James Gordon who I highlighted here when he was interviewed for Newsweek, has now been interviewed on NPR. He claims, rightly so, as far as I’m concerned that depression is not a disease. Listen on NPR here.
They have another psychiatrist for “balance” holding up big pharma’s and general psychiatrys take on the issue, Dr. Kramer, saying that it is a disease.
More refreshing perspective here on NPR from James Gordon, in any case. Also see: Unstuck: Your Guide to the Seven-Stage Journey Out of Depression
Depression is a wake-up call! We are not living our life as we should. We need to recover and re-balance. Or alternatively life is hard. All the sages through out history have known that. In Buddhism they say, “live is suffering.” They also teach skills to escape that suffering.
My mother-in-law died today. I’m not doing so great. Dr. Kramer might say I’m suffering from a disease.
James Gordon rightly knows I can deal with my grief by simple non-pharmaceutical methods.
His message is one of hope and recovery!
Note: In response to a post out there in the blogosphere, for the record, I have never, ever suggested people come off their meds. I think people should make up their own mind and so know too that I have never lectured anyone about stopping any drug. That would simply be dangerous.
More articles that explore the chemical imbalance myth:
● The chemical imbalance myth (mental health): by Chris Kresser
● Chemical imbalance myth takes a big public fall (no, antidepressants do NOT correct an imbalance of serotonin, nor do other psychiatric drugs correct anything at all)
● “The chemical imbalance theory of mental disorders was disproven long ago”
● Bipolar Medication Myths — Joanna Moncrieff MD
● An Interview with Joanna Moncrieff: The Myth of the Chemical Cure
Trolls need to know/be reminded that this forum is moderated by an assistant to Gianna.
I am so sorry to hear about your mother-in-law. You will be in my thoughts and prayers.
excellent perception sloopy, props to you
What a debate. I’m planning on writing a post on chemical imbalances soon…
I am sorry about your MIL. I will keep you, your husband, and your entire family in prayer tonight.
and thanks twitterbug!!
comments are allowed again, offending trolls have been put on moderation.
Read my latest post for update.
there is no doubt that SSRI’s cause suicides and homicides…
there are countless stories of people being put on SSRI’s for things unrelated to depression and still causing suicide…
I’m tired, don’t want to moderate this anymore…I’m closing comments if I can figure out how…
again if you want to see non-pharmaceutical interpretation of studies and data…you can find them…I’m not going to go back and forth anymore…that’s not my reason for having a blog.
and mark, lots of us have been on meds for many years before becoming completely disenchanted and discovering that hey had made us profoundly sicker…
that is the really disturbing part for me…
Sloopy, thank you, I am starting to believe he’s nothing more than a troll…
I wonder how industry propagandists actually work these forums?
Do they operate in teams from offices, or as individuals from home?
Do they work to pre-written scripts? Is their work like that in a modern call centre? Do they use software with flow charts which spew out ready-rolled answers to fit any occasion? I am always interested.
Witness how this particular operative posits an argument that he appears to endorse, yet he returns to it later, seemingly to challenge it.
In doing so, not only does his pro-Pharma argument get a double airing (always a good ploy) but the operative gets to feign open-mindedness!
That behaviour suggests he is someone who has been professionally trained in the art of propaganda.
Note how the operative is completely at ease using language of the industry. He casually mentions “NICE treatment guidelines” for the prescription of anti-depressants. (NICE is an acronym for the National Institute for Clinical Excellence) – hardly the parlance of the average patient!
Note also how he has journal citations at his fingertips to bolster his case. Within minutes, he conjures two properly cited references to the AJP. We are honoured!
I am confident this operative is an industry shill. Probably clinically trained, essentially working for BigPharma but working at a plausibly deniable arm’s length to the industry.
Possibly a team member at a Perception Management company like Hill & Knowlton which has BigPharma clients.
That he presents himself as simply “one of us”, I find deplorable.
There is another excellent post on Gordon here:
I don’t think the number of teen suicides in the U.S. is debatable, but I don’t think you can necessarily make the leap between a reduction in the number of scripts written for SSRI’s and the increase in suicides. I just point out that it is possible an association exists. I think the critical information will be what the 2005 data shows us about the number of suicides and prescribing data.
With respect to the post written by “Sloopy Cowbell” I certainly agree that the understanding of depression in its infancy, but I don’t think that has anything to do with the endorsement of the use of SSRI’s. The Royal College of Psychiatrists endorse the NICE treatment guidelines, which call for the use of an antidepressant in moderate to severe depression.
I respect your thoughts about the use of antidepressants, but the accusation they cause homicidal and suicidal behaviors is not only inflamatory, but not proven either. I can cite you the same outcome of an increase in suicidal behavior following the initiation of psychotherapy
(Bridge JA, Barbe RP, Birmaher B, Kolko DJ, Brent DA (2005). Emergent suicidality in a clinical psychotherapy trial for adolescent depression. Am J Psychiatry 162:2173-2175)
and that SSRI use actually decreased suicidal behavior in adolescents (Simon GE, Savarino J, Operskalski B, Wang PS (2006). Suicide risk during anti-depressant treatment. Am J Psychiatry 163 41-47).
