but it's a virus you don't need an antibiotic and it takes time for the GP to say you don't need an antibiotic and it's the GP is responsible for prescribing he is to prescribe responsibly I do believe that the GPS are doing a good job in the face of tremendous stress and overwork doesn't mean to say you do Bad Medicine you actually have to treat patients well also I think the pharmaceutical industry is not doing such a bad job either it spends a lot of money on research and development I also like to know where the drugs are coming from that are going to treat the dementia that will afflict some of us in years to come who is going to help develop vaccines for Ebola the ones that are making the excess of profits prescribed ssris perhaps when I hope I hope when you leave here tonight that it's not just simply a case of expensive placebos pharmaceutical companies prescribing it's bad for you actually it's good to detect depression it's good to DET detect anxiety and I nearly detected a case of anxiety tonight my colleague and friend professor Simon Wesley said I'm quietly going mad here as he couldn't find his script for the speech and I thought maybe I should give him a Valium but then I thought no I won't so in summary ladies and gentlemen there's a lot of complexity in this system I do believe that as Mr self says there's a lot to do with feelings here we're not here just to treat feelings we are here to treat disease thank you

Channel: Intelligence Squared

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Id: pT_7MXawaZU

Length: 21min 54sec (1314 seconds)

Published: Wed Feb 28 2024