Psychiatric Medications Kill More Americans than Heroin

In 2014, 10,574 people died of heroin overdose while 15,778 died from an overdose of psychiatric medications, nearly 50% more.
We often hear the shocking fact that deaths from heroin increased nearly 5 fold (374%) between 1999 and 2014, but rarely – if ever – do we hear that deaths from psychiatric drug overdoses have increased nearly 4 fold (278%) over the same time period. The data are summarized in Figure 1.

The biggest killers are sedatives (benzodiazepines such as Xanax and Z-drugs such as Ambien), antidepressants, psychostimulants (Ritalin, amphetamine, and methamphetamine), and antipsychotics, in that order, as shown in Figure 2.

What accounts for this high overdose death rate for users of psychiatric medications and for the steep climb in death rates over the past 15 years? A number of factors appear to contribute to this, including increased prescribing, increased polypharmacy (prescribing multiple drugs to the same person at once), increased off-label prescribing, and increased prescribing of psychiatric drugs by non specialists, including general practitioners, nurse practitioners, and others untrained in the field of psychiatry. We will proceed to look at each of these factors below.
According to data from the MEPS (Medical Expenditure Panel Survey) database, the number of prescriptions for psychiatric medications (i. e. sedatives, antidepressants, psychostimulants, and antipsychotics) increased 117% between 1999 and 2013, from 197,247,557 prescriptions in 1999 to 427,837,506 prescriptions in 2013. Meanwhile, death rates from psychiatric medication overdose climbed a whopping 240% over the same time period, from 1.31 deaths per 100,000 in 1999 to 4.46 deaths per 100,000 in 2013 (we are excluding the CDC death rate data from 2014 since the MEPS 2014 data has not yet been published).
Details of prescribing by drug class are given in Figure 3 and percentage of increase in prescribing is in Figure 4. Although the increase in number of prescriptions partially accounts for the increase in death rates, it is clear that it does not account for all of them, and that there must be other factors involved. Those primary factors are most likely polypharmacy, off-label prescribing, and non-specialist prescribing.

Polypharmacy

Although medical scholars use the word polypharmacy in several different ways, the simplest definition is “the prescription of two or more drugs at the same time.” In other words, drug mixing. In some cases, such as HIV treatment, polypharmacy is an evidence-based best practice. In other cases, such as psychiatric treatment, there is little research to back up most instances of polypharmacy; moreover, inappropriate polypharmacy can be harmful or even deadly.
Kingsbury and Lotito (2007) state that:

“A great deal of data exists about the dangers of polypharmacy. Persons with psychiatric disorders experience increased risk for adverse drug interactions because of the great frequency with which multiple medications are used. Using multiple antipsychotics concomitantly has been associated with increased mortality in patients with schizophrenia. Reports of adverse psychiatric polypharmacy effects are abundant, including increased duration of hospital stay.“

Kukreja et al. (2013) tell us that:

“While evidence for the added benefit of psychiatric polypharmacy is limited, there is growing evidence regarding the increased adverse effects associated with such combinations. Concerns with polypharmacy include not only possibilities of cumulative toxicity and increased vulnerability to adverse events but also adherence issues which emerge with increasing regimen complexity.”

Mojtabai and Olfson (2010) report major increases in psychiatric polypharmacy: in office-based psychiatry practices in the United States the median number of medications prescribed per visit doubled from 1 in 1996-1997 to 2 in 2005-2006 and the mean number increased by 40.1% from 1.42 in 1996-1997 to 1.99 in 2005-2006.
In Figure 5 we show the percentage of deaths due to drug mixing in each psychiatric medication class in 2014. Figure 6 lists the drug combinations with psychiatric medications which had the highest death rates in 2014.


