Consider these findings: The antidepressant drugs, used to treat depression and many other mental disorders have limited effectiveness, they have significant side effects, and many people who take the drugs have a hard time withdrawing from them. In addition, no one has yet discovered a biological basis for DSM-defined mental disorders such as anxiety and depression, and the elusive “soon-to-be-discovered genes” underlying these conditions still remain hidden.
Ten years ago, these notions would have been considered blasphemy by the medical profession, but there has recently been a rapid and dramatic shift in our understanding of mental disorders and psychiatric medications. It is now quietly acknowledged that we know very little about the biological basis of any mental disorder and that existing treatments are less than ideal. It seems like we see a new study almost every week pointing out the counterevidence to the accepted conventional wisdom. However, while the scientific literature marches ahead, it appears that clients are often given inaccurate information.
As just one example, take the Serotonin Theory of Depression, which during the 1990’s became an essential part of American pop culture. The idea was that someone was walking down the street, everything was going fine, life was good, the sun was shining, and then, all of a sudden, out of the blue, there was a chemical shortage. At the route of every twisted thought was a twisted molecule — so the thinking went. Modern day medicine embraced the vision of the scientific biological psychiatrist, armed with an arsenal of drugs to normalize chemical imbalances and cure their patients. No more twisted molecules, so no more twisted thoughts. In 1999 alone, three-and-a-half billion doses of SSRIs were consumed, with many prescriptions based on the theory that depression and anxiety were due to an underlying biological deficit which was corrected by the medication.
In a popular book about this biological revolution in Psychiatry, The Broken Brain, Nancy Andreasen, summed up the theory: “1) The major psychiatric illnesses are diseases. 2) These diseases are caused principally by biological factors and most of these reside in the brain. 3) As a scientific discipline, psychiatry seeks to identify the biological factors that cause mental illness. 4) The treatment of these diseases emphasizes the use of somatic therapies.” Although she provides little scientific evidence to support her theory (some say she doesn’t provide any), she concludes that the brain of a psychiatric patient is little more than a collection of neurotransmitters and receptors in need of fine-tuning.
In 2005, we published an article in the journal PLoS Medicine in which we summarized the scientific standing of the Serotonin Theory of Depression. Put simply, we found that in peer-reviewed articles and psychiatry textbooks, the Serotonin Theory is well-known to be false. For instance, in a popular medical school textbook, psychiatrist Stephen Stahl stated: “So far, there is no clear and convincing evidence that monoamine deficiency accounts for depression; that is, there is no “real” monoamine deficit.”
This was but one of many direct statements from psychiatric experts, including many who prescribe antidepressants, who leave no doubt that the serotonin imbalance is not known to be the cause of clinical depression. However, in direct-to-consumer advertising, on the web, and in some clinician’s offices, this well-falsified theory is repeated as if it is a scientific fact. In conversations with family, friends, reporters, and students, we note how often people are surprised to find that this is so.
Following the publication of our article we were contacted by numerous reporters who were somewhat surprised that we were attacking such a well established theory. What we pointed out to these reporters was not that we were knocking down a well-accepted theory, but rather that we were pointing out the lack of acceptance of the theory within the psychiatry profession. Moreover we encouraged these reporters to not simply take our word for it, but to contact the various professional bodies, such as the NIMH, APA, FDA, etc.
In perhaps the most interesting example, one reporter contacted Wayne Goodman, the head of the FDA psychopharmacology Committee. Goodman told the reporter that the theory was a “useful metaphor” but said that it was not one that he used with his patients. Goodman’s statement confirmed the main hypothesis of our paper which was that scientists did not give much credence to the theory. What we find problematic is that many patients surely listened to their own physician’s explanation about depression being caused by an imbalance of serotonin and thought they were hearing about science. How many knew they were hearing a metaphor?
In a somewhat brash statement, David Healy, a prominent historian of psychopharmacology, referred to the theory as “akin to the masturbation theory of insanity.” Although rare, there are some cases where the scientific evidence has trickled down to publications designed for laypeople. A recent article in Newsweek titled, “The Depressing News About Antidepressants,” discussed recent studies documenting the limited effectiveness of the antidepressants. The author of the article, Sharon Begley, in a somewhat more subdued tone than Healy, stated: “Unfortunately, the serotonin-deficit theory of depression is built on a foundation of tissue paper.” Goodman, Healy, or Begley did not mince words when it came to theory. Yet, five years later, we still find that many people are surprised to hear that the Serotonin Theory of Depression has been discarded by neuroscientists, if not by clinicians.
Biological explanations for mental disorders are seen as potentially useful, because they may de-stigmatize mental health conditions and lead to useful treatments. When the information presented is inaccurate, though- even according to psychiatric textbooks- this raises a fascinating problem. How many clients have been told by their physicians or clinical psychologists that their problems with depression are due to a serotonin imbalance…and assumed that their clinician was using the language of science rather than speaking in a metaphor?
We are living in the age of the “Broken Brain,” in which the paradigm of mental disorders as brain diseases reigns supreme. However, as this blog post highlights, there is often a large disconnect between the conventional wisdom and the scholarly data on the cause and treatment of mental disorders. We believe that clients deserve to receive evidence-based information, in order to best aid them in making treatment decisions. Our blog will be dedicated to an evidence-based discussion of the bioreductionistic claims made about mental health issues and their treatment, and it is our hope that both practitioners and clients will be well-served by the most accurate, up-to-date information possible.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.