Causes of Depression

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Are Antidepressant Drugs for Depression Wrong? Three part series. All three videos are included on this page. Kathy Fountain: No question what drugs are making the most money these days in this country. Many of them are the antidepressants. The Prozacs, Zolofts, Paxils. Americans are gobbling them up to alter their mood. Well, their effectiveness has almost been unquestioned until recently. A study just published questions whether they really work the way they claim to or whether a chemical imbalance--that’s what you’ve all been hearing: You must have a chemical imbalance, lack of serotonin is what these drugs are treating?

The bottom line: Are many Americans taking these drugs and wasting their money? A very radical idea. The two researchers behind one of these studies joins us today: Jonathan Leo, Ph.D, is Professor of Anatomy at Lake Erie College of Osteopathic Medicine and Jeff R. Lacasse is a researcher and Ph.D (Doctoral) candidate in Social Work at Florida State University.

Healing Depression & Bipolar Disorder Without Drugs features Gracelyn Guyol’s own story and those of thirteen other people around the country who have cured their depression and bipolar disorder using only natural therapies. In-depth research and the expertise of alternative health-care professionals are included in this landmark guide for patients and caregivers seeking responsible, safe alternatives to psychiatric drugs.

This is almost blasphemy gentlemen. We are finally getting people to feel that depression is a medical condition caused by a chemical imbalance and if you go get some medication for it, you’re going to be better. We’re finally getting people treatment. What’s wrong with that theory?

Jonathan: Well, what interested Jeff and I, what got us interested in this was that both of us have spent a lot of time reading medical journals and we also see the simplistic version in the advertisements and we see this big disconnect between the literature and the advertisements. It’s not that we’re writing a paper saying the whole medical field is wrong. It’s we don’t think the medical is acknowledging that there’s a problem with this, but that’s not portrayed in the advertisements. So we compared statements in the literature to the statements in the advertisements.

Kathy: So the statements in the advertising say what?

Jonathan: A very simplistic presentation that depression is caused by low serotonin and it has virtually invaded pop-culture, where out of no where depression just happens. Some one is walking down the street and all the sudden they’re struck by low serotonin levels, it’s a medical condition and a medical condition is treated with a pill. So, let’s treat the low serotonin.

Kathy: That’s what the ads say?

Jeff: That’s what the ads say.

Kathy: You’re saying science doesn’t back it up?

Jeff: No. When we say we looked at the literature, what we mean by that is that we looked at psychiatric text books that are used to educate doctors and articles in medical journals and actual prescription information for the medication which is approved by the FDA (Food and Drug Administration) and what we found across the board was that’s [advertising claims] not cited in any of those sources, which are the premiere scientific sources.

Kathy: Okay, but people who take them [antidepressants] get better.

Jonathan: Some do. And there are studies showing that 60% of people who take them, or at least start them, within 4 weeks go off them, stop taking them. We’re not against some who takes the antidepressant medications and feels that they work. What we’re for is consumers being given accurate information when they make that decision to start the antidepressant medication.

Kathy: So, if it’s not a chemical imbalance, if it’s not a lack of serotonin that antidepressant drugs give them more of that makes them feel better, then where does depression come from? [actually, SRRI drugs do not give people more serotonin, SRRI drugs prevent the reuptake of serotonin. That is, antidepressants maximize the use of serotonin that already exists in the brain. One analogy of reuptake is putting a plug in a sink, where serotonin is the water.]

Jeff: If we could look at the opposite side of that real quick. We’re not at arguing that the antidepressants affect levels of serotonin. They definitely do that. They have various effects on people, some people really like it; they may make you chill out, they may reduce your anxiety, they may boost your energy. For some people, they do that. But that doesn’t mean you have a problem with your serotonin in the first place. They give these antidepressants to “normal people” through psychiatric diagnoses and these normal people experience something from the drugs as well. That’s like saying you went to a bar, you were nervous and you had a couple of drinks and now you feel relaxed that you had alcohol deficiency before you walked into a bar.