Off-label and general practitioner prescribing of psychiatric medications: Off-label prescribing refers to prescribing a drug for a reason other than one which has been approved by the FDA. Although there are instances where off-label prescribing is based on sound published scientific evidence, this is not so in the vast majority of cases. Radley et al. (2006) found that only 4% of off-label psychiatric prescriptions had strong scientific support. Ali and Ajmal (2012) report that off-label prescribing carries clinical risks, such as adverse effects and unproven efficacy. Additionally, Mojtabai and Olfson (2011) report that 72.7% of antidepressant prescriptions in 2007 were written in the absence of any psychiatric diagnosis. Moreover, according to Mark et al. (2009) less than one fourth of prescriptions for psychiatric medications are written by psychiatrist, over three fourths are written by general practitioners, nurse practitioners, and others untrained in the field of psychiatry.
In my personal experience running an alcohol support group, I have had countless women tell me that, despite admitting they were drinking too much, their GPs still prescribed an SSRI antidepressant and, shortly after starting the antidepressant, their alcohol consumption went through the roof. This is not surprising, in light of the fact that research by Naranjo et al. (1995) showed that women treated with SSRIs drank significantly more than women given a placebo; a survey by Graham and Massak (2007) also found antidepressants were useless for reducing drinking in women. Unfortunately, doctors who have been encouraged to write off-label prescriptions frequently jump to the conclusion that women who drink too much must be depressed, so they wind up prescribing an antidepressant that actually makes them drink more. There is a great deal of potential harm which can result from off-label prescribing.

Alternatives to Drug Therapy

Wouldn’t it be great if there were some way we could permanently change the wiring of the brain to ameliorate or eliminate things like depression, anxiety, and schizophrenia without a lifetime reliance on potentially deadly drugs? Actually there is: it is called psychotherapy.
Everything you do which changes the way you think also changes your brain. Recent neuroimaging studies of people who have undergone Cognitive Behavioral Therapy (CBT) by Porto et al. and by Quide et al. show different patterns of brain function than those who have not had such therapy. There is another type of psychotherapy known as Dialectical Behavioral Therapy (DBT) which incorporates mindfulness and meditation practices into CBT. A large body of neuroimaging studies by Newberg demonstrate that mindfulness and meditation practices also permanently change the functioning of the brain.
But what about schizophrenia? Isn’t the only hope for schizophrenics to keep them doped up in a zombified stupor until the day they day? A recent New York Times article titled “New Approach Advised to Treat Schizophrenia” says no; the best treatment for schizophrenics is minimal use of antipsychotic drugs and lots of psychosocial therapy. The article then goes on to tell us that there is actually nothing “new” in this treatment approach, as it has been used in Scandinavia and Australia with great success for decades. It is only new to American psychiatrists who are too ignorant and arrogant to learn anything from the rest of the world and will only accept a study that has been carried out in America. But the reality is that it is not new – even in America. It is the model pioneered by Loren Mosher back in the 1970’s before Big Pharma got him fired from his post as chief of NIMH’s Center for the Study of Schizophrenia…because he was interfering with the profits from their latest huge money maker: antipsychotic drugs.
The reality is that drugging patients into a stupor with huge doses of antipsychotics prevents recovery from schizophrenia. This is why third world countries like India and Nigeria have much higher recovery rates for schizophrenia than the US; they cannot afford antipsychotic drugs which have good short term effects and very bad long term effects. Harding’s Vermont study found that half to two thirds of unmedicated schizophrenics recovered and Harrow found similar results. This is in stark contrast to medicated schizophrenics whose recovery rate is around 10 to 20%.

Conclusion

When prescribed appropriately, psychiatric medications are lifesaving, life changing wonder drugs. However, when over-prescribed or inappropriately prescribed they can lead to great harm and even death. What is needed is a major curtailment of polypharmacy, off-label prescribing, and non-specialist prescribing. The use of psychiatric drugs needs to be reduced to a mere fraction of current use rates and needs to be replaced or supplemented with appropriate psychosocial interventions which include not only therapy but such basics as housing, food security, and education. Money needs to be invested in social change rather than pill popping if we wish to create a healthy nation.
Would we say that just because insulin is good for diabetics that everyone should take it? No, that is nonsense because it would totally destroy a normal metabolism. Yet this is exactly the approach we are taking with psychiatric medications thanks to the misinformation that Big Pharma feeds to doctors and the general public in order to increase their sales and line their pockets.

