NBC News Transcripts

SHOW: Today 7:00 AM EST NBC

June 27, 2005 Monday

HEADLINE: Dr. Steven Shafstein and Dr. Joseph Glenmullen discuss debate over antidepressants sparked by Tom Cruise's statements

ANCHORS: KATIE COURIC, MATT LAUER, MATT LAUER, NATALIE MORALES

REPORTERS: AL ROKER

KATIE COURIC, co-host:

We're back at 7:41. Tom Cruise raised a lot of eyebrows last week when he slammed mental health treatments in this country, including the use of antidepressants. Here's another look at what he had to say to Matt.

Mr. TOM CRUISE: I have never agreed with psychiatry, ever. Psychiatry is--is is a pseudo-science. Here we are today, where I talk out against drugs and the psychiatric abuses of electric shocking people...

MATT LAUER, co-host:

Mm-hmm.

Mr. CRUISE: ...OK? Against their will. Of drugging children, with them not knowing the effects of these drugs. Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug? Do you understand that? (Unintelligible)...

LAUER: I understand there's abuse of all of these things.

Mr. CRUISE: No, you see, here's the problem. You don't know the history psychiatry. I do. All it does is mask the problem, Matt. That's what it does. That's all it does. You're not getting to the reason why. There is no such thing as a chemical imbalance in a body.

LAUER: So postpartum depression, to you, is--is...

Mr. CRUISE: Matt...

LAUER: ...kind of psychological...

Mr. CRUISE: ...don't...

LAUER: ...gobbledy-gook?

Mr. CRUISE: No. But what happens is that the antidepressant, all it does is mask the problem. There's ways of vitamins and through exercise and various things. I'm not saying that that isn't real. That's not what I'm saying. That's an alteration of what--what I'm saying. I'm saying that drugs aren't the answer. That these--these drugs are very dangerous. They're mind-altering, antipsychotic drugs, and there are ways of doing it without that, so that we don't end up in a brave new world.

COURIC: Dr. Steve--Steven Sharfstein is president of the American Psychiatric Association and Dr. Joseph Glenmullen is a professor of psychiatry at Harvard Medical School, and author of the book "The Antidepressant Solution."

Gentlemen, good morning. Nice to see you both.

Dr. STEVEN SHARFSTEIN (President, American Psychiatric Association): Good morning.

Dr. JOSEPH GLENMULLEN (Harvard Medical School): Nice to see you.

COURIC: All right, lots to tackle here, and let me start with you, Dr. Sharfstein. Tom Cruise's statement--he says drugs are never the answer, basically, when it comes to psychological and behavioral problems. What do you make of what he had to say about this?

Dr. SHARFSTEIN: Well, Mr. Cruise may be a halfway decent actor, but when he starts to play doctor, he's being totally irresponsible. This is--his statement crossed the line, especially when he took after Brooke Shields, who came forward and described a true, important, medical psychiatric condition, postpartum depression, and her treatment for it, and said that she needed diet and exercise for that. That, I think, is a disservice not only to her, but to psychiatric patients across the country.

COURIC: Doctor Glenmullen, you've written two books, I know, about antidepressants. What do you make of his assertion that they're dangerous, and really should never be prescribed?

Dr. GLENMULLEN: Well, I don't agree with everything that Tom said, and I--I'm a psychiatrist, I prescribe the drugs myself, but I think there's a middle ground here. I'm very much a moderate in the debate. And I think we don't want to lose sight of the fact that he did, in fact, raise some very important issues.

COURIC: Like what? What do you think is important?

Dr. GLENMULLEN: Ritalin. Ritalin and Adderall are being used as street drugs.

COURIC: But so are some painkillers, to be perfectly honest. Does that mean that painkillers shouldn't be prescribed?

Dr. GLENMULLEN: But--but patients should be told. They should be told when they start these drugs. Psychiatric drugs can mask the real problems. Psychiatric drugs are being overprescribed. He's right when he actually says that there are no proven biochemical imbalances. Everyone's shocked by that, but it's true, and we don't want to lose sight of the very real issues that he's raised.

COURIC: Well, let me talk to Dr. Sharfstein about that. What about--he said there's no such thing as a chemical imbalance. Tell us your reaction to that.

Dr. SHARFSTEIN: Well, that's total nonsense. It belies the last 20 years of incredible breakthroughs in neuroscience and our understanding of how the brain works, and the fact that the medications that we use are very helpful--often very helpful. I also take the middle ground. Obviously, often these medications are overprescribed. But also, I think they're underprescribed because there are many people out there who have not come forward for treatment who could benefit from the medication.

COURIC: I just have to, Dr. Glenmullen, ask you, if you believe--if you agree with him there's no such thing as a chemical...

Dr. GLENMULLEN: Right.

COURIC: ...brain imbalance...

Dr. GLENMULLEN: Right.

COURIC: ...then why are you prescribing antidepressants?

Dr. GLENMULLEN: Well, they clearly help. I've seen them help patients. There are studies that show they help, but...

