Thanks, very good summary. The misunderstandings are lame and contrary to evidence. After all, if depression has nothing to do with brain chemistry, anti-depressant drugs shouldn't work at all, yet they do.
The scientific illiteracy and ignorance of basic logic among the press and Americans in general is, dare I say it, depressing.
I particularly find irksome the "Dont take drugs man, take lots of [vitamin C|D][kelp] etc etc" instead. As if they are not treating those substances like a drug or because its "natural" :( Natural like plutonium ?
That study seems very compelling and very well done. A long study with a very large population.
I think the conclusion is that many, but not all, of mental health diagnoses, are mistreated with these drugs. I think this is a very good thing to have discovered. Everyone owes Tom Cruise a big apology.
A lot of people are very uncomfortable with the idea that the brain could malfunction. In discussions about homelessness some say they are choosing to be homeless. But in many cases the choosing part of the brain is the part that’s malfunctioning. That idea freaks a lot of people out.
I have several friends and family members that suffer or have suffered from depression. It could be argued that environmental factors (e.g., bad marriage, job issues, etc.) contributed to their issues.
However, some experience arguably abnormal lows absent any readily apparent external factor, and some responded to clinical therapy, sometimes supplemented pharmacologically.
I think the tremendous complexity and diversity in the human population makes finding a cure all incredibly difficult. I wish there was some kind of “light switch” solution that worked for everybody because depression can be debilitating, occasionally extremely so. Hopefully those pursuing a remedy continue their pursuit despite the cultural churn creating eddies and currents making their work needlessly more difficult.
Thank you, Mr. deBoer, for your thoughtful treatment of a difficult, often contentious subject, and here is to hoping for a brighter future for those afflicted with depression.
Well, sure — in the ultimate sense, everything is physiological. That doesn’t mean, however, that the solution to many psychological maladies isn’t environmental, in more or less precisely the way that the solution to lead poisoning is to not put lead in the environment.
(As for your point that we all live under capitalism but only some of us are diagnosed with depression — I don’t think that’s inconsistent with an environmental hypothesis. It just means some people are more sensitive to the environmental trigger than others. But that doesn’t mean that, in the absence of the trigger, there’s an underlying “disease” that is caused by a “chemical imbalance” in the brain.)
And I think people would be less skeptical of pharmaceutical interventions if people didn’t keep radically over-claiming for them. “You’re not going to get COVID if you have these vaccinations” is just the dumbest and most extreme example of a long line of the public being told things about all manner of interventions that simply aren’t borne out by the actual science. The efficacy of SSRI’s was massively oversold. Now you’re mad at people for being skeptical? People are gonna be skeptical.
I clicked on the link to see the meta-analysis. Quoting from the summary: "The results showed that both TCAs and SSRIs *were* effective for depression." (Emphasis mine.) How are people concluding from this that SSRIs don't work? (Or that serotonin isn't somehow implicated in depression?)
"Why are so many people who do not suffer from mental illnesses or work with them professionally, both left and right-wing, so deeply eager to deny the physiological basis of mental illness and the efficacy of psychiatric medication?"
You cannot ask that question without acknowledging that there are evil people with a financial incentive to oversell the phsyiological basis of mental illness and the efficacy of psychiatric medication. The reason the serotonin theory of depression took such deep hold in the popular consciousness despite dubious scientific grounding is because of an enormous marketing campaign to convince people that medication was the best and perhaps only answer to depression. You are absolutely right that the issue calls for nuance and compassion to people who are suffering, but I think you are wrong to cast outrage and backlash over the success of profiteering in health care as some kind of mean-spirited "eagerness" to invalidate people's pain.
Of course we should be compassionate and not dismissive of those for whom the drugs work. But, that is not to say that we should not demand more from our doctors. As stated, "we know depressingly little about the brain," therefore, if doctors are to maintain their oath and "do no harm", they should not be prescribing drugs willy-nilly, and much less also conclusively parroting unproven theories, such as the serotonin re-uptake one they all authoritatively mouthed when this Prozac Nation period began, some 20+ years ago.