Recent research shows that American doctors are still over-prescribing many different kinds of drugs,¹ especially antibiotics and opioid pain killers, despite repeated calls for prudence.
U.S. health care expenses have also risen, hitting $3.2 trillion annually as of 2015, and rising prescription prices combined with over-prescribing are significant drivers of these rising costs, according to a government report.^2,3,4,5
While psychiatric drugs were not included in that report, statistics reveal a very clear trend of over-prescribing here as well. According to recent research, 1 in 6 Americans are now on antidepressants or some other type of psychiatric drug, and most appear to be taking them long-term.^6,7,8,9,10
That's quite an extraordinary number, and a significant increase, nearly doubled, from 2011 when 1 in 10 American adults reported using a psychiatric drug.¹¹ According to lead author Thomas J. Moore, a researcher at the Institute for Safe Medication Practices:¹²

"To discover that 8 in 10 adults who have taken psychiatric drugs are using them long term raises safety concerns, given that there's reason to believe some of this continued use is due to dependence and withdrawal symptoms."

Dr. Mark Olfson, a professor of psychiatry at Columbia University, commented on the findings saying it reflects a growing reliance on prescription medications to manage common emotional problems.

Seniors, Women and Caucasians Use the Most Psychiatric Drugs

Among the noteworthy statistics revealed in this latest study, which is based on government survey data from more than 37,400 Americans:

• Nearly 17 percent of American adults used one or more psychiatric drugs in 2013, up from 10 percent in 2011
• 12 percent of users are taking antidepressants; 8.3 percent are taking anxiety drugs, sedatives and/or sleeping pills; 1.6 percent are taking antipsychotics
• Caucasians are twice as likely to use psychiatric drugs than African-Americans, Hispanics and Asians (20.8 percent were Caucasian, 9 percent African-American, 8.7 percent Hispanic. Only 5 percent of users are Asian)
• 25 percent of seniors between the ages of 60 and 85 are taking at least one psychiatric drug. This despite the fact that incidence of diagnosable mental problems tends to be lower in seniors than younger adults overall
• Nearly twice as many women use psychiatric drugs than men (21 percent and 12 percent respectively)

Psychiatric Drugs Are Over-Prescribed

Other recent research shows that anti-anxiety benzodiazepine drugs accounted for nearly one-third of the 23,000 prescription overdoses in 2013.
According to researchers, part of the problem appears to be that primary care physicians are under-educated on the risks associated with psychiatric drugs. As reported by Scientific American:¹³

"For antidepressants, there is limited information available about how long an individual should stay on the drug … For certain drugs in the sedative, hypnotic and anxiolytic category, however, people can become dependent, the researchers noted.

To improve the safety of psychiatric drugs, Moore and Mattison suggested increasing the emphasis on prescribing these medications at the lowest effective dose and continually re-assessing the need to keep individuals on the drugs."

Declining Mental Health Is a Wakeup Call for Psychiatry

While prescriptions for psychiatric drugs are increasing,¹⁴ several parameters show that mental health in the U.S. is declining.¹⁵
Suicide rates are at a 30-year high, prescription drug abuse and overdose deaths have become a public health emergency, and mental disorders are now the second most common cause of disability, having risen sharply since 1980.¹⁶
All of these statistics suggest that far from being helpful, the availability of psychiatric drugs and the ease of getting them are making the situation worse.
Sure, these drugs may be helpful for a small minority of people with very severe mental health problems, such as schizophrenia, but clearly, the vast majority of people using these drugs do not suffer from severe psychiatric illness.
Most are struggling with sadness, grief, anxiety, "the blues" and depression, which are in many ways part of your body's communication system, revealing nutritional or sunlight deficiencies and/or spiritual disconnect, for example.
The underlying reasons for these kinds of troubles are manifold, but you can be sure that, whatever the cause, an antidepressant, sedative or antipsychotic will not correct it.

