Depression, Antidepressants, and Psychiatry

You feel depressed. You run to a psychiatrist. S/he tells you that you have clinical depression, or bipolar disorder. S/he prescribes a medication such as Prozac or Paxil or Lexapro. A few weeks go by. You feel maybe a little better. Or not. It's hard to tell. There are side effects, such as dry mouth, constipation, sexual dysfunction, and/or disturbed sleep. When you go back to your psychiatrist and say that you're not feeling much better, s/he tells you that you haven't been on the medication long enough for it to take full effect, or simply prescribes something else. You might repeat this process several times until the "right" medication is found.

Welcome to the world of trial-and-error psychiatry. When a patient complains of feeling low, the instant diagnosis is a "chemical imbalance", which of course requires a long (perhaps lifelong) series of expensive office visits and pharmaceuticals. Some people claim that they feel better with these chemicals, while others don't. Some people get over their depression in a matter of months and live medication-free thereafter, while others remain dependent on artificial chemicals, or at least the belief that they work. So, what gives? Is depression an actual disease, i.e., a physical problem? Or is it simply a negative feeling caused not by the brain but by traumatic life events and/or negative thoughts about them?

This is the subject of intense debate because there is no way to prove that either side is 100% correct. Unlike cancer, atherosclerosis, infections, and broken bones, there is no diagnostic (X-ray or blood) test that can prove the presence of a medical condition. Additionally, study results are all over the place: some show that antidepressants work, while others show that they don't work any better than placebo¹.

Depression is a very complicated condition because it can be caused by a number of physical, environmental, and psychological factors, often in combination, but sometimes not. A person might be lonely, or have a hectic life of a stressful job and family, or a history of traumatic life events, which could cause "depression" even in people with perfectly healthy brains. Or s/he could have an overly sensitive brain that will enable loneliness, stress or trauma to trigger depression, while a less sensitive person might not become depressed under the same circumstances.

So, without any sort of physical test, how do we determine the role that the brain plays in depression? One avenue is twin studies. Identical twins share genes, so if depression is genetic, then as long as twins experience similar environments, there should be a near-100% correlation: if one twin is depressed, then the other should be; and if one is not, the other should not be. What do twin studies show? They show that there is a less than 50% correlation². This does not help us much, since there is a correlation, but not a powerful one. It appears that depression is a complex disorder that does not result from either genetic or environmental influences alone but rather from both³, ⁴.

Even if there is a genetic component, that does not prove that depression results from a chemical imbalance. The genetic factor might have to do with synaptic wiring, i.e., the way that neurons in certain parts of the brain are arranged. The amounts of neurotransmitters such as serotonin, norepinephrine, and dopamine might be perfectly fine. This might be why some people with brain abnormalities cannot be helped with antidepressants and mood stabilizers.

This is not to say that there are no helpful medications. Anxiolytics and sedatives such as Xanax and Valium can help calm people down when they're agitated. However, they have no effect on the supposed culprits of clinical depression (serotonin, etc). Rather, they enhance the activity of a key neurotransmitter called gamma-amino butyric acid (GABA). This neurotransmitter has an inhibitory effect on motor neurons, thus slowing nerve impulses throughout the body. Alcohol also enhances the effects of GABA, which is why so many people drink in order to lessen their emotional pain. The problem with anxiolytics and sedatives is that they are not viable long-term solutions due to tolerance and addiction.

Pharmaceutical companies run many studies in order to "prove" that their products work. Some studies show that their products are effective, and some don't. Seeing as their bottom line is at stake, how likely are they to tell the public about the latter studies? Not very. In fact, they overwhelmingly favor the release of positive studies over negative ones⁵, ⁶.

Is this legal? Can pharmaceutical companies withhold the results of failed trials and release only the "successful" trials, thus fooling the public into buying an ineffective product? Yes they can. In order to approve a product, the FDA requires only two clinical trials showing a significant difference between drug and placebo, regardless of the number of failed trials. That is, a company can run 100 trials, 98 of which fail, and simply release the two that succeeded¹.

