March 27, 2025 • Brooke Siem
How the National Institute of Mental Health created the depression epidemic: And the Role of Pharmaceutical Strategies in Shaping Public Perception.
Recently, through a text message from a mutual friend, lifestyle design guru Tim Ferriss asked me a question:
“Could you ask her, if she has time, what the TL;DR (too long; didn’t read) is for the book explanation of why we’ve had such an astonishing rise in mental illness?”
Tim was referring to the book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. I’d recommended the book to him by way of said mutual friend after Tim and one of his recent podcast guests, psychiatrist and Stanford researcher Nolan Williams, got the history of antidepressants wrong during the interview. Already annoyed by the proselytizing and arrogance that comes with elite academia, it pissed me off that Williams didn’t know the basic history of the field he’s trying to revolutionize.
William’s research, which focuses on a non-invasive, rapid-acting form of transcranial magnetic stimulation (TMS) called Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), is reported to reduce severe depression symptoms in 90% of participants. Though I admit this is intriguing if replicable (and a good 5-10 years away from mainstream adoption), it would do Williams some good to remember George Santayana’s prophetic quote:
“Those who cannot remember the past are condemned to repeat it.”
And so, from a parking lot in a strip mall, I texted a friend to ask him to pass the book title along to Tim, given that it corrects the error and was then asked to summarize the book’s thesis. Here’s what I sent back:
The hypothesis of the book asks exactly that question. Why, despite billions of dollars invested in research, has the number of disabled mentally ill in the United States tripled (as of 2011) over the past two decades? Whitaker uses disability rates as a measurement, since there aren’t any practical biological markers/blood tests/or scans to identify or diagnose mental illness, and self-reported surveys aren’t the hallmark of anything resembling good science.
The TL;DR of it all: over long periods—longer than your average 4-12 week study—the drugs (which have been our only real strategy since the 90s), across the board, create changes in the brain/body to cause denigration to the psyche, which results in a mental illness diagnosis and more drugs. And of the long-term studies that do exist, they all point to this same conclusion. In schizophrenics, for example, long-term use of antipsychotics reduces grey matter. So not only is there a reduction of brain volume, but there’s the physical dependence on the drugs which, when they’re taken away, causes withdrawal…but withdrawal symptoms haven’t historically been considered in the research, leading to both misdiagnosis and sixty years of science confusing relapse with withdrawal and more people permanently disabled.
When you combine this with some of what’s come out recently about the shit science in psychiatry—notably, the publication bias in the original Xanax trials (four of the five original studies on the effectiveness of alprazolam found it to be no better than a placebo or a negative result, but the data was cooked and now we have an opioid crisis), the call to retract the STAR*D trial due to protocol violations that grossly inflated the announced remission rate (not to mention there wasn’t was a placebo control group which is baffling), broadening diagnosis + patents expiring on hallmark drugs, and the anti-stigma campaigns (many of which are funded and created by pharmaceutical companies), and you’ve built yourself a lucrative, psychiatric bomb where individuals suffer at every step.
It’s also interesting because years ago when I was researching an op-ed I wrote for The Washington Post, I spent time with Fidel Vida Rodriguez in his lab at the University of British Columbia. His lab does TMS-fMRI and tDCS-fMRIs. It’s interesting to watch technological progress meet the same mistakes we made in the past, and I’ll be curious to see if this stuff can escape the problematic structural issues in psychiatry.
To which, Tim responded: “Smart woman! Pls extend my thanks.”
Who am I to argue with Tim Ferriss? Perhaps I should add “Tim Ferriss says I’m smart” to my LinkedIn Profile.
Though I stand by my stance of this psychiatric bomb being made up of a collection of ingredients, perhaps the most influential propellant was the National Institute of Mental Health’s 1988 Depression Awareness, Recognition and Treatment campaign (DART) that was “designed to alert health professionals and the general public to the fact that depressive disorders are common, serious, and treatable” and “change public attitudes so that there is greater acceptance of depression as a disorder rather than a weakness.”