Better Treatment Alternatives Are Sorely Needed

As noted by Dr. Edmund S. Higgins, a psychiatrist who has authored a number of articles and books on psychiatry:¹⁷

"The American Psychiatric Association, the American Psychological Association and big pharma explain the deterioration of mental health nationally by proposing that not enough people are getting treatment. But this suggestion seems a bit self-serving.

Another explanation points to the vague nature of psychiatric diagnoses … [M]ental disorders … seem to expand and contract with the economy. Thus, changes in the prevalence of mental disorders may not necessarily reflect changes in the biology of mental illness.

It is also possible that we are hampered by not having new treatments for patients seeking help. As it turns out, drugs developed in the past 20 years perform like older medications …

[I]t is paramount that we discover new mechanisms to treat mental illness …  [T]here is one unique, promising treatment that is struggling to get approval: psychedelic-assisted psychotherapy.

Preliminary evidence suggests that drugs such as LSD and psilocybin could be used episodically, together with psychotherapy, to enhance the healing process."

 Indeed, I recently wrote about research showing a single dose of psilocybin, also known as magic mushrooms, helped many cancer patients in two separate studies achieve immediate and long-lasting relief from anxiety and fear of death.
A major part of this remarkable recovery appears to be related to the spiritual intensity of the experience.
Apart from the spiritual reconnection itself, the feeling of love and being "one" with everything also appears to result in alterations in the brain — a mechanism ascribed to neuroplasticity, where your brain actually changes in accordance to experience. Indeed, a majority of the participants ranked it among "the most meaningful" experiences of their lives, which in turn resulted in a feeling that everything has purpose, including their own struggles.
In my view, it is lack of life meaning and lack of connection to something larger than ourselves that pervades the lives of so many these days, and the answer is not to shut down or mask your emotions with a pill. The relief you seek is more likely to be found through careful soul searching and implementation of strategies to boost your emotional resilience, which can include spiritual practices.

Six years ago, I interviewed journalist and Pulitzer Prize nominee Robert Whitaker about his books "Mad in America" and "Anatomy of an Epidemic," both of which address the dramatic rise of mental illness in the U.S., and its treatment. When looking at the research literature, short-term trials show that antidepressants fail to provide any clinically significant benefits for mild to moderate depression when compared to a placebo.
Indeed, if you believe in following the recommendations of science-based medicine, you simply would not take an antidepressant. You might as well take a sugar pill and avoid all the side effects. As noted in a 2014 paper on antidepressants and the placebo effect:¹⁸

"Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain … But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect ...

Analyzing the data we had found, we were not surprised to find a substantial placebo effect on depression. What surprised us was how small the drug effect was. Seventy-five percent of the improvement in the drug group also occurred when people were give dummy pills with no active ingredient in them.

The serotonin theory is as close as any theory in the history of science to having been proved wrong. Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future."

Placebo Effect Accounts for 82 Percent of Drug Response

The author of that 2014 study, Irving Kirsch, is a psychotherapist who has performed a number of analyses on antidepressants. In 2002, his team filed a Freedom of Information Act (FOIA) request to the U.S. Food and Drug Administration (FDA), asking for the trial data provided by drug companies as part of the drug approval process.
The FDA requires drug companies to provide data on all clinical trials they've sponsored, including unpublished trials. As it turned out, nearly half of all clinical trials on antidepressants had never been published. When both published and unpublished trials were included, 57 percent showed the drug had no clinical benefit over placebo. What's more, the placebo response actually accounted for 82 PERCENT of the beneficial response to antidepressants!
These results were reproduced in a 2008 study¹⁹ using another, even larger set of FDA trial data. According to Kirsch, "once again, 82 percent of the drug response was duplicated by placebo." A major benefit of evaluating FDA trial data was that all of the trials used the same primary measure of depression, which made the drug to placebo effects very easy to identify and compare.
The primary measure of depression used in these studies was the Hamilton depression scale, a 17-item scale with a possible score of 0 to 53 points. The higher your score, the more severe your depression.
Importantly, the mean difference between antidepressants and placebo was less than two points (1.8) on this scale, which is considered clinically insignificant. To illustrate just how insignificant of a difference this is, you can score a 6-point difference simply by changing sleep patterns without any reported change in other depressive symptoms.