Having spent some significant time dealing with my own depression I found that a combination of meds, counseling, and changes in lifestyle are what have helped me. I have been on my current medication for 6 years with no plan of discontinuing due to the severity and duration of my episodes. Again, without casting aspersions at “Organised Psychiatry” or “Puppetmasters” do you really believe that all antidepressant use is bad and damaging? I agree that they don’t work as well as often advertised, but neither do most chemotherapy regimens, but to just say ssri’s have no place doesn’t make sense to me.
there are lots of people who support big pharma whole heartedly and are not industry insiders…lots of patients fully support their treatment…they may not be fully informed but accusing people of having an agenda when it may simply be not knowing the whole picture isn’t fair.
I used to take meds for many years…I was open minded always, but I believed I had no choice…
people who support med taking are not all evil.
I know many people who have benefitted tremendously from antidepressants
That you are an industry insider is obvious.
We should be afforded the courtesy of a proper introduction by yourself, starting with full and verifiable disclosure of your professional background.
I..looked over the Royal College of Psychiatrists website. The understanding of depression is really in its infancy
Then you acknowledge Dorothy Rowe’s point?
The Royal College of Psychiatry will not endorse the industry’s Big Lie of the “chemical imbalance”.
I am not sure why they would be discouraged from using a medication that perhaps saved their life.
Because psychiatric drugs frequently kill people, leave them permanently brain damaged, and induce suicidal and homicidal ideations.
Not that any of those piffling reasons matter a damn to Organised Psychiatry and the puppetmasters at Lilly, Pfizer et al.
I see Dr Peter Breggin, one of the most famous critics of bio-psychiatry has re-designed his website. Very nice, too.
Breggin has a new section titled: “What you may need to know about: Violence and suicide caused by antidepressants”
Take a peek!
those stats on suicide are highly suspect too from what I’ve read….Furous Seasons interprets the numbers completely differently with no increase in suicides.
I was a psyciatric social worker….I’ve been on both side of the proverbial fence…the mental heath professionals are fed lot of crap…there is a huge powerful money making pharma driving statistics in ways that profit them.
If you’re really curious about the politics of all this I do recommend you check out Furious Seasons…it’s on my side bar…
I do not retain this sort of data well..my cognition has been severely impacted by psych meds.
and so that’s another reason I stay away from this sort of argument, but my gut remembers what I read and witness and experience, even if I can’t recall all the facts…
please check out Furious Seasons…the first time I went there I spent about 3 hours in the archives….now there is probably triple what was there when I first discovered Philip…
anyway, here’s the link…
Thanks for your comments. I have no interest in arguing either I just believe differently than you. I have watched with interest as of late with the data related to the decrease in SSRI prescriptions in both teens and adults between 2003-2005 (peds -20%, general -30%) since the FDA black-box warnings and the increase (2004 increase 14%) in teen suicides. I am not arguing cause and effect because the data is not all there, but it does give one cause to pause. As I stated above I know many people who have benefitted tremendously from antidepressants and you know many who have had problems with them. It is my opinion that multiple approaches to addressing the complexities of depression are needed and to summarily dismiss one treatment is neither responsible or beneficial.
also pills in general, if they do work “poop-out” at some point for virtually everyone supporting the placebo effect…
depression needs to be dealt with in much deeper ways then the bandaid approach afforded by antidepressants.
and Mark, psychiatrists are the most guilty spreading propaganda about antidepressants…it’s their lively hood…they’re not gonna look for critical perspectives.
This is the story I hear much more often…just 2 to 3 points difference…not 50% or 60% vs 30%
Antidepressants are widely believed to be exceptionally effective medications. The data, however, tell a different story. Kirsch et al. (2002a) analyzed the data sent to the U.S. Food and Drug Administration by the manufacturers of the six most widely prescribed antidepressants (fluoxetine [Prozac], paroxetine [Paxil], sertraline [Zoloft], venlafaxine [Effexor], nefazodone [Serzone] and citalopram [Celexa]). Their research showed that although the response to antidepressants was substantial, the response to inert placebo was almost as great. The mean difference was about two points on the Hamilton Rating Scale for Depression (HAM-D). Although statistically significant, this difference is not clinically significant (Jacobson et al., 1999). More than half of the clinical trials sponsored by the pharmaceutical companies failed to find significant drug/placebo difference, and there were no advantages to higher doses of antidepressants. The small difference between antidepressant and placebo has been referred to as a “dirty little secret” by clinical trial researchers (Hollon et al., 2002), a secret that was believed by FDA officials to be “of no practical value to either the patient or prescriber” (Leber, 1998, as cited in Kirsch et al., 2002b).
Again, I’m not here to argue…there are way to many of us who got progressively worse or drastically worse upon ingesting antidepressants and I’ve seen dozens of studies like the one I just posted…
anti-depressants fail to be more effective than placebo…mark left a good video reporting the same thing in Canada…
Fascinating! I have read this post from top to bottom and I also looked over the Royal College of Psychiatrists website. The understanding of depression is really in its infancy when compared to other medical conditions which have benefitted from improved technologies and better funding. The argument that antidepressants are not beneficial and actually are harmful is always interesting to me. I have met many people (antedotal evidence yes) who have successfully dealt with their depression through the use of an SSRI and therapy. I am not sure why they would be discouraged from using a medication that perhaps saved their life. Conversely I know many individuals who have overcome their depression without any medication or counseling, but I would say those folks struggled for longer periods of time.
With respect to the Royal College of Psychiatry they post a leaflet on depression which states…(http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/depression/antidepressants.aspx)
“How well do they work?
After 3 months of treatment, the proportions of people with depression who will be much improved are:
50% and 65% if given an antidepressant
25 – 30% if given an inactive “dummy” pill, or placebo”
I say whatever works for a particular individual with regard to their depression should be pursued. To take any treatment (meds, therapy, lifestyle change, exercise, diet, etc) off the table seems cruel to me. Thanks for the opportunity to chime in! Good health to all.
