The National Institute of Mental Health (NIMH) said an estimated 21 million adults, representing 8.3% of all U.S. adults, had at least one major depressive episode in the past year. There were 14.5 million adults with at least one major depressive episode with severe impairment in the past year, 5.7% of all U.S. adults. More women (10.3%) than men (6.2%) were diagnosed with major depression. Adults between the ages of 18 and 25 had the highest prevalence (18.6%). In 2008 the WHO ranked it as the third leading cause of disease worldwide, and projected it would rank first by 2030.
The etiology or cause of Major Depressive Disorder (MDD) is now said to be multifactorial, including biological, genetic, environmental, and psychosocial factors. When SSRIs, selective serotonin reuptake inhibitors, came to market, MDD was typically described as a chemical imbalance, primarily caused by neurotransmitter abnormalities, especially serotonin, norepinephrine, and dopamine. “However, recent theories indicate that it is associated primarily with more complex neuroregulatory systems and neural circuits, causing secondary disturbances of neurotransmitter systems.” Nevertheless, 80% of the general public still believe depression is caused by a chemical imbalance.
In “Depression: Biological or Psychological?”, psychologist Allan Leventhal noted how people believed psychiatric drugs were effective treatments because, they “corrected” a biological causation for depression, a chemical imbalance in the brain. “These beliefs have been shaped by NIH’s National Institute for Mental Health (NIMH) and by psychiatrists, whose opinions regarding mental health care are trusted by the public.” Yet, for most of the 20th century, depression was understood to have a psychological, not a medical origin.
In 1964, the head of NIMH’s Depression Section said in “Therapeutic Efficacy of Antidepressant Drugs,” the effectiveness of the antidepressant drugs available for the previous seven years was still not clear. While many clinicians thought the drugs were useful and effective, controlled clinical trials did not always lead to “unequivocally positive findings.” He said even when the findings were favorable to the drug in the trial, the differences between the drug and placebo were not as great as one might wish; “or as one might have anticipated after reading published reports of uncontrolled studies.” Depression was then understood to be one of the psychiatric conditions with the best prognosis for eventual recovery—not as a leading cause of disease worldwide.
In Anatomy of an Epidemic, Robert Whitaker wrote the efficacy record for tricyclic antidepressants in the 1970s was slightly better than an inactive placebo, but no better than an active placebo. This statement was confirmed in “Depression: Biological or Psychological?” which said outcome studies failed to find imipramine to be effective. Over the short term (three months), patients treated with the drug did no better than those treated with a placebo.
Even worse, when drug effectiveness was measured long-term, after 18 months of treatment (the more meaningful measure), the drug-treated patients received no more benefit than those treated with a placebo; the drug-treated patients had a lower number of weeks being symptom-free; they had higher relapse rates; and a higher percentage of the drug-treated patients sought additional treatment. Most damningly, patients treated with a placebo, and patients not treated at all, faired better than the patients treated with the drug.
Whitaker said belief in the efficacy of antidepressants was “reborn” with the approval of the first SSRI, Prozac, in 1988. “This selective serotonin reuptake inhibitor (SSRI) was said to make people feel ‘better than well.’” Then researchers like Irving Kirsch began examining the clinical data submitted to the FDA and the better than well story crumbled. Kirsch concluded the FDA’s belief that SSRIs were an effective treatment for depression was not correct. Leventhal said, “His statistical analyses of the data show the drugs qualified as producing a placebo effect, not a drug effect.”
Outcome research conducted in other countries on the effectiveness of the SSRIs report results consistent with these findings. The UK’s health department found antidepressant drugs are no more helpful short-term than placebos and much less helpful than placebos long-term. A Swiss study found the long-term outcome for patients treated psychologically was significantly better than those treated with antidepressant drugs (SSRIs) and that patients treated with antidepressant drugs fared worse than those not treated at all.
See “Antidepressant Fall from Grace, Part 2” for more on Irving Kirsch and his findings.
Leventhal said these negative results shouldn’t be surprising. The justification for SSRIs by psychiatry was based on the chemical imbalance theory of depression—depression is caused by a deficiency of serotonin in the brain, and SSRIs corrected that deficiency. Research conducted by UK psychiatrist Joanna Moncrieff found no support for the chemical imbalance theory of depression. “Follow-up data show that rather than alleviating depression, psychiatry’s medicalization of depression is contributing to it.” For more on Moncrieff’s research, see “The Myth of the Serotonin Theory of Depression” and “Paradigm Shift Needed with Depression.”
Patients being treated for depression are led to believe in antidepressant drugs by drug company hype, trust in their doctor’s advice, the popularity of taking these drugs, the placebo effect, and misinterpretation by the doctor and the patient of adverse drug effects as a recurrence of depression. Not by biology, not by genetics.
Psychiatric Diagnoses Are Descriptive, not Causative
SciTechDaily said most psychiatric diagnoses are purely descriptive. A depression diagnosis is only a description of the various psychological symptoms and not an identification of its cause. “Yet depression is often talked about as a disorder that causes low mood and other symptoms.” This is a form of circular reasoning, where a psychiatric diagnosis like depression is said to cause symptoms like anhedonia or decreased interest in pleasurable activities, feelings of guilt or worthlessness, lack of energy, poor concentration, and more. “Presenting depression as a uniform disorder that causes depressive symptoms is circular reasoning that blurs our understanding of the nature of mental health problems and makes it harder for people to understand their distress.”
A study by Finnish researchers, “A Descriptive or a Causal Explanation?,” showed that people are given misleading information about depression by health organizations like the World Health Organization (WHO), the American Psychiatric Association (APA), and the National Health Service (NHS) in the UK. They found that the majority of popular websites managed by leading mental health organizations “presented depression as a cause, instead of a description of symptoms.” They concluded this misleading information makes it harder for people to understand the causes of their distress.
One of the Finnish researchers said to SciTechDaily: “People seem to have a tendency to think that a diagnosis is an explanation even when it is not. It is important for professionals not to reinforce this misconception with their communication, and instead help people to understand their condition.”