I, for one, am absolutely livid at the doctors who prescribed this to me, and many loved ones, throughout the last few decades, while authoritatively parroting the re-uptake b.s.
In this, and other areas of medicine (trans care for minors?) perhaps doctors should be more humble and just say, "This may work, but we don't know what the consequences may be, nor whether or how it works."
When I was studying neuroscience at university it was shocking to me when we discussed the chemical.imabalance theory. Shocking because there had *never* been any evidence behind it. Even so, much of the field treated this as a settled fact.
Obviously there's something neurological going on causing mental illness. People who say otherwise are simply lying or don't know enough to even lie about it.
But this study is very important. The pharmaceutical industry has massive sway in the field, funds tons of research, funds many of the major international conferences, and has even bought some of the major periodicals (where, incidentally, they publish non-peer reviewed research).
That's not to say pharmaceuticals play no part in treating illness, mental or otherwise. But many people within the field and especially outside of it treat the pharmaceuticals that alleviate symptoms as the cure. Also, many people prescribed these medications never meet with a psychiatrist in a meaningful way. It's not infrequent that an educator recommend that a parent get medication for their child, for example.
So, yes, of course there are bad actors, but this is pretty important. It's the kind of research that has been sometimes difficult to fund and difficult to get published because of the immense influence of the pharmaceutical industry on the field.
Also worth pointing out: Dr. Joanna Moncrieff, who led the metastudy, is a known critic of psychopharmaceutical interventions, it's kinda her life's work. Sometimes, when you look for something, you find you what you are looking for.
I think most people in the mental health field want broader adoption of a bio-psycho-social approach to treatment, but it's been wild to watch New Age bypassers celebrate this study like SSRI/SNRIs do not massively benefit people
"Chemical imbalance" was always an overconfident phrase masking the level of ignorance that you rightly note. People overgeneralizing from headlines is typical behavior, especially online. So is indiscriminate destruction of a perceived shibboleth.
Thanks, very good summary. The misunderstandings are lame and contrary to evidence. After all, if depression has nothing to do with brain chemistry, anti-depressant drugs shouldn't work at all, yet they do.
The scientific illiteracy and ignorance of basic logic among the press and Americans in general is, dare I say it, depressing.
I particularly find irksome the "Dont take drugs man, take lots of [vitamin C|D][kelp] etc etc" instead. As if they are not treating those substances like a drug or because its "natural" :( Natural like plutonium ?
That study seems very compelling and very well done. A long study with a very large population.
I think the conclusion is that many, but not all, of mental health diagnoses, are mistreated with these drugs. I think this is a very good thing to have discovered. Everyone owes Tom Cruise a big apology.
A lot of people are very uncomfortable with the idea that the brain could malfunction. In discussions about homelessness some say they are choosing to be homeless. But in many cases the choosing part of the brain is the part that’s malfunctioning. That idea freaks a lot of people out.
I have several friends and family members that suffer or have suffered from depression. It could be argued that environmental factors (e.g., bad marriage, job issues, etc.) contributed to their issues.
However, some experience arguably abnormal lows absent any readily apparent external factor, and some responded to clinical therapy, sometimes supplemented pharmacologically.
I think the tremendous complexity and diversity in the human population makes finding a cure all incredibly difficult. I wish there was some kind of “light switch” solution that worked for everybody because depression can be debilitating, occasionally extremely so. Hopefully those pursuing a remedy continue their pursuit despite the cultural churn creating eddies and currents making their work needlessly more difficult.
Thank you, Mr. deBoer, for your thoughtful treatment of a difficult, often contentious subject, and here is to hoping for a brighter future for those afflicted with depression.
Well, sure — in the ultimate sense, everything is physiological. That doesn’t mean, however, that the solution to many psychological maladies isn’t environmental, in more or less precisely the way that the solution to lead poisoning is to not put lead in the environment.
