'the myth of the chemical cure'

[MitchyInge]

what do you think of this bbc article?

[Threadworm2]

It seems like an annoyingly rhetorical way of putting things. Of course these drugs are psycho-active and of course they put you into a 'drug-induced state'. That is true whatever stance you take on her other claim -- that doctors are wrong to speak of ADs as correcting an imbalance in serotonin.

It is this second claim that is the interesting one. Is she saying that there is evidence that they do not correct an improper serotonin level (even when they are effective)? Is she saying that the idea of 'correcting' a distorted brain chemistry is a kind of propoganda to make us feel happier taking psycho-active drugs?

It does seem that she is dressing up a perfectly uncontroversial point against over-use of ADs by trying to make us nervous about the concept of a 'psycho-active drug'. What is so wrong with a psycho-active drug if it has the proper effect?

[FabBakerGirlIsBack]

I think she is talking crap. Initially you might feel a bit spaced out as your body gets used to the tablets but I know they work for me and I would be in a really bad way without them.

[Threadworm2]

On re-reading I see that she does say "scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed. "

So I suppose if that is true then it is wrong for professionals to speak of the 'broken serotonin levels' so readily. But it is also true in my experience that doctors are quite ready to say 'we don't really know how ADs work (when they do work)'. And I still feel a little peeved by the slightly scaremongering 'they are making you a junkie' tone of her piece.

[MitchyInge]

The bit about antipsychotics made me laugh, I take a LOT (for bipolar) and shudder to think what I'd be like if my thoughts and feelings were not 'damped down' - anyway, if I stop taking them I get ill and if I get ill I have to go into hospital, so whether that's a placebo type effect or because the drugs do what they're supposed to I'll stick with them for now. Have too much to lose not to.

She is probably not entirely wrong though, it's a massive industry and am sure lots of people are prescribed SSRIs unnecessarily, because the resources needed to support people in other ways are just not there.

[Heathcliffscathy]

I totally agree with the article.

We are medicating the mind as if it is an organ like any other when in fact it isn't.

Of course medication that alleviates unbearable pain 'works' in that it creates a drug induced state that feels preferable.

But whilst psychotropics and ADs can get people through crisis moments in their lives (and they must be given credit for doing so) they do not 'cure' anything.

[GIvePeasAChance]

There is a lot of research that shows that ADS are not effective at all, unless they are supplemented with some talking therapy. And on their own, they are no more effective than the placebo ( which in itself is not insignificant, but does not account for ADs just being the placebo)

[MitchyInge]

As for the serotonin thing, what I take for the depressive phase of my mood disorder has nothing to do with serotonin - I'm on lamictal (which is an antiepileptic) and a very low dose of reboxetine (which is supposed to target noradrenaline only) and I haven't had a proper bout of depression for years.

[GIvePeasAChance]

The thing that made me question this medicating of the mind was this.........when you give someone ADs, yes their serotonin levels change within 4-8 hours. But there are absolutely NEVER ever reports of people feeling better about themselves within 4-8 hours of taking their first pill. The earliest is 4 weeks-ish that people start to feel any better............this indicates to me that it is not just a biological 'cure', there is something else going on here, and the placebo studies for me are really interesting.

[TrinityRhinoHasASillyStepson]

I am a long term antideppresant taker

they work to stop me feeling like I dont want to carry on

BUT

they are the crutch I need to begin to cure the problems I have with my self esteem, panic, slight ocd, paranoia

They work as an aid to begin to be able to tackle the root issues

I have a counsellor, cpn, family worker and close liason with my hv (who is actually well trained and nice )

these things are improving my mental health

but on their own they didn't work as I could not move out of my @i am shit and ther is no point' mindset

[Heathcliffscathy]

google her, she is really interesting. she is an eminent psychiatrist that has been involved in many antidepressant trials.

I think it is fantastic that someone from within the profession is telling the truth like this. Of course we need medication for mental health disorders. But there is huge overprescription, AND people are fed this line that they have a chemical imbalance that will be put straight by drug treatment when in fact what is happening is that the drugs induce an altered state which feels more bearable to the person concerned.

[FabBakerGirlIsBack]

sophable some things can't be cured and tablets are the only thing that keeps one going.

[MitchyInge]

But how would you treat mania without drugs? The physical toll alone of an untreated episode doesn't bear thinking about, not to mention the high probability of inadvertantly killing yourself through some crazy antic or other.

[Heathcliffscathy]

absolutely trinity, the drugs helped you to access the support which may slowly change how you feel.

[Heathcliffscathy]

i don't disagree bakergirl or titch. can you see the difference between what you're saying and the line that many GP's and psychiatrists give their patients: these drugs will cure your problem.

[Threadworm2]

The piece seems to say imply that there is something wrong with the whole idea of a drug that makes you less ill by altering your brain-state.

Granted, for an awful lot of depressed people their condition has no primary organic (brain-chemical) cause and that for many or most of those people ADs are not an appropiate treatment. We know already how overused they are.

But for very many people with a mental illness there is a primary organic cause. And a drug that has an effect on brain-state can help a lot. It is not at all helpful to somehow suggest that the whole notion of a 'psycho-active drug' is tainted.

[Heathcliffscathy]

I don't think she is doing that is she? That's not how I read it, clearly she doesn't advocate NOT using drug treatment for mental illness.

I would strongly dispute that there is an organic cause for most mental illness.