COURIC: Well, obviously, are they helping with brain chemistry?

Dr. GLENMULLEN: Well, we don't know that. It's never been proven. Do you know that the FDAs in other countries have actually banned pharmaceutical companies and doctors from making that claim because it's actually never been proven. So it's misleading to tell a patient, `You have an biochemical imbalance. This drug is going to correct that imbalance.' It's in TV ads, it's in magazine ads. It's said all the time in doctor's offices. That's why people--millions of people are shocked by what Tom Cruise said, but that is actually true.

Dr. SHARFSTEIN: I disagree. And this is the kind of scientific debate that we are having within the field of psychiatry that's constructive. That's very different than Mr. Cruise's assertions, which I think are destructive.

COURIC: What about the whole notion of vitamins and exercise? Does he have a point that there are alternatives to medication?

Dr. GLENMULLEN: Absolutely. There is an excellent study comparing, for example, the antidepressant Zoloft to exercise for mild to moderate depression. Same kind of studies that are used to study the drugs for approval for FDA, and exercise was as good as Zoloft head-to-head in a study. Now, if you're are severely depressed, you may not have the energy to exercise. But once you're feeling a little bit better, maybe on an antidepressant, exercise can be one of the best ways to help you wean off an antidepressant.

COURIC: Do you agree with that?

Dr. SHARFSTEIN: I certainly do. I--I'm very much in favor of exercise. But as Dr. Glenmullen said, and this is where we certainly agree, that when you get--are severely depressed, medications are very important.

COURIC: Let's talk about Ritalin and Adderall, because not only did he talk about antidepressants, he talked about medications that have been used for millions of kid for ADD and ADHD. And--and do you think that there are--that there's any useful purpose? Again, I think we can even state they're over-prescribed, perhaps. Maybe doctors turn to them too quickly. Having said that, do they have any value?

Dr. GLENMULLEN: Oh, absolutely. Again, the middle ground is really the place to come on this. So there's no question that some children are so hyperactive that they really can't benefit from school. They can't take information in. But at the same time, it's also true that many children who get these drugs, it's because the classroom is too big and there aren't enough teachers, and maybe the family situation is a little out of control, and they need help and support and therapy, maybe, instead of the drugs. So again, we just need to strike a middle ground. You know, Katie, these are not black and white issues.

COURIC: Right.

Dr. GLENMULLEN: And it's very important not try and limit them to black and white.

Dr. SHARFSTEIN: You know, kids with attention deficit disorder need more than the medications. They need psychotherapy. They need family interventions, work with the teachers. But just ask any parent of a child with attention deficit disorder, and they will tell you how important these medications are.

COURIC: But also therapy is so important, too. And when Tom Cruise says these medications sometimes mask the cause, too often doctors these days are doling out antidepressants or some things like Ritalin and Adderall and other drugs without the necessary counseling to kind of work with kids on issues that can't be cured with a pill, right?

Dr. GLENMULLEN: Absolutely. And you know, people get very passionate about this. You know, if you took a hundred people who went on an antidepressant and felt better, the science shows that 75 to 85 of them would have had the same thing happen on a sugar bill--if they were given a sugar pill...

COURIC: A placebo.

Dr. GLENMULLEN: ...and they didn't know it was a placebo. The placebo effect is very powerful. It's very persuasive. People really feel, `Wow, this really helped me.' So, again, we need to just educate people so they can make truly informed choices.

COURIC: And really have a more balanced view of this, but not necessarily throw the baby out with the bath water.

Dr. GLENMULLEN: No, no. No. Absolutely. Again, a moderate position. They help many, many people, but they also are over-prescribed. They have side effects that people aren't often told about. They have dangers that people aren't often told about. And there are, as you said, alternatives.

COURIC: When you say dangers, real quickly, what do you mean?

Dr. GLENMULLEN: Well, for example, with antidepressants, we now have a warning that they can make people suicidal. People gain 20, 30, 40 pounds of weight.

COURIC: And very quickly...

Dr. GLENMULLEN: People have severe withdrawal. Serious side effects.

COURIC: We're almost out of time. I'm so sorry. But Dr. Sharfstein, I have to give you the last word with about 10 seconds to go.

Dr. SHARFSTEIN: Well, I believe that antidepressants save lives. I've treated patients for over 30 years. I've seen how useful they are. I think if you need it, you ought to take it. I think that's really critical.

COURIC: But also be educated about it, I think.

Dr. SHARFSTEIN: Be educated about it. You know the reason people get pills these days and not therapy is because of--of the insurance. And...

COURIC: And that's a whole 'nother can of worms, which we can't talk about this morning. Dr. Glenmullen, Dr. Sharfstein, thank you both so much.

Dr. SHARFSTEIN: Thank you.

Dr. GLENMULLEN: Thank you for having us.

Dr. SHARFSTEIN: My pleasure.

COURIC: You're welcome.

And we'll be back with more of TODAY right after this.