1 What We Think We Know About Antidepressants
You know how depression is actually just a chemical imbalance in your brain?
And how it’s pretty complicated, but all has to do with serotonin levels?
And how the antidepressants taken daily by 13% of all American adults and 17% of all British adults fix this imbalance by adjusting serotonin levels in your brain?
If you know all this, it turns out you, and the doctors who explained it to you, may have also been drinking Big Pharma’s Kool-Aid.
Yet another meta-study, this one from Molecular Psychiatry, has just been published that concludes this alluringly simple ‘chemical imbalance’ notion of depression is hogwash.
The academics from the UK, Italy and Switzerland, presumably not funded by the companies that make SSRI (Selective Serotonin Reuptake Inhibitor) pills, don’t of course use words like ‘hogwash’. Here’s how they put it:
Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.
2 First, Do No Harm
The report explains that it may not even be benign hogwash.
It doesn’t explicitly discuss the billions earned by Big Pharma over decades for selling pills that don’t work (or more accurately don’t work as much as they claim for the reasons they claim). That’s the remit of politics and finance, rather than molecular psychiatry.
The paper’s authors focus on the consequences of assuring vulnerable people that their depression is just a ‘chemical imbalance’. We hear this a lot because the drug companies tell us, but also because it’s a superficially reassuring message: it’s not you, it’s the chemicals.
This may have helped those for whom depression is a major social stigma confront their malady, but that stigma is diminishing by the day. The point this research makes is that blaming brain chemistry may cause more mental problems than it cures.
Here’s how its authors, from UCL, Goodmayes Hospital, University of Greenwich, Psychiatry-UK, Sapienza University, and Zurich University of Applied Science, put it.
The chemical imbalance theory of depression is still put forward by professionals, and the serotonin theory, in particular, has formed the basis of a considerable research effort over the last few decades.
The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities], and this belief shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood.
The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue antidepressant medication and may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.
So, quite apart from appearing to be plain wrong, and based on pseudoscientific mumbo-jumbo concerning ‘serotonin receptors’, the ‘brain chemistry’ theory removes any sense of agency from the depressed person.
This not only reduces depressed peoples’ chances of working it out for themselves or seeking talking therapies, but may also lead to a lifelong dependence on brain-altering drugs that may be doing you more harm than good.
3 How Did This Happen?
Eli Lilly started marketing the first major SSRI, Fluoxetine, in 1987. Prozac, as they branded it, was a huge hit, earning Lilly up to $2.6Bn/year until their lawyers could no longer persuade judges to extend their patent, in 2001. Generic pill-makers eagerly took up the slack.
Proprietary or generic, SSRI antidepressants remain a major part of any pharmaceutical company’s drug portfolio.
Rival drug companies developed their own SSRIs, different enough to protect themselves from lawsuits, but based on the same brain chemistry principles. The Federal Drug Administration (FDA) has waved through Sertraline (Zoloft), Citalopram (Celexa) and Escitalopram (Lexapro).
These families of SSRIs have become front-line weapons of choice in clinics around the world. Veteran depressives can sound like wine buffs, swapping their experiences and theories about the best brands, comparing dosages and times to pop them.
But how is it that the phrase ‘SSRI’ rolls off the tongue of hundreds of millions of patients, pharmacists and physicians worldwide?
Lilly came up with the idea that depression is down to serotonin imbalance in the early ‘70s. Their researchers reckoned an antihistamine called diphenhydramine had antidepressant effects.
They substituted a chemical with a similar structure, 3-Phenoxy-3-phenylpropylamine, thought it was probably something to do with serotonin uptake, and started isolating the component they believed responsible.
They settled on fluoxetine, and the rest is marketing history.
4 Why Is It Still Happening?
But as recent papers like the Molecular Psychiatry one we mentioned at the start of this article point out, the scientific thinking behind these drugs has proved to be at best comically simplistic, and at worst cynically exploitative.
As with so much neurological and psychiatric research, the more we learn about the brain, the more complex it reveals itself to be.
It should follow that we should be less assertive in prescribing such simple fixes, but as the Manhatten Project physicists discovered once the Generals had The Bomb, once released into the wild, dangerous beasts become hard to control.
The appeal to patients suffering from depression of silver bullets like SSRIs is obvious, but just as obvious is their appeal to Big Pharma shareholders. As researchers and academics became more dependent on drug companies for funding, few people spoke up about his, and those that did found it hard to make their voices heard.
Independent researchers, i.e. those not funded by Big Pharma, have been waving red flags for years. This landmark paper detailing how drug companies suppress the publication of negative studies was published in the New England Journal of Medicine in 2008.
In 2011 Robert Whitaker brought his Emperor’s New Clothes analysis of the Depression Industry to public attention, with the publication of his classic Anatomy of an Epidemic. This was published before factors like Climate Anxiety had become widely recognised.
