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Title: Happy Pills in America:
Source: [None]
URL Source: [None]
Published: Oct 17, 2015
Author: david herzberg
Post Date: 2015-10-17 18:27:22 by tpaine
Keywords: None
Views: 491
Comments: 3

http://www.nejm.org

Happy Pills in America:

From Miltown to Prozac The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers Before Prozac: The Troubled History of Mood Disorders in Psychiatry

N Engl J Med 2009; 360:841-844February 19, 2009DOI: 10.1056/NEJMbkrev0809177

Article Happy Pills in America: From Miltown to ProzacBy David Herzberg. 279 pp., illustrated. Baltimore, Johns Hopkins University Press, 2009. $45. ISBN: 978-0- 8018-9030-7

The Age of Anxiety: A History of America's Turbulent Affair with TranquilizersBy Andrea Tone. 298 pp., illustrated. New York, Basic Books, 2009. $26.95. ISBN: 978- 0-465-08658-0

Before Prozac: The Troubled History of Mood Disorders in PsychiatryBy Edward Shorter. 304 pp. New York, Oxford University Press, 2009. $29.95. ISBN: 978-0-19- 536874-1

Psychotropic drugs are sometimes used to treat particular diseases such as obsessive–compulsive disorder, schizophrenia, and panic attacks. More often, however, they are used to alleviate the stresses of everyday life and to enhance well-being. This more general use seems to account for the enormous popularity of Miltown (meprobamate) in the 1950s, of Librium (chlordiazepoxide) and Valium (diazepam) in the 1960s and early 1970s, and of selective serotonin-reuptake inhibitors (SSRIs) such as Prozac (fluoxetine) today.

Tranquilizers, benzodiazepines, and SSRIs are the heirs of opium, marijuana, and morphine, which were widely available in the 19th century. Through sophisticated marketing to a culturally respectable base of users, pharmaceutical manufacturers successfully separated psychotropic drugs from their discredited and now illegal progenitors. Moreover, psychotropic drugs have come to be viewed as treatments for specific diseases instead of as quick and reliable ways to relieve stress and to attain more pleasurable states of mind. Each new generation of such drugs has been proclaimed to be far superior to its predecessors until the patents expire and newer and more profitable drugs enter the market. The three excellent books reviewed here, all written by historians, tell the important and fascinating stories of the rise and fall of the various drugs that have been used to treat what feminist author Betty Friedan famously referred to in The Feminine Mystique (New York: W.W. Norton, 1963) as “the problem that has no name” — the ubiquitous malaise, tension, and anxiousness that results from the gap between the expectations of a fulfilling life and the realities of a stifling existence. Although Friedan was referring to the malaise of housewives during the 1950s, the unnamed problem she noted is far more widespread in the general population of contemporary societies.

Current rates of the use of SSRIs alone are staggering. The Centers for Disease Control and Prevention reports that from 1999 through 2000, 10% of women and 4% of men used such drugs each month; nearly one third of all patients who see general physicians receive prescriptions for antidepressants. These drugs have earned billions of dollars for their makers each year and have propelled the pharmaceutical industry to become one of the most profitable global industries. Prozac and its siblings are cultural icons, brands as recognizable as Prada, iPod, or Pepsi.

SSRIs are promoted for the treatment of specific mental disorders, especially major depressive disorder, but also for social anxiety disorder, post-traumatic stress disorder, eating disorders, substance abuse, and many other conditions. They are ubiquitously touted — in video and print advertisements, in testimonials by celebrity users, by armies of drug representatives, and through educational symposia that are sponsored by pharmaceutical companies. But initial reports that such drugs made people “better than well” and were free of addictive qualities subsided into claims of merely good efficacy and high tolerability. More recently, there have been reports of many side effects and occasional dependency, and some leading psychiatric researchers have been accused of serious conflicts of interest for accepting large and unreported payments from pharmaceutical companies.

The authors of these three books indicate that the pattern followed by this latest class of psychotropic drugs — first promises and then reputed defects — is nothing new. It has become clear that SSRIs are the latest treatment for the so-called neurasthenic tradition of disorders. The term “neurasthenia” dates from neurologist George Beard's work in the 19th century and encompasses a broad and amorphous range of symptoms of distress that seem to be experienced primarily by the relatively privileged. Before Prozac arrived, Miltown and then Librium and Valium were unabashedly promoted as wonder drugs that could be used to help manage an enormous range of life problems, ranging from tension, nerves, and irritability to menopause, juvenile delinquency, family and marital difficulties, and problems at work. Then, as now, drug companies used aggressive public relations and marketing efforts that were directed at the popular media, as well as at physicians, to embed tranquilizers in the culture of consumerism.

Pharmacies in Los Angeles (Left) and New York City (Right) Advertising Their Supplies of Tranquilizers, Mid-1950s.

