Aug 12, 2010 12:00 AM

For more than 20 years, our country has been conducting an extraordinary medical experiment. Ever since Prozac arrived on the market in 1987, our societal use of psychiatric medications has gone up and up, and while the drugs generally have been shown to curb a target symptom better than placebo over the short term, their long-term effects have not been regularly assessed. Thus, 23 years into this psychopharmacology era, it might be wise for us to ask: How is this medical experiment turning out?

As a society, we naturally would expect that the widespread use of these medications would have lessened the societal burden of mental illness. Unfortunately, that has not been the case. From 1987 to 2007, the number of adults receiving government disability payments due to mental illness more than tripled, rising from 1.25 million to 4 million.

The disability numbers for children are even more alarming. In 1987, there were 16,200 children under 18 years of age who received a government payment because they were disabled by a mental illness. By 2007, there were 561,569 such children on the disability rolls. In the short span of 20 years, during which time the prescribing of psychiatric medications to children became common, the number of disabled mentally ill children rose 35-fold.

These numbers do not tell of a paradigm of care that is working well for us as a society. But we also need to look at a second question: How is this paradigm of care working for individuals? Does the scientific literature tell of medications that alter the long-term course of mental disorders for the better? Or for the worse?

This is a controversial topic, but suffice to say that the scientific literature contains one surprise after another. For instance, we all “know” that people diagnosed with schizophrenia need to be on antipsychotic medications all their lives. Yet, the National Institute of Mental Health have been funding a long-term study of schizophrenia outcomes by University of Illinois researcher Martin Harrow, and in 2007 he reported that at the end of 15 years, 40 percent of schizophrenia patients off medication were “recovered,” versus 5 percent of those on medication. More than 50 percent of those off medications were working, including several in “high-level” professional jobs.

“Our data is overwhelming that not all schizophrenic patients need to be on antipsychotics all their lives,” Harrow told the audience at the 2008 annual meeting of the American Psychiatric Association.

His study — and many others — suggests that selective use of antipsychotics, with some patients given medical support to go off the medication, would produce much better outcomes than a paradigm of care that emphasized continual anti-psychotic use for all. The outcomes literature for the major mood disorders — major depression and bipolar illness — also suggests that there is something amiss with the “drugs for life” paradigm.

Forty years ago, major depression and bipolar illness were understood to run an episodic course, with fairly good long-term outcomes. Today, they run a chronic course, with the deterioration in modern bipolar outcomes especially striking. Employment rates for adults so diagnosed have dropped from around 85 percent to 33 percent, and over the long-term, many bipolar patients today show signs of cognitive decline, which didn’t use to be the case.

As Harvard Medical School psychiatrist Ross Baldessarini confessed in a 2007 paper, “Prognosis for bipolar disorder was once considered relatively favorable, but contemporary findings suggest that disability and poor outcomes are prevalent.”

Our society’s grand medical experiment with psychiatric medications is now entering its third decade, and it is clear we need to have a vigorous public discussion about its merits. If some patients with schizophrenia can fare better off antipsychotics, we need to know that, and if mood disorders have been transformed from episodic illnesses into chronic ones, we need to know that too.

Fortunately, something of this sort is starting to happen in the Eugene area.

LaneCare, a provider of mental health services, and MindFreedom, a patients’ rights organization, are focusing attention on this subject, and so perhaps it is here, in this corner of the United States, that a seed for change can be planted.

Robert Whitaker is a medical journalist and author of the recent book “Anatomy of An Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.” He will give a free talk for the public at the Hilton Eugene at 7 p.m. Aug. 20, 2010.

[On the same day as the above was published, the local weekly newspaper — Eugene Weekly — published a column by mental health worker Chuck Areford challenging the psychiatric drug model of the current mental health system, and mentioning Whitaker’s and MindFreedom’s work. To read Chuck’s column, click here.]