Biodeterminism

response to:
"In Defense of Antidepressants"
http://www.nytimes.com/2011/07/10/opinion/sunday/10antidepressants.html

Of course, who else but a psychiatrist would write "in defense" of antidepressants?

First the doctor says, "Antidepressants work — ordinarily well, on a par with other medications doctors prescribe," but then he says, "BETTER-DESIGNED research may tell us whether there is a point on the continuum of mood disorder where antidepressants cease to work." Is his first claim really true? A study from January 2010 published in JAMA entitled "Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis" already found, "True drug effects were nonexistent to negligible among depressed patients with mild, moderate and even severe baseline symptoms, whereas they were large for patients with very severe symptoms" (see http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=23274 ). My guess is the doctor's not convinced. No doubt the doctor's understanding of "BETTER DESIGNED" research on antidepressants is the type that are designed to keep underscoring only the positive attributes.

The above research suggests the largest population paying for their prescription drugs may indeed be getting no benefit from them. So why do psychiatrists like Peter Kramer keep tooting there are great benefits of antidepressants and prescibing them for just about ALL of their patients?

Apart from the sheer political powers of the pharmaceutical industry, which are shaping protocol for mental health professionals, it's because gone are the days when anyone cared about the stress diathesis model. We live at a time where biodeterminism has become the norm. Peter Kramer is a doctor of medicine who is part of a field making the half-truth basic assumption that first physiology changes and then a person gets a mood disorder. Pair this with the premise that psychiatric disorders "run in the family" because of genes and it supposedly explains depression from the only qualified perspective: a medical one.

Most people believe that in order to "cure" a person of something like depression you must alter brain physiology. Pharmacotherapy is then directly responsible for creating a chemical imbalance of its own in the brain, one that can be so severe that individuals taking antidepressants for extended periods get withdrawal upon trying to stop the drug, which can even be misunderstood as a relapse of the disorder. These drugs can induce suicidality and come with terrible side effects, perhaps most notorious is weight gain, sleep loss, even Parkinsons-like tremors. Meanwhile, there is no conclusive research indicating that when a person has a problem with depression this person has an "imbalance" of brain chemistry in the form of a neurotransmitter disease that disrupts the function of serotonin or norepinephrine or dopamine. In most cases, to suggest the cause of depression is mainly physiological is far too reductionistic.

While the "chemical imbalance" rhetoric continues to mislead the public in drug advertisements, I don't find it appropriate that doctors defend the kind of treatment that causes iatrogenic illness such as obesity or Parkinsonism. True treatments for depression are holistic approaches in which drugs do not get prescribed as the "treatment of choice" but only when absolutely no alternative is left.