I don't understand why on earth the implication is that somehow the complex interaction between genetic propensity and psychological and emotional early environment which is at the root of most mental illness is so problematic for people. Why do we struggle so hard with the fact that the medico-biological model of mind just doesn't work.

[Threadworm2]

Sophable, you would take your last paragrapgh to apply to all mental illness? Or just depression, anxiety, and the like?

I think that the view of your last para isunproblematically acknowledged to be true in the case of conditions like depression. And in my experience not even GPs present ADs as a simple cure for a simple organic dysfunction.

[MitchyInge]

I suppose it's because the 'there is something wrong with my brain FACT' approach somehow exculpates you from responsibility and accountability for your behaviour, lifestyle and choices. With meds that contain episodes, and lengthen the distance in time between them, I can work on creating, maintaining and improving a life that promotes wellness. The two go hand in hand, but why, when they are pumping you full of haloperidol or similar, can't they also prescribe self-management courses that really help you to understand your condition?

[MitchyInge]

I do hate the way people with schizophrenia and bipolar are encouraged to accept 'meds for life' though. I think evidence is emerging to support an approach of treating acute episodes and ditching the 'prophylactics' in between. After all you can't really know for sure that the drugs have averted more relapses, or given you a great deal more time between them. You'd probably have to be pretty good at recognising when you were getting ill though, and when your mood shoots up the last thing you feel like doing is going to the doctor!

[Threadworm2]

Agree Mitchy that even in the case of mental illnesses for which there is a very definite organic cause, and a very clear benefit of drug treatment, you can't reduce the person to the illness and therefore you can't reduce the treatment to the drug. There needs to be personal responisibility and as you say lots of support with self-managing strategies.

But that is quite analogous to the case of plain physical illness, isn't it? If you are dealing with chronic pain, for example, you will fare better if you are enlisted as a person in the management of your condition, given responsibilities and strategies. Those aids don't undermine the 'biological-medical model' of the illness or the cure.

I do utterly agree that in the case of depression there is unlikely to be a simple brain-chemical cause or cure, that there is, as soph says, an interplay of genetic conditions and early experiences and so forth. I just dislike the scaremongering and rather moralistic stance regarding the concept of 'psycho-active medication' that the article employed. And I really don't think that most doctors, or most people, push the simplistic straight-biological account of most depressions.

[FabBakerGirlIsBack]

I am quite possibly misunderstanding all of this but all I know is there are no tablets in the world that are going to fix what is wrong but I also know I can't manage without them.

[Heathcliffscathy]

are there any mental illnesses for which there are simple reducible organic causes. certainly not schizophrenia or bi-polar disorder.

also, i don't agree at all that a non-organic explication of mental illness means that the patient is responsible for it.

early attachment physically affects the wiring of our brains. to say to someone that has borderline personality disorder for example that they need to take responsibility and stop behaving as they do is insane (!)...they can not help being flooded with negative emotion when triggered in certain ways any more than someone with measles can help having a rash.

the big difference is that through therapy, crisis support networks and self-management that person can learn what is happening and even over time 're-wire' their brain!

[Heathcliffscathy]

i think the reviews of her book on amazon are definitely worth a read

i will be buying the book!

[YanknCock]

'But there are absolutely NEVER ever reports of people feeling better about themselves within 4-8 hours of taking their first pill. The earliest is 4 weeks-ish that people start to feel any better'

Allow me to be the first report of this....ADs work like a light switch for me. I start feeling better and more like myself within 2 days. Don't scream 'placebo effect' at me, I've been on and off enough times to know how my brain works.

Whilst I agree ADs are overprescribed and for SOME people they are more helpful when combined with talking therapy, that isn't the case for me. I'm a direct contradiction to what this woman is saying. It has taken a long time for me to accept that ADs are going to be with me for life. I don't think this is or should be the case for everyone.

This opinion isn't new, and it's caused people like me a lot of grief, because we're under pressure to stop ADs. Every time I've stopped, no matter how good my life is, I go into a downward spiral of depressive thoughts and get to the point that I push everyone away, hide from the world, fail at work/education, and generally make a mess of things. Fortunately, I've learned to ignore articles like this and do what I know is best for me. It's not 'chemical' for everyone, but in my case it is.

I've been under the care of numerous psychiatrists and counsellors over the years, and I've had plenty of talking therapy. One thing that has been consistent with all of them is the opinion that ADs work for me, and they work without the talk therapy too.

Most recently, I came off ADs for pregnancy, and it was a terrible mistake. I spent months being miserable, and then finally got back on a proper dose of Citalopram and I was back to myself (as much as one can be when pregnant) within 2 days. The social worker from the community mental health team is amazed, as is the GP, the psychiatrist, and the midwife. The only thing that changed were those little pills.

So if this woman wants to claim I am in a 'drug-induced state' because I can function, prepare for the birth of my baby, and generally not be suicidally depressed, then fine, she's welcome to her opinion. I'd rather be alive and able to cope.

[OrmIrian]

Same here yank. I took my first citalopram in great fear and trepidation after reading the contraindications about how I might feel worse initially. But within a few days I was feeling 100% better (but sleepy).

There is a point when the depression is so bad that you need something to get back onto a level state in order to start addressing what the problems might be that got you there. It's like telling someone with a horrendous migraine that they need to give up cheese/chocolate/red wine (or whatever the triggers are) and refusing them pain releif meanwhile.