Years ago, maybe decades ago, when I was taking a course about how medicinal drugs worked, the professor explained how depression results from not enough of certain chemicals in the synapses. At the time it sounded good. However, later when I researched the topic more fully for an article I was writing, I found out from many sources that antidepressants will increase the level of neurotransmitters in the synapses immediatly, yet most depression will not begin to lift until a week or two later. So if the lack of transmitter was the cause, why did’t the depression lift as soon as the transmitter was restored?
A few years ago when I was writing an article for my webpage on this topic, I would find in the scientific literature articles written by various researchers saying that we had no idea what caused depression.
I do believe that at least some people will not do the work to get better. Many of my friends are on disability due to mental illness. If they got better, they will have to go to work. Being ill is a great reason to not face up to responsibilities. I say that because I have that tendency. I can be on the shy side. If I do not want to be around people, I can just say I do not feel good. As a child I loved it when I got a cold, sore throat, or other illness because I did not have to face school. School was painful due to my learning problems.
I think it was just rude for someone to demand a complicated explaination when you had a death in the family. Actually, for some people no explaination is long or detailed enough.
Sue this whole blog talks about diet, nutrition, spirituality and the original post does too…
I have severe toxic reactions to chemicals that are manifested emotionally.
I certainly don’t disagree with what you’re saying and I don’t think anyone else here does either…except maybe tsfiles.
there is though, too, a lot of mental distress that is caused by emotional and spiritual dysfunction that we must take responsibility for, just as we must take responsibility for how we take care of our bodies.
I’m surprised it sounds like you don’t see how this blog approaches all these issues.
Unfortunately the problem is so multi-faceted not all aspects of every single element that goes in to mental health care can be dealt with every time an issue is brought up…
this blog presents a montage of all sorts of causes to mental distress and the vast array of ways people heal without pharmaceuticals.
I’m sorry to hear about your loss, and also to read this heated commentary you had to deal with. I think the discussion is productive, I’m sad we can’t do it without the oft-snide tone of tsfiles, and the raw hurt feelings in return.
For me, decades down of observing my brother with schizophrenia and his common-law wife who is big on telling us how they are as they as because “it’s a disease,” the problem with this is what it entails. The medical model, faith in the Pharma Nazis, and a general sit-back-and-wait-to-be-cared-for by the profiteers in medicine. I fear that tsfiles is here, and stuck in his misery, and I feel for that rut of disempowerment.
But we’re all onto something if we recognize the whole-body physiological truth now termed just “mental” “illness.” Are we dis-eased, sick, from toxins like rife synthetic chemicals (now there’s the chemical imbalance–throughout all bodies on this Mother Earth), heavy metals, infectious agents and chronic autoimmune disorders? Do they effect behavior in a really big way? Yes, and yes. Dis-ease exists.
So I wish we could get down to the underlying argument. Real grief and low energy because a family member died is not disease. But I cannot agree that the chronic physical-behavioral problems epidemic on this globe are “just life.” As ecosystems become more toxic, our minds and bodies do too.
These epidemic conditions affect the emotions, our relationships, and our future as a species. We need a holistic, not just a brain-centered, approach to this. We need for ourselves and our planet to be well. We need not attack one another, because all of us here have suffered in much the same ways.
Sincere condolences to you, and your husband. Take time to grieve, to remember your mother in law for all the nice hapenings she brought to your life.
I havn’t looked at all the comments, although I would not agree that depression is an illness. My doctor would say it is an emotion. Psychiatrists like to make elaborate assumtions and diagnoses. I like what you’ve said about getting the balance right.
Take it easy.
Belated condolences – I THOUGHT I’d be able to just log on & leave a brief comment this AM, until I skimmed the maelstrom of commentary!
Anyway, my deepest sympathy on your family’s loss, Gianna – and Steven Morgan, you’re my hero!
Best wishes, Val
Thanks for being the man I would have liked to have been yesterday – your demeanor and calmness….
You are a man of peace – without doubt.
The following is taken from the website of the esteemed Dorothy Rowe:
See: David Healy Let Them Eat Prozac New York University Press
just another news report that says antidepressents don’t work. on the CBC here in Canada, ( same as the BBC)
Oh my! Why do they always have to get rude? Aggressive? Hostile? Arrogant? I’m certainly not an angel myself (Steven is), but when challenged in a civil way, I try the best I can to respond in a civil one. And I can’t find anything in neither your post nor your comments, Gianna, that wouldn’t be civil and thus could explain/excuse tsfiles’ rudeness. But I have a hunch, that this is mostly about in how far people would have to take responsibility for themselves and their suffering – or leave it to some pill to fix the alleged chemical imbalance. More than it is about scientific evidence. And that’s a really painful one for many people. Even more painful than “depression” or whatever “mental illness” itself.
First, Gianna my condolences on your loss i am sending you some hugs from the West.
Second, I was trying to come up some replies for tsfiles.
Steven snagged some of the best lines already. So yeah so listen to Steven, tsfiles, he is breaking it to you a lot nicer than I could.
Oh and Hi Steven! Yours was the best video of the video media presentation on bipolar at ny times by far, excellent work!
I hope you didnt ban him already G, I would love to see some rebuttal.
tsfile: Part Two: Reading
Do you ever listen to Dennis Prager?
A Conservative’s conservative?