Antidepressants Raise Your Risk of Suicide While Offering Little Hope of Remission for Major Depression

Adding insult to injury, many of these drugs have serious side effects, including worsening depression, anxiety and violent ideation that can lead to both murder and suicide. According to Whittaker, long-term studies indicate that of people with major depression, only 15 percent of those treated with an antidepressant go into remission and stay well for a long period of time.
The remaining 85 percent start having continuing relapses and become chronically depressed, and this tendency to sensitize the brain to long-term depression appears to be the same both for the earlier tricyclic antidepressants and the newer selective serotonin reuptake inhibitors (SSRIs).
This is one reason why antidepressant use among adolescents and young adults need to be strongly discouraged. Children and adolescents are also at high risk of suicide when using antidepressants, even if they were not suicidal before.

Treatments Scientifically Validated as Being the Most Effective Are Typically Ignored

Research suggests that one of the most effective treatments for depression is exercise, a healthy lifestyle strategy that few people are engaging in on a routine basis these days. That in and of itself may be a reason for our declining mental health. Diet and certain nutritional deficiencies — especially vitamin D and omega-3 deficiencies — have also been shown to play very important roles.
One of the reasons why your diet is so important is because it affects your gut microbiome, for better or worse. Many studies have demonstrated that improving the diversity and increasing the number of beneficial bacteria in your gut can have dramatic impact on your mental health, boosting mood and reducing your risk for more serious mental health problems.
Some researchers in this field even refer to probiotics as "psychobiotics," noting that dietary treatments for mood disorders may be part of the future of psychiatry. In addition to eating real food and avoiding processed foods as much as possible, be sure to eat plenty of fiber — which help nourish important bacteria — and a variety of traditionally fermented foods, which help reseed your gut with beneficial bacteria.

Vitamins and Supplements Boost Effectiveness of Antidepressants

Considering the fact that antidepressants have the clinical effectiveness of a placebo, is it any wonder that nutritional supplements can "boost" their effectiveness? That's exactly what a recent study found. The meta-analysis, published in the American Journal of Psychiatry, looked at 40 clinical trials in which supplements were added to the drug regimen.^20,21,22 
The following four supplements were found to improve the impact of the medication — which included serotonin reuptake inhibitors (SSRI's), serotonin-norepinephrine reuptake inhibitors (SNRIs) and tricyclic antidepressants — compared to medication only:

• Fish oil
• Vitamin D
• Methylfolate (an effective form of folic acid)
• S-adenosylmethionine (SAMe)

Fish oil produced the most significant improvement. Interestingly, while docosahexaenoic acid (DHA) is typically credited with being the most important omega-3 fat for brain health, here, eicosapentaenoic acid (EPA) was found to have the most prominent effect. The best way to get these fats is from small fish like sardines and anchovies. If that is not an option then krill oil is a far superior choice to fish oil as it is better absorbed and less oxidized.
In my view, it would have been far more interesting to see how these supplements might have fared without the use of medication, as the supplements could very well have been the true benefit. After all, studies have shown that both omega-3 and vitamin D can help improve mental health all on their own, and if the medication doesn't add anything of real value, why risk your health and wellbeing by taking it?

Overcoming Depression Without Drugs

Research has revealed there are a number of safe and effective ways to address depression that do not involve drugs. So, if you suffer from an anxiety- or depression-related disorder, please consider addressing the following diet and lifestyle factors before resorting to a psychiatric drug:

Eat real food and avoid all processed foods, sugar (particularly fructose), grains and genetically modified organisms (GMOs) High sugar and starchy non-fiber carbohydrates lead to excessive insulin release, which can result in falling blood sugar levels (hypoglycemia). In turn, hypoglycemia causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety and panic attacks. Sugar also fans the flames of inflammation in your body. In addition to being high in sugar and grains, processed foods also contain a variety of additives that can affect your brain function and mental state, especially MSG and artificial sweeteners such as aspartame. Gluten sensitivity is also a common, hidden cause of depression, so going on a gluten-free diet can be part of the answer. Recent research also shows that glyphosate, used in large quantities on genetically engineered crops like corn, soy and sugar beets, limits your body's ability to detoxify foreign chemical compounds. As a result, the damaging effects of those toxins are magnified, potentially resulting in a wide variety of diseases, including brain disorders that have both psychological and behavioral effects.

