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Sep, 2016

Depression; Medical Doctors are Questioning the Role of Medications

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This is an excerpt from “A Mind of Your Own” by Dr. Kelly Brogan and has been edited for length and understanding but otherwise has been left unchanged from it’s original.

Antidepressant medication

The predominant theory behind modern antidepressants (SSRIs, or selective serotonin re-uptake inhibitors) is that they work by stopping to body from re-absorbing serotonin from the gaps between the cells of the brain.

The chemical imbalance theory

This hypothesis, grew primary out of two main observations in the 1950’s and 60’s. One in patients being treated for tuberculosis who experienced mood related side effects from the drug iproniazid (which can change the levels of serotonin in the brain). Another was the claim that reserpine, a medication for seizures and high blood pressure, depleted serotonin and caused depression. That was until there was a 54 person study that demonstrated that it resolved depression.

Inconsistent Science

From these preliminary and largely inconsistent observations a theory was born, crystallized by the work and writings of the late Dr. Joseph Schildkraut (a prominent Psychiatrist at Harvard).
In 1965 Schildkraut wrote a speculative manifesto claiming that people before and during treatment with antidepressants found that depression suppressed norepinephrine’s effectiveness as a chemical messenger in the brain. He then theorized broadly about the biochemical underpinnings of mental illness. And from that point forward researchers stared looking for the ever elusive “biochemical imbalance” that causes mental illness, including depression.
In a field struggling to establish legitimacy (beyond the therapeutic lobotomy!), psychiatry was desperate for a rebranding, and the pharmaceutical industry was all too happy to partner in the effort.

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No one has questioned this for decades

This idea that these medications correct an imbalance that has something to do with a brain chemical has been so universally accepted that no one bothers to question it or even research it using modern rigor of science.
According to Dr. Joanna Moncrieff, we have been lead to believe that these medications have disease-based effects — that they’re actually fixing, curing, correcting a real disease in human physiology. Six decades of study, however has revealed conflicting, confusing, and inconclusive data.

Never been studied in humans

That’s right: there has never been a human study that successfully links low serotonin levels and depression.
Brain imaging studies, blood and urine tests, post mortem suicide assessments, and animal research have never validated the link between neurotransmitter levels and depression. In other words, the serotonin theory of depression is a total myth that has been unjustly linked to a range of problems, including schizophrenia and autism.

Canadian doctor’s questioning the biochemical theory

Paul Andrews, an assistant professor of psychology, neuroscience, and behaviour at McMaster University in Canada, is among one of the more vocal experts challenging the traditional depression model. In a 2015 review, he wrote that the science behind antidepressant medications appears to be backward: serotonin is a downer, not an upper.
Andrews argues that serotonin is like a first responder to stress. When our bodies are under duress, serotonin helps to reallocate resources at a cellular level. This further shows that we really have no idea what’s going on when it comes to looking at one simple chemical.
Andrews brings up a good point in a recent review: we can’t measure serotonin in a living human brain yet, so it’s impossible to know exactly how the brain is releasing and using serotonin. What scientists must do instead is rely on evidence about levels of serotonin that the brain has already metabolized, and by studying serotonin in animal models.
To date, the best available evidence indicates that more serotonin — not less — is released and used during depressive episodes. This natural surge of serotonin helps the brain adapt to depression; it forces the body to spend more energy on conscious thought than to areas such as growth, development, reproduction, immune function and the stress response.

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Normal response to stress

Andrews also reports that antidepressants leave individuals worse off after they stop taking them. He agrees that even though depression can be a painful, troubling experience, most forms of depression are normal adaptations to stress.

Brain is fighting the depression AND the medication

According to Andrews, when patients on SSRI medication improve, it appears that their brains are actually overcoming the effects of the antidepressants rather than being helped by them.
The drugs are interfering with the brain’s own mechanisms of recovery. This is an important point, because time and time again people ask me how antidepressants appear to be helpful in the short term. Perhaps, in the rare instance that their effects are adaptive, it is by the virtue of the brain’s own powers trying to combat the assault of the antidepressants — not the other way around. But over time, as the assault continues, the brain is functionally compromised under the constant force of the incoming drugs.
One critical review of the serotonin hypothesis concludes:”. . . .there is no direct evidence of serotonin or norepinephrine deficiency despite thousands of studies that have attempted to validate this notion.” And in a scathing review on major depression published in the New England Journal of Medicine in 2008, the researchers write: “…numerous studies of norepinephrine and serotonin metabolism in plasma, urine, and cerebrospinal fluid as well as post-mortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably”.

Convinced ourselves we found the cure

In the cogent words of Dr. Daniel Carlat, author of Unhinged, “We have convinced ourselves that we have developed cures for mental illnesses. . . when in fact we know so little about the underlying neurobiology of their causes that our treatments are often a series of trials and errors.” Indeed, the brain orchestrates a delicate interplay among some one hundred neurotransmitters, including fourteen different types of serotonin receptors. To think we can cherry-pick one brain chemical and cure all and every behavioural disturbance is a gross oversimplification and downright absurd.
The brain is much more complex that the serotonin model can describe. To be clear SSRIs block the removal of serotonin from the junctions between nerve cells (synapses) in the brain so there is increased firing of serotonin nerves.
But when serotonergic nerves are overstimulated, they become less sensitive in a bid to establish equilibrium again. In science speak that is called down regulation. And such down regulation doesn’t return to normal after the drug is stopped. We in the scientific community still don’t know if the down regulation can become permanent, but a cadre of my colleagues and I believe this poses a serious risk to the brain.

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Huge number of adverse effects reported

It’s no surprise to me that in the first 12 years after its initial marketing blitz, Prozac was named in more than 40,000 reports of adverse effects submitted to the FDA. No other drug comes close to such a history.
Even if we accepted the proposition that these drugs are helpful for some people, extrapolating a medical cause from this observation would be akin to saying that shyness is caused by a deficiency of alcohol, or that headaches that are caused by a lack of codeine. And what about a genetic vulnerability? Is there such a thing as a depression gene? In 2003, a study published in Science suggested that those with genetic variation of their serotonin transporter where 3x more likely to be depressed. But six years later this idea was wiped out by a meta-analysis of 14,000 patients published in the American Medical Association that denied such as association.

Drug companies are happy to provide a bandaid in the absence of research

Dr. Thomas Intel, director of the National Institute of Mental Health, commented with the following: “Despite high expectations, neither genomics nor imaging has yet impacted the diagnosis or treatment of the 45 million Americans with serious or moderate mental illness each year.” Dr. Carlat goes on to state what he has observed in mental health: “And where there is a scientific vacuum, drug companies are happy to insert a marketing message and call it science. As a result, psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.”

A Mind of Your Own

A Mind of Your Own, by Dr. Kelly Brogan MD pages 45-49 and is available in our lending library at Lighthouse Chiropractic.

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