Anti-Depressants: Effective Treatment or Comforting Myth?

According to the NIMH, their most recent survey estimated that 18.6 percent of all U.S. adults suffer from some diagnosable mental, behavioral, or emotional disorder.

The industry claims that more than 20 percent of Americans take some sort of prescribed mood or mind-altering medication. Even so, patients and doctors alike question the safety and efficacy of these drugs.

A look at the history of how we came to prescribe many of these drugs will show it’s no surprise that they are now questioned. Lithium, Thorazine,Tofranil, Librium, Valium, and others were all tried out on patients and found to be useful without any idea of how they worked or what the side-effects might be. Doctors began to theorize that mental illness was caused by chemical imbalances and to tout the benefits of pharmaceuticals based on apparent usefulness in hospitals and mental institutions, not on scientific study that could show effectiveness.

The fact is that the theory that mental illness was caused by a chemical imbalance was propagated by the pharmaceutical companies themselves.

Copyright_kurhan_123RFStockPhotoAccording to The New Yorker, in the early 60s, the drug manufacturer, Merck, paid a psychiatrist, Frank Ayd, to write the book, Recognizing the Depressed Patient, so they could distribute it to doctors. The book spread the hopeful story that drugs would fix mental problems because they fixed the chemical imbalances that caused them.

Although the accuracy of the book was questioned immediately, it was still considered useful:

As one reviewer put it, in 1961, “One might quarrel with the author’s tendency to ascribe etiology [causation] primarily to diencephalic misfunction [brain malfunction]. …The author does display a sensitivity and concern regarding the importance of the physician-patient relationship. This little book has a practical orientation, and may be read with profit by any physician.”

It was not until 1965 that Joseph Schildkraut, a psychiatrist with the NIMH, working with depression, reverse-engineered antidepressants and offered an actual theory about how they worked. He postulated that the neurotransmitters were affected by dopamine and norepinephrine. As The New Yorker says, “Seven years after antidepressants were invented, and five years after Ayd asserted that depression was a chemical problem, psychiatrists finally had a precise, scientific explanation for why they worked. But Schildkraut was wrong.”

Greater understanding of the brain revealed that antidepressants act by increasing the availability of serotonin—rather than dopamine and norepinephrine. A new group of drugs sprang up to take advantage of the new information. The serotonin theory, however, turned out to be wrong, too.

“While S.S.R.I.s surely alter serotonin metabolism, those changes do not explain why the drugs work, nor do they explain why they have proven to be NO MORE EFFECTIVE [emphasis ours] than placebos in clinical trials.”

Despite the fact that scientists, doctors, and drug companies still don’t know how the drugs work or even that they work any better than a placebo, doctors continue to tell patients that their mental illness is due to a chemical imbalance. As Frank Ayd pointed out in his written-for-hire book, telling them this reassures patients that their doctors will fix their problems easily with drugs.

But the myth is breaking down and drug companies have stopped funding research to find real causes. As Steven Hyman, former director of NIMH, wrote, the idea that “disease mechanisms could … be inferred from drug action” has succeeded mostly in “capturing the imagination of researchers” and has become “something of a scientific curse.” Believing this myth has sent researchers down a dead end, chasing chemical imbalances that may not exist.

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