Unhappiness, sadness and 'depression' : antidepressants and the mental disorder epidemic

206 Pages·2017·2.597 MB·English

by  Giraldi, Tullio

ANTIDEPRESSANTS AND THE MENTAL DISORDER EPIDEMIC
UNHAPPINESS,
SADNESS
AND ‘DEPRESSION’
TULLIO GIRALDI
Unhappiness, Sadness and ‘Depression’
Tullio Giraldi
Unhappiness,
Sadness and
‘Depression’
Antidepressants and the Mental
Disorder Epidemic
Tullio Giraldi
University of Trieste
Trieste, Italy
ISBN 978-3-319-57656-5 ISBN 978-3-319-57657-2 (eBook)
DOI 10.1007/978-3-319-57657-2
Library of Congress Control Number: 2017940344
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For my hugely supportive family, and in particular for Vlady, for the
patience she has shown while I have been absorbed in writing this
manuscript—in case I cannot express my gratitude in a future one…
Foreword
The great accomplishment of Tullio Giraldi’s able and carefully consid-
ered work on antidepressants is to place these drugs in the context of
the mental illness revolution.
As Giraldi shows, this revolution soon gave way to partial disappoint-
ment, because of the difficulty of translating its great hopes into con-
crete results. When the first international Symposium on Psychotropic
Drugs was held in Milan in 1957, a good number of these drugs were
already available and the main categories had been identified. The first
tranquiliser, meprobamate, was already in circulation, as were pheno-
thiazines, the first antipsychotics. Meanwhile, the sphere of “depression”
was dominated by monoamine oxidase inhibitors.
From there, the number of antidepressant drugs increased enor-
mously, and at present there are almost 40 available. However, the
advantages of more recent drugs over their predecessors are limited, and
their success is more often the result of advertising than of rigorously
controlled clinical trials. Unfortunately, the pharmaceutical lobby has
had a powerful influence on European legislation, and it’s this legisla-
tion that guides the European Medicines Agency (EMA), the body that
monitors drugs across Europe.
vii
viii Foreword
As a result, the law currently states that new drugs should be
approved on the basis of their quality, safety and efficacy, and although
these are all important considerations, they do not take into account
what the public actually expects of new drugs: that they should improve
on the old ones. In fact, simply adding the three words “therapeutic
value added” to the current legislation would be enough to show up
most of the 40 drugs currently available.
If you then consider that almost all the controlled clinical trials for
approving new drugs are carried out by the pharmaceutical industry, it’s
reasonable to ask how we can accept this incredible conflict of inter-
ests. If European legislation only accepted clinical studies by independ-
ent, non-profit bodies, the range of antidepressant drugs on the market
would probably be very different. And as Giraldi notes in this book, a
significant shift in the way we use the various different “generations” of
antidepressant drugs is currently underway. For example, Kirsch’s stud-
ies have shown that, except in extreme cases of depression, there is no
significant difference between the effects of antidepressant drugs and
placebos. Even in extreme cases, antidepressants are only more effective
because of the reduced effectiveness of placebos, and yet the vast major-
ity of antidepressants are prescribed for cases where placebos would be
just as effective.
It’s important in this context to distinguish between the disease of
depression and depressing situations. While the disease of depression
is serious and therefore requires treatment, even when it is objectively
difficult—given the lack of comparative studies—to choose the best
method, depressing situations should not be considered pathological. If
someone loses a loved one, has financial problems or is fired from their
job, this naturally leads to a “depressed” emotional state. In such situa-
tions, people do not need antidepressant prescriptions but help realising
that life goes on and that strength comes from within themselves. This
is even more important when you consider that using antidepressants
for extended periods causes withdrawal syndrome. That means that peo-
ple who interrupt their treatment often resume it quickly in order to
avoid symptoms that are even worse than before the prescription. That
is why, today, people are advised to start not with antidepressants but
Foreword ix
with cognitive behavioural psychotherapeutic treatments, which con-
trolled clinical studies have shown are just as effective as drugs.
This book suggests that we are still waiting for more effective and
better-tolerated depression treatments. Unfortunately, for the moment
multinational pharmaceutical companies seem to have deserted the field
of psychopharmacology, deeming the discovery of new drugs both dif-
ficult and unprofitable. The sick, however, cannot wait, so it is now
up to charities and the public sector to drive research programmes and
develop new antidepressant drugs. And if the politicians and research
programmers in charge of health agencies read Tullio Giraldi’s excellent
book, they must surely come to the same conclusion and support fur-
ther research into treatments for depression.
Silvio Garattini
Direttore, IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri”
Acknowledgements
This book would not have been possible without the generous and
unstinting support of Beneficentia Stiftung. I am profoundly grateful to
them for backing not only my research but also my extended analysis of
depression and other subjects in this work.
My sincere gratitude is also due to the Fondazione Callerio of Trieste,
which supported my research and my work on this volume.
I would like to extend particularly heartfelt thanks to Dr. Maša Jović
for the skill and dedication with which she has assisted me in the writ-
ing and editing of this text over the past few years. Her help with verify-
ing the citations has been especially important.
I developed the ideas in this book largely as a result of many stimulat-
ing discussions over the years with numerous friends in medicine and
experimental research. Attempting to list all of these people would inev-
itably lead to some unforgivable omissions. I will therefore limit myself
to mentioning some of the institutions I have worked at in the course of
my career, and which have provided me with extraordinarily stimulat-
ing academic environments. First, I should mention the Medicine and
Surgery, Pharmacy and Psychology Faculties at the University of Trieste,
where I have spent most of my academic career, with the exception of
xi
xii Acknowledgements
almost a decade at the nascent Faculty of Medicine and Surgery at the
University of Udine and several short periods abroad.
I also have fond memories of my early forays into research with
the Tom Connors group at the Chester Beatty Research Institute
in London, and at the Bethesda Md National Cancer Institute and
National Institute of Health. Here I had the pleasure and honour of
working with the late Abe Goldin and numerous others.
Collaborating with colleagues from the Department of Mental
Health and the local healthcare organisation, the Azienda per
l’Assistenza Sanitaria no 1 Triestina, has also been an extraordinary
experience. Their Franco Basaglia-inspired psychiatry and community
care have left a strong impression.
Furthermore, I am delighted to have been able to contribute to the
Slow Medicine movement in Italy, which is growing at such a rate now
that it is even becoming influential at an international level, through
associations such as Choosing Wisely. I am particularly grateful to all
the staff and outstanding academic colleagues at the Department of
Social Sciences in Health and Medicine at King’s College, London,
where I am currently a visiting professor, and where much of this book
was written. In this hugely stimulating environment, I have been able to
have many fascinating, in-depth discussions about often-delicate health-
related subjects.
Finally, I would like to extend my heartfelt thanks to all the col-
leagues and students I have had the pleasure of working with in the
course of my teaching and research. These experiences have certainly
enriched me and I hope they have been mutually rewarding.