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  1. seeingred
    'The Myth of the Chemical Cure'
    Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance.
    But in this week's Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into "drug-induced states".

    If you've seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it.
    It's not just doctors that think this way, either.

    Magazines, newspapers, patients' organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

    People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin.
    The trouble is there is little justification for this view of psychiatric drugs.

    Altered states
    First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.
    Second, it is often said the fact that drug treatment "works" proves there's an underlying biological deficiency.
    But there is another explanation for how psychiatric drugs affect people with emotional problems.

    It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis.
    Psychoactive drugs make people feel different; they put people into an altered mental and physical state.
    They affect everyone, regardless of whether they have a mental disorder or not.

    Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce.
    Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis.

    Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation.
    Drugs labelled as "anti-depressants" come from many different chemical classes and produce a variety of effects.
    Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

    'Informed choice'
    Views about psychiatric drugs changed over the course of the 1950s and 1960s.
    They gradually came to be seen as being specific treatments for specific diseases, or "magic bullets", and their psychoactive effects were forgotten.
    However, this transformation was not based on any compelling evidence.
    In my view it remains more plausible that they "work" by producing drug-induced states which suppress or mask emotional problems.


    This doesn't mean psychiatric drugs can't be useful, sometimes.
    But, people need to be aware of what they do and the sorts of effects they produce.

    At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.
    That sounds good. If your brain is not functioning properly, and a drug can make it work better, then it makes sense to take the pill.
    If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.

    If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could.
    On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.

    People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems.
    To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce.


    Dr Moncrieff's book "The Myth of the Chemical Cure", published by Palgrave Macmillan, will be available in paperback from September.

    VIEWPOINT
    Dr Joanna Moncrieff
    Mental health expert
    Page last updated at 04:30 GMT, Wednesday, 15 July 2009 05:30 UK

    http://news.bbc.co.uk/2/hi/health/8138893.stm

Comments

  1. el burgo
    Maybe the NHS does not have the resources to treat emotional problems via therapeutic methods so prescribe drugs as a quick fix. If so then SWIM thinks this is very irresponsible.
  2. bennett211085
    Swim has been preaching this for years. Anti-depressants are their biggest business and Swim is pretty sure long term use permanently changes people in many ways (leading to more prescriptions of some sort).
  3. missparkles
    Personally Sparkles thinks there's a place in the treatment of mental health issues for meds. Non meds treatment has to be the first choice, if a particular illness will respond to some form of talking therapy.
    But some don't...and as such meds have to be used. Don't throw the baby out with the bathwater.
    Sparkles knows that at the present time there are not enough trained professionals to give this therapy and cost is an issue. She's not saying it shouldn't be an option but would like to know where the money for this is going to come from? Any ideas?
    Sparkles.:)
  4. Routemaster Flash
    The title of this thread is very misleading. Saying it's a myth that drugs can 'cure' mental illnesses is a lot different from saying mental illnesses don't exist, which is what the title seems to be implying.

    Could the OP, or perhaps a mod, change the title to something more appropriate?
  5. 3333
    Swim totally agrees. The thing that scares swim the most about drugs is their totally unknown and unmeasurable effects on the brain. We can record the amount of mental illnesses produced by drugs, as well as other psychological effects such as personality changes, however what is really happening to the brain because of drugs is scary, that is why swim has never taken weed. Swim has been prescribed two different antidepressants and both have helped with the depression, however swim decided that he should use them no longer that 6 months. He just doesn't know what they may be doing to his head. He only took them because he really needed them.
  6. Miss Alice
    Swim (who is might start going by Isis) absolutely needs her crazy-pills. Even when she's off them for 5 days she gets grouchy, irritable, stubborn, and suicidal. She has Boarderline Personality Disorder, a very serious disorder that greatly affects your attitude. Swim couldn't imagine living without her anti-depressants, even if they're just "mood-altering drugs".
  7. MisterV
    SWIM agrees with the opinion that these meds are often prescribed as "ultimate cure" - but there are so many illnesses a therapy-only treatment doesnt work. A combined-treatment with meds often helps and lowers the mental problems.