After years covering the pharmaceutical industry for the New York Times, Whitaker asked a simple, but awkward, question:
If these pills are so effective, why has the explosion of their use coincided with an explosion in mental illness?
It’s always instructive to hear reactions from people who have this statistical no-brainer pointed out to them for the first time.
If we’re shown two similar graphs about related topics, each showing a huge rise over the same period, it’s not unreasonable to assume correlation as a starting point. Imagine two graphs showing the growth in car ownership, and traffic accidents.
Yet presented with similar evidence of the correlation between drug prescription and mental illness, we reflexively look for reasons why it must be a coincidence.
- ‘But it must be to do with increased diagnosis…’
- ‘But people are more open about mental illness these days…’ etc.
The fact that we explain this inconvenient truth away with a series of ‘But…’s tells us just how deeply embedded the fantasy – rather than facts – of antidepressants have become.
Not all SSRI’s are always useless for everyone. There are plenty of papers that demonstrate benefits. A recent publication suggested they have anti-inflammatory properties that might benefit people taking them. Maybe they do. Maybe they also work better than sugar pills for half the people who take them. But this isn’t what we were originally told, and many such papers are funded by SSRI manufacturers.
Questioning the reliability of Big Pharma-funded papers than are supportive of SSRI medication is more than knee-jerk, Follow-The-Money cynical journalism. Big Pharma has a long track record of cherry-picking good data, and binning or even suppressing ‘bad’ data by any research. It’s hard to fund independent research without Big Pharma money.
Moreover, all the major drug companies have paid out huge fines for kickbacks, fraud, ‘off-label promotion’ (=bribery), and various other illegal practices. Even multi-billion-dollar fines have no obvious impact on such practices. They seem to be regarded as just another cost of doing business.
Pointing to anti-inflammatory benefits is post-hoc goalpost-moving. One thing we have learned about brain chemistry is that is fantastically complex and multi-factorial. If you fire a chemical blunderbuss into our brains, you can expect to hit different targets. What’s certain is that this is a very different narrative from the confident ‘chemical imbalance’ mumbo-jumbo originally used to justify them.
If you want evidence, just look at the arse-covering, small-print list of possible side-effects that accompany every box of SSRI antidepressants. They include:
- weight gain
- weight loss
You can be sure Big Pharma wouldn’t include these inconvenient truths unless they had to.
The truth is brains are way more complex than our brains can understand, and everyone’s brain is different from everyone else’s. A little humility would help.
5 Why Can’t We Just Accept The Science?
For a start, what do we mean by The Science?
If you’re unfamiliar with the work of Cochrane, this non-profit, independent research organisation on double-blind trials is an excellent place to start questioning the basis of all those apparently pristine, neutral, peer-reviewed studies that so often form the basis of newspaper articles.
At the risk of bombarding you with recent academic publications, this recent article from Science Advances may help answer the more pressing question of why arguments based on overwhelming scientific evidence can be so unpersuasive.
Researchers at Northwestern University did what so many commentators, journalists and online Twitter-warriors have done. They tried to work out why facts are not enough, why The Science doesn’t always persuade us.
The language, again, is appropriately academic, but it’s hard not to summarise their findings as ‘because some people are stupid’.
Here’s how one of the authors, a Professor of Marketing, when interviewed about their paper, put it rather more diplomatically:
Knowledge overconfidence is associated with anti-consensus views on controversial scientific issues.
For many years, smart people thought that the way to bring people more in line with scientific consensus was to teach them the knowledge they lacked. Unfortunately, educational interventions haven’t worked very well.
Our research suggests that there may be a problem of overconfidence getting in the way of learning, because if people think they know a lot, they have minimal motivation to learn more. People with more extreme anti-scientific attitudes might first need to learn about their relative ignorance on the issues before being taught specifics of established scientific knowledge.
The research focused on 8 ‘hot topic’ issues, which remain highly controversial in the public sphere despite massive scientific consensus:
- Climate change
- Nuclear Power
- Genetically Modified Foods
- The Big Bang
- Homoeopathic Medicine
Whatever metric was used, public attitudes followed a similar pattern – the further our views from the scientific consensus, the more confident our assessment of our own knowledge becomes and the less actual knowledge we possess.
The pattern was stronger in some topics than others. COVID-19 provided the starkest disconnect between imagined and actual knowledge. This may not be surprising given that it’s the most recent topic that none of us had heard of until late 2019, but it’s also the one which has probably received the most intense ‘public education’. This rather proves the researchers’ fundamental finding:
Essentially, the people who are most extreme in their opposition to the consensus are the most overconfident in their knowledge. Our findings suggest that this pattern is fairly general.
But interestingly, from the perspective of See Through News or anyone engaged in climate activism, while all these topics are matters of bitter division, the reason for this division might vary.
