Dear Dr Chris Steele
RE: This Morning Feature on Depression – 18th of March 2014
We would like to express our grave concern over the information and advice you gave several of your participants on the programme including Dee, and then Nicola and Dan specifically, during the phone-in.
On the majority of occasions whilst imparting your medical knowledge (and personal experience) on depression, you clearly stated that this condition was due to a ‘chemical imbalance’ in the brain caused through a depletion of serotonin. You stated quite categorically that anti-depressants (ADs) would be the main answer to help people get back on track (like they continue to help you). You even stated a person might need to be on anti-depressants for life and that this would be ok.
It was clear Dee has major social difficulties and this is having an impact on her ability to manage and cope. Although you stated Dee’s circumstances caused a depletion of serotonin in her brain and that drugs would correct this, there is no scientific evidence to support your assertion that Dee actually has a “depletion” or chemical imbalance and that ADs correct any imbalance. What is the proper level of serotonin? What medically established, peer reviewed test, measures serotonin in the brain? What region is this serotonin being sampled?
It was also very clear to us that Dan was suffering from bereavement due to the recent loss of his father. He said he was feeling tired, grumpy, couldn’t sleep and was crying all the time. Yet again you said Dan had all the symptoms of clinical depression and therefore it would be better for him to see his practitioner, who would hopefully prescribe anti-depressants. Can I ask you: If Dan’s above reactions are ‘symptoms’ of clinical depression, then what would you say are the signs of understandable grief? Grief is not an illness and feeling overwhelming emotions is a natural human response. In fact, there can be a number of stages someone will go through like shock, sadness and anger to name a few. Doctors are supposed to use the least intrusive method possible first, and recommending he begin taking a brain-altering drug was unhelpful and potentially harmful considering the main effects of taking ADs such as aggression, suicidal ideation, and suicide itself. Bereavement cannot be ‘medicalised’ in this way and to suggest this is sending out the wrong message to a person having to accept loss and work through the grieving process.
Regarding Nicola, you again pushed the use of long-term drugs, saying it ‘gets you back to normal.’ Drugs cannot make you ‘normal’, as their very mode of action is to impair true normal brain functioning. You are making yet another recommendation for drugs to correct an imbalance that has never been consistently found and shown to cause depression. Quite the opposite in fact: Research has shown that psychiatric drugs do indeed create ‘perturbations in neurotransmitter functioning’ thereby affecting normal homeostatic mechanisms that exist in the brain, which in the long term can cause permanent neural dysfunction (Hyman 1996). As a result, we feel Nicola would clearly have benefitted more from intensive talking therapy to explore her underlying fears and anxiety, and certainly from the support of caring friends and family rather than resort to long term ADs.
The notion of a ‘chemical imbalance’ is now a fairly outdated view, and it is irresponsible and unethical to continue to indicate to the public they suffer from an imbalance where non has ever been consistently found and replicated within the peer reviewed professional journals.
“There is no scientific evidence whatsoever that clinical depression is due to any kind of biological deficit state.” (Ross 1995, Associate Professor of Psychiatry)
Stanford Psychiatrist Dr. David Burns has stated:
“I spent the first several years of my career doing full time research on brain serotonin metabolism, but I never saw convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.” (Lacasse, J. 2005)
In fact the American Psychiatric Association has openly admitted for a long time now that this theory of a chemical imbalance was all just a metaphor, a myth invented by the pharmaceutical companies to generate drug sales!
“The psychiatric profession has finally come clean and confessed on a national media outlet that there is no evidence to support the Serotonin Theory of Depression . . . However, according to Pies, it was the pharmaceutical companies who espoused the theory, and not well-informed, practicing clinicians, because the psychiatry community has known all along that the theory is not true.” (Leo, J. and Lacasse, J., 2012)
There are many more academic papers and journals highlighting these findings. We feel to ignore such evidence is unprofessional, naïve and unethical.
To imply to viewers there is known scientific evidence to support the ‘chemical imbalance’ theory is misleading and could potentially do more harm than good. If a person is led to believe they have a ‘chemical deficiency’ then this can affect how they perceive themselves, how other perceive them, cause them to take drugs thereby masking the main external difficulties, affect ‘treatment’ plans and more so, create a prolonged road to healing. Instead of focusing on how they can sort their external life out, they resolve themselves to believing there is nothing they can do due to their ‘illness’. To suggest a person needs anti-depressants only reinforces that they are ‘ill’, with ‘a magic bullet’ being the only solution.
The chemical imbalance theory of depression can affect a person’s perception of himself or herself. Compared to a bio-psychosocial explanation, the chemical imbalance explanation was less credible and led to decreased personal and moral responsibility for depression, a worse expected prognosis, and the perception that psychosocial interventions are largely ineffective. (Deacon and Baird 2009)
To suggest that a person has a depletion of chemicals in their brain actually leaves the problem at the person’s door. So, as in the cases of Dee, Dan and Nicola it implies that suffering is caused by an internal biological abnormality, which can be treated with drug intervention. So who helps to support Dee with her social problems, Dan with his grief and Nicola with her deep rooted fears? Detracting from their external predicaments and suggesting a physiological internal cause, is equivalent to using people as scapegoats and ignoring the moral and social responsibilities we all have as people to support the vulnerable and to challenge the wrongs that reside within society.