    SWIM is on a variety of psychoactive drugs, some with bad side effects. But SWIM has no other option.

    What SWIM surprised a little bit is the fear of unexpected and yet not know effects but on the other side common drugs and even RCs are taken.
  8. staples
    You have to be kidding me. This statement is as false as they get.

    Not in such words, really; the fact that a drug treatment "works" suggests that the underlying problem is related to the mechanism of action of that drug treatment.

    True, but misleading. Alcohol and cannabis are not the products of a ridiculous amount of research. You wouldn't really expect a non-diabetic to be able to take shots of insulin without any effect, so why would you expect an SSRI not to do anything to a normal healthy person?

    To what way of understanding how psychiatric drugs affect people is this an alternative?

    But drugs were once used because they happened to alleviate some symptoms, and that could be seen as one of the overall effects of the particular drug. Now drugs are developed to target more specifically an exact problem and correct it, but this is still considered "masking" emotional problems?

    Am I the only person who is unfamiliar with a medical system where doctors assert that a medication will cure a mental health problem in a particular patient? Am I the only one who is given the prescription information on every single medication for which he has been written a prescription? If you tell a doctor you are depressed, I would have a hard time believing that the doctor concluded from your statement that your depression is caused by lower than normal levels of serotonin, and not by, say, a thyroid problem, or a traumatic life event.
  9. Amnesia
    In some instances this can be true of the lesser mental health problems such as depression, anxiety, OCBD etc – but for the serious mental health problems i.e. personality disorders, bipolar disorder and schizophrenia, the idea of taking a non-medication based approach is laughable. Yes, talking therapies can help those with serious mental health problems, but only when they are sane enough to be able to participate. This sanity can only be provided through medication, and only the medication can keep them sane. SWIM says she speaks not only as one of the insane, but one who chose to study these disorders.
    No amount of therapy or happy, positive thinking can correct the imbalance of neurotransmitters in the brains of those with serious mental health problems. And these imbalances are easily observable in PET scans.
    If one considers the time before the introduction of modern antipsychotics and mood stabilisers, manic patients would often die of exhaustion, unable to sleep or stop ‘bouncing off the walls,’ so to speak. Before the introduction of these new, and yes, unpleasant medications, those with serious mental health problems were locked away indefinitely in psychiatric facilities where many would remain until they died. If talking or anything else had been able to help them, they would not have lived out their lives in an institution, they would have recovered and been released.
    Take a seriously mentally ill patient off their medication at any point and it leads to only one thing - relapse. This has been proven by mounds of clinical examples, experiments and documentations. Also, it is now in NICE guidlines that the side effects of all medication must be discussed by the patient and psychiatrist before treatment is commenced, unless that patient is delirious.

    One of the problems is the attitude of the public. They think that a life should be completely happy and stress free and, if it isn’t, they think something is wrong and that it needs to be fixed. Most people want the easy option of medication, and many of them are unaware of the hideous nature of anti-depressants, antipsychotics and mood stabilisers. Yet, even if they were aware, most people would probably still take the easy route of medication rather than the long, slow process of therapy, which requires people to actually help them selves.

    Those who are seriously mentally ill, however, do not need to be belittled by being told that they don't need medication, that other things such as talking therapy and positive thinking can overcome a genetic illness (bipolar, schizophrenia). These illnesses can not be cured, that is a fact, the symptoms can merely be controlled and that is the purpose of medication.

    Perhaps SWIM is cynical (actually there’s no ‘perhaps’ about it) but this seems like bullshit put forth just to sell a book.
    She would be interested in observing this technique used for a trial period on those with serious mental health problems and, then, she would be interested in the enormous lawsuits that followed the patients' deaths/suicides. She hopes, however, that this will not happen because people who desperately need real help would die.
  10. staples
    Ok, the claim that there is no scientific evidence for the serotonin hypothesis of depression bothered me so much that I've found and attached the following:

    Asberg M, Thoren P, Traskman L, Bertilsson L, Ringberger V. " Serotonin depression"–a biochemical subgroup within the affective disorders? Science. 1976;191(4226):478–480.

