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Treatment based on old myths rather than current realities
The myth of the chemical imbalance
Re: Chemical Imbalance: Humoralism Redux
Chemical Imbalance: Humoralism Redux
Inconsistent position on SSRI ads
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Dr. Herbert H. Nehrlich Private Practice
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drhhnehrlich{at}westnet.com.au Dr. Herbert H. Nehrlich
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Dr.Joanna Moncrieff makes an excellent point. I especially appreciate her not mincing words. It is, indeed, dishonest to imply that we know the cause and we do have the pills to cure it but it is not an isolated problem in modern medicine. This reminds me of the saga about the condition known as schizophrenia . Dr. Abram Hoffer, together with Dr. Humphrey Osmond proposed the substance adrenochrome as a significant cause in the etiology of schizophrenia. Adrenochrome, being adrenalin that has chemically gone astray, explains much of the symptomatology of schizophrenia and the treatment is orthomolecular medicine (O.M.) with its focus on restoring a balance in the body by using substances normally present in the system. Hoffer et al found in the fifties that conventional treatment with what one could lump under tranquillisers would eventually lead to tranquilliser psychosis. While it was effective in combating the "hot symptoms" it was not the answer and it didn't cure anyone. The concept of serotonin/dopamine etc. was too simplistic but it was attractive and profitable. About fifty years of O.M. have proven the efficacy of this "megavitamin therapy" yet conventional psychiatry ignores it and belittles the adrenochrome concept. One could think that the first step ought to be to disprove the adrenochrome hypothesis and then do whatever it takes to bring back the schizophrenic into society. Hoffer showed that many of his patients recover. "They pay taxes", he says. Looking at the use of drugs to treat an illness like depression reminds one that medicine is an art, not much of a science. That would explain why chemotherapy for cancer is so popular inspite of the fact that outcome of cancer is only helped in 2 % of sufferers through chemo. Conflict of Interest:None declared |
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Joanna Moncrieff Department of Mental Health Sciences, University College London
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j.moncrieff{at}ucl.ac.uk Joanna Moncrieff
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Although Dr Adetunji is right to point out that there are decades of research into noradrenalin, serotonin and other biochemical systems in depression, this research has not yielded any consistent evidence that there is an underlying biochemical abnormality in the brains of people with depression. For example, links with suicidal behaviour were not confirmed in numerous studies, and serotonin receptor studies yield contradictory findings. Tryptophan depletion studies, which were first thought to demonstrate that serotonin reduction causes depressed mood, are also inconsistent and are now thought to merely reflect the consequences of SSRI treatment. No effects on mood have been seen in people without a history of treatment for depression (1). It is dishonest to promote the "chemical imbalance" theory without evidence, since it implies that drugs correct a pre-existing biological abnormality, which makes them sound safe and appealing. In contrast I suggest that drugs create an abnormal brain state (1). It is difficult to see how this can help people to deal with depression. If the public were told this they might be less keen on chemical fixes and their advocates. References: (1) Moncrieff J, Cohen D. Do antidepressants cure or create abnormal brain states? PLoS Medicine, in press. Conflict of Interest:I am co-chair person of the Critical Psychiatry Network |
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Babatunde Adetunji, MD Dept. of Psychiatry, Drexel University College of Medicine, Philadelphia.
