I've been itching to blog about this since I first read it earlier today. I thought I'd dip it in some warm tea first, digest it, then indulge myself. Hey, if the pro-antidepressant brigade can take the biscuit then why can't I?
The article, penned by Daily Mail Health correspondent, Jenny Hope, tries to offer balance in as much as we see one psychiatrist, Dr. David Healy, make claims that depression is not caused by low serotonin levels and most drugs used to treat it are based on a myth, while other psychiatrists, quoted in the article, um, basically agree with him yet make outlandish statements regarding the efficacy of antidepressants.
You confused? I certainly was after reading it.
In fact the professionals offered a chance to rebut Dr. Healy's claims, namely Professor Sir Simon Weasly, President of the Royal College of Psychiatrists, and Professor David Taylor, Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King’s Health Partners, South London and Maudsley NHS Foundation Trust, actually make the article more entertaining with their blinkered views without actually offering any scientific evidence. NHS Choices and Dr Paul Keedwell, Consultant Psychiatrist and Specialist in Mood Disorder, also add input.
So, here's the crux of the article. Healy has claimed that the belief that the most popular antidepressant drugs raise serotonin levels in the brain is nothing more than a myth, adding, that they took off because of the idea that SSRIs restored serotonin levels to normal, ‘a notion that later transmuted into the idea that they remedied a chemical imbalance’.
So, all pretty standard stuff and nothing that we (who move in these circles) haven't heard before.
Here's where it gets interesting.
Weasly: "Antidepressants are helpful in depression, together with psychological treatments, is established. How they do this is not."
So, he is saying that, yes, antidepressants work but he, or anyone else for that matter, don't know why or how.
Weasly continues with, "Most researchers have long since moved on from the old serotonin model."
Great stuff Mr. Weasly but it would have been nice if this statement was followed up with an explanation as to what the current model is...if indeed there is one?
Next we have a spokesperson for NHS Choices chip in. They claim, "It would be too simplistic to say that depression and related mental health conditions are caused by low serotonin levels, but a rise in serotonin levels can improve symptoms."
So, NHS Choices are agreeing with Healy then?
I'm not so sure. Here's what they say about bipolar disorder, "Bipolar disorder is widely believed to be the result of chemical imbalances in the brain. The chemicals responsible for controlling the brain's functions are called neurotransmitters and include noradrenaline, serotonin and dopamine. If there is an imbalance in the levels of one or more neurotransmitters, a person may develop some symptoms of bipolar disorder."
Here's what they say about trichotillomania (hair pulling)
"As trichotillomania involves compulsive behaviour, some experts think it's closely related to obsessive compulsive disorder (OCD). OCD tends to run in families. It's thought to be caused by both biological and environmental factors, which may lead to a chemical imbalance in the brain. Neurotransmitters are chemicals that send messages from your brain to your nervous system. If something goes wrong with the way neurotransmitters work, it can cause problems, such as compulsive and repetitive behaviours."
Just two examples, both of which are not backed up with any scientific evidence whatsoever. In fact the evidence they run with is the classic line, "...is widely believed to be the result of..."
So, NHS Choices are, it seems, basing their evidence on some sort of faith? Exactly who are those believers and when and where did this belief originate from?
Healy offers the answer, and I concur. "...the misconception that low levels of serotonin were responsible for depression had become established fact." He suggested that the success of so-called SSRI drugs – which include Prozac and Seroxat – was based on the ‘marketing of a myth’.
Next, and somewhat absurdly, we see David Taylor, Director of Pharmacy and Pathology and Head of Pharmaceutical Sciences Clinical Academic Group, King’s Health Partners, South London and Maudsley NHS Foundation Trust, offer his opinion. (Because that's all it is)
"Professor Healy makes a forceful but poorly supported argument against something which doesn't and has never really existed: the idea that SSRIs ‘correct’ an ‘imbalance’ of serotonin in the brain."
What?
So, let me get this straight. For years psychiatrists have been telling patients, adults, children and children's parents, that their depression is caused by a chemical imbalance yet Taylor claims that they haven't?
**Insert canned laughter here**
It's one thing to spin a lie but another to claim that the lie never existed. In any event, who made David Taylor the spokesperson for the whole of the psychiatry profession?
Like Weasly, Taylor follows up his statement with, "Researchers and psychiatrists alike know that SSRIs are effective in a number of disorders but no one is sure exactly how they work."
Guinea pig trials anyone?
If you don't know how a drug works then you won't know if that drug is causing an adverse event or not, right? You can, and more often than not you do, blame it on the condition, which, according to Weasly and Taylor, has nothing to do with a chemical imbalance.
Honestly, it would be easier to do the Rubik's cube behind my back then make heads or tails out of what Weasly and Taylor are saying here.
Finally, we have a sinister warning from Dr Paul Keedwell, Consultant Psychiatrist and Specialist in Mood Disorder.
"In the real world of the clinic, SSRIs are undeniably effective in treating individuals with major depression.
"They have become the first line treatment of choice because they have fewer troublesome side-effects than their predecessors, and are safer in overdose.
"David Healy has previously claimed that SSRIs cause dependence or provoke suicide. In so doing he has risked deterring individuals with severe depression from getting the help they need and this latest article just adds to this problem.
"The risk of suicide from untreated depression is much greater than the risk of treating it with antidepressants, and yes, this includes SSRIs."
So, in essence, Weasly, Taylor and Keedwell, don't know what causes depression but they know it isn't a chemical imbalance. They are all for prescribing SSRi's because, well, because they apparently have fewer side effects than the older types of antidepressants and are safer in overdose (apparently).
Yet neither Weasly, Taylor or, indeed, Keedwell know how SSRi's work. So, ladies and gentlemen, boys and girls, they are suggesting that you and I take a drug that will alter the thoughts in your brain - they can't tell you how or why these drugs do it though.
Keedwell further criticises Healy for speaking out, claiming that Healy is deterring individuals with severe depression from getting the help they need.
Naughty Irishman - Last time I looked, he wasn't outside any pharmacy pointing a gun at people who were walking out with their pills to alter the chemical imbalance that they haven't got. Remember, we have to believe that the diagnosis of their 'illness' is based on a faith... it is widely believed, but we don't know by whom.
It's all about informed consent and, judging by the reaction of Messrs. Weasly, Taylor and Keedwell, it would seem that the only information they want you to believe is the information that they give you, which basically amounts to having no scientific evidence to back up their claims.
Doncha just love the wonderful world of psychiatry.
Bob Fiddaman.
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