As much so as Peggy Noonan…..
I have never heard him be disrespectful to a guest – not once – not ever….If you’ve never head him – you should listen…in fact, he has a pretty cool show called the “Happiness Hour” – devoted toward how to find happiness…
I heard him say once “All people have an equal right to an opinion, but not all opinions are equal”….
So it is with you – and your “chemical imbalance” theory….You are certainly of equal importance, and have a right to voice your opinions – We need to respect you – but, we can reject your opinions….I have….
Normally, I like to close my emails with good thoughts to the person on the other side….Forgive me, but after taking a swing at a person I love dearly, I just ain’t up to it, and I’d be lying anyway….
Also, I normally ask the other person to email me offline – so I can give them more information….not tonight – not with the well-read guy…..the one who already knows everything….
Wanna learn more – start here – I put it together quickly tonight….Start here, and move off these sites, and read some good books on natural healing –
Dangers of Psychiatry
International Center for the Study of Psychiatry and Psychology http://www.icspp.org
Alliance for Human Research Protection http://www.ahrp.org
Medical Accountability http://www.medicalaccontability.net Children and Adults Against Drugging America http://www.chaada.org
Able Child http://www.ablechild.org
John Breeding, PhD ‘Wildest Colts’ http://www.wildestcolts.com
Injury Caused by Psychotropics
Gwen Olsen http://www.gwenolsen.com
SSRI Stories http://www.ssri-stories.com
SSRI Research http://www.ssri-research.com
Wood Matters http://www.woodymatters.com
Mad in America http://www.madinamerica.com/Mad%20In%20America/Home.html
Truth about NAMI
NAMI Pharma http://www.namipharma.org
Mind Freedom http://www.mindfreedom.org
Law Project for Psychiatric Rights http://www.psychrights.org
Couldn’t help myself – got on your blog
…a conservative, a Catholic, a displayer of our nation’s two most sacred documents….
Don’t pretend to be the voice of conservatism or the church of Rome, or of those who love their country my friend – not in one fell-swoop…..not with this kid….
I consider myself each of these things – and, you and I have very little in common……
Boy, when you swing – you swing big-time…..Didn’t your little league coach ever tell you “not to try to knock it outta the park”? Didn’t your dad ever tell you to “repect those you disagree with”? Didn’t your priest ever teach you the the spiritual laws of the Christ? Did you skip catechism, or the lessons on “faith, hope, and love”…..
You come on big time my friend – like a tough-guy….We were all unimpressed by you – each of us – anyone would be….
Gianna explained in this post that she had just lost a family member – were you reading, or listening? She tells you she is a compassionate person – and you say you don’t see any? That says all there is to know about you – and says nothing about who she is, and what she means to us…..
You take a swing at Sloopy – my friend from across the pond – whom I’ve had some wonderful conversations with – a true friend of anyone who suffers – he’s done quite a bit himself….
You toss out a few names – like Marx, and Lenin,and Trosky….like a big-shot – like the only one who’s ever read a history book….Read Gordon Wood – read about how Jefferson despised big business once it got involved with big government, and big banking…..You know nothing about history…..
Now to the subject at hand…..
“Chemical imbalnce” theory – that’s what it is at best – in fact scientific “theory” is too strong a word….
Reader oh reader, lover of the printed word……go back about 4 months – articles in each of the major papers – not around the nation – around the world…..anti-depressants clinically no better than placebo – the major pharmaceutical companies decided not to published one-third of the clinical data…..
When you consider the fact that any FDA approved test need only be better (by a few percentage points) over placebo (sugar pill), I could grind up Texas license plates – toss out a third of the data, and “prove” swallowing ground up metal can alleviate the symptoms of depression – pick a substance….any substance….
Do you know that only 1/3 of the “new” drugs on the market are “new” – lover of the pharmaceutical industry? 2/3 are re-treads of older versions….
The pharm people have no idea how these drugs work – none. The reason is that to measure the effect on neurotransmitters would require an atopsy – of course, I’m sure you already knew that….Start with two books by Peter Breggin, MD – he’s not quite as smart as you – He only graduated from Harvard Medical School Psychiatry – I’m sure your medical degreee was from a much more prestigious university – “Toxic Psychiatry”, and “Your Drug May be Your Problem – How and Why to Stop Taking Psychiatric Medication” – but, you “like to read”, so don’t stop there – complete his whole series – amazing how he has come to understand (through his many years as a doctor) that love may be the greatest healer of all – something the Christ tried to teach us over 2,000 years ago…..something we failed to learn…..
He also is a big believer in individualized recovery – something as simple as reading, walking, gettting involved in community – surely these things could never “heal” – surely, you must be right….afterall several milenium of human experience pales in comparison to the “drug trials” of Pfeizer, Merck, and Lilly….they know – surely, we should trust them – rather than our own human experience – our own wisdom…..
Lover of the free market (as am I), this is not “free market” – this is major industry in union with enormous government ….these are state-funded universities, with research chairs who are given big-bucks – to keep good studies, and toss out bad ones….not exactly “pure scienc” – backed with billions by federal tax dollars…..these drugs are purchased in large amts by states – medicade – and they are lining up my friend – over 30 two months ago….suing the ever-lovin crap outta pharma – for deception, for falsification – for lies….but then, you’re a reader – you know all this already….
Chemical imbalance – show me where it is on an MRI or C-T scan? It ain’t there buddy – it ain’t there….
That doesn’t mean there isn’t pain or suffering – it means it ain’t quite a simple as not enough serotonin, or dopamine….