Kathy: Oh I see. Alright.

Jeff: But if you were led to believe by the advertisement that you had a flaw and neurochemical problem in your brain that requires only this medication to fix it, you’re less likely to think of other options, well-validated options, actually, that you might address your emotions, your feelings, your depression with.

Kathy: What were you going to say?

Jonathan: There are a lot of drugs that affect the brain, behavior and all that. But a lot of these drugs, most drugs, that affect the mind, we don’t talk about as a disease. Just because a drug has an affect, doesn’t necessarily mean there’s a disease. There was a study done, a survey, in the mid 1990s of lay people-- and what they attributed unhappiness and depression to-- and 80% of them, the majority, attributed mental states to their societal and situational issues going on in their life. And 80% of them were also skeptical about the antidepressant medications and the side-effects and the addictive properties of them. The medical community and the pharmaceutical companies in particular looked at that [the research] as: We need to re-educate these people. These people need to learn that depression is a medical condition. And that’s been an overwhelming purpose of the ads is to medicalize depression.

Kathy: Medicalize. Right.

Jonathan: What many people think is short of being an aspect of being human.

Kathy: What I hear you saying and I agree to some extent is that if you’re depressed, if you’re unhappy, that it could be a combination of cultural factors, social factors, psychological factors, and maybe medical factors. There may be some medical things that are going on there but that these antidepressant pills make it all one cause: Medical, medical, chemical imbalance.

Jonathan: And that’s been the overwhelming [purpose of the pharmaceutical ads]. If you think of all this on a spectrum, on one end you have a very clinically depressed person and on the other end you have general unhappiness. In the border is borderline and shades of grey area, moderate, mild depression and that’s the area that’s been expanded. That’s the area where drug use has increased and efforts have been focused on that group [mildly depressed group] to increase sales of anti-depressants.

Kathy: Okay. So, the people in the middle, take one of these antidepressant drugs and they feel better. So, what? What’s your problem with that?

Jeff: We have no problem with that whatsoever as long as they were given full consent up-front. Like, if they were told,” The reason you need this drug is I can tell you have a lack of serotonin.” This is not scientific evidence to make it legitimate.

Kathy: [lack of serotonin is ] Not a scientific evidence?

Jeff: If they were told this medication will have this effect, it will help X percent of people, placebo helps a lot of people, also. You might also consider psychotherapy, there are good studies on that which shows that it’s very helpful. You might consider exercise. If you’re spiritual, you might want to reengage in your spirituality, people who are oriented that way find that helpful. But if you have something wrong with your brain, why would it help to exercise? It pulls them away from options that are scientifically legitimate options, actually evidence-based options when they’re told, “It’s simply a serotonin problem.”

Depression is much more complex problem than that [a serotonin problem].

Kathy: Well, I’m sure you’re stirring things up with these statements and with your study, but I did read other studies that said that you could be on to something here. We’ll take a break.

If you’ve taken antidepressants and you’ve had an experience with them or maybe you sell them, I’d like to hear from you. We’ll be right back.

In 1999, 3 of the top 10 best selling drugs were Paxil, Prozac and Zoloft with a combined revenue of $6.7 billion. Source: American Psychiatric Association, 2002.

Part II: Alternative Depression Treatment Methods

Kathy: Okay, Jeff Lacasse and Dr. Jonathan Leo joining us today, authors of a study published in a PLOS Journal, saying that this chemical imbalance idea, that we may have problems with just throwing that out there medicalizing all depression as being a medical condition. Pat in St. Petersberg, let’s go to you.

