Teenagers on SSRIs

Jonathan Leo, PhD
17
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Last week, the Wall Street Journal has an article titled The Medication Generation by Katherine Sharpe which questioned the fact that a large number of teenagers are currently taking antidepressants. In several respects the article was a bit of a refreshing change from how the topic has often been presented  as it raises important questions about what it means for a generation of teenagers to grow up on medications.  It also has some refreshing quotes from experts who point that there are no easy answers. Of course, all this is nothing new to the readers of this website. But at least some of the major newspapers are beginning to publish skeptical articles. (The article never brings up the efficay problem with the SSRIs but that is another story).

However, one aspect that stands out in the current paper is the author’s discussion about the chemical imbalance theory of depression.  Sharpe is on the fence about the theory and can’t quite decide if it is a good thing or bad thing that people have been told that depression is caused by low serotonin. On one hand she points out a potential problem with biological theories: “there are the consequences of teaching young people to think about their problems in biomedical terms.” But then on the other hand she sees a silver lining because the chemical imbalance theory has supposedly removed any negative stigma: “the acceptance of depression as a biological illness has been hailed for removing shame and stigma from the condition.”

But rather than discuss the theory’s utility shouldn’t the questions focus on the accuracy of the theory? If it is not scientifically accurate, isn’t it misleading to portray it as a scientific fact? Several years ago we monitored the media for mention of the chemical imbalance theory. Whenever an article in the main stream media mentioned the theory as a well-established proven fact an email was sent to the author asking if they could supply a reference in support of their statement. None of the reporters provided any citations that could be considered sound evidence to support the theory. Many of the responses seemed to equate this request with asking for a citation that the world was really round. Some of the organizations supplied citations which were little more than similar statements from another organization.

As just one example, consider the following. In the Philadelphia Inquirer, a reporter wrote that “mental illnesses are simply chemical imbalances.”  For her reference she supplied  a statement made by the President of the Society of Neuroscience, which was part of a request made to a congressional panel for more funding. He said: “mental illnesses were due to a chemical imbalance.” When it was pointed out to the reporter that this was not a scientific reference, she replied, “I did not conduct an extensive literature search, as I assumed that if an individual such as the president of the Society of Neuroscience, among others, stated that a mental illness represents a chemical imbalance, there must be some evidence to that fact.”  In the published paper there are many more examples like this.

What would probably come as a surprise to many of these reporters that we talked to is that some leaders in the field have even stated that the psychiatry profession never accepted the theory in the first place and that the chemical imbalance theory is really nothing more than a straw man argument developed by scientologists.

Any discussion about too many teenagers taking SSRIs needs to examine the role of a now largely discredited theory about depression. The presentation of a false scientific theory cannot be excused by some sort of utilitarian argument that ultimately the public is well served by a falsehood.

17 COMMENTS

  1. Jonathan, I agree:

    “But rather than discuss the theory’s utility shouldn’t the questions focus on the accuracy of the theory? If it is not scientifically accurate, isn’t it misleading to portray it as a scientific fact? ”
    And I would go so far as to say that THIS on this ONE statement of fact, we can begin the process of criminal indictments for leading academic psychiatrists and the leadership of the APA, FDA, AMA, NIMH, Editors of Medical Journals, etc., etc…

    1) Reasonable expectation that scientific knowledge is the foundation of medical science and a prerequisite for a license to practice medicine in the U.S.

    2) Reasonable expectation that statements written and spoken for both medical education purposes and public information by academic psychiatrists, will reflect scientific knowledge and evidence of this knowledge in clinical practice.

    3) Exhibit A : (arbitrary representation of 1 & 2) “Straight Talk about Psychiatric Medications for Kids”by Timothy Wilens MD- 217 pages of explicitly FALSE statements related to : brain disorders and biochemical imbalance as causes for “psychiatric disorders” in children as young a 3 years ; FALSE and misleading statements re: FDA approval. licensing and black box warnings for psychiatric drug use in children; FALSE and misleading staements related to SAFE & EFFECTIVE psych drugs for use in children; ABSENCE OF FOOTNOTES— to support any *scientific claim*; no presentation of opposing arguments; no evidence of academic research process, or this being a “scholarly” work. Appears to be in the format of PHARMA ghostwritten marketing, published 2009–one year following the investigation of Dr. Wilens and subsequent proven claim (2011) that he accepted at least $1.2 million from PHARMA co.’s AND no charges relatd to malpractice or academic disciplinary action from HMS or MGH!!!