My best guess (from my very limited reading – we aren’t all as smart as you) is that depression can come from a host of areas – faulty thyroid, poor absorption, hormonal problems, candida problems (in women), environmental allergies, toxidity….it can also be caused by trauma…..another subject – another day….But, don’t take my word for it – look at what the best board certified doctors in Holistic, Homeopathic, Environmental, Naturopathic, Traditional Chinese, Orthomolecular Medicines have to say……
Oh, I almost forgot – you’re smarter than they are….
I’m a Texan, and a former boy scout (pretty conservative guy my friend)…..I remember our scout master teaching us to “make sure the campsite is cleaner than when we arrived” – When I think of my friend Gianna, I think of someone who has made this world a better place – in her darkest hours – she has reached out – to help countless others….
I also remember camping in the hill country – how we used to watch out for each other – there were a lot of rattlesnakes in that area…..We used to listen for them – to protect each other…
I never liked snakes.
I really doubt you’re going to find much of an audience here for your take on depression…Like Gianna, I don’t wish to waste any energy arguing with people who see depression in this light. I’ve done the medication route, as have most here, and been more devastated, then satisfied by the results. And, like most here, what I’m most interested in is exploring life without meds….not arguing about it.
You are beautiful and awesome and if I had some brain cells left after all the psych meds fried my brain (you know, treating that chemical imbalance) I might be able to respond with such eloquence…I could at one time—lost it…but hope it comes back as I recover from the poisons.
I submitted the above post before tsfiles responded so strongly.
tsfiles, you want us to provide you with studies that debunk the theory, but there are no studies to prove it (you’ll see this yourself if you accept my above challenge), so how will there be studies to debunk it? It’s like saying, “Aliens cause depression,” now find me science that debunks such a theory.
Anyhow, if you want to read more into the problem with chemical imbalance theories, start here:
Click to access fulltext.pdf
And to comment on another one of your comments, the problem with conceptualizing depression as a physical disease is that we stop looking to other catalysts, you know, like trauma, abuse, monotonous wage labor, 3000 media messages a day, war, greed, homophobia, poverty, religious fuck-with-your-brain stuff, neglect, the breakdown of communities, violence and violence and violence, loss of sacred, and on and on.
So, by calling depression a brain disease, we in effect let all of these huge problems off the hook. And that may prevent us from actually changing and challenging the culprits for misery.
You’re a doll!
I once vehemently beleived in the chemical imbalance theory, and I’m no Fox News soldier.
The chemical imbalance theory can be very addictive and soothing because it offers a simple way to approach an often terrifying and abstract state of existence. For many years, I definitely beleived it, not only because it provided relief for my sense of failure, but also because doctors and advocates told me it was true. And in our culture, medical practitioners are equated with having important knowledge that laypeople do not.
tsfiles, I know you believe strongly in the chemical imbalance theory. I can feel it in your writing. I want you to know that I understand that belief very well. But I want to respectfully ask you to consider putting it down for only a moment.
The way that we make knowledge in mental health is primarily through scientific studies. Thus, there should be a wealth of evidence that points to a chemical imbalance in the brain for mental illness, since that theory is so predominant.
My gentle challenge to you is: please find one study or one link to a study that demonstrates that a chemical imbalance causes mental illness. If the theory holds weight, this challenge should be no problem, and then we don’t even have to discuss it further.
One study, that’s all. You can begin by searching here: http://www.ncbi.nlm.nih.gov/sites/entrez/
If you do or do not find anything, or end up puzzled, please feel free to contact me at firstname.lastname@example.org , and I’ll be happy to continue this discussion…
the link doesn’t work…here is the text in full:
Advertisements for SSRIs May Be Misleading
Laurie Barclay, MD
Nov. 8, 2005 — Advertisements in the U.S. for selective serotonin reuptake inhibitors (SSRIs) are not based on science, according to an essay published in the December issue of the Public Library of Science (PLoS) Medicine. Since the 1960s, investigators have proposed the “serotonin hypothesis,” which implicates low brain levels of serotonin in depression. However, extensive research to date has failed to confirm this theory.
In 1965, Joseph Schildkraut suggested that depression was linked to low levels of norepinephrine, but investigators subsequently proposed that serotonin was the responsible neurotransmitter. Numerous studies to identify reproducible changes in neurotransmitter levels in the cerebrospinal fluid of clinically depressed patients, or to induce or correct depression by manipulating brain serotonin levels, were inconclusive and fraught with methodological limitations. Contemporary research has failed to prove any serotonergic lesion in any mental disorder, according to the PLoS Medicine essay.
Consumer advertisements for SSRIs in the U.S. “typically claim that depression, or other psychiatric condition, is probably caused by a chemical imbalance of the neurotransmitter serotonin, and that SSRIs correct this imbalance,” lead author Jeffrey R. Lacasse, MSW, a PhD candidate at Florida State University College of Social Work in Tallahassee, told Medscape. “They routinely use visual portrayals of a nerve synapse demonstrating the action of SSRIs, showing a ‘chemical imbalance’ which is then ‘corrected’ by the medication.”
Gordon McCarter, PhD, an assistant professor of biological sciences at the College of Pharmacy of Touro University in Vallejo, California, agreed that the evidence for an “imbalance” in neurotransmitters causing depression is “circumstantial” and “more and more tenuous.” He noted the dearth of studies showing any measurable difference in serotonin or norepinephrine between depressed patients and controls, with the limited positive findings based on suicide victims. Dr. McCarter was not involved in the PLoS Medicine essay.