    Mann JJ, Malone KM, Diehl DJ, et al. Demonstration in vivo of reduced serotonin responsivity in the brain of untreated depressed patients. The American journal of psychiatry. 1996;153(2):174.

    Stockmeier CA, Shapiro LA, Dilley GE, et al. Increase in serotonin-1A autoreceptors in the midbrain of suicide victims with major depression-postmortem evidence for decreased serotonin activity. Journal of Neuroscience. 1998;18(18):7394–7401.

    Stahl SM. Mechanism of action of serotonin selective reuptake inhibitors serotonin receptors and pathways mediate therapeutic effects and side effects. Journal of affective disorders. 1998;51(3):215–235.

    Ogilvie AD, Battersby S, Bubb VJ, others. Polymorphism in serotonin transporter gene associated with susceptibility to major depression. Year Book of Psychiatry & Applied Mental Health. 1998(9):373.

    Malison RT, Price LH, Berman R, et al. Reduced brain serotonin transporter availability in major depression as measured by [123I]-2$\beta$-carbomethoxy-3$\beta$-(4-iodophenyl) tropane and single photon emission computed tomography. Biological Psychiatry. 1998;44(11):1090–1098.

    Owens MJ, Nemeroff CB. Role of serotonin in the pathophysiology of depression: focus on the serotonin transporter. Clinical Chemistry. 1994;40(2):288–295.

    Sussman N. SNRIs versus SSRIs: mechanism of action in treating depression and painful physical symptoms. Prim Care Companion J Clin Psychiatry. 2003;5(suppl 7):19–26.
  11. nibble
    But the monamine theories of depression are undoubtedly extremely narrow, if serotonin was such a huge factor in depression full stop then why do drugs that increase synaptic levels of serotonin and/or other monoamine neurotransmitters not prove very effective in treating depression? The simple fact is that they don't in many or most cases. Many antidepressants have been shown to be no better than placebo. The huge number of people whom experience a worsening of their condition upon use of SRI's or similar is surely also testament to the fact that these drugs are not very effective and that there is far more to it than the abnormalities of single neurotransmtter systems.

    The problem also is, whether they are supposed to or not, doctors will often prescribe SSRI's or the like with no additional therapy, ergo they essentially are using them as some sort of cure.

    Antipsychotics and drugs like lithium used to treat more acute mental illnesses such as psychotic or manic disorders are a different animal entirely, you can't lump them in together. In many cases these drugs are certainly effective in treating a direct symptom and in that regard I do disagree with Dr Joanna Moncrieff. That's not what I have the issue with though, it's modern "antidepressants" such as trycyclics or SSRI's.
  12. staples
    In fact, the FDA requires that an antidepressant has a proven efficacy higher than that of a placebo. The fact that depression symptoms can worsen upon starting SSRI treatment is a testament to the complexity of the neurotransmission involved, and the length of time it takes to establish a new homeostatic state (e.g, up- and down-regulation of receptors and auto-receptors).

    I'm not sure this is true (that "doctors will often prescribe SSRI's or the like with no additional therapy"); it certainly has not been my own experience, and I cannot find any literature to corroborate the claim. The only information that seems even remotely relevant has to do with patients without (adequate) health care who could not afford cognitive-behavioral therapy.
  13. Nature Boy
    Problem with diagnosing mental illness: no empirical data. That's why you hear of so many screw-ups and that's why the industry of pharmaceuticals can be so corrupt. At the end of the day, a medical professional who prescribes a risky drug is gambling with your sanity. Although I trust that many psychiatrists and psychologists try to be as responsible as possible, I fear that the subjectivity of the diagnosis leaves the door open for all sorts of nightmares.

    I don't mean to get all Tom Cruise here but the history of psychiatry (much like the history of medicine in general I suppose) is downright scary. From labotomies to shock therapies to experimental drugs, there are stories worthy of horror movies.
  14. Amnesia
    In the UK, NICE guidelines were changed so that therapy had to be offered first or with medication. Unfortunately there is an immense shortage of psychologists, the waiting lists are very long, and often people turn down therapy when they finally get it. The waiting list here is two years long.
    Some of the older doctors probably do think antidepressants are a cure, certainly the ones SWIM has dealt with, but she has found this is not the case for younger GPs. SWIM thinks that the general public still regard them as a cure though.

