The Antidepressant Wars: A Fierce Debate That Ignores Patients
I began to think of suicide at sixteen. An anxious and driven child, I entered in my mid-teens a clinical depression that would last for 40 years. I participated in psychotropic drug therapy for almost 30 of those, and now, owing in part, but only in part, to the drug Cymbalta, I have respite from the grievous suffering that is mental illness.
As a health policy scholar, I understand the machinations of the pharmaceutical industry. My students learn about “me-too” drugs, which barely improve on existing medications, and about “pay-for-delay,” whereby pharmaceutical companies cut deals with manufacturers of generic drugs to keep less expensive products off the market. I study policymakers’ widespread use of effectiveness research and their belief that effectiveness will contain costs while improving quality. I appreciate that randomized controlled trials are the gold standard for determining what works. Specifically, I know that antidepressant medication is vigorously promoted, that the diagnostic criteria for depression are muddled and limited, and that recent research attributes medicated patients’ positive outcomes to the placebo effect. In my own research and advocacy work, I take a political, rather than a medical, approach to recovery from mental illness.
Cymbalta in particular epitomizes pharmaceutical imperialism. Approved by the FDA in August 2004 for the treatment of major depressive disorder, it has since gotten the go-ahead for treating generalized anxiety disorder, fibromyalgia, and chronic musculoskeletal pain, including osteoarthritis and lower back pain. It remains under patent to Eli Lilly.