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“Every marketer’s dream is to find an unidentified and unknown market, and develop it.  That’s what we were able to do with Social Anxiety Disorder.”

                                   —Barry Brand, Paxil product director

FIFTEEN YEARS AGO while writing our book Selling Sickness, Ray Moynihan and I probed deeply into the pharmaceutical industry’s involvement in the development and marketing of a little known condition called “social phobia.”  Apparently, some people are so nervous in social situations that they rarely leave their house. Public speaking? Definitely out of the question for social phobics.

While the extreme form of that condition could certainly be debilitating for some, with the financial might of one of the world’s biggest pharmaceutical companies, and the FDA approval for paroxetine (Paxil) to treat this new condition, “social anxiety disorder” (SAD) became a multi-billion dollar market almost overnight. With some of the slickest, award-winning drug marketing ever seen, the poster tagline behind Paxil read: “Imagine being allergic to people.” The ad didn’t even mention the name of the drug. Why? Because they were just marketing the condition, and they had (at that time) the only pill approved to treat it.

The whole fascinating tale, complete with celebrity spokespeople, athletes on the payroll, and fake patient groups promoting the disease, was textbook bamboozlement, selling consumers and prescribers a company-sponsored version of “abnormal” mental health.

Enter the pandemic, an unprecedented time of worry, where stress, fear and anxiety among a locked-down population become the perfect petri dish to spawn new customers of psychiatric drugs of all sorts.

A report from the US pharmacy management company Express Scripts said that the number of prescriptions filled per week for antidepressant, anti-anxiety and anti-insomnia medications “increased 21 percent between February 16 and March 15.” The kicker here? Three quarters of these were for new prescriptions.

The Council for Evidence-Based Psychiatry (CEP) in the UK reported that 20 percent of the adult population in the UK were taking antidepressants. They are worried that “reframing situational distress as a psychiatric condition” could lead to speculative, pre-emptive prescribing. That is, getting a script “just in case.”

Suffice to say a whole lot more of us might be coping with their lock-down situation with the help of a new drug, an adventure that may not end when the pandemic has run its course.

If you’re anxious, does that mean you’re sick?

There are many things wrong with this picture. First of all, feeling anxious towards situations out of one’s control is normal. Feeling a sense of loss and worry given the rapid way in which society is being reshaped by the pandemic? Also normal. People need social interaction and the support of their families and peers, something which social distancing makes more difficult. Yet a pharmaceutical lifebuoy may not be the answer for most.

The history of “selling” depression, which put generations of people on antidepressants, is built on a false narrative of “chemical imbalance” where wonky brain chemistry is blamed for your sorrow and thus tweaking your neurotransmitters fixes it.

If it were only so simple.

Today, most thoughtful psychiatrists have largely discarded the chemical imbalance theory, yet patients come to them for chemical help. Undoubtedly media saturation, and the infodemic of minute-by-minute death numbers due to COVID-19, adds to the stress of pandemic-induced isolation and disruption. Media reports claiming we’ve got a full blown “mental health crisis” on our hands—whether true or not—likely means that careful and cautious prescribing gives way to an epidemic of people taking antidepressants and anti-anxiety drugs.

KIM WITCZAK BECAME A FIERCE DRUG SAFETY ADVOCATE 15 years ago, after her husband Woody took his own life after being prescribed Zoloft, a widely-prescribed SSRI antidepressant (this class of drugs include Prozac and Paxil). Well-versed on the dangers of antidepressants, Kim is one of the most coherent voices on the dangers of psychiatric drugs and sits as a patient representative on the US FDA’s Psychopharmacologic Advisory Committee. Advocates like Witczak have influenced regulators about drug warnings and in fact her testimony and others in front of the FDA on the risk of suicide related to SSRI depressants forced the US FDA to put black box warnings on those drugs. (See www.woodymatters.com)

Kim Witczak

I contacted her at her home in Minneapolis to talk about the impact of COVID on mental health. “So many lives have been greatly damaged or impacted by the economic toll on families,” she said, adding, “drugs are going to be thrown at people.”

“People need to be informed…Pills are not a quick fix, but I fear they will be the easiest way to deal with mass mental health issues of society,” said Witczak. What adds fuel to this fire is the fact that telemedicine in both Canada and the US are loosening the requirements and making it a lot easier to prescribe a range of drugs.

Witczak is concerned that many patients aren’t going to have needed conversations around the immediate and long-term harms including addition and withdrawal effects related to psychiatric drugs. “These are serious, mind-altering drugs that have real risks,” she told me.   

“It is normal to be struggling with intense emotions like anxiety, fear, sadness, anger given this global pandemic and no one having a clue what the future holds. But is it really mental illness? People should pause and think twice before quickly resorting to a pill.”

There are effective alternatives to drugs including counselling, cognitive behavioural therapy, mindfulness-based stress reduction and “exposure therapy” which can effectively reduce anxiety without the potential problems that come with any drug. The normal advice about reducing stress applies even more: getting exercise, eating properly and getting out into nature. My lay advice would add one thing: stop squirrelling away with social media or reading the news all the time. The world might be crazy but you don’t have to be.   

Some people are questioning this premise that we’re facing a massive mental health crisis and noting that there is a flip side to all of this. George Monbiot, writing in the UK’s Guardian, noted that the pandemic is causing a global outpouring of community action—people getting to know and look after their elderly neighbours, volunteers delivering food for healthcare workers and first responders, kids building healthcare visors on their home 3D printers and so on. Maybe the inherent altruism of people is emerging as a way to deal with the pandemic’s stresses?

But back to the selling of social anxiety. In surveys people often say they fear public speaking more than they fear death. But is being afraid of speaking in public a “disease?” Is the fear of death? Maybe imagining the worse makes us all eager to reach for any lifebuoy at hand. But for those of us who are well aware of the dangers of prescription drugs, we just want to make sure that what keeps you afloat is buoyant, and not another anchor.

At the end of the day it’s OK to feel anxious. Our world is changing. What would be really bad is if the short-term solutions turn into much worse long-term problems.

Alan Cassels studies pharmaceutical policy and works at UBC. His book Seeking Sickness: Medical Screening and the Misguided Hunt for Diseases is available from bookstores and libraries. You can follow him on twitter @akecassels.