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BMJ Editorial: Serotonin and depression, the marketing of a myth

Discussion in 'Other Health News and Research' started by A.B., Apr 23, 2015.

  1. A.B.

    A.B. Senior Member

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    http://www.bmj.com/content/350/bmj.h1771
     
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  2. Esther12

    Esther12 Senior Member

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    Saw that the Science Media Centre's experts were not keen on this.

    http://t.co/C1Lub2Jic3

    Although strangely, the SMC response to this weeks mindfulness vs anti-depressants paper made the reasonable point that without a placebo control it was difficult to say much about either intervention.

    I know a number of people who were encouraged to take anti-depressants by their doctors promoting this tale of correcting the brain's chemical imbalance. It was quackery for professionals to be making these claims to patients, seemed related to the view that those with depression deserved to be manipulated/guided, and I've not seen much apologising for it.

    Having said that, I've previously been a bit concerned that Healey makes valid criticism of the approaches of others, but then puts forth alternatives that could be even worse.
     
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  3. adreno

    adreno PR activist

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    Well, tricyclics are certainly worse (side effect and risk wise) and ketamine doesn't seem very useful. Memantine, another NMDA antagonist hasn't been effective, either. Finally, talk therapy doesn't seem to work better than SSRIs.

    So far, it seems we really don't understand enough about depression (or anxiety) to treat it. As always, I think we will eventually have to turn to the microbiome for effective treatments of this.
     
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  4. JPV

    JPV ɹǝqɯǝɯ ɹoıuǝs

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  5. Esther12

    Esther12 Senior Member

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    Also, even if there is little evidence that ADs are significantly better than placebo for all those with depression overall, that does seem to partly reflect the fact that drug companies over promote their products, and that this waters down any genuine effect from those who do benefit.

    I don't know... whole thing seems a bit of a mess to me.
     
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  6. Snow Leopard

    Snow Leopard Hibernating

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    "we admit we don't know how SSRIs work"

    It's the old EBM vs SBM debate... We prescribe drugs that we don't know how/why they work.
     
  7. Bob

    Bob

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    I've always thought that neuro-chemicals (serotonin, dopamine, etc.) may have a role to play in depression, at least for a subset of depressed patients, but that the serotonin explanation for SSRIs was over-simplistic and misleading even for those patients who respond to SSRIs. And, of course, depression is likely to be highly heterogeneous so there are probably many biological pathways to depression.

    I think the article makes some useful points, but I think it misses the crucial point in relation to why SSRIs became such a sensational success story (in terms of sales). It was because their side-effect profile was a substantial improvement over the trycyclics (or at least the side effects of SSRIs were more acceptable to many patients because SSRI's don't cause drowsiness), and their safety profile was a substantial improvement over MAOIs (which involve dangerous interactions with common foods).

    As Esther suggested, above, SSRIs probably work well for a subset of depressive patients, but the average effect gets watered down when assessed over the widest range of patients.
     
    Last edited: Apr 23, 2015
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  8. Got put on them three times...hellish absolutely hellish effects.
     
  9. Sidereal

    Sidereal Senior Member

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    David Healy has been writing the same editorial over and over again for a number of years now. For once I find myself agreeing with the SMC press release. SSRIs are trash but the "alternatives" these anti-biological psychiatry people propose (like psychotherapy) are worse.
     
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