    SWIM thinks many people want the easy route – just the medication, because therapy can be a trying time and involves work by the patient. Many people find it hard to face the fact that a lot of the way they feel is down to their own thinking patterns – people see this as a failure on their part. It can be an unpleasant and daunting thing to undertake. No one likes to be told they’re effectively screwing themselves up - SWIM certainly doesn’t (even when she knows it’s true). Some people accept that medication is just a part of treatment, something to enable them to engage in therapy but, in her experience, many people deny that they have any control over their thinking patterns and consequently fight the therapy.

    Diagnosis can be incredibly difficult because many illnesses can present in very similar ways e.g. bipolar I and schizophrenia. It takes time and patience on the part of the psychiatrist to be able to discern between illnesses - SWIM must admit that, from her experience, a lot of them don't bother, especially when it comes to re-evaluating a previous diagnosis.
  15. staples
    Although diagnosis may be made based on the subjective report of symptoms by the patient, doesn't empirical data show that patients report such and such symptoms for a specific (set of) physiological problems? Isn't that the idea of psychopathology? you rule-in a diagnosis? It would be a terrible waste of resources (at least, with current technology) to conduct the appropriate scans to confirm a mental disorder for every single patient, and while that's the case, then yes, misdiagnoses is possible and the treatment may be a nightmare for the patient (or it may just not be effective), but the treatment course would then be corrected, and the odds of that happening are only improving (for patients); for what else can you ask? Any patient may certainly order the necessary tests to make an objective diagnosis, but most patients would be in a lot of debt before they even start treatment.

    I would like to know how many patients were told that they do have depression, and that the medication will absolve it? While I can see patients being told they have depression is probably common, especially if they've been treated with cognitive-behavioral therapy and were referred to a psychiatrist to combine treatment with drug therapy, I'd be a little surprised to find a doctor who is certain that a specific SSRI, or even SSRI treatment in general, will alleviate the depression, particularly without side effects.

    I know that electroconvulsive therapy has been widely over-sensationalized and distorted by hollywood (specifically by One Flew over the Cuckoo's Nest), unless by "history" you mean all the way back to the 16th century? But even then, hollywood's distorted portrayal is that of a (relatively) modern medical practice.. Labotomy has also been over-sensationalized by hollywood, but I haven't read as much about labotomies so I'm not certain of how grim their history really is. It would be silly to deny the contribution to neuroscience from the prefrontal labotomy--indeed, it won a Nobel Prize--even if the procedure is no longer the best available treatment option and appears barbaric in comparison to today's treatment options.

    If you are referring to any set of incidents where a treatment is forced upon a patient without their consent, then I must point out that the doctor was probably also forced to preform the procedure; any stigma given to psychiatry would be misplaced, since some aspect of the judicial system would have mandated the treatment.

    I don't know too much about the history of experimental medications, but certainly this hasn't been an issue for decades. I know that there are still cases of people suffering terrible reactions to experimental medication, but now it is only given after full informed consent; besides, I would consider this "research" before "psychiatry."
  16. seeingred
    Thanks for your input swimmers. It seems there are varying reactions to the article and opinions. Staples, insightful and informative. I appreciate that you took the time to look up those articles. Swim has an issue with the idea that once someone gets a diagnosis it can be considered permanent and then when going to a psychiatrist, seems they just go by their clipboard and hardly talk to a patient anymore. You go to a psychiatrist to get meds and that's pretty much it. These chemicals do have effects though. that should not be ignored. For instance say SWIM had taken a medication and was stable for years but there was no 'recovery' no 'positive attitude' no 'pat on the back' good job congratulations....no sense that the meds were no longer even important and in fact at that point could be detrimental. It also depends on what you're medicating, when you have no symptoms it's like a psychological dependancy when you take pills like that. I don't think that would be healthy. There's a lot of indifference in psychiatrists today.
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