“This doesn’t mean there isn’t a difference, [but] it may be too localized and too small to measure with current techniques,” Dr. McCarter told Medscape. “Serotonin clearly plays a role in some [cases of] depression and blocking its reuptake clearly helps many depressed patients, but this may be a symptomatic approach. Current thinking is that genetics, perhaps regarding serotonin-handling molecules in some cases, combined with life history affects the likelihood that stressful life events will trigger a depressive episode. Stating that depression is caused by a chemical imbalance is extremely simplistic.”
The evidence that is usually used to support the claim of a serotonin imbalance, according to Mr. Lacasse, is the efficacy of SSRIs. Because SSRIs have an effect on depression, and SSRIs affect serotonin, the conclusion touted in the ads is that depression is due to serotonin imbalance. However, this line of reasoning may be inherently flawed; aspirin may relieve headache, but we do not therefore conclude that headaches are caused by low levels of aspirin in the brain.
Another difficulty with using the efficacy of SSRIs in depression to bolster the serotonin hypothesis is that the efficacy itself is problematic. A meta-analysis cited in the PLoS Medicine essay reviewed all clinical trials of antidepressants submitted to the U.S. Food and Drug Administration (FDA). This meta-analysis showed that placebo duplicated about 80% of the antidepressant response, and that more than half of pharmaceutical company–sponsored trials failed to show a statistically significant difference between antidepressant and placebo. Moreover, antidepressants that do not affect serotonin are as effective as SSRIs in reducing symptoms of depression, and even placebo and nonpharmacologic treatments have been shown to have robust effects.
“The etiology of depression and anxiety is still a mystery, and this is reflected in the scientific literature,” senior author Jonathan Leo, PhD, a professor of neuroanatomy at Lake Erie College of Osteopathic Medicine in Bradenton, Florida, told Medscape. “The Diagnostic and Statistical Manual of Mental Disorders does not list serotonin as a cause of any mental disorder; it is simply one neurotransmitter that continues to be investigated. And the prescribing information for the SSRIs does not claim that their mechanism of action is to correct a chemical imbalance, although this is exactly what the advertisements claim.”
The PLoS Medicine essay cites a recent review article on depression published by John Mann in the New England Journal of Medicine, which lists a dozen chemicals potentially involved in depression, and several pharmacologic interventions that do not affect serotonin; and a Cochrane review showing no major difference in efficacy between SSRIs and tricyclic antidepressants. Bupropion and reboxetine, which do not significantly affect serotonin, were shown to be as effective as SSRIs in the treatment of depression. In recent randomized controlled trials, St. John’s wort and placebo were each more effective for depression than SSRIs, and exercise was as effective as the SSRI sertraline.
“The pharmaceutical industry has managed to convey a misleading picture,” Joanna Moncrieff, MD, a senior lecturer in psychiatry at University College London, U.K., told Medscape. “I speak to quite a few journalists, and they are shocked to hear that the link between serotonin and depression is very tenuous and the research conflicting and not convincing. The psychiatric profession and academic researchers are probably also partly to blame for glossing over the weakness of the research.”
The FDA is charged with the duty of regulating direct-to-consumer advertising (DTCA), and with ensuring that it is grounded in scientific evidence. However, the PLoS Medicine essay points out the “remarkable, and possibly unparalleled” disconnect between the scientific literature and the SSRI ads.
“All prescription drug advertising is to be fair and balanced, with an accurate portrayal of the benefits versus the risks,” FDA spokesperson Crystal Rice, from the Trade Media and Exhibits Center for Drug Evaluation and Research, told Medscape. “There would be no difference with regard to these drugs — as with any drug, these same rules apply. Concerning what information must be disclosed and in what manner, and how that would apply specifically to this situation, this is done on a case-by-case basis and dependent on the specific product and specific promotional piece.”
The FDA requires that drug advertising present the most serious risks and the most common risks, according to Ms. Rice. The Division of Drug Marketing, Advertising, and Communications works closely with the medical review divisions and others in the FDA in determining which specific risks should be presented. The FDA has requested a labeling change for antidepressants, now requiring that drug companies include the warning about increased risk of suicidality in their advertising promotion. Until Feb. 28, 2006, the FDA has an open docket seeking the public’s input on DTCA (http://www.fda.gov/OHRMS/DOCKETS/98fr/05-18040.htm).
“I don’t really think [DTCA statements about serotonin in depression] are untrue, especially if they are presented with qualifiers such as ‘research suggests’ and ‘scientists believe,’ but they might be bordering a little on unbalanced, so I think the FDA could be doing a little better in this regard,” Dr. McCarter said. “By implying that depression is ‘only’ a chemical imbalance, [the ads] are leaving out very important aspects of the depression story. A ‘balanced’ statement on the etiology and treatment of depression directed at consumers should note that certain forms of counseling or psychotherapy, in particular cognitive-behavioral therapy, is equally effective in the treatment of major depression as antidepressant medication, and that together they are even better.”
The PLoS Medicine essay notes that SSRIs are now among the best-selling drugs in medical practice, thanks in large measure to successful advertising campaigns. The marketing emphasis in SSRI ads on a theoretical serotonin imbalance appears to be specific to the U.S., causing “striking differences” from advertising in the EU. Unlike the U.S., the EU does not allow DTCA.
“Two very different pictures emerge of the same exact medication, depending on government regulation and marketing practices,” Dr. Leo said. “It’s two very different political climates. We suspect that one important factor is the amount of influence that pharmaceutical companies hold in a particular society.”