Pat [caller]: My depression started in the mid 1960s. I was always a super Mom and I could handle anything but during that particular period, my grown daughter and my husband both passed away. I, for some reason, started having panic attacks and heart-felt sensations (?), high-blood pressure, lethargy, all the normal things. And I did go to counseling and that didn’t do me much good. Then they put me on various drugs; currently I’m on Wellbutrin, but what I’m finding now and they’re just discovering this, is that I have a lot of muscle pain in my back. I get exhausted very easily, my back burns. I’m taking Wellbutrin XL right now and that seems to alleviate some of the symptoms.

Kathy: So, do you have a bottom-line point you want to say here?

Pat [caller]: Well, I guess the bottom line is that it’s a combination of everything. I think there could very well be an imbalance of some sort that may be caused by extreme mental drama.

Kathy: Hmmm. Do you, gentlemen, feel that people, if they’re on antidepressant medication and they feel like they’re being helped, to get off because you don’t think it does any good?

Jeff: Absolutely not. It’s not my place to tell people what drug to take. If they get full informed consent, it’s totally their decision. Totally.

Jonathan: Without a doubt. Pat hit on an interesting point there, mentioning that she thought the chemical imbalance was caused by things going on in her life. And that’s different than the chemical imbalance theory that the chemical imbalance is leading to these depression symptoms, not the other way around.

Kathy: I see.

Jonathan: And cause and effect here is one of the things we’re in favor of.

Kathy: So you’re saying that there is a theory out there that my dog dies, my mother dies, then I lose my job and all of a sudden I develop a chemical imbalance. And you’re saying that’s non-sense?

Jonathan: There are certainly environmental stressors that definitely affect biology and we could probably all look back on our lives when we’ve been under emotional stress and psychological stress and felt our biology was out of whack. But again, it’s different than saying it’s the other way around.

Kathy: You’ve gotten a lot of response to throwing this out there [the theory that depression is not solely caused by low serotonin alone]. The FDA (Food and Drug Administration) responded to you.

Jonathan: The head of the FDA psychopharmacological Advisory Committee responded and he basically agreed with us. He said that there’s very little science behind [low serotonin as the sole cause of depression]. He said he could not bring himself to tell his own patients this line, but he thought it was a useful metaphor. And this is where we have a big problem because when a patient is—

Kathy: What is a useless [useful] metaphor?

Jonathan: Well, from his point of view it’s getting the patients to the doctors and seeing them. But the problem we have is when a patient is sitting there, talking to their doctor and hearing about high cholesterol or high blood pressure, the patient is hearing science. Now, when the doctor switches and starts talking about the chemical imbalance, is the patient aware that the conversation has switched from science to a metaphor? And we don’t think that’s the case: That when a patient hears this talk about a chemical imbalance, they think they’re hearing science.

Kathy: Are you saying that if you do things like exercise, you go to therapy, and you do Yoga, meditation and things like that, and stress reduction techniques, that that is as effective [as taking antidepressants]? Have there been studies that have shown that those things are as effective as taking Prozac or Zoloft?

Jeff: There have been many studies that have shown Zoloft is inferior, not as good as exercise in one long-term study in older adults.

Kathy: Really?

Jeff: So you look at what is recommended for older Americans: exercise versus taking medication with adverse side effect profiles. It’s an interesting decision there. As far as the FDA stuff, I study its policies, is what I do. The reason so many people, as far as a metaphor, it’s really not within FDA regulation, at least tentatively that you can promote a metaphor as a fact. So, that’s one of the things we concentrate in our articles, is asking the FDA if they want to intercede, send some warning letters to these pharmaceutical companies because they’re spreading these metaphors as if it is a fact [that serotonin is the sole cause of depression, which the researchers believe it’s not]. There is an argument that can be made that the pharmaceutical companies shouldn’t be permitted to do that. If you take away all the pharmaceutical advertising, we wonder to what degree people would even believe the serotonin metaphor. The primary disseminators of that have been the pharmaceutical companies.

Kathy: This is amazing, you’re calling the serotonin thing [serotonin deficiency syndrome of depression] a metaphor. That’s just amazing.

