Antidepressants – Big Money, Bad Science?

The idea that depression is caused by nothing other than a chemical imbalance is a comforting one for people who are persistently unhappy. There is no need for soul-searching, no need to wonder what you might be doing wrong or consider what it might be about your past or present circumstances that led you to feel that way. The chemical imbalance theory relieves you and those around you of blame – and, to some extent, responsibility. The answer is to pop a pill once or twice a day and hope that this time the medication works for you.

According to some research, the chances of any given anti depressant working are good, up to 70%. No one would argue that they can be of enormous benefit. But there is also a substantial amount of research that suggests that they are no more effective than a placebo. Recent studies by Professor Irving Kirsch at Harvard university suggests that the placebo effect is the most common mechanism by which antidepressants work, having about twice the effect than the actual physiological effect of the drug. This being the case, he has concluded, as have others, that the idea that a chemical imbalance causes depression is a mistaken one. Therefore, he says, our belief that ‘anti depressants can cure depression is simply wrong.’

There is no doubt that antidepressants can lift mood, whether due to its’ chemical properties or the placebo effect. It seems over-simplistic, though, to conclude that because antidepressants lift mood, the cause of depression is revealed by studying how they work. Paracetamol gets rid of a headache – does it therefore follow that headaches are caused by a lack of paracetamol? Obviously not.

Although academics, scientists and doctors confidently state that the cause of depression is a problem with the brains production of the neurotransmitter serotonin, this remains an unproven hypothesis. The emergence of new drugs for depression that lift mood yet don’t utilize serotonin suggests that the full picture is incomplete at least.

In the past 4 years prescriptions for antidepressants in the UK have risen by 43% – 23 million prescriptions for antidepressants are now issued annually in this country. So are everyones serotonin levels dropping suddenly? Or could the recent difficulties we’ve seen be the cause? Does a recession and rioting cause depletion of serotonin, or does not having enough money and seeing feral youths looting at will simply make people unhappy?

When faced with a situation in which answers are not immediately forthcoming, such as the dramatic rise of antidepressant use, it can be useful to ask the following question – ‘who benefits from all this?’ In the case of antidepressant prescribing there are many possible answers, some easier to swallow that others. But one answer is obvious – the drug companies benefit massively. They develop, conduct research into and market these drugs on their own terms because they know they can make many hundreds of millions of dollars from their sales.

The argument is not that antidepressants never make you feel better. Rather it is a question of scientific validity. If a researcher observes that boosting an individuals serotonin levels lifts moods, it doesn’t necessarily follow that low levels of serotonin are the cause of depression. Obviously it’s worth investigating, but it’s hard to understand how that researcher can confidently state that they understand the cause of depression. Unless, of course, scientists, who are supposed to represent the absolute apex of knowledge and rationality in our time, are not that scientific. Maybe they are as flawed, unreliable and hungry for status, respect (and wealth) as any other human.

I take an antidepressant and it definitely lifts my mood and eases my anxiety. I worry about it’s effect on my physical health and wish I didn’t have to take it. But I know that for the time being it makes sense to keep on doing so. If a person is on an antidepressant which really helps and has no serious side effects, there seems to be no reason to stop taking it. As Professor Kirsch says, if it ain’t broke don’t fix it.

I can’t escape the feeling, however, that drugs aren’t the answer in the long term. They can stop working and can have side effects that may continue even after the drug is no longer being taken.  And the questions remain – why am I unhappy? Why do people get depressed? What’s really going on? Life can be difficult, can’t it?

This post was inspired by an article in the I newspaper (‘What if the drugs really don’t work?‘, Markie Robson-Scott, 25.10.11) and also by the work of Robert Whitaker, Richard Bentall and others.



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