Life has its ups and downs and everyone gets sad once in a while, but the toll of mental illness can be grave. The numbers reveal that one in ten people in the US takes antidepressants and the nationwide rate of antidepressant use has quadrupled in the last 30 years. In most cases, these drugs help stabilize mood without any serious drawbacks. But adverse reactions can happen, as on display in the new thriller Side Effects, out this Friday in theaters across North America, written by Scott Burns and directed by Steven Soderbergh, the same people behind the 2011 viral pandemic movie Contagion (which Nature Medicine reviewed at the time).
Both films are structured around a specific modern-day fear. But the threat in Side Effects mutates faster than any virus could.
In the movie, Emily Taylor (Rooney Mara) and her husband Martin (Channing Tatum) are a young and successful couple living a lavish lifestyle until Martin is sent to prison for insider trading (see trailer below). Devastated, Emily waits for him for four years while living in a tiny apartment in upper Manhattan, struggling with depression. When she is finally reunited with Martin, Emily becomes completely unhinged. After it’s thought that she’s a threat to herself, Emily is assigned to a psychiatrist named Jonathan Banks (Jude Law).
Banks’ practice is booming and pharmaceutical companies approach him to run clinical studies for their new drugs. In a bid to help Emily avoid being committed to a mental institution, Banks consults Dr. Victoria Siebert (Catherine Zeta-Jones), a psychiatrist who first treated Emily when Martin went to jail, and decides to prescribe her a new anti-depression medication called Ablixa, a made-for-the-movie fake drug complete with its own fake website that warns of potential serious side effects including confusion, suicidal thoughts and sleep disturbances. The movie suggests that we are an over-medicated society as Emily’s co-workers comment on her anti-depression regimen, sharing their experiences with this or that particular generic and how it worked out for them.
Ablixa produces unexpected side effects and the plot unfolds such that Emily ultimately finds herself in the midst of a courtroom drama. Banks meanwhile, becomes a truth crusader, which puts him on a collision course with Siebert, precipitating a game of cat and mouse between the dueling psychiatrists with Emily caught in the middle.
But if any of the actors in Side Effects ever wondered, “Is there a doctor in the house?” to help them deliver a believable performance, the answer was Alexander “Sasha” Bardey, who sat in on the set.
Bardey, a forensic psychiatrist and clinical instructor at the NYU Langone Medical Center in New York City, was the real-world person behind the medical science and served as a medical consultant for the film. In a conversation this week in New York, he told Nature Medicine how he coached the film crew and actors to make the science behind Side Effects as realistic as possible:
Steven Soderbergh’s Contagion and Side Effects are both structured around a specific modern-day fear. What differentiates the fear in these two films?
In the movie Contagion, if the person is dying of an infection, you know it. They look sick. When you are dealing with psychiatric symptoms, they are kind of hidden. It starts to raise issues of trust, of what’s real and what’s not real. And so, in that sense, I think there is a little bit more smoke and a little bit more mirrors [in Side Effects] whereas Contagion was more straightforward in terms of what the message was.
How did you become involved with Side Effects?
Scott Burns and I met at Bellevue [Hospital] more than ten years ago. He was writing for a TV show called Wonderland based on the characters [in] the prison ward, which is where I worked. We became friends and then within a couple of years we knew we had to write a story about that world and turn it into a movie.
What were your suggestions to make it more realistic?
As Scott was writing the story, he would bounce ideas off of me [but he] wasn’t looking just for a couple of words to make it correct, he wanted the action to be inherently correct from the psychiatric and scientific perspective.
And during the filming?
I had the crew talking to me [and] my colleagues, making copies of my diplomas, seeing what kind of books I have on the shelf and asking me questions like, ‘What kind of pen do you use to write your prescriptions with?’ I [also] spent a lot of time with Jude Law, the main psychiatrist in the film, who was very interested in his character, how his character performed, what the issues were—he got a good sense of what a psychiatrist does.
What might be the explanation for the side effects observed in the movie?
These [drugs] are medications that impact on the neurotransmitters of the brain [and] can act on different parts of the brain in different ways. The effect might be to resolve anxiety, stop hallucination or stabilize mood, [but] may include also changes in level of cognition, memory problems. Irritability, aggressivity and violence are all, albeit rare but still, potential side effects to many of these medications.
Do you think the pharmaceutical industry will take issue with any of the depictions in the movie?
The depiction of the pharmaceutical industry in the film is accurate—and just because it’s accurate does not mean people will not take offense. But from my perspective as a psychiatrist, I think we should depict things in a realistic way. The only way that we will ultimately deal with the stigma of mental illness is to be more realistic, open and honest about the illness, its treatment and how it all works.
When would you say a doctor’s responsibility ends and a patient’s begins?
Psychiatric illnesses impact on peoples’ thinking and behavior, [and] sometimes in extreme cases [they] can become a danger to themselves or others. If I decide that someone needs to go into the hospital against their will, I’m depriving them of their civil rights, [and] if I let someone into the community who is dangerous, then I failed at my job. So it’s a very delicate balance to try to figure out where that line is between the doctor and the patient to do the right thing without doing any harm.