Jeff: That’s the FDA (Food and Drug Administration), a guy on the accounts member of the FDA, anyway.

Jonathan: Other scientists have agree with us in print. Peter Kramer, one of the main proponents of Prozac, who brought Prozac to the general awareness of the public, he basically agreed with us.

Kathy: Dale from Thonothosassa, let’s go to you, Sir.

Dale [caller]: Thank-you for taking the call, Kathy. Good day, Tampa Bay. This question is basically for Jeff. My experience with antidepressants has been mostly neutral. Thankfully, there have been no withdrawal symptoms. But my question is two-fold. Is the media the appropriate place to put pharmaceutical drugs? In other words, is it appropriate to put an advertisement for something…In other words, I can go to the store and buy crackers if I see them advertised, but I can’t go to a pharmacy and buy a pill. So where do we go to get good information?

Kathy: But what you do is go to your doctor and say, “I saw this ad on TV and the ad says ask your doctor about…” So there is this huge media campaign, maybe not on the news side, maybe the news side is involved, but on the advertising side that says, “Ask you doctor. This is what you need to go take.”

Jeff: What you don’t see is ask, “Ask your doctor about exercise, psychotherapy, etc. , etc. It is a totally warped toward the corporate view. To answer the caller’s question, we’re the only country in the world that has uncontested advertisements like this on television. The same claims that are made here on national television are banned from either being distributed to patients by doctors, in Ireland for instance. So, this is an American phenomenon as far as the advertising end of it.

Kathy: And you know we have some facts coming up as we go to the break. Maybe you’ll read some of this. But one of the ones that I found most startling was this multi-billion dollar pharmaceutical industry in the United States buys 1/3 of all the drugs that are purchased in the world. Absolutely amazing. We’ll be right back.

the pharmaceutical industry is America’s most profitable industry and is number one return on revenues, return on assets and return on equity.
Part III: Antidepressants Aren't That Effective

The pharmaceutical industry has $250 annual business worldwide with the USA accounting for 1/3 of all pharmaceutical sales. Source: American Psychological Association, 2002. [ In 2007, the sales figure is over $550 billion].

Kathy: The pharmaceutical industry has more lobbyists in Congress than there are Congressmen.

Jeff: They have at least one lobbyist for each Member of Legislature.

Caller: Good evening. How are you all doing? I’ve been taking Paxil, Zoloft as depression medication, and Effexor. None of these seemed to be helping. I found myself being more suicidal. Being paranoid, always looking over my shoulders from this medication I’m taking for depression. My thing is if they treat you for depression, they say that’s what you have, you can’t just wean off it, then they find out that you have something else, and they put you on Effexor. I think it’s what makes you have the wall breakage, it makes you more depressed than anything when they put you on medication.

Kathy: Let me ask you something. When they said you were depressed, did they suggest anything else besides medication? Did your doctor say, have you tried exercise? Have you tried therapy? Did you try…

Caller: I tried all of that. I went to therapy and I’m still in therapy since 1996. I found myself being suicidal. …I was suicidal from this medication...They put me on Zoloft. Zoloft didn’t help me. So, they put me on Paxil.

Kathy: Well, I’m not the doctor here so I’m not even going to jump into what’s going on in. But I know one of the things you two wanted to make a mention of was coming off these depression medications once you get on them.

Jonathan: The worst thing you can do is all of a sudden stop taking the medication cold turkey without seeing a doctor. And anyone who’s even thinking about doing that should see a doctor, if they’re contemplating doing that. But the caller brings up two points. Without speaking to her specific situation. One is, that the FDA (Food and Drug Administration) has acknowledged and put a Black Box warning on these medications. That in some people the depression medications do appear to increase the risk of suicidal thoughts. It’s clearly a problem.

Kathy: That’s controversial.