Specifically, they found the pattern for Climate Change, Evolution and the Big Bang Theory was different from the other topics.
When you consider that Our World, How We Got Here, and How It Was Made are the kind of topics that have historically fallen under the aegis of belief-based systems like religion, and how closely aligned religious belief can be with political identity, this becomes less surprising. But no less important if you seek to shift views.
For climate change, for example, attitudes in line with science tend to be held by liberals, whereas for an issue like genetically modified foods, liberals and conservatives tend to be fairly split in their support or opposition. It could be that when we know our in-groups feel strongly about an issue, we don’t think much about our knowledge of the issue.
For climate activists who have spent decades banging drums and ‘raising awareness’ with little to show for it, this kind of analysis re-defines the problem in a helpful way.
The challenge then becomes finding appropriate ways to convince anti-consensus individuals that they probably aren’t as knowledgeable as they think they are.
When it comes to possible solutions, the researchers suggest shifting focus from individual knowledge to the influence of experts.
They seem to have ‘proper’ experts in mind, like themselves, but how many ‘proper’ scientists really drive public opinion on scientific issues?
For better or worse – usually worse – non-expert Influencers are far more influential. Pragmatically speaking, maybe we should focus more on getting Kim Kardashian to change her messaging than Dr. Brian Cox, or David Attenborough.
If the end of preserving human civilization doesn’t justify these means, nothing will.
The paper demonstrates how social norms can even trump personal views, which underlines just how compliant we are as a species, and hence how vulnerable to manipulation. For example, it details how many Japanese wore COVID-19 transmission-reducing masks not because they were convinced by the scientists telling them it would mitigate personal risk, but to conform to a societal norm. The shame of being perceived as Not One of Us proved to be a more powerful force than any rational ‘education’, for or against.
This seems a powerful point, and a key takeaway for effective climate activism. As the researchers put it:
People tend to do what they think their community expects them to do. It is incumbent on society to try to change minds in favour of the scientific consensus.
‘Incumbent on society’ – three words that do much heavy lifting.
See Through News has characterised the power dynamics that bear on ‘society’ with its story of The Three-Headed Beasts. SternWriter’s language is less academic, and it’s only 300 words, but it’s describing this dilemma in allegorical form:
Not long ago, in a world the same as our own, lived Three-Headed Beasts.
Each Beast had a Government Head.
To one side, a Business Head, to the other, a Media Head.
The Government Head could control the other two, but rarely did.
Below the neck, Heads were joined by Power.
Below the belly, Beast was joined to Beast…
What the Northwestern Uni researchers don’t tell us is what to do when ‘society’ is part of the problem.
What if ‘society’ includes populist politicians, in the pocket of corporations who benefit from ignorance, whose interests align with the billionaire owners of the main media outlets?
6 It’s Not Just The Drugs
So there’s our correlation. This is why See Through News, with a mission is to measurably reduce carbon, pays so much attention to research on antidepressants.
It’s all the same wrestling match.
In one corner, wearing the white leotards, slapping each other on the backs, the tag-team of Truth, Evidence & Facts.
In the other, dressed in black and taunting the crowd, their nemesis team, Belief, Bluster and Bullshit.
History has taught us the power of the Three B’s declines over time. Most of us now accept the Earth is round, it revolves around the Sun, and that we share a common ancestor with apes.
Even in the case of climate change, the drip-drip of facts is eroding belief-based systems.
Outright denialism is, at long last, in rapid decline, as the truth that it’s already happening, not a theoretical future, comes home to us in the form of floods, fire, famine and pestilence.
The problem is, we don’t have much time.
Remember the ‘But…’s, our reflexive objections to the notion that antidepressants might cause or prolong, rather than cure, depression?
Consider how so many people, for so long, when presented with the infamous ‘hockey stick’ graphs, showing the sharp rise in greenhouse gases coinciding with humans burning fossil fuels, continued to search for other explanations, however far-fetched: sun spots, natural cycles, dodgy emails between scientists… anything was more comfortable than facing the truth, and acknowledging the need to change our behaviour.
The reason for our reflexive defence of the status quo, in defiance of what our eyes and common sense might otherwise tell us, is the same whether we’re talking about antidepressants and atmospheric concentrations of CO2, and it’s no coincidence.
Loads of it, strategically spent and ingeniously targeted over decades, to secure the prospect of even more money earned by the industries that benefit from the status quo.
If this still sounds unbelievable, conspiratorial or over-egged, whistleblowers and legal disclosure mean we know this beyond any doubt. For Big Oil, listen to Amy Westerveld’s podcast Drilled. For Big Tobacco, read Robert Proctor’s Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition. For Big Pharma, there’s Patrick Radden Keefe’s book Empire of Pain: The Secret History of the Sackler Dynasty
If you still find the notion of antidepressants being anything other than effective medication sold by unimpeachable pharmaceutical companies uncomfortable, maybe because they