    EVERY state has an Attorney General, whose office assumes responsibility for prosecuting criminal fraud that violates the public trust. THIS is a case of “willful deceit for profit that has caused substantial harm”.

    YES, it does matter that this myth, this lie is neither challenged or rectified by leading academic psychiatrists from Boston to Stanford — and as you conclude:

    “Any discussion about too many teenagers taking SSRIs needs to examine the role of a now largely discredited theory about depression. The presentation of a false scientific theory cannot be excused by some sort of utilitarian argument that ultimitely the public is well served by a falsehood.”

    WE are the public, and we have work to do!!!

  2. Oh, of course psychiatrists believed their own propaganda.

    That article by Ron Pies is nothing but an effort to save face. He’s trying to say psychiatry wasn’t so stupid as to be hoodwinked (when it was) and the “chemical imbalance” lies told to patients were to make them feel better, not because the doctors were clueless (when they were).

    Otherwise, it would have been a confession that psychiatrists are not the intellectual giants they claim to be, fit to stand astride both psychiatry and neurology and call themselves “neuroscientists.”

    Psychiatry, as exemplified by Dr. Pies, is squirming to get out of the mess it’s made with sloppy science and careless clinical practice. Dr. Pies excels as sophistry in this regard.

    Katherine Sharpe’s book appears to be soft on science and big on sensationalistic human interest in a topic that is actually of utmost importance: An entire generation being injured by misdiagnosis and unnecessary psychiatric medication — except she doesn’t address the misdiagnosis and lack of necessity.

  3. Altostrata, I agree with your take on Dr. Pies’ article linked above. The use of an obfuscation tactic when finding oneself in trouble is hardly what we would reasonably expect form an Educated Professional in the field of medicine? Is it? AND when it is used, as Dr. Pies has so adeptly demonstrated, the result for me is a heightened fear response—gut reaction- like; this guy is as evil as he is blind and ignorant—

    But then, the crux of the usurping of medical doctor stature by psychiatrists IS a claim to having knowledge of our mechanistic underpinnings— physiological wild cards that sabotage our best efforts to cope with the trials and tribulations of life. Ultimately there is NOT going to be definitive diagnosis or treatment info focused on our biology. Truly cutting edge revelations point to the mystical function of *mind*, *consciousness*— that actually influences and even changes, the brain!!

    So, it seems a matter of urgency to me that we really hone in on confronting beliefs/science of psychiatry that are FALSE and misleading- that we raise the consciousness of the public to heighten a sense of fear and loathing for psychiatry.( in the style of Hunter S. Thompson)

    Dr Pies?? Well, ok– he has made it clear in this article that biochemical imbalance theories of mental illness are a non issue for real PSYCHIATRISTS … yes, I would like to say TO: Dr. Pies, or rather, ask him:

    ” BUT what about the overwhelming majority of the public who believes and acts on this myth as if it were FACT? And how about all the web sites that propagate this myth? And how about the damages suffered ? ”

    SO– to DR. Pies and his consorts, I address this question::
    “WHY AREN’T YOU ADDRESSING THE URGENT NEED FOR REFUTING AND CONDEMNING THE PROPAGATION OF THIS DESTRUCTIVE MYTH???”

    and I want to keep the discussion going with this guy— asking

    “Dr. Pies, Do you NOT realize that it is PEOPLE not psychiatrists who are being hurt by these lies? ”

    Well, that’s when I understand my own intense aversion to Dr. Pies attitude/thinking— it is focused on self preservation at the expense of any and all of the rest of us…!!! EVI in a nut shell.

  4. Jon, thanks for another excellent post! The accuracy argument you make here isn’t emphasized enough, in my opinion. If healthcare providers have an ethical obligation to provide accurate information to their patients, and entities like the APA, NIMH, and NAMI have a similar obligation to the truth, spreading a falsehood is unethical, period, regardless of its supposed beneficial side effects. A benevolent lie told to a patient is still a lie, and doctors are supposed to be sources of accurate information.

    I have a question for you Jon, and anyone else reading this who might have an answer to contribute. Outside of psychiatry, are there other areas of medicine in which patients are routinely provided with misinformation based on the notion that it is helpful in others ways such as stigma reduction or treatment compliance? I’d like to understand how unique widely disseminated falsehoods like the “chemical imbalance” and “biologically-based brain disease” really are in medicine.

    Thanks!

