An American psychiatrist is campaigning foralternative ways to treat depression, writes Sylvia Thompson
Depression is one of the easiest conditions for psychiatrists to treat, compared with all the other conditions they have to deal with.
That's the view of American psychiatrist and author Dr Peter Breggin, who will be in Dublin later this month to speak at a conference on depression. He is a specialist in clinical psychopharmacology and a veteran international campaigner for change within psychiatry.
So why does he believe that depression is the easiest mental health problem to treat?
"Because it's so easy to understand," he says. "There are elements of hopelessness and despair and often self-hatred. What you must do is instil hope and encourage the person to have better principles for living so that they can get what they need out of life. It's about loving other people and giving to other people."
Breggin also contends that anti-depressants are not useful - and are in fact dangerous at times - in the treatment of depression.
The Dublin conference at which Breggin will speak shares this view of depression. Entitled Healing Depression without drugs or electric shocks, it is organised by the newly formed Wellbeing Foundation.
Breggin says he is looking forward to his first visit to Dublin. "I'm excited about the fact that Ireland might be spearheading reform in psychiatry," he says, admitting that his own unrelenting campaign hasn't met with the results he would like to see.
"Psychiatry is increasingly doing more harm than good because in the last 20 years - in the United States - psychiatrists have increasingly insisted on seeing human suffering in terms of biology and genetics."
Breggin believes the medical training of psychiatrists results in depression being seen as having a biological cause, the treatment of which requires medication and in severe cases electro-convulsive therapy (ECT).
"We can't let go of it. There is a power base behind this biological and medical model of depression which has no understanding of the psychological, social and spiritual dimensions of depression," he says.
"Things may be changing in Ireland, but in the US and Britain there is a long tradition of not criticising people in your own profession so as not to undermine the prestige of psychiatry.
"I've been the only active voice trying to stop electro-shock treatment in the US for the last 30 years," he says.
Over the past 30 years, Breggin has been a medical expert in court cases involving the use or misuse of psychoactive medications.
His research into these drugs led to the publication of Your Drug May Be Your Problem; How and Why to Stop Taking Psychiatric Medications (Perseus Books, 1999) by Breggin and Dr David Cohen, and The Antidepressant Fact Book - what your doctor won't tell you about Prozac, Zoloft, Paxil, Celexa and Luvox (Perseus Books, 2001) by Breggin.
"Even the Food and Drug Administration [ FDA] now admits that anti-depressants don't work," he says.
"There is a placebo effect equivalent to a sugar pill and withdrawal from them can mimic the original symptoms, leading sometimes to violence and suicide."
Breggin was also one of the key people who campaigned for label changes on antidepressant drugs sold in the US. And in March 2004, the American FDA issued an official warning on the increased risk of suicidal tendencies when taking antidepressants such as Prozac.
Since then, the makers of Prozac and nearly all other major antidepressants used in the US (Paxil, Zoloft, Wellbutrin, Effexor, Celexa and Lexipro) must include a warning that in the first days and weeks of treatment, side effects such as agitation, panic, irritability, insomnia and severe restlessness may occur, contributing to an overall increase in the risk of suicide.
In Ireland, the former inspector of mental hospitals, Dr Dermot Walsh, has publicly expressed his concern that doctors are over-prescribing antidepressants with little evidence of any public health benefit. Walsh also said that "the rise on suicides mirrors almost exactly the increased use of antidepressants".
Breggin contends that, in the US, de-institutionalisation hasn't led to an improvement in the conditions of people with mental illnesses.
"The Community Mental Health Act in the 1960s led to community centres, clinics and day hospitals being set up. Those community centres are now drug dispensaries. People can now have outpatient electro-shock treatment in the US.
"There are more people in the US on psychiatric drugs now than when the large mental hospitals were filled with patients. Schools in the US also dispense a large number of drugs to children," he says.
Although supportive of the movement of former psychiatric patients who reject the biomedical model of depression, Breggin believes that their power is marginal compared with the multibillion-dollar pharmaceutical industry.
"The main impact of the patient movement [ Mind Freedom Support Coalition International, and others] is to help people who have been injured by psychiatry, to give them support and help them to maintain their dignity," he says.
No doubt many of his books, including Toxic Psychiatry: Why therapy, empathy and love must replace the drugs, electro-shock and biochemical theories of the "new psychiatry" (St Martin's Press, 1994) and more recently The Heart of Being Helpful: empathy and the creation of a healing presence (Springer Publishing, 2006), have been read by these former psychiatric patients.
So what is his approach to treating depression?
"Empathy is central. I've never met a good therapist who didn't draw on various therapeutic approaches. The most important element of therapy is the presence of another caring individual," he says.
"I do that through an insight-oriented therapy which helps people understand their childhood, their conflicts, what went wrong with the principles that they developed. Then, I encourage them to develop better ideas, values and principles for living."
He concludes: "The question is, how do you train a profession such as psychiatry to deal with people in this way - to consider that depression is fundamentally about someone who has lost their love for life and other people?"