Map of life expectancy at birth from Global Education Project.

Monday, December 16, 2013


I put the title of this post in quotation marks because I believe that even the name of these chemicals is misleading. Alan Frances, who led development of the DSM-IV, pretty much stands by that work but he really, really doesn't like the DSM-V. (I don't particularly like either one of them, but Frances is reasonably up-front about the limitations of psychiatric nosology, and his contribution to the debate over the DSM-V has been largely helpful.) Anyway, in the linked essay Frances and Christopher Dowrick offer the astonishing factoid that 11% of the U.S. population over the age of 11 currently takes an anti-depressant.

Wow. These are drugs that have numerous serious side effects, are essentially addictive for many people in the sense that they can't stop taking them without experiencing intolerable symptoms, and they don't actually treat any known disease. Yep, I meant that. There is absolutely no evidence -- in fact compelling evidence to the contrary -- that a shortage of serotonin in the brain does not cause, and is not even associated with, the collection of symptoms labeled "depressive disorder." The way they get approval for these drugs is to ask people some questions -- from, for example, the Beck Depression Inventory -- feed them antidepressants, and then see if there is a "statistically significant" difference in the amount of change in how they answer the questions, compared to people who take a placebo.

Sample questions (pick the answer that best applies to you)

0 I am not particularly discouraged about the future.
1 I feel discouraged about the future.
2 I feel I have nothing to look forward to.
3 I feel the future is hopeless and that things cannot improve.

0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.

It doesn't matter if you're say, serving a life sentence, or living in Aleppo, if you get a high score on this test you have a disease called depression. It turns out that for people diagnosed with major depressive disorder, clinical trials tend to show that about 15% of them have a response in how they answer these questions that exceeds the response to placebo. Or so it seems based on the data we've been able to see. Selective publication and data massaging are ubiquitous in this field.

Anyway, as Frances and friend tell us, according to the DSM-V if your spouse or parent or child  died two weeks ago, and you're still feeling sad, you have a disease. And you should take pills. That is a) nuts and b) evil. There is indeed terrible suffering that comes upon some people, not necessarily in reaction to any particular unhappy event, and that won't lift. We don't understand why, and for some of these people, antidepressants may give some relief. Others, not. But . . .

A lot of suffering is just the human condition. It comes with the big brain, the curse of consciousness, and the indifference of the universe. Let's all try to love and succor each other. But stop taking the damn pills. Thank you.

1 comment:

roger said...

" I feel the future is hopeless and that things cannot improve." well... i think that a rational assessment of the human situation is dire and that there is no foreseeable resolution. gimme a pill, that'll help.