Positive Health Online

Last December the Medicines and Healthcare products Regulatory Agency (MHRA) published their report on their two year study of the selective serotonin reuptake inhibitor antidepressant drugs (SSRIs such as Seroxat and Prozac), and advised that they should not be prescribed in cases of mild depression or anxiety. These drugs were found to increase thoughts of suicide, produce psychomotor restlessness and the particularly unpleasant symptoms of akathisia, as well as dependence, which made withdrawing from the drugs very difficult.

The MHRA report ignored what is in fact the greatest problem with these drugs. This is that they are based on a myth. This myth is that depression is caused by lowered serotonin levels in the brain. Yet, as Professor David Healy states in his book Let Them Eat Prozac, ‘No abnormality of serotonin in depression has ever been demonstrated’.

David Healy’s study of the relationship between suicide and the SSRI drugs was one of the factors that forced the MHRA to undertake a study of the effects of these drugs on the people who take them. David Healy was working as a consultant psychiatrist and lecturer at the University of Wales and saw the SSRIs as a useful medication to prescribe for his depressed patients. However, he was presented with a series of cases where a quiet, peaceful person who’d become depressed was prescribed an SSRI and within a few days of taking this drug changed into someone quite unlike his former self, someone who couldn’t control his behaviour, was a danger to himself and, in some cases, to other people. A significant number of these people committed suicide and a few murdered their family before killing themselves.

David Healy investigated these cases and, in reporting his research results, found himself drawn into the politics of psychiatry and the pharmaceutical industry. He tells the story of this in his latest book Let Them Eat Prozac – The unhealthy relationship between the pharmaceutical industry and depression. He was forced to risk his career and his good name to carry out his investigations and to speak publicly about what he found. He’d been appointed to the University of Toronto in Canada as professor of psychiatry in the Mood and Anxiety Disorders Programme and was awaiting his visa prior to moving to Canada. In a talk at a conference in Toronto, he touched briefly on the research which showed that SSRIs can make people suicidal. A few days later the offer of the job at Toronto University was withdrawn. In the previous year the Mood Disorders Programme had received over 50% of its funding from pharmaceutical companies. Along with this story and his accounts of the court cases in the USA, where he has been an expert witness, David Healy tells the history of antidepressant drugs. This is not a story of scientific discovery but of pseudo-science in search of great profits.

In the 1960s a scientist in Edinburgh, George Ashcroft, who was studying serotonin in the brain, created the hypothesis that lower levels of serotonin could be the cause of depression, but he abandoned this theory in 1970 because none of his research supported it. In the USA, in 1965, Joseph Schildkraut put forward the idea that lowered levels of norepinephrine in the brain caused depression. This idea was seized upon by psychiatrists, who wanted an explanation that would impress their depressed patients, and by the media. David Healy wrote, “This key myth still flourishes in popular consciousness almost forty years later”.

Alas, it flourishes in more places than that. The SSRI drugs and SNRI drugs (selective norepinephrine reuptake inhibitor) were created and are sold on the idea that the function of these drugs is to replace the serotonin or norepinephrine missing in the brains of depressed people. These drugs do add these substances to the brain but, whatever they do, it isn’t restoring a balance as there was never any imbalance to restore. Nevertheless, there are many doctors who happily tell their patients, “You’ve a chemical imbalance; these pills will restore your brain to normal”.

Everyone, and not just doctors and patients, like a simple explanation and a simple solution to a problem. This is why a simple myth is clung to and a truth ignored. Antidepressants have been around since the late-1950s, so now there are many long-term studies which show that depressed people treated only with medication are very likely to get depressed again. Indeed, every episode of depression increases the likelihood of getting depressed again. However, those people who are brave enough to explore themselves, their past, and the way they make sense of themselves and their world, are very likely to develop an understanding of their experience of depression, which means that they can stop themselves from going down the much-practised way of thinking that leads them to the prison of depression. This process of exploring and changing involves the hardest work of all, thinking. There must be a great many biochemical changes going on in the brain where such thinking and changing of ideas occurs, but scientists have a long way to go before they can describe how our mind/brain operates. Hanging on to the myth that a chemical imbalance in the brain causes depression helps no one.

Reference

Rowe D. Depression: The Way Out of Your Prison. Third edition. Brunner-Routledge.