(Note: the research is normally behind an academic paywall, but I got a hold of it and uploaded it to a Google Drive for you to view. Yet another reason why it’s impossible for the average person to “do their own research.”)
My god, the language used here is brilliant. In 37 words, a previously unknown problem is revealed, the public is shamed for viewing this unknown problem as personal weakness, and a treatment is teased for the disorder so many people don’t know they have. And it’s all couched in subtle influence that says we’re here to protect you.
But here’s the thing. The DART campaign launched five months after Prozac, made by Eli Lilly, hit the market. And prior to the release of Prozac, a NIMH survey found that only 12% of American adults would take a pill to treat depression. The rest said they “would live with it until it passed.” And as much as it would be nice to believe that the NIMH was truly acting in the public’s best interest, even if they came to that conclusion through cooked research, that argument quickly falls apart given that the program and clinical training were funded by pharmaceutical companies.
The document continues, emphasis my own:
“With pharmaceutical company support, APA [American Psychological Assotiation] also has sponsored a series of training sessions for primary care physicians. Particular emphases for nonmedical mental health providers have been on biological and pharmacological treatments; for medical specialists, diagnoses and a full range of treatments have been emphasized.”
Read that again. Part of the program involved going to mental health providers who legally can’t prescribe (and therefore remained employed by using non-pharmaceutical therapies) and “educating” them on the wonders of drugs.
A wide variety of “public education materials” were also developed, including “radio and television public service announcements, posters, flyers, print advertisements, bus cards, bookmarks, and educational brochures at various age and education levels in English and Spanish.”
Furthermore, Eli Lilly helped fund the printing and distribution of 8 million DART brochures titled “Depression: What You Need to Know,” which wound up in physician’s offices all over the country.
The pamphlet explained the merits of “serotonergic” drugs that acted specifically on the serotonin system, which was extremely convenient given Eli Lilly’s concurrent Prozac promotion, which garnered major media profiles and landed the drug on the cover of Time Magazine.
In one 1990 New York Times feature—which in some ways, is more concerned with the negative effects of antidepressants than most reporting from the past 10 years—readers are told that Prozac works because of its “novel biochemical nature” that “is believed to zero in on serotonin, blocking the removal of the important signal from the neurochemical loop in the brain and thus allowing serotonin to remain operative on neurons for a longer time. That blockage seems to restore overall serotonin activity to a more normal state, which somehow helps alleviate many cases of depression.”
All of this, from the prescriber training programs to the Spanish bus cards to the cover of Time, is a lesson in the power of guerilla marketing. I don’t remember the early 90s well, but I imagine it was impossible to get away from this campaign. No matter where you went, the marketing was there to get you to do one thing: talk to your doctor, nurse, occupational therapist, or social worker who, unbeknownst to you, had received “short-term training in the diagnosis and treatment of depressive disorders” that from 1987 to 1988, had “been offered somewhere in the United States every week over the past year.”
Let’s break down the timeline and look at the financials:
1975: American revenue from antidepressant sales valued at less than $200 million
December 1987: The FDA approves Prozac.
January 1988: Prozac hits the market.
May 1988: DART campaign is launched, pamphlets distributed to physicians, the word “serotonergic” introduced to the public
1990: Projected Prozac Sales: $700 million
1991: Zoloft approved by the FDA.
1992: Prozac graces the cover of Time Magazine.
1993: Annual Prozac sales: $1.2 billion
1994: Zoloft sales $638.4 million
1998: Annual Prozac sales peaked at $2.8 billion
2001: Zoloft’s “sad blob” ad launches, cementing the chemical imbalance theory in the zeitgeist.
2005: Zoloft sales $3 billion.
2023: Total antidepressant market size: $17.41 billion—one hell of a return on investment.
More articles from the blog
see all articles
April 17, 2025
Every medical test I used to heal my body after 15 years of antidepressants: Actual medicine, unlike what’s going on in psychiatry
read the article
April 10, 2025
Letter from a past life: What I found after scrubbing the screws on my toilet.
read the article
April 3, 2025
