The Chemical Imbalance Myth and Antidepressant Harm
In the U.S., an estimated 17.3 million American adults (7.1% of the adult population), experienced at least one major depressive episode in 2017.1 The highest rates are reported among those aged between 18 and 25.2 However, not only is there evidence that depression is vastly overdiagnosed, but there's also evidence showing it's routinely mistreated.
With regard to overdiagnosis, one 2013 study3 found only 38.4% of participants with clinician-identified depression actually met the DSM-4 criteria for a major depressive episode, and only 14.3% of seniors 65 and older met the criteria.
As for treatment, the vast majority are prescribed antidepressant drugs, despite the fact there's virtually no evidence to suggest they provide meaningful help, and plenty of evidence showing the harms are greater than patients are being told.
According to a 2017 study,4 1 in 6 Americans between the ages of 18 and 85 were on psychiatric drugs, most of them antidepressants, and 84.3% reported long-term use (three years or more). Out of 242 million U.S. adults, 12% were found to have filled one or more prescriptions for an antidepressant, specifically, in 2013.
According to data5 presented by a watchdog group, hundreds of thousands of toddlers are also being medicated with powerful psychiatric drugs, raising serious ethical questions, along with questions about the future mental and physical health of these children.
Recent studies are also shedding much needed light on the addictive nature of many antidepressants, and demonstrate that the benefits of these drugs have been overblown while their side effects — including suicidal ideation — and have been downplayed and ignored for decades, placing patients at unnecessary risk.
The Chemical Imbalance Myth
One researcher responsible for raising awareness about these important mental health issues is professor Peter C. Gøtzsche, a Danish physician-researcher and outspoken critic of the drug industry (as his book, "Deadly Medicines and Organized Crime: How Big Pharma Has Corrupted Healthcare,"6 suggests).
Gøtzsche helped found the Cochrane Collaboration in 1993 and later launched the Nordic Cochrane Centre. In 2018, he was expelled by the Cochrane governing board following the publication of a scathing critique of a Cochrane review of the HPV vaccine, in which he and his coauthors pointed out several methodological flaws and conflicts of interest.
Over the past several years, Gøtzsche has published a number of scientific papers on antidepressants and media articles and a book discussing the findings. In a June 28, 2019 article,7Gøtzsche addresses "the harmful myth" about chemical imbalances — a debunked hypothesis that continues to drive the use of antidepressants to this day. He writes, in part:8
"Psychiatrists routinely tell their patients that they are ill because they have a chemical imbalance in the brain and they will receive a drug that fixes this …
Last summer, one of my researchers and I collected information about depression from 39 popular websites in 10 countries, and we found that 29 (74%) websites attributed depression to a chemical imbalance or claimed that antidepressants could fix or correct that imbalance …
It has never been possible to show that common mental disorders start with a chemical imbalance in the brain. The studies that have claimed this are all unreliable.9
A difference in dopamine levels, for example, between patients with schizophrenia and healthy people cannot tell us anything about what started the psychosis … [I]f a lion attacks us, we get terribly frightened and produce stress hormones, but this does not prove that it was the stress hormones that made us scared.
People with psychoses have often suffered traumatic experiences in the past, so we should see these traumas as contributing causal factors and not reduce suffering to some biochemical imbalance that, if it exists at all, is more likely to be the result of the psychosis rather than its cause.10
The myth about chemical imbalance is very harmful. It makes people believe there is something seriously wrong with them, and sometimes they are even told that it is hereditary.
The result of this is that patients continue to take harmful drugs, year after year, perhaps even for the entirety of their lives. They fear what would happen if they stopped, particularly when the psychiatrists have told them that their situation is like patients with diabetes needing insulin."
According to Gøtzsche, there is no known mental health issue that is caused by an imbalance of brain chemicals. In many cases, the true cause is unknown, but "very often, it is a response to unhealthy living conditions," he writes.11
He also cites the book,12 "Anxiety — The Inside Story: How Biological Psychiatry Got It Wrong," written by Dr. Niall McLaren, in which the author shows that anxiety is a major factor in and trigger of most psychiatric disorders.
"A psychiatrist I respect highly, who only uses psychiatric drugs in rare cases … has said that most people are depressed because they live depressing lives," Gøtzsche writes.
"No drug can help them live better lives. It has never been shown in placebo-controlled trials that a psychiatric drug can improve people's lives — e.g., help them return to work, improve their social relationships or performance at school, or prevent crime and delinquency. The drugs worsen people's lives, at least in the long run.13"
Gøtzsche rightfully points out that antipsychotic drugs create chemical imbalances; they don't fix them. As a group, they're also somewhat misnamed, as they do not address psychotic states. Rather, they are tranquilizers, rendering the patient passive. However, calming the patient down does not actually help them heal the underlying trauma that, in many cases, is what triggered the psychosis in the first place.
As noted in one 2012 meta-analysis14 of studies looking at childhood trauma — including sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death and bullying — and subsequent risk of psychosis:
"There were significant associations between adversity and psychosis across all research designs … Patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls … The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis."
Economy of Influence in Psychiatry
A related article,15 written by investigative journalist Robert Whitaker in 2017, addresses the "economy of influence" driving the use of antidepressant drugs in psychiatric treatment — and the "social injury" that results. As noted by Whitaker, mental disorders were initially categorized according to a disease model in 1980 by the American Psychiatric Association.
"We're all familiar with the second 'economy of influence' that has exerted a corrupting influence on psychiatry — pharmaceutical money — but I believe the guild influence is really the bigger problem," he writes.
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