This also brings us to the point that during your TV appearance, the advice you gave placed the greatest emphasis on psychiatric drug interventions. We felt that ‘talking therapies’, social work or carer support – not to mention support and love from family and friends, participation in external activities etc was gravely omitted from your advice. We felt these options would have been far more effective for Dee, Dan and Nicola enabling them to explore and manage their life circumstances. Yet, you instantly jumped to drugs as the remedy without consideration for their extenuating circumstances.
Research has actually shown that ‘antidepressants’ are no more effective than placebo and clearly have unwanted side effects like agitation and anxiety.
The problem is not that people do not improve on medication. They do, and on average the degree of improvement is clinically significant. But people also improve on placebos. This suggests it is not the drug that is making people better (Kirsch 2009)
Even more alarmingly, it’s now recognised by the medical profession that suicidal thoughts and feelings can increase, whilst starting and during the first few weeks and even months of taking an anti-depressant.
To suggest also that someone should be on them for life ‘which is ok’, we find even more shocking considering the long term physical damage that can occur. We also find it quite sad that you actually feel you need to be on anti-depressants for life yourself. Based on the research, we would question your claim and wonder if you too, have actually bought into the myth of the chemical cure or if your own drug usage is the reason for such recommendations? If this is the case then using yourself as an example, is not evidence-based interventions based on peer reviewed long term data but rather personalised marketing. In some circumstances medical professionals also have vested interests in the pharmaceutical industry and patients deserve to know if this is the case, although we are not suggesting this here with you.
Dr Steele, bearing in mind the findings from the research we have highlighted above and the ever growing publication of research on this subject matter, we trust you will take our concerns onboard and refrain from using information that cannot be substantiated scientifically. To continue to do so is not only misleading but also grossly unethical. Making claims via the media that cannot be proven scientifically we feel actually has serious implications for the health and well being of This Morning’s viewing audience and therefore the programme could be an infringement of broadcasting legislation.
We would appreciate a response from yourself or producers of This Morning as soon as possible.
Julie Leonovs (with contributions by Nick Redman)
Julie Leonovs: BSc (Hons), MSc Psychological Research Methods, Mental Health Advocate
Nick Redman: Bristol Hearing Voices Network
Deacon, J. B and Baird, L. G. (2009) “The Chemical Imbalance Explanation of Depression: Reducing Blame at what Cost? Journal of Social and Clinical Psychology, Vol 28, No. 4: pp. 415-435
Hyman, S. (1996) “Initiation and adaptation: A paradigm for understanding psychotropic drug action”. American Journal of Psychiatry 153 151-61
Kirsch, I. (2009) The Emperor’s New Drugs: Exploding the Antidepressant Myth. The Bodley Head, London.
Lacasse, J. (2005) ‘Serotonin and Depression: a disconnect between the advertisements and the scientific literature’. PloS Medicine Vol 2.: 1211-16
Leo, J and Lacasse, J (2012) Psychiatry’s Grand Confession [online] Available from: http://www.madinamerica.com/2012/01/psychiatrys-grand-confession/ [Accessed March 2014]
Ross, C (1995) ‘Pseudoscience in Biological Psychiatry’. (New York: John Wiley & Sons) 111
In support of this letter:
Rachel Waddingham: London Hearing Voices Project Manager, Mind in Camden
Patrice Campion: BSc (Hons), MSc Psychological Research
Mental Health North East (MHNE) England.
Dr R Huws: Consultant Psychiatrist, Sheffield
Hugh Middleton: Hon. Consultant Psychiatrist Nottinghamshire Healthcare NHS Trust & Associate Professor, University of Nottingham. Co-Chair, UK Critical Psychiatry Network.
Dr James Davies: Senior Lecturer in Psychology and Social Anthropology, University of Roehampton
Suman Fernando: Visiting Professor, Faculty of Social Sciences & Humanities, London Metropolitan University. Former Consultant Psychiatrist
Philip Thomas: Honorary Visiting Professor, Social Science and Humanities, University of Bradford. Formerly Consultant Psychiatrist Bradford District Care Trust
Sami Timimi: Consultant child and Adolescent Psychiatrist, Director of Medical Education Lincolnshire Partnership Foundation NHS Trust
Paula J. Caplan: Ph.D., clinical and research psychologist, Associate, DuBois Institute, Harvard University, former member of two DSM committees, and author of They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.
Mary Maddock: Board Member MindFreedom International/Co-author Soul Survivor – A Personal Encounter with Psychiatry.
Katie Mottram: Development Group Member UK Spiritual Crisis Network
Marian B. Goldstein: Counsellor, Co-char Danish Hearing Voices Network
Olga Runciman: Psychologist and Chair of the Danish Hearing Voices Network.
Speak Out Against Psychiatry (SOAP)
Susan Kingsley-Smith: IC – Contributing Author: Coming off Psychiatric Drugs 2014 by Peter Lehmann Speaker: Proactive Planning – Reducing Reliance on and Considering Safe Withdrawal from Psychiatric Drugs, Companion Guide to the PACE Manual: Creating Your Own Proactive Plan; Founder Empowering Solutions project.
Nancy Rubenstein Del Giudice: Director of Public Education and Volunteer Coordinator The Law Project for Psychiatric Rights (PsychRights.org)