Increase consumption of traditionally fermented and cultured foods Reducing gut inflammation is imperative when addressing mental health issues,23 so optimizing your gut flora is a critical piece. To promote healthy gut flora, increase your consumption of probiotic foods such as fermented vegetables, kimchee, natto, kefir and others.

Get adequate vitamin B12 Vitamin B12 deficiency can contribute to depression and affects 1 in 4 people.

Optimize your vitamin D levels Vitamin D is very important for your mood. Seasonal Affective Disorder (SAD) is a type of depression related to sunlight deficiency, so it would make sense that the perfect way to optimize your vitamin D is through UV exposure. Be sure to check your levels (via blood test) at least once or twice a year. You'll want to be within the therapeutic range of 40 to 60 ng/mL (100 to 150 nmol/L) year-round. If you cannot get sufficient sun exposure to maintain this level, taking an oral vitamin D3 supplement would be advisable. Just remember to also increase your vitamin K2 and magnesium when taking oral vitamin D.

Get plenty of high quality animal-based omega-3 fats Your brain is 60 percent fat, and both DHA and EPA are crucial for good brain function and mental health.24,25 Unfortunately, most people don't get enough from diet alone, so make sure you take a high-quality omega-3 supplement. I recommend small sea foods like sardines and anchovies and if that is not possible then krill oil, which has a number of benefits over fish oil, including better absorption.26

Beneficial herbs and supplements: SAMe, 5-HTP and St. John's Wort SAMe is an amino acid derivative that occurs naturally in all cells. It plays a role in many biological reactions by transferring its methyl group to DNA, proteins, phospholipids and biogenic amines. Several scientific studies indicate that SAMe may be useful in the treatment of depression. 5-Hydroxytryptophan (5-HTP) is another natural alternative to traditional antidepressants. When your body sets about manufacturing serotonin, it first makes 5-HTP. Taking 5-HTP as a supplement may raise serotonin levels. The evidence suggests 5-HTP outperforms a placebo when it comes to alleviating depression27 — more than can be said about antidepressants. One caveat: anxiety and social phobias can worsen with higher levels of serotonin, so it may be contraindicated if your anxiety is already high. St. John's Wort has also been shown to provide relief from mild depressive symptoms.

Evaluate your salt intake Sodium deficiency actually creates symptoms that are very much like those of depression. Make sure you do NOT use processed salt (regular table salt), however. You'll want to use an all-natural, unprocessed salt like Himalayan salt, which contains more than 80 different micronutrients.

Get adequate daily exercise Studies reveal a strong correlation between improved mood and aerobic capacity. There's also a growing acceptance that the mind-body connection is very real, and that maintaining good physical health can significantly lower your risk of developing depression in the first place. Exercising creates new GABA-producing neurons that help induce a natural state of calm. It also boosts your levels of serotonin, dopamine and norepinephrine, which help buffer the effects of stress.

Get enough sleep If you aren't sleeping well you can easily become depressed. Sleep and depression are so intimately linked that a sleep disorder is actually part of the definition of the symptom complex that gives the label depression. Most of us need a minimum of seven hours every night and eight would be better.

Use energy psychology Energy psychology techniques such as the Emotional Freedom Techniques (EFT), can be very effective for reducing symptoms of depression or anxiety by correcting the bioelectrical short-circuiting that causes your body's reactions, without adverse effects. Recent research has shown EFT significantly increases positive emotions, such as hope and enjoyment, and decreases negative emotional states.  EFT is particularly powerful for treating stress and anxiety because it specifically targets your amygdala and hippocampus, parts of your brain that help you decide whether or not something is a threat.28,29 For serious or complex issues, seek out a qualified health care professional that is trained in EFT30 to help guide you through the process.