The Shell Game With Psychiatric Medication

Group of different colored tablets and drugs

Some psychiatric drugs have been renamed and used for disorders or “mental illnesses”  quite different from their original use. Patients are often under the impression that they are getting the latest, newest drug researched and developed just for their needs. That amounts to a “shell game” with medication. Some psychiatric diagnoses have gone through a number of different names until a “marketable” name was decided on. Then, a drug for that disorder or mental illness was soon easily prescribed and widely used. The end goal in all of this: increased market share and profitability for the pharmaceutical industry.

Prozac to Sarafem: From Anti-Depressant to Menstrual Disorder Relief

Once a drug is on the market and before the patent expires, pharmaceutical companies may well attempt to find another use for the drug and market it under a different name. If that can be accomplished, then another patent for that drug’s new use can be filed and more profits will follow. The company’s marketing will typically have people believe that there is now a newly developed drug on the market to give relief for their disorder.

One clear example is Sarafem, prescribed for women’s menstrual issues, but in reality is no different from Prozac, an anti-depressant. Eli Lilly had made around 2.6 billion USD in Prozac sales in 2000, and the patent would soon expire. Researchers at Eli Lilly apparently indicated that Prozac could give relief for Premenstrual Dysphoric Disorder (PMDD) –  a disorder that has had challenges for official recognition. But doctors and women’s organizations were not pleased to have Premenstrual Syndrome (PMS) or PMDD in any way associated with depression. The solution? Rename Prozac as Sarafem, use a different colour and packaging for the “new” medication and launch an ambitious campaign. The campaign appears successful with over 202,000 Sarafem prescriptions in the first year. Prozac has also been prescribed for OCD and bulimia.

For women who have been helped by the medication, barring any serious side effects, one can always be thankful. But this rebranding poses a deeper, more fundamental question. Prozac as an anti-depressant is claimed to be an SSRI (Selective Serotonin Reuptake Inhibitor), to supposedly restore a person’s serotonin neurotransmitter level. But this is not part of the discussion for women taking Sarafem for PMS or PMDD, and thereby undermines the notion of some specific or “selective” action of the drug.

Wellbutrin to Zyban: Anti-Depressant to Smoking Cessation

Another example is relief from nicotine withdrawal, a noble objective when rightly concerned about lung cancer and related issues. Wellbutrin is an anti-depressant, but not an SSRI since it apparently works on dopamine, another neurotransmitter. However, it is also marketed under a different name, Zyban, and re-packaged. No one really knows how it works in smoking cessation. Similar to Prozac used as Sarafem, this makes one wonder about the validity of the biological and medical hypotheses for Wellbutrin.

From Minimal Brain Dysfunction to ADHD

Imagine meeting with your school counsellor and being told that your precious child has minimal brain dysfunction. How does that sound? Would you accept the diagnosis and the drugs? Not so readily, I expect. But if precisely the same condition is now called ADHD, would that be more acceptable, less onerous? Actually, ADHD went through over twenty-five name changes, including “restlessness syndrome,” “brain-injured child,” and “hyperkinetic reaction of childhood” (Pills for the Soul? Page 195). The renaming appears incredibly successful for the pharmaceutical companies as seen by the virtual explosion of Ritalin sales. Breggin, in his heavily researched and documented book, Brain-Disabling Treatments in Psychiatry, pages 253-282, documents the lengths to which the pharmaceutical industry has marketed drugs for ADD and ADHD with revenue from almost $760 million USD in 2000 to over $ 3 billion by 2004. Does anyone really believe that there has been such an “epidemic” in ADD and ADHD in those years? Meantime, the FDA’s approval was based on inadequate research as to the long-term side effects and health hazards for those drugs. Chapter 11 in Breggin’s book, “Stimulant-Induced Brain Damage, Brain Dysfunction, and Psychiatric Adverse Reactions” is both illuminating and alarming reading, especially if your child is taking medication for ADHD. With the market “saturated” since Americans are quite willing to drug their children, the push was on to market these drugs to adults and thereby increase market share. Interestingly enough, Europeans are less inclined to so readily medicate their children. What’s in a name, Shakespeare once wrote? Apparently, millions or billions of dollars.

From Neurotic Depression to “Dysthymia” 

Decades ago, psychiatrists were increasingly concerned about the negative connotations with the term neurotic depression, widely used as a diagnosis that generated a lot of revenue. But revenue was going down. They therefore renamed this with the more clinical and socially acceptable term dysthymia, which was also moved from the personality axis in the DSM-III to the disease axis (Pills for the Soul? Page 195). It’s all in the “packaging.”

I once saw a cartoon about a man concerned over the strange behaviour of his pet dog. So, like any responsible dog owner, he took his dog to the local animal psychologist. After analyzing the dog, the psychologist discussed the situation outside the office so the dog could not hear. The psychologist said that the dog was suffering from chronic low-grade depression with derealization and a partial dissociative disorder. And furthermore, the psychologist said, the dog is not able to find his “squeaky toy.”

Companies need revenue to fund research and when people are genuinely helped, everyone can be thankful. But the questionable tactics of the pharmaceutical industry, as shown in this blog, seem to have “crossed an ethical line”. When a drug is prescribed for a mental illness for a supposedly specific biological function, such as increasing the level of some neurotransmitter, and then later prescribed for an entirely different mental illness or disorder where neurotransmitter action is not hypothesized, one should question the entire biological validity of the drug in the first place. When the sales of a drug virtually explode when an “acceptable and marketable” name for a disorder or mental illness is promoted by the industry, one should be incredibly skeptical. One cannot help but think of all of this as a “shell game” of the pharamceutical industry.



Author: Dieter K Mulitze, PhD

Dieter has written three books on the ministry of transforming and healing prayer. One of Dieter’s main roles in this ministry is teaching the seminar series and speaking at conferences. Dieter’s three books serve to articulate and strengthen the theology and practice of the ministry of transforming prayer for the whole person. Dieter graduated from the U. of Guelph (BSc) and holds a PhD in quantitative genetics from the U. of Saskatchewan. Dieter was an associate professor with the University of Nebraska, and has co-authored scientific papers in several professional journals. He is a graduate of Regent College, Vancouver, B.C., with the Master of Christian Studies (MCS) degree, concentrating in spiritual theology. Dieter has served as an elder in a number of churches. Dieter is bi-vocational, serving as the Chief Scientific Officer for Agronomix Software, a software development company which develops, distributes and supports a software application for plant breeders and agronomists worldwide. With his experience in the corporate world, Dieter has also taught on the theology of work. Dieter is no stranger to international travel – having lived in Syria and Morocco for a total of 6 years and travelling to over 50 countries worldwide for business or ministry. Dieter and his wife Ellen live in Winnipeg, Manitoba, Canada. They have one daughter, Karissa, who lives in France with her husband and children.