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medikhelp{at}yahoo.com Babatunde Adetunji, MD
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Even though it is wrong for Dr Goodman to be comfortable with the claim that SSRIs ‘normalize some chemical imbalance’, his further assertion and the e-response of Tomi Gomori (1), are undermining decades of researches and efforts of biological psychiatrists, which have demonstrated strong associations between serotonin imbalance and depression. To infer that no research exist linking depression and chemical changes in the brain is clearly inaccurate. CMAJ readers are advised to do a Medline and Pubmed search from 1966 to 2006 to apprise themselves of the innumerable researches that have been done in this area. In 1966, Dencker and colleagues (2) found a reduction in acid monoamine metabolites of cerebrospinal fluid in depression. In 1981, Asberg and Traskman (3) presented a CSF study showing a strong association between a low CSF 5-HIAA (serotonin metabolite) and tendency towards suicidal behavior. In between these studies and since then, there have been other well controlled studies, which have shown a reduction in serotonin levels in depressed patients with and without suicidal behavior. References: 1)Tomi Gomori: Chemical imbalance, humoralism redux. E-letter to the CMAJ, 15 March 2006. 2)Dencker SJ, Malm U, Roos BE, et al. Acid monoamine metabolites of cerebrospinal fluid in mental depression and mania. J Neurochem 1966; 13:1545–8 3)Asberg M and Traskman L: Studies of CSF 5-HIAA in depression and suicidal behavior. Advances in Experimental Medicine & Biology. 133:739-52, 1981. Conflict of Interest:None declared |
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Tomi Gomory Florida State Universiy
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tgomory{at}mailer.fsu.edu Tomi Gomory
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Dr. Goodman's statements about the use of the term chemical imbalance to explain the actions of SSRIs is puzzling to say the least. While admitting that no such chemical imbalance of serotonin is to be found in individuals or should be used as a scientific description for the route of their actions, none the less he feels comfortable in stating that it " is reasonable shorthand for expressing that this is a chemically or brain-based problem and that the medications are normalizing function." This would make sense if he could produce the evidence that depression is causally connected to chemical change in the brain in the preferred direction (from chemical action to depressive experience and not the other way around) and offer the references for such a scientific claim. He doesn't because no such research exists. Without this he is making the trivial claim that the volitional behavior and the mood states of human beings involves chemical activity in the brain. We should also note that the term "reasonable" when appended to factual claims is a wiggle term and does not mean validity. It may be reasonable to call someone's attention to a beautiful sunrise, but it is not a true description of the state of affairs. The sun does not rise, in fact it does not move. The Earth rotating on its axis and revolving around the sun creates the optical illusion of the "sunrise." Finally, it is important to recognize that the notion of physiological imbalances of one form or another to explain "reasonably", human behavior is very old. We had a whole school of medicine based on the concept, the Hippocratic school of humoral medicine. This school claimed that "the body was subject to rhythms of development and change, determined by the key humours ... . Specifically in terms of mental disorder, excesses both of blood and of yellow bile could lead to mania, whereas surplus of black bile ... resulted in lowness, melancholy, or depression " (Porter, 2002, pp. 37- 41). The repetition of such ancient and falsified notions of medical science by its current representatives would be depressing if it wasn't so humoral. Reference: Porter, R. (2002). Madness: A brief history. Oxford: Oxford University Press. Conflict of Interest:None declared |
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David Cohen Florida International University
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cohenda{at}fiu.edu David Cohen
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Dr. Wayne Goodman, Chair of the US Food and Drug Administration Psychopharmacologic Drugs Advisory Committee, is quoted at the beginning of your article as saying that he thinks ads about SSRIs stating that the drugs correct a serotonin "imbalance" are not based on scientific evidence and should be prohibited. At the end of the article, however, Dr. Goodman refuses to comment on whether the FDA should ban the ads and he endorses the admittedly unsupported claim that the drugs normalize some kind of chemical imbalance. Obviously, this is an inconsistent position, more so because only the FDA has the explicit power and mandate to regulate drug ads in the US. For the general public, ads are crucial determinants of the perceived effects of drugs. Dr. Goodman's comments illustrate that, despite a vast drug regulatory bureaucracy, profit-imbued manufacturers can make any claims about their products as they wish, with no attention to scientific evidence and no real fear of consequences. Actually, such a situation existed about 100 years ago, during the era of "patent medicines," and perhaps it should exist again. But it's one more sign that the adman is rapidly replacing the physician as the the true intermediary between patients and their drugs. Conflict of Interest:None declared |
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