    Brett

  5. Jonathan–

    Not only is Sharpe’s willingness to entertain a utilitarian justification morally wrong, it is factually ill-based. Though psychiatrists constantly claim that the biological psychiatry ideology decreases stigma, that’s untrue.

    A major study, funded by NIMH and published in the American Journal of Psychiatry, found that acceptance of the “neurobiological illness” idea increases stigma.

    As “psychcentral” summarizes, “. . . the results show that although believing in neurobiological causes for these disorders increased support for professional treatment, it did nothing to alleviate stigma. The results show that, in fact, the effect increased community rejection of the person described in the vignettes.”

    You can find the published study here:
    http://ajp.psychiatryonline.org/data/Journals/AJP/1818/appi.ajp.2010.09121743.pdf

    Excuse me, please, for a moment of, “I told ’em so.” In “Cultures of Healing” I predicted exactly this.

    • Hi Bob, your link is not working, at least it isn’t working for me…..

      Here’s a different link though, about some research done where the researchers pretended to have a test to show if a depressed person had a biochemical imbalance or not

      Those who thought they had been found by a test to have such an imbalance did not experience any less self blame, but did become more pessimistic about their condition, saw themselves as less able to regulate their mood state, and less able to benefit from therapy – http://www.ncbi.nlm.nih.gov/pubmed/24657311

  6. “But then on the other hand she sees a silver lining because the chemical imbalance theory has supposedly removed any negative stigma: ‘the acceptance of depression as a biological illness has been hailed for removing shame and stigma from the condition.'”

    Of COURSE ‘bio-lie-o-psychiatry’ has increased stigma. It’s created a ritual whereby formerly equal human beings go through a period of distress, and come out with the rest of their community believing they are under the control of a brain disease.

    Psychiatry can claim all it likes that it doesn’t believe in ‘chemical imbalance theory’, who cares!? They DO, DEFINITELY believe in brain disease theory, regardless of the obfuscations.

    They are happy to let every legislator, politician, and judge, believe there is something ‘scientifically provably’ wrong with the brain of the person who is is about to have their brain confiscated from them and forcibly drugged or electroshocked in a court room.

    The real question about emailing reporters and so on, is how did we as a people become so entranced and unthinkingly worshipful of the medical profession, that we believe in BS just because it comes dressed in a white coat.

    Take the Anonymous questionnaire, the battery of tests designed to conclude how ridiculous this is:…..

    1. Do you take HIV drugs?

    2. No, of course not, because I don’t have HIV.

    3. How do you know you don’t have HIV?

    4. Don’t be ridiculous, I know because I’ve never tested positive for HIV. Why would I take toxic drugs if I don’t have HIV? You’re crazy man.

    5. Do you take neurotransmitter altering drugs?

    6. Yes.

    7. Why?

    8. Because I have a chemical imbalance and I hold my HIV status to a higher standard than my very thinking organ.

    9. Some thinking organ, that.

    • THiS questionnaire would be a wonderful addition to the soon- to -be- available patient prompter kit , the title of which is:
      “ASK YOUR DOCTOR…”

      Today, I added these questions:

      “Dr. Flatulater, is there some biochemical cause for feeling stigmatized by having a diagnosis of a brain disorder? I know I am NOT supposed to feel this way— Could I be experiencing an adverse effect from one of the 5 drugs you have prescribed for the brain disorder you thoughtfully diagnosed and medicated so that I won’t feel stigmatized? “

  7. Thanks for pointing interesting bits. While I usually oppose bashing any psychiatrist, I find it interesting when one of them does it at Psychiatric Times.

    Rone Pies says:

    “In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim, except perhaps to mock it. On the other hand, the “chemical imbalance” trope has been tossed around a great deal by opponents of psychiatry, who mendaciously attribute the phrase to psychiatrists themselves.”

    I am not sure in what alternate dimension Dr. Pies has lived in the last 30 years: making an association between “chemical imbalance” and ignorant, untrained psychiatrists is a double-edged sword, and the second edge is wide and powerful.

  8. What we do know is this: depression doesn’t eme rge from exposure to alcohol in the knuckles. Brain tissue is what dies from alcohol poisoning. The brain is the best sourc of which we know so far as the most likely place to find cognition and emotion. Likely, secrets to the mysteries of errant thought patterns and emotional illnesses will be found within that structure consisting of 100 billion neurons. Emotions and thoughts are not formed in one’s knees. We have not even scratched the surface to begin to understand how the human brain works.