Patients eagerly sought these seemingly miraculous drugs, and their physicians freely prescribed them. Within a year of Miltown's introduction in 1955, as many as 1 in 20 Americans had used it. At the peak of the popularity of minor tranquilizers, in the mid-1970s, more than 100 million prescriptions for them were filled annually, and about 15% of the population reported having used one of them during the preceding year. After unrealistically high expectations about the power of these drugs, a comparably unrealistic reaction against them set in. Beginning in the early 1970s, tranquilizers were stigmatized as widely abused and dangerous drugs that could easily lead to dependency and addiction. By 1980, their use had steeply declined, but because their patents had expired, their makers had no incentive to sponsor research that might refute such allegations and reestablish their effectiveness and safety.

David Herzberg, in Happy Pills in America, stresses the dynamics of sex roles and social class that underlie the culture of psychotropic drug use. He grounds the success of tranquilizers in the consumer culture that emerged after World War II, emphasizing the shrewd marketing techniques that allowed drug companies to separate their products, which appealed to a largely white, middle-class constituency, from the illegal drugs that were used by marginalized racial, ethnic, and class groups. Drug companies also promoted the tranquilizers in ways that reinforced traditional sex roles, implying that their products would allow men to strengthen their authority at home and in the office and would allow women to embrace their duties as wives and mothers.

Andrea Tone's book, The Age of Anxiety, overlaps with Herzberg's book (indeed, the two include many of the same drug advertisements, photographs, cartoons, and quotations). Tone also emphasizes the consumerist culture that drove millions (men in the 1950s, and then women in subsequent decades) to enthusiastically embrace chemical remedies for everyday ills. Whereas Herzberg focuses on the marketing of the drugs, Tone highlights the contributions of scientists such as Frank Berger and Leo Sternbach, whose work led to the discovery of the new drugs.

Herzberg and Tone have written superb histories that illustrate which cultural groups embraced tranquilizers, how these drugs were initially wildly popular but were subsequently rejected, and the rise of SSRIs as their replacements. Neither author, however, emphasizes the actual therapeutic impact of these tranquilizers — the major focus of Edward Shorter's book, Before Prozac. Shorter does not claim that SSRIs will follow the same cycle of popularity and decline of the earlier drugs but instead makes the startling assertion that the earlier tranquilizing drugs were far more effective and had no more side effects than SSRIs. In contrast to SSRIs, the earlier drugs gave immediate relief, did not need to be taken continuously to produce their effects, were more efficacious in helping patients to deal with the stresses of everyday life, and had milder side effects.

According to Shorter, “we have wrongly cast drugs aside because of a staggering overestimation of their side effects and an underestimation of their clinical benefits.” Indeed, he later asserts, Miltown “was probably one of the best drugs in the history of psychiatry,” and the benzodiazepines (Librium and Valium) were “probably . . . the best drug class in history, for they have few side effects and deliver a significant therapeutic punch in a wide range of illnesses.” In contrast, he argues that SSRIs are “one of the least effective drug classes in the history of psychopharmacology.” Although Shorter's claims are exaggerated, he accurately stresses that SSRIs gained preeminence because of their slightly greater effectiveness as compared with placebo — not because they were better than tranquilizers. Given the lack of motivation that pharmaceutical companies have to determine whether off-patent drugs have equal or superior value to more profitable medications, it is unlikely that we will ever have definitive answers to the questions that Shorter raises.

Shorter emphasizes two factors that explain the replacement of what he believes to be an effective class of drugs with an ineffective class of drugs. The first is the Food and Drug Administration, which used an aggressive attack on the tranquilizers during the 1960s and 1970s as the lynchpin in its attempts to bully drug companies and to assert its own bureaucratic power. Since that period, however, it has capitulated to industry, lowered its standards for bringing drugs to market, and allowed drug companies to use the unimpressive but profitable SSRIs to drive the more efficacious tranquilizers (as well as the superior antidepressant tricyclics and monoamine oxidase inhibitors) out of the market without a demonstration of superior efficacy.

The second factor that accounts for the rise of SSRIs, according to Shorter, resulted from the work of the academic psychiatrists who developed the definition of major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), in 1980. This definition was not a result of empirical evidence, but rather a result of efforts to raise the scientific status of psychiatry and the reliability of its diagnoses. It led to the creation of a one-size-fits-all diagnosis that incorporated a heterogeneous mix of conditions, including many ill-defined life problems and genuine depressive disorders. The psychiatrists who developed the new definition also discarded the distinct category of melancholic depression (a particularly severe condition that features severe feelings of worthlessness, vegetative symptoms, and sometimes psychotic indicators) that had been at the heart of classifications of depression for centuries.

When SSRIs were developed during the 1980s, the scope of the definition for major depressive disorder allowed them to be promoted as “antidepressants,” a far more acceptable label at the time than “anxiolytics” or “tranquilizers,” which had been stigmatized as dangerous and addictive drugs. The shift from the prominence of anxiety during the 1950s and 1960s to the rise of depression after that period was largely due to the marketing of “antidepressants” as an alternative to the “antianxiety” drugs that had dominated prescribing practices in earlier decades. In other words, the SSRIs as much created the explosion of depressive diagnoses during the 1990s as they were a response to it.