(As for your point that we all live under capitalism but only some of us are diagnosed with depression — I don’t think that’s inconsistent with an environmental hypothesis. It just means some people are more sensitive to the environmental trigger than others. But that doesn’t mean that, in the absence of the trigger, there’s an underlying “disease” that is caused by a “chemical imbalance” in the brain.)
And I think people would be less skeptical of pharmaceutical interventions if people didn’t keep radically over-claiming for them. “You’re not going to get COVID if you have these vaccinations” is just the dumbest and most extreme example of a long line of the public being told things about all manner of interventions that simply aren’t borne out by the actual science. The efficacy of SSRI’s was massively oversold. Now you’re mad at people for being skeptical? People are gonna be skeptical.
I clicked on the link to see the meta-analysis. Quoting from the summary: "The results showed that both TCAs and SSRIs *were* effective for depression." (Emphasis mine.) How are people concluding from this that SSRIs don't work? (Or that serotonin isn't somehow implicated in depression?)
"Why are so many people who do not suffer from mental illnesses or work with them professionally, both left and right-wing, so deeply eager to deny the physiological basis of mental illness and the efficacy of psychiatric medication?"
You cannot ask that question without acknowledging that there are evil people with a financial incentive to oversell the phsyiological basis of mental illness and the efficacy of psychiatric medication. The reason the serotonin theory of depression took such deep hold in the popular consciousness despite dubious scientific grounding is because of an enormous marketing campaign to convince people that medication was the best and perhaps only answer to depression. You are absolutely right that the issue calls for nuance and compassion to people who are suffering, but I think you are wrong to cast outrage and backlash over the success of profiteering in health care as some kind of mean-spirited "eagerness" to invalidate people's pain.
Of course we should be compassionate and not dismissive of those for whom the drugs work. But, that is not to say that we should not demand more from our doctors. As stated, "we know depressingly little about the brain," therefore, if doctors are to maintain their oath and "do no harm", they should not be prescribing drugs willy-nilly, and much less also conclusively parroting unproven theories, such as the serotonin re-uptake one they all authoritatively mouthed when this Prozac Nation period began, some 20+ years ago.
I, for one, am absolutely livid at the doctors who prescribed this to me, and many loved ones, throughout the last few decades, while authoritatively parroting the re-uptake b.s.
In this, and other areas of medicine (trans care for minors?) perhaps doctors should be more humble and just say, "This may work, but we don't know what the consequences may be, nor whether or how it works."
When I was studying neuroscience at university it was shocking to me when we discussed the chemical.imabalance theory. Shocking because there had *never* been any evidence behind it. Even so, much of the field treated this as a settled fact.
Obviously there's something neurological going on causing mental illness. People who say otherwise are simply lying or don't know enough to even lie about it.
But this study is very important. The pharmaceutical industry has massive sway in the field, funds tons of research, funds many of the major international conferences, and has even bought some of the major periodicals (where, incidentally, they publish non-peer reviewed research).
That's not to say pharmaceuticals play no part in treating illness, mental or otherwise. But many people within the field and especially outside of it treat the pharmaceuticals that alleviate symptoms as the cure. Also, many people prescribed these medications never meet with a psychiatrist in a meaningful way. It's not infrequent that an educator recommend that a parent get medication for their child, for example.
So, yes, of course there are bad actors, but this is pretty important. It's the kind of research that has been sometimes difficult to fund and difficult to get published because of the immense influence of the pharmaceutical industry on the field.
Also worth pointing out: Dr. Joanna Moncrieff, who led the metastudy, is a known critic of psychopharmaceutical interventions, it's kinda her life's work. Sometimes, when you look for something, you find you what you are looking for.
I think most people in the mental health field want broader adoption of a bio-psycho-social approach to treatment, but it's been wild to watch New Age bypassers celebrate this study like SSRI/SNRIs do not massively benefit people
"Chemical imbalance" was always an overconfident phrase masking the level of ignorance that you rightly note. People overgeneralizing from headlines is typical behavior, especially online. So is indiscriminate destruction of a perceived shibboleth.