The accepted wisdom is that the arrival of chlorpromazine in asylum medicine in 1955 kicked off a psychopharmacological revolution, this great advance in care. Chlorpromazine is remembered today as the first "antipsychotic," and soon the field gained new antidepressants, and new anti-anxiety drugs. Then, starting in the late 1980s, a second generation of psychiatric drugs came to market, said to be safer and more effective than the first. That is a story of continual medical progress.Share
Yet, as this revolution has unfolded, the burden of mental illness in western societies has increased. Disability rates due to mental illness have soared, and this is particularly true during the past 25 years, since Prozac came to market. Furthermore, the long-term outcomes for major mental disorders have, if anything, gotten worse during the last 25 years.
Thus, you have a puzzle: if the medications are so helpful, why is the burden of mental illness increasing? Why haven't long-term outcomes improved?
The prescribing of psychiatric drugs in children really began in the United States in 1980, when the American Psychiatric Association created the diagnosis of attention deficit disorder for the first time, when it published the third edition of its diagnostic and statistical manual. Then, if you look at the growth of this practice, of prescribing psychiatric medications to children, it is easy to identify the commercial forces involved. And finally, this is being done in the absence of good evidence that the medications help the children over the long term. (Read more.)