Depression: Theory or fact?

UPI has an article on a study which finds that the media presents depression's "chemical imbalance" as a fact instead of a theory. According to Jeffrey Lacasse and Jonathan Leo, the DSM says "the cause of depression and anxiety is unknown." Lacasse and Leo asked members of the media to submit evidence that supports chemical imbalance as a fact but no one did. This finding comes after the near-damning U of Hull study that asserts antidepressants don't work much better than a placebo on the majority of depressed patients. If the efficacy of antidepressants are this dubious, how much more are antipsychotics?

This article gets me thinking about the idea of media responsibility. I feel like what we call "news" has reverted to the days of yellow journalism. Sometimes, even worse than that. While the majority of publications strive to adhere to ethical practices and accuracy, many major publications will resort to printing anything that sells — even if it's libelous. But I'm getting off track here.

I can't wholly blame the media for sensationalism on certain topics like depression.  Most of them aren't scientists or research experts – they only report what they're told. Take NIMH's explanation of the way medication works for depression:

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

NIMH isn't presenting the way antidepressants work as a theory. It's an authoritative paragraph that sounds as though it's fact. If the chemical imbalance that causes depression is only theory then one must conclude the way antidepressants work as a theory as well, no? The NIMH has a section that explains what causes depression:

There is no single known cause of depression. Rather, it likely
results from a combination of genetic, biochemical, environmental, and
psychological factors.

"Likely results" leaves the door open to interpret the sentence as "maybe it's a combination of…" However, most people aren't scrutinizing words that carefully. Most people see this: "Rather, it results from a combination of…" Yes, I'm being nitpicky but the word "likely" still strikes me with a more authoritative connotation than maybe or perhaps. Here's a quote from a recent report from a local news station News 8 Austin:

Depression is more than just a negative state of mind. There are physical changes that occur in the brain that disrupt that natural balance of chemicals called neurotransmitters. (emphasis mine)

There is no single factor that causes depression. In fact, many experts believe most cases
[sic] of depression are a result of several sources. (emphasis mine)  

Again, I'm being nitpicky. "There are" is an authoritative phrase. People are unlikely to argue with a statement that includes the verb "are." Take for example, "There are people outside" or "There are five cats at the door." There's no question in the speaker's mind about whether people exist outside or the number of cats at the door. With subjects like depression that involve psychiatry and neuroscience, the majority of people aren't going to question these assertions either. I'm surprised that second paragraph didn't read, "many experts say …" Unless you're an expert yourself, you'd be unlikely to argue on what an expert says versus what the expert believes.

While I appreciate Lacasse and Leo's study on the inaccurate way depression is presented in the media, the "authoritative" sources on the issue would be loathe to correct it. Right now,  the big picture of raising awareness about depression is more important than to correct a trivial thing about the chemical imbalance being a theory. Pharmaceutical companies don't like correcting minor nuisances like theories.

To sum it up, I think the idea of a chemical imbalance causing depression is a theory. That's not a dubious statement. Unless it depends on your definition of what is is. 

Pharmaceutical cynicism

seroquelA mental health blog I’ve recently started reading, Furious Seasons written by P. Dawdy, has been blogging about Seroquel, a medication that has normally been used for acute mania in bipolar disorder. Now, Seroquel is being pushed for depression in bipolar disorder. In one of his older posts, he wrote: “So my hunch is that there must be money for researchers in going after BP, and Pharma companies must be willing to foot the bill. Yes, I am cynical.”

This has been my thinking for sometime now and I’m glad that someone had the gumption to say so. I’m highly cynical of pharmaceutical companies. Pharmaceutical companies don’t care about whether medications help people as long as they don’t kill anybody, which detracts from their profits in the form of class-action lawsuits. (See the Vioxx case with Merck.)

Dawdy also writes: “We are the only group in the psych business that matters. But our interests are not well served in the current power arrangment, in which we don’t even have much of a share or a voice. That is also bullshit and must change.”

I often feel disconnected from the pharmaceutical industry and the world of psychiatry. I am being told things and diagnosed left and right and I don’t understand much of what I’m being told by anybody. My concern is that clinical trial data is being fudged by doctors who receive funding from pharmaceutical companies but fail to disclose their ties. This area needs government regulation and a higher standard of ethical practice. Perhaps the APA should form a bureaucratic board of ethics specifically to overseen the relation between doctors working with (and often for) pharmaceutical companies.

Mood: 4