Jonathan: It’s controversial but the FDA did do it. It did come out with the Black Box Warning Label [Short of an outright ban, a "black box" warning is the most serious caution the FDA can require.]. The other part, there are several fault lines running through this whole antidepressant story. Ours is one of them. But alongside it is the placebo effect. There’s a very little difference between the placebo effect and drug effect in these studies.

Kathy: What do you mean?

Jonathan: Well, in most of these studies, very many of them, the drug effect, about 60% of the people in the drug group might get better. But 50% of the people in the placebo group get better.

Kathy: Meaning they were getting a harmless sugar pill but thought they were getting an antidepressant and 50% got better on the sugar pills and 60% got better on the drugs?

Jonathan: Yes. So the drug effect is very small. 10%.

Kathy: So if I tell you you’ll feel better, you might feel better?

Jonathan: It’s fascinating. There was a researcher from the University of Connecticut, Irvin Kirsch, who used the Freedom of Information Act. He gained access to all the studies submitted to the FDA. There were 47 different studies submitted to the FDA for these medications. When he looked at all these studies together, in what’s called a meta analysis. He found that there was a very small difference, really clinically insignificant difference between the drug and the placebo effect.

Kathy: Are you saying you don’t believe antidepressants work?

Jonathan: They work on some people. They clearly do. But the placebo effect works, too.

Jeff: One of the psychiatrists, Michael Fay, who tested the SSRIs, well-known in the bio-psychiatric community, he says that 1 out of 10 have a robust response to antidepressants.

Kathy: A robust response?

Jeff: So, that’s maybe a good full-informed consent. If the doctor says to the patient, “Look 1 out of 10 people have a really impressive response; 9 out of 10 don’t; 6 out of 10 have a mild or moderate adverse effects. The patient can make a decision there. But 1 out of 10, that depends on your judgment if that’s a big number or not, but that’s the number used to advocate the use of antidepressants.

Jonathan: Meaning for every 10 people we give antidepressants to, we really help 1 person.

Kathy: So, people go to their doctors and say, “My dog died, my mother died, I lost my job, I’m depressed. I really want something for this, the doctor will give it to you? Aren’t they in that position feeling like they...

Jonathan: Sure. The doctors want to do something and they want the patient to go away feeling like they something’s been done. We’ve talked to doctors, both Jeff and I have, who feel they’re in a bind to, when a patient comes in and says I’ve seen this ad, I’ve got a chemical imbalance. I need this medication. If you don’t give it to me, I’m going to go down the street and get it from another doctor.

Kathy: Dave from St. Petersburg, your turn.

Dave (caller): I was getting off drugs and the first thing that slapped me was one of those chemical withdrawals. And man, I was worse than when I was on prescription drugs. You’re laughing about it, Kathy. It was done in Vietnam. They can psychologically tell you something long enough and you’ll believe it. It was done in Vietnam.

Kathy: I see your analogy.

Caller: It was done in Vietnam. Then you’ve got these kids, when they’re 18 they’re freaking out because they can’t take that Ritalin no more.

Kathy: Just bottom line, somebody who feels like they’re really depressed or anxious and they really need some help and they go to the doctor. What do you suggest they do? What kinds of questions should they ask?

Jeff: I think the hallmark of a productive patient/doctor relationship is full-informed consent and they should ask, what are my options? What are the various rates of effectiveness of various treatments? What might be good about some, what might be negative about some? The patients should make the decision in concert with their doctors. That takes a lot more times than most doctors have and that may be one of the problems.

Jonathan: One of the problems of the ads is that the ads have gotten into the doctor / patient relationship. So, it’s no longer a conversation between the doctor/ patient but between the patient and the ads.

Healing Depression & Bipolar Disorder Without Drugs features Gracelyn Guyol’s own story and those of thirteen other people around the country who have cured their depression and bipolar disorder using only natural therapies. In-depth research and the expertise of alternative health-care professionals are included in this landmark guide for patients and caregivers seeking responsible, safe alternatives to psychiatric drugs.

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