In most studies, volunteers are each given a daily pill. Some get the medication being tested, and some get a placebo. None of them are told which they are getting. Because the volunteers are human, many of them will anticipate improvement in their condition simply because they might be getting medication. This causes a certain percentage of them to get a false sense of hope, generate positive thoughts, and consequently feel better (which shows that their "depression" was not clinical but a reaction to negative thoughts). The drug in question is deemed effective only if the percentage of people taking it who report improvement is significantly greater than the percentage of placebo takers who improve. As mentioned earlier, some studies show that medications are better than placebo and some don't.

Unfortunately many patients figure out whether they're receiving medication or placebo. How? Side effects. Many drugs cause dry mouth, constipation, upset stomach, sexual dysfunction, or disturbed sleep. Placebos don't. When someone experiences side effects, they know that they are taking a pharmaceutical, and this can give them increased hope and greater expectation of improvement, which in turn creates a positive emotional feeling, which of course skews the results in favor of the medication. If there were no side effects, how many of the positive studies would have been negative?

The most often discussed brain chemical in regards to depression is serotonin. Millions of people are told that their depression is caused by a deficiency of this chemical. They get "treated" with selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil, and Celexa, that increase the availability of serotonin. Many patients report feeling better, so the serotonin hypothesis is thereby "confirmed". Hold that thought.

Let's look at one particular antidepressant that affects serotonin levels. Its chemical name is tianeptine. It is not available in the U.S., and it's marketed in Europe under the trade name Coaxil. It has been shown to be effective in clinical trials. This should be yet more "proof" that the serotonin theory is correct. That is, until you learn that tianeptine actually decreases serotonin levels⁷. Unlike SSRIs, which inhibit serotonin reuptake, tianeptine is a selective serotonin reuptake enhancer (SSRE). Now, if the serotonin theory were correct, wouldn't tianeptine cause depression?

I know. You or a loved one has been taking psychotropic medication and has improved. That in and of itself proves that these medications work, at least for you. But have you or your loved one ever participated in a double-blind, placebo-controlled study? How can you be 100% positive that this medication has helped? And how much improvement has there been? Are you or your loved one back to being happy-go-lucky like you or they were in the past, or has the improvement been only mild? Is enjoyment of life at the level it once was, or have you or they merely been "stabilized"?

Let's look at this another way. Imagine that you have chronic pain. You go to your doctor for help. S/he prescribes something. It doesn't work, so s/he prescribes something else. It doesn't work either. S/he doesn't take any X-rays or order any blood work. S/he just keeps throwing different medications at you in trial-and-error fashion. It is obvious that no medical expertise is being used, because if it were, s/he would have gotten it right the first or second time. Eventually a medication works somewhat. You still have some pain, but it's less now. Unfortunately you are now dependent on your doctor and the medication: every month you have to visit and pay him/her, then go to the pharmacy and pay for a drug. Also you notice that while the drug kind of works, you get equal (though temporary) relief from visiting friends, exercising, being involved in an interesting hobby, and meditating. Heck, even alcohol works. Would this be acceptable to you? Would you resign yourself to the idea that you have a condition that cannot be cured but can only be managed, and spend the rest of your life paying for doctor visits and medication that only partly works? Would you willingly give up your independence that easily? Well, that is exactly what millions of people do when it comes to depression. Wouldn't it make more sense to keep looking for a better solution?

I have had a lot of personal experience as a "depressed" patient, and after visiting about a half dozen psychiatrists I can say with confidence that many psychiatrists are frauds. First of all, the "professionals" I saw couldn’t even agree on what my ailment was: all but one of them diagnosed me as “depressed”, and the other diagnosed me as “bipolar”. Second, not one of them psychoanalyzed me to determine whether my "depression" was caused by cognitive distortions, traumatic life events, or some other non-chemical culprit. Every one of them immediately assumed that my problem was chemical-based and prescribed drugs: Prozac, Paxil, Lexapro, Cymbalta, Luvox, Wellbutrin, Lamictal, and maybe a few others that I've forgotten. Every time that I reported no improvement, they would simply prescribe something else. Some of these charlatans didn't even take insurance. One guy charged me $500 for my initial visit.

