and more of something to think about

'The benzodiazapines were perfectly appropriate for the treatment of anxiety and mild depression, and science-schooled psychiatrists did well to put their patients on them. Yet it had now become apparant [since Valium surpassed librium as number one on the American drug list] that great sums were to be earned in the sale of psychiatry drugs. As Valium soared into popularity, awareness dawned among drugmakers that here lay the markets of the future. As the highly competitive drug companies rushed into psychopharmaceuticals, they began to distort pscyhiatry's own diagnostic sense. In trying to create for themselves market niches, drug companies would balloon illness categories. A given disorder might have been scarcely noticed until a drug company claimed to have a remedy for it, after which it became epidemic. As historian of psychopharmacology David Healy puts it, "as often happens in medicine, the availability of a treatment leads to an increase in recognition of the disorder that might benefit from that treatment".

Take, for example, panic disorder. The tradition in psychiatry was to see panic as part of anxiety. As DSM-II said in 1968 of "anxiety neurosis" "This neurosis is characterised by anxious over-concern extending to panic and frequently associated with somatic symptoms". In 1964, however, Donald Klein, then at Hillside Hospital in Glen Oaks, New York, published an article suggesting that panic was really an illness distinct from anxiety. Partially funded by the Geigy and the Smith Kline & French drug companies, the study concluded that one could forestall such attacks by staying on medication. As Klein was a member of the DSM-III task force, as well as its subcommittee on "anxiety and dissociative disorders" he was able to persuade other members of the correctness of his views. In 1980 with the publication of the DSM-III panic disorder became an illness of its own, characterised, it was said, by "the sudden onset of intense apprehension" and marked by physical sensations such as sweating and faintness. The following year, in 1981, the Upjohn Company of Kalamazoo, Michigan, marketed a new kind of benzodiazepine generically named alprazolam (Xanax). Because the market for benzos was sinking at the time, Upjohn attempted to reposition its benzo as a drug specific for the newly created disease entity "panic disorder". In the 1980's the company funded extensive field trials - orcestrated by Cornell's Gerald Klerman - to establish that panic was really an independent disease for which alprozolam worked wonders. The results were not entirely convincing. Nonetheless, by the early 1990's Xanax had become one of the hottest drugs in psychiatry, prescribed by many psychiatrists in good faith that they were practicing scientifically and that Xanax offered unique hope in the epidemic of panic disorder sweeping the nation. Among insiders, panic jokingly became known as "the Upjohn illness".

Against this background of psychiatric diagnosis increasingly manipulated by pharmaceutical companies arose the pscyhiatry drug that was to become the household word of the 1990's: Prozac. When Valium came along, both patients and their doctors were willing to define their problems in terms of anxiety once an effective drug existed for treating it. When Prozac, a drug for depression, arrived on the scene, the accent fell on depression as the hallmark of distress. "Our phone rings off the hook every time someone does a story about Prozac", said one physician at Manhattan's Beth Israel Medical Centre. "People want to try it. If you tell them they're not depressed they say, 'Sur eI am!'"...

In 1990, three years after Prozac was released, two researchers at McLean Hospital published an article suggesting that the drug was effective not merely for depression but for a range of disorders from panic to drop attacks ("cataplexy"). Since all of these conditions responsed to Prozac (as well as to other drugs), they must have something in common, perhaps membership in an Affective Spectrum Disorder (ASD). This created an apparant scientific justification for expanding greatly the notion of depression, which now became one of "the most widespread diseases of mankind" as the authors put it. One of the authors, Harrison Pope, was quoted as saing that ASD affected "possibbly one third of the population of the world". The prospects for prozac became incalculable.

And so word went out. By 1993 almost half of all visits to American Psychiatrists were for mood disorders. Just as Valium had assuaged a nation beset by anxiety, the availability of a new drug for depression had produced a pattern of disorder the drug was capable of treating.

What followed was a media circus of suggestion, as Prozac and its competitors were extended to the world public as a panacea for coping with lifes problems even in the absence of psychiatric illness (one recalls that the great majority of individuals with a formal psychiatric illness seek no treatment of any kind [due to inflated numbers to keep certain professions in business]). Prozac is "much more than a fad" proclaimed Time in 1993. "It is a medical breakthrough" that has brought relief to individuals such as "Susan", a self described workaholic who becomes irratible around the time of her periods and once threw her wedding ring at her husband. Now the edges of her personality had been planed off a bit. It would be ludicrous to argue that such people suffered a formal psychiatric illness in the historic tradition of the agonised and the inconsolable, for real psychiatric disease causes terrible pain and disablement. Yet here lay part of Prozac's core market...

By 1990, less than three years after its appearance, it had become the number one drug prescribed by psychiatrists... By 1994 Prozac had become the number two best-selling drug in the world, following, perhaps ironically, an ulcer drug named Zantac.'

[helped with destigmatisation though didn't it just]

Shorter 'A History of Psychiatry' pp. 319-324

And the media circus continues with advertising all over consumer run boards like we don't get enough of it via other avenues such as TV. And it drives people searching for that magical diagnosis, you know, that magical diagnosis that will give them access to the magical pill. And one of the ads says 'is your depression really a symptom of bi-polar?' You just know they ask this because their company makes mood stabilisers and they are just trying to pick up the business. Designer drugs where psychiatrists often have little more to go on than the consumer and when the consumer pressure for taking x (because it looks so pretty on the ads) can be unbearable. I mean you don't want to risk your clients being unsatisfied, do you now?

Advertising makes me feel sick... I don't really watch TV because I don't want to be exposed to that (though I've been a bit slack lately). When you aren't used to ads its remarkable how much they get to you. But of course they get to us all really... That is precisely why they spend the money they do on them.

Don't get me wrong I appreciate this site has to cost money to host. I also appreciate that even if a profit is made a lot of time must go into running / maintaining it.

But they ads get to me, yeah they do. And I'm not at all convinced they are helpful or beneficial to consumers... To be seen to condone them to be seen to tolerate their presence and their hyperbolic claims etc.

Anyway just my 2 cents worth. I had fairly much the same thing in more readable fashion but seems a song that topped the charts in Australia is considered to political to post... I didn't need the politics... It was the commentary on medical advertising that I wanted to illustrate the point.