Psychiatry has made significant strides in its attempt to become a respected medical specialty. The reputed success of psychiatric drug treatments has been foundational to the efforts of psychiatrists to elevate their field's status within the medical community. Yet the authors of each of these informative and intriguing books raise the question of how much progress has really occurred in the chemical treatment of psychiatric disorders. The profession relies on a diagnostic system that often fails to accurately distinguish specific types of mental disorders, to separate normal from abnormal conditions, and to suggest distinct drug treatments for different kinds of conditions.

Psychiatrists, as well as other physicians who treat patients with psychiatric problems, rely on a class of drugs that is probably no better than the tranquilizers and antidepressants it replaced. Of course, psychiatrists (and general physicians) might consider using psychosocial alternatives instead of drug treatments. However, the extensive evidence of the past half-century (and far earlier), as presented in these books, indicates that Americans have long craved chemical solutions to their problems of living. The many names that psychiatrists have given to the various manifestations of “the problem that has no name” will change, and the newest blockbuster drugs to treat them will come and go. The angst that drives the voracious and profitable consumption of psychotropic drugs is, however, unlikely to subside. Educated consumers and their physicians would be well advised to take a careful look at the history of tranquilizers before seeking or providing a prescription for the newest miracle drug that reputedly will relieve the perennial pains of human existence.

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#1. To: tpaine mothers little helpers (#0) (Edited)

What a drag it is getting old
Kids are different today,
I hear every mother say
Mother needs something today to calm her down
And though she's not really ill
There's a little yellow pill
She goes running for the shelter of a mothers little helper
And it helps her on her way, gets her through her busy day

Things are different today,
I hear every mother say
Cooking fresh food for a husband's just a drag
So she buys an instant cake and she burns her frozen steak
And goes running for the shelter of a mothers little helper
And two help her on her way, get her through her busy day

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

Men just aren't the same today
I hear every mother say
They just don't appreciate that you get tired
They're so hard to satisfy, you can tranquilize your mind
So go running for the shelter of a mothers little helper
And four help you through the night, help to minimize your plight

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

Life's just much too hard today,

I hear every mother say
The pusuit of happiness just seems a bore
And if you take more of those, you will get an overdose
No more running for the shelter of a mothers little helper
They just helped you on your way, through your busy dying day


The D&R terrorists hate us because we're free, to vote second party
"We (government) need to do a lot less, a lot sooner" ~Ron Paul

Hondo68  posted on  2015-10-17   19:17:36 ET  Reply   Trace   Private Reply  


#2. To: tpaine, stoned zombie voters (#0)

Shorter emphasizes two factors that explain the replacement of what he believes to be an effective class of drugs with an ineffective class of drugs. The first is the Food and Drug Administration, which used an aggressive attack on the tranquilizers during the 1960s and 1970s as the lynchpin in its attempts to bully drug companies and to assert its own bureaucratic power. Since that period, however, it has capitulated to industry, lowered its standards for bringing drugs to market, and allowed drug companies to use the unimpressive but profitable SSRIs to drive the more efficacious tranquilizers (as well as the superior antidepressant tricyclics and monoamine oxidase inhibitors) out of the market without a demonstration of superior efficacy.

The second factor that accounts for the rise of SSRIs, according to Shorter, resulted from the work of the academic psychiatrists who developed the definition of major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III), in 1980. This definition was not a result of empirical evidence, but rather a result of efforts to raise the scientific status of psychiatry and the reliability of its diagnoses. It led to the creation of a one-size-fits-all diagnosis that incorporated a heterogeneous mix of conditions, including many ill-defined life problems and genuine depressive disorders. The psychiatrists who developed the new definition also discarded the distinct category of melancholic depression (a particularly severe condition that features severe feelings of worthlessness, vegetative symptoms, and sometimes psychotic indicators) that had been at the heart of classifications of depression for centuries.

They've gone from "happy pills", to SSRI "murder pills" the choice of mass murderers.

Politicians have learned that if you dope up populace enough with government subsidized prescription drugs, they're more likely to vote D&R party.


The D&R terrorists hate us because we're free, to vote second party
"We (government) need to do a lot less, a lot sooner" ~Ron Paul

Hondo68  posted on  2015-10-17   19:35:25 ET  Reply   Trace   Private Reply  


#3. To: hondo68 (#1)

--- the extensive evidence of the past half-century (and far earlier), as presented in these books, indicates that Americans have long craved chemical solutions to their problems of living.

--- Granted, the extensive evidence of the past half-century (and far earlier), as presented in these books, (for hundreds, even thousands of years) ---- indicates that human beings have long craved chemical solutions to their problems of living, and that NOTHING, (not even drastic criminal prohibitions) ---- will ever stop them from using mind altering substances.

Thus, it is wise to ignore prohibitions on mild substances like booze, marihuana, etc, and let medical professionals prescribe, monitor, and regulate the use of the more powerful substances.

But in NO CASE should we authorise our politically dominated governments to control and/or regulate such usage, -- as prohibitions simply encourage black markets...

tpaine  posted on  2015-10-17   19:52:04 ET  Reply   Trace   Private Reply  


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