The trial-and-error drug method is very common in the mental health "profession". Why? Money. Pharmaceutical companies work in tandem with psychiatrists to rake in hundreds of billions of dollars each year in the U.S. alone⁸. (This happens with all types of medication, not just psychotropic ones. Pharmaceutical companies pay lots of money to both doctors and politicians in order to push their wares and ensure favorable legislation⁹, ¹⁰. Click here to see whether your doctor has received money from pharmaceutical companies.)

The bottom line is that the more mentally "ill" people there are, the more money there is for psychiatrists and Big Pharma to make. Their very livelihood depends on people believing that they have a lifelong medical "condition" that necessitates long-term office visits and medication. It is against their interests to tell you that your problem stems from erroneous thought patterns that can be retrained and thereby enable you to live drug-free. As a result, many people who don't meet the criteria for depression are nevertheless prescribed psychotropic medications¹¹. We see this in other supposed mental conditions, such as attention-deficit hyperactivity disorder (ADHD)¹².

If you still believe that successful clinical trials have proved the efficacy of antidepressants, then it would be logical to believe that successful clinical trials of any treatment proves its efficacy, right? Well, both exercise¹³ and St. Johns Wort¹⁴ have been shown to relieve depression in at least some clinical trials. So why don't psychiatrists prescribe these treatments? Could it be because there's no money in it for them?

Conclusion

The causes of depression are varied and often intertwined. Genetics, upbringing, brain chemicals, traumatic life events, and thought patterns can all play a role. Even allergies and the weather can contribute. Each case of depression is caused by a unique permutation of these factors.

Many treatments are available: medications, cognitive behavioral therapy, shock treatment, exercise, and more. Which treatments work depends on which factors cause one's depression.

There is no doubt that some patients do benefit from psychotropic medications. However, some of them improve only marginally at best and no better than with placebo. Many other people don't improve at all. Additionally, several of these medications have unpleasant side effects. Nevertheless, these drugs are heavily pushed by psychiatrists, many of who are incompetent, dishonest, and/or financially persuaded by greedy drug companies. Patients are thus kept in a dependency cycle and never regain their autonomy.

Anyone who is currently under psychiatric care might want to assess:

how much effort their psychiatrist puts into understanding their life situation
how quick their psychiatrist is to prescribe drugs
how long the office visits are
how much they have really improved with their current medication
whether their improvement outweighs the medication's side effects and cost as well as office visit costs

References

[1] Antidepressants and the Placebo Effect

[2] A Swedish National Twin Study of Lifetime Major Depression

[3] Genetic Epidemiology of Major Depression: Review and Meta-Analysis

[4] Overview of the Genetics of Major Depressive Disorder

[5] Selective Publication of Antidepressant Trials and its Influence on Apparent Efficacy

[6] Evidence Biased Medicine--Selective Reporting from Studies Sponsored by Pharmaceutical Industry: Review of Studies in New Drug Applications

[7] Tianeptine: A Review of its Use in Depressive Disorders

[8] Making Money from Addiction: 30 Million Americans On Antidepressants. Twenty Facts on America’s Big Pharma Nightmare

[9] Matching Industry Payments to Medicare Prescribing Patterns: An Analysis

[10] Pharmaceutical lobby Wikipedia page

[11] Antidepressant Use and Lifetime History of Mental Disorders in a Community Sample: Results From the Baltimore Epidemiologic Catchment Area Study

[12] Does ADHD Exist?

[13] Effects of Exercise Training on Older Patients With Major Depression

[14] St John's Wort for Depression - A Systematic Review