The British equivalent of the FDA, known as the Medicines and Healthcare products Regulatory Agency (MHRA), and U.K. medical literature published in the British Medical Journal and elsewhere have preceded the FDA in their open criticism of U.S. marketing practices for SSRIs.
“I personally feel that all drug advertising should be banned both to professionals and patients,” said Dr. Moncrieff, who is also a founding member and cochair of the Critical Psychiatry Network. “Information about drugs should come from independent sources that people can access if required, and not be constantly shoved into people’s faces. We currently have a manufactured epidemic of psychological disorders, and the drug industry is at least partly to blame.”
However, Dr. Leo and Mr. Lacasse are not convinced that a ban on DTCA would eliminate misinformation about the serotonin theory.
“We suspect that this theory is repeated to patients by physicians, and that the problem is not limited to DTCA,” they explain. “Depression and anxiety are complicated issues that cannot be explained in a 30-second commercial…. When the serotonin theory is portrayed with clever visual portrayals that do not accurately represent the neuroscience research, consumers are led to believe that medication is necessary for the treatment for depression.”
Ostensibly absent from commercials is information concerning alternatives to medication, including evidence from randomized controlled trials that psychotherapy and exercise are effective in the treatment of depression; and significant adverse effects from SSRIs, including very high rates of sexual dysfunction. Other issues typically omitted from DTCA are difficulty in withdrawing from SSRIs in some patients; the self-limited nature of depression for many people, in whom it lasts for only several months; and the robust placebo effect documented in the overwhelming majority of clinical trials.
Dr. McCarter suggests that the FDA or even the National Institutes of Health might provide clear and concise information on the issues surrounding specific prescription drug classes, and treatments for diseases in general.
“Perhaps drug companies could be required, whenever they wish to advertise a prescription drug, to pay into a fund that provides public service announcements regarding that particular therapeutic area,” he said. “Maybe there should be required a general ‘balance statement,’ produced by the FDA to accompany any advertising — short and sweet, not like the notorious ‘brief summaries’ that were fired out in staccato or squished into microscopic text on the next page.”
Another important concern embedded in DTCA is the issue of informed consent, which Mr. Lacasse and Dr. Leo believe is essential to an ethical and productive physician-patient relationship.
“If a patient comes into the office believing the serotonin theory and the doctor doesn’t take the time to correct them, we wonder where that leaves the issue of informed consent, and especially the issue of potential risks and benefits,” they point out. “We suspect that many consumers believe the serotonin theory to be more scientifically based than it is, and that they might have chosen an alternative approach to their distress if they were fully informed. These ads work to confound informed consent, essentially.”
One example is a television ad for sertraline (Zoloft), which portrays a serotonin imbalance and claims, “Prescription Zoloft works to correct this imbalance.” DTCA for fluoxetine (Prozac), Paxil, escitalopram (Lexapro), and other SSRIs has voiced comparable messages.
“In terms of real-life effects of this advertising, we are concerned that this oversimplified theory has become the intellectual justification for 10-minute office visits which result in the prescription of antidepressants for a variety of ill-defined conditions,” Mr. Lacasse concluded. “In general, people need to be more skeptical regarding claims of chemical imbalance as explanation for psychological distress.”
On the other hand, Dr McCarter believes that heightening consumer awareness of depression may produce some positive effects.
“While the ‘chemical imbalance’ message is overly simplistic and may mislead the audience away from an understanding of the cognitive and behavioral aspects of depression, if it gets someone who is suffering from this disease to think about seeing a doctor or even just to consider for the first time that there is a biological aspect to it, then some overall benefit has been achieved,” he said. “I just wish there were other equally prominent information sources that were not produced under a profit motive.”
Drs. Lacasse and Leo report no competing interests and no commercial funding for this work.
PLoS Med. 2005;2(12):e392
Reviewed by Gary D. Vogin, MD
here’s one, but dammit, I am tired…so you do your own damn research…the evidence is out there.
and now I’m banning you because you certainly did not keep the civil tone I was creating—-I welcome discussion but not personal attacks.
Now you’re getting reactionary…I’m exhausted because my mother-in-law died yesterday and I’m getting a house on the market and buying another all on my own while my husband is overseas taking care of his family..
If you’re going to be rude I shall delete your comments…I was not rude to you…
I told you I would try to get some links when I had more energy, just not now…
I don’t tolerate personal attacks and it seems you are verging on one..
I asked Sloopy to remain civil and now I ask you to do the same…as you said you do not know me…so stop making assumptions about me.
“the chemical imbalance theory has been totally debunked including by psychiatrists who are still beholden to big pharma…”
Since it has been “totally debunked,” it should be totally easy to refer me to several reputable studies which totally debunk my chemical imbalance comment. I love to read, and I await your response.
“I don’t have the energy to argue with someone who is probably unshakable in their chemical imbalance faith…”
Not enough energy? I am sorry to hear that. It’s a common problem among those with depression. Perhaps you are lacking in energy because you aren’t putting forth the “discipline and patience… [and] sacrifice…”
Suppose for a moment that I am actually right: that depression is a physical condition, why is that a problem in your view?
Or is all this primarily because you really dislike and distrust any industry with a lot of money and power? That’s all the rage since, well, Karl Marx/Lenin/Trotsky….
“I speak from experience as someone who has dealt with a tremendous amount of depression.”
