The myth of the chemical cure

[Sapphire]

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.

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

[INFERNO]

I'll go in reverse order for this post.

For the informed choice, doctors can educate the patients but it's a matter of whether or not the patients will understand. Doctors can pull out piles of information regarding the mechanisms of action of the medication but the patient may not understand a word of it. Psychiatrists are very busy and usually don't have much time for each patient so they may not be able to explain it clearly so the patient can understand.

I agree, if you told the person you're not sure really where the problem(s) in their brain are but take some magic pill just for the hell of it, they may not take it. But doctors can obtain a decent picture of what's going on in their patients' brains. However, if the patients don't take the medications, there's a much lower chance of them getting better, so if the doctors give most of the information but leave out some bits about not entirely knowing where the problem(s) in the brain are, then the patient has a better chance of reducing their symptoms and carrying on with their lives.

However, there is still one big issue, how do the doctors tell all this information to the patients in a way that the patients will understand and in a short amount of time? To make it quicker and easier to explain, they need to remove some parts that are not too important.

I do agree with what you mentioned about the altered states. If you put something in your body, then something probably will change but it's going to be temporary. Things like Diazepam have a half-life of around 40-60 hours (I think it's closer to 40 though). But for pharmacuticals, what tends to be a common phenomenon is people figure out that a certain pill makes people seem better but they don't always understand its mechanisms entirely.

For the newspapers, pamphlets, magazines, internet sites and such that claim a drug rectifies a certain problem in the brain, this is usually partially true. The drug would affect numerous parts of the brain so it would also affect the parts believed to have some sort of problem but also many other areas. But these little distortions of the truth are necessary for the patients to be more willing to take the medications.

[Sapphire]

For the informed choice, doctors can educate the patients but it's a matter of whether or not the patients will understand. Doctors can pull out piles of information regarding the mechanisms of action of the medication but the patient may not understand a word of it. Psychiatrists are very busy and usually don't have much time for each patient so they may not be able to explain it clearly so the patient can understand.How can you say that? A doctors duty is to present all treatment options to the patient so that the patient can make an informed decision. To say that doctors are too busy to do this basic duty is ridiculous.

I agree, if you told the person you're not sure really where the problem(s) in their brain are but take some magic pill just for the hell of it, they may not take it. But doctors can obtain a decent picture of what's going on in their patients' brains. However, if the patients don't take the medications, there's a much lower chance of them getting better, so if the doctors give most of the information but leave out some bits about not entirely knowing where the problem(s) in the brain are, then the patient has a better chance of reducing their symptoms and carrying on with their lives.Temporarily improving the symptoms isn't the same as addressing the core problem. And rest assured, anti-depressants and the such like do only address symptoms.
How do we know this? Without psychological therapies patients who discontinue these medications do not continue to feel the same as when they were on them - they often feel worse again.

However, there is still one big issue, how do the doctors tell all this information to the patients in a way that the patients will understand and in a short amount of time? To make it quicker and easier to explain, they need to remove some parts that are not too important.I wouldn't say the fact that these drugs aren't the answer to all the patients problems is a piece of information that can be deemed as "not too important".

I do agree with what you mentioned about the altered states. If you put something in your body, then something probably will change but it's going to be temporary. Things like Diazepam have a half-life of around 40-60 hours (I think it's closer to 40 though). But for pharmacuticals, what tends to be a common phenomenon is people figure out that a certain pill makes people seem better but they don't always understand its mechanisms entirely.

For the newspapers, pamphlets, magazines, internet sites and such that claim a drug rectifies a certain problem in the brain, this is usually partially true. The drug would affect numerous parts of the brain so it would also affect the parts believed to have some sort of problem but also many other areas. But these little distortions of the truth are necessary for the patients to be more willing to take the medications.Why do patients need to be more willing to take these medications?
I can see the need for someone with bipolar disorder to be compliant with medication. But depression, anxiety and the such like don't carry the same need. Anxiety disorders (e.g. phobias) are able to be overcome through psychological therapies with great success. The same goes for depression.

Tbh, I think you need to give this article more credit.

[INFERNO]

How can you say that? A doctors duty is to present all treatment options to the patient so that the patient can make an informed decision. To say that doctors are too busy to do this basic duty is ridiculous.

Then you didn't read what I wrote. I never mentioned anything about presenting a diversity of treatment options. I said that the doctors would be too busy to properly educate the patient as to the mechanisms of action of the medication.


Temporarily improving the symptoms isn't the same as addressing the core problem.

If the core problem is somewhere in the brain and the medications act in that part of the brain, then it is addressing the core problem. The only issue is that it needs refills of pills to keep addressing, there's no one pill to cure it all forever.


I wouldn't say the fact that these drugs aren't the answer to all the patients problems is a piece of information that can be deemed as "not too important".

I meant the fact that they don't mention all the mechanisms of action by the medications and such.


Why do patients need to be more willing to take these medications?

