In the past, we have brought many incidents of the pharmaceutical industry’s influence over the FDA and the medical community in general to light. This problem is most disturbing in the psychiatric community, where time and time again we see the pharmaceutical companies exact their influence over how our country is treated and when doctors turn to drugs to treat a patient.
Today’s version of the story: grief, or bereavement. The change being made is to the definition of depression in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the major guide to all doctors working in the field, including family physicians who are often called upon to make mental health diagnoses when they don’t have the exact expertise. Depression is defined by a list of symptoms, such as sadness, insomnia, fatigue, loss of appetite, etc. If a person has five of these symptoms for two weeks, the DSM says that a diagnosis of depression is appropriate.
However, there has always been a bereavement exclusion to this diagnosis. Oftentimes, a person grieving for a loved one will exhibit these same symptoms, but unless they go on for more than 2 months, depression was not to be diagnosed.
But with a little help from the same pharmaceutical companies who manufacture anti-depressants, the exclusion has been removed.
Now, if after two weeks, a person who has lost a spouse, a friend, a parent, or even a child, still feels the symptoms of grief that are so similar to depression, he has a diagnosable, treatable mental disorder.
Most people, including many doctors and psychiatrists, find this odd. Isn’t the emotional reaction to the loss of a loved one a normal part of life? Is yet another normal facet of human existence being pathologized? And how did this major change come to be made? Through studies funded by drug companies, including GlaxoSmithKline’s Wellbutrin study.
Not only do the drug companies tout the benefits and effectiveness of treating the bereaved with their antidepressants, but the majority of the experts on the American Psychiatric Association committee that voted on this change have financial ties to the drug companies. Some have received the money in the form of research grants, others hold stock in the drug companies, and others serve as speakers and consultants. The key advisor who wrote the scientific justification for the removal of the exclusion was also the lead author of the Glaxo-sponsored study that showed Wellbutrin’s effectiveness at treating bereavement.
With the decision-makers standing to make (more) money from these changes, are these changes to be trusted, or is it just another way for the drug companies to add to their $10 billion per year anti-depressant empire?
Often members of such committees receiving compensation from drug companies justify it by saying that all potential experts do it, therefore there are no neutral party options. This, however, has been shown not to be true. About 36% of full professors at medical schools have no financial connections to the industry. A more neutral, unbiased set of guidelines IS possible.
Our country is one of the extremes when it comes to mental health. There are segments of the population that are suffering from severe mental illness that receive no attention or treatment, and then other cases, such as this one, people are being subjected to treatment when their symptoms are a normal part of human life, and if left to properly grieve, will come out the other end intact.
In the case of bereavement, the exclusion that is being removed did not keep all of the bereaved from being treated. In fact, the exclusion led to a more honest discussion of the patient’s feelings. In most cases, the patient himself knows when the line between normal bereavement and real depression has been crossed. But with no exclusion at all, doctors might start recommending drug treatment for people who don’t need it at all. And because no drug comes without side effects, this is a dangerous road to start down.
Some doctors not only strongly disagree with the removal of the bereavement exclusion but think an expansion of the exclusion would have served the patient population better. There are other forms of bereavement that result in depression-like symptoms but would do just fine to resolve in their own time, such as the loss of property, etc.
Human suffering is an unpleasant but unavoidable aspect of life. The medical community is too heavily under the thumb of the pharmaceutical industry, and its profit-based decision-making has done a disservice to the neutrality of a very important guide.
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