Join the club. On the other hand, there are many people who have not experienced depression who are just as qualified (or more so) than you or I.
“Recovery takes dedication, discipline and patience. It also takes sacrifice…”
Yes, yes, yes and yes. Just curious if you would ever say any of this to a person with cancer, a broken leg, chronic pain, etc.
“most people DON’T want to do the things that allow them to heal, so yes, I think people avoid getting well… absolutely!”
THEREFORE, people prefer mental anguish over discipline? People prefer physical and mental pain over doing whatever it takes to get better? People find it more convenient to suffer mood swings, reduced energy, shattered friendships and marriages, etc. rather than getting well?
“it seems you think I am without compassion and nothing can be further from the truth.”
I don’t know you so judging you would be silly I think. Based on your comments, however, on this particular topic, your logic and compassion are absent.
Sloopy, are you the court jester on this blog? I appreciate the free hits. I always welcome new readers.
Rather than attack the content of my blog or of what I posted here, it’s a lot easier to attack me, which is exactly what you did. Very good. You are now prepared to debate 3rd graders.
The notion that I have an “agenda” is bizarre (and could also apply to you). I blog on whatever interests me and try to shed some light on current topics. If that’s an “agenda,” you have a really wide definition of the term.
I’d like to keep things civil here. I don’t agree with tsfiles politics either, but I like to believe mental health politics transcends global politics—-certainly it is often conservative politicians who take our side Sloopy—at least in this country—I don’t know about the UK.
Human suffering is universal regardless of our political beliefs…
and Sloopy, this is not to put you down at all, I agree with your politics and in another forum would gladly take them up…
I like to stick to mental health here…
I thank you for your thoughts though, really.
His mindless Big Pharma thinking on depression is surpassed only by his unswerving belief in Western military propaganda, and its veracity, too.
What I do find depressing is that he has swallowed all the Big Lies of this century, hook, line and sinker!
The Official Legends of OBL, 9/11, 7/7, Madrid, Bali – he’s lapped up the whole damn lot!
You’ve got to be a serious mind control victim to buy into that volume of fanciful fairytales. It is a salutary lesson to us all. You can take Fox News far too seriously!
Incidentally, I just scrolled down his blog, and found several smears on the anti-pharma lobby, so he certainly has an agenda.
and dear tsfiles,
I speak from experience as someone who has dealt with a tremendous amount of depression. Recovery takes dedication, discipline and patience. It also takes sacrifice…most people DON’T want to do the things that allow them to heal, so yes, I think people avoid getting well…absolutely!
but then again we don’t have proper care or guidance…it seems you think I am without compassion and nothing can be further from the truth.
the chemical imbalance theory has been totally debunked including by psychiatrists who are still beholden to big pharma…
it is NOT a brain disease…
I’m too tired to take this on…would one of my readers come up with some links for tsfiles…
This is not like diabetes or cancer….no I don’t agree. And there is much proof and evidence to support this…you can even find it on this blog.
Maybe I’ll get back to this later…I just wrote a really long piece and sorry, I don’t have the energy to argue with someone who is probably unshakable in their chemical imbalance faith…
please help—someone with more energy!! I’d appreciate it.
My sincere condolences to you and your family.
Depression is caused by a chemical imbalance in the brain. It is a very painful and debilitative illness (“disease” or not) which impacts virtually every aspect of the sufferer’s life.
I realize your post is not complete, but I suspect that based on some of your comments (“We need to recover and re-balance. Or alternatively life is hard.) that you believe that depression can be simply be avoided at will or turned off like a switch.
I assure you that this is not true. If it was true, do you not think that anyone suffering from depression would do so? Query: would anyone tell a person who has a tumor that he/she needs to “recover and re-balance”? That “life is hard”?
I highly doubt it.
Very sorry to hear the news. Though I am glad that your husband got to say goodbye to his mum, and that he can be there for his dad at this sad time.
thanks everyone for all your good wishes!
I wouldn’t say it’s about taking your mind off stuff….that’s called avoidance…dealing with our crap means staring it in the face and making peace with it. It’s not for the faint of heart.
that’s why so many people are so ready to pop pills….they don’t want to deal.
i am sorry about your loss.
i agree that depression is a wake up call. something to remind us that hey, you need to do something and keep yourself busy so you can take your mind off whatever it is that is making you depressed… or better yet, yes… ‘re-balance’
I’m sorry about your mother in law.
James Gordon’s book sounds real interesting. I was told that depression was confusion. When we untangle the confusion, the depression will lift. Sometimes we need to stop and make some decisions and find our purpose. I’m also coming to believe that we all need some sort of challenge to keep us busy. Just losing ourselves in social activities, games, and other diversions does not work for long. Many find their way out with hobbies, volunteer work, or some major project.
Sorry again about your loss,
Gianna, I am sorry to learn about your loss. Stay strong. My thoughts are with you and your husband.
Oh Gianna, I’m so sorry to read this about your mother in law, and am sending you love and peace and to your husband as well.
“Hang in there baby”
hugs again, Gianna, and my deepest sympathy to you, your husband, and your family–it sounds like he made it there just in time to say goodbye to her…i am sure that his presence eased her suffering, in a way that only he could…
*hugs*, Gianna…you and your husband are in my thoughts.
no, depression is not a disease. it’s a deep sadness you feel when life is seriously sucky. it’d be like saying the loneliness is a disease. no, it’s what you feel when you’ve got no one cheering in the stands for you.
my deepest condolences to you and your husband. another angel in heaven for both of you. hugs.