So they can carry on with their lives whilst having the symptoms reduced. Otherwise, they may lose their job and tumble down the ladder.

I can see the need for someone with bipolar disorder to be compliant with medication. But depression, anxiety and the such like don't carry the same need. Anxiety disorders (e.g. phobias) are able to be overcome through psychological therapies with great success. The same goes for depression.

If the symptoms of the disorders are impeding their lives, making it harder for them to function at their jobs and increasing unemployment, making them more unhappy, etc..., then that may be a reason for them to be more compliant.

You're right, anxiety and depression can be overcome through psychotherapies.


Tbh, I think you need to give this article more credit.

Seeing as how you misunderstood part of what I wrote, gave an answer on something I never mentioned and the fact that I agreed with a good amount of the article, you may want to wait a bit before telling me I should give the article a different amount of credit. :yes:

[Sapphire]

So they can carry on with their lives whilst having the symptoms reduced. Otherwise, they may lose their job and tumble down the ladder.Medication isn't the only (or the best) way to help people do this.

If the symptoms of the disorders are impeding their lives, making it harder for them to function at their jobs and increasing unemployment, making them more unhappy, etc..., then that may be a reason for them to be more compliant.

You're right, anxiety and depression can be overcome through psychotherapies.Why should they comply with medication when psychotherapies and life changes would achieve the same goal (relief from depression/anxiety) with the additional benefit of longer lasting effects like happiness in their home life?


Ok, so I took some of what you said the wrong way. But this bit I still have a problem with:But doctors can obtain a decent picture of what's going on in their patients' brains. However, if the patients don't take the medications, there's a much lower chance of them getting better, so if the doctors give most of the information but leave out some bits about not entirely knowing where the problem(s) in the brain are, then the patient has a better chance of reducing their symptoms and carrying on with their lives.Show me the evidence to support the biological explanation of depression in a significant portion of patients. Most studies indicate a relationship between depression and biochemical imbalances but as of yet none have identified a causal relationship.
Medications only treat the symptoms in patients who are depressed for non-biological reasons and therefore are clearly less desirable than psychotherapies and life changes.

[INFERNO]

Medication isn't the only (or the best) way to help people do this.

I don't recall saying it was.


Why should they comply with medication when psychotherapies and life changes would achieve the same goal (relief from depression/anxiety) with the additional benefit of longer lasting effects like happiness in their home life?

People tend to want a faster result, which medications can provide. Certain disorders though, such as a schizophrenic's hallucinations can be reduced rather easily through medications. Ideally, they should have both: the medications to reduce the symptoms briefly and the psychotherapy to form a longer-lasting form of treatment.


Show me the evidence to support the biological explanation of depression in a significant portion of patients. Most studies indicate a relationship between depression and biochemical imbalances but as of yet none have identified a causal relationship.
Medications only treat the symptoms in patients who are depressed for non-biological reasons and therefore are clearly less desirable than psychotherapies and life changes.

Before you go about telling me to give you evidence, perhaps you'd be so kind as to give some evidence for the bolded part.

But as you did ask, I'll give some support, the Drevets hypothesis. One of his findings was about a 39% reduction of the gray matter volume in the brain. It involves the amygdala (surprise, surprise) and the HPA-axis, which results in secreting too much hydrocortisone and the BDNF. The Drevets hypothesis can be found in:

Drevets, W.C., J.L. Price, J.R. Simpson, R.D. Todd, T. Relch, M. Vannier & M.E. Raichle (1997). Subgenual prefrontal cortex abnormalities in mood disorders. Nature 386: 824-927

AND

Kolb & Whishaw (2009) Fundamentals of Human Neuropsychology, 6th edition

[Sapphire]

That is all well and good but it only covers a fraction of the population of depressed patients and is over 10 years old.

Look at this article (http://health.usnews.com/usnews/health/healthday/080116/antidepressant-effectiveness-probably-overstated-report.htm) it has huge ramifications for the knowledge on anti-depressants and their role in treating depression.

Medications like anti-depressants do not guarantee a positive result and can come at a cost (nasty side effects).

[INFERNO]

That is all well and good but it only covers a fraction of the population of depressed patients and is over 10 years old.

It covers more than just a fraction. I'll admit, it is relatively old but it still is valid.


Look at this article (http://health.usnews.com/usnews/health/healthday/080116/antidepressant-effectiveness-probably-overstated-report.htm) it has huge ramifications for the knowledge on anti-depressants and their role in treating depression.

You're absolutely right, it does have huge ramifications and can possibly be extended to other medications.


Medications like anti-depressants do not guarantee a positive result and can come at a cost (nasty side effects).

Medications in general don't guaruntee a positive result and almost all of them have side-effects of some intensity and amount.

[Sapphire]

It covers more than just a fraction. I'll admit, it is relatively old but it still is valid.It accounts for less than 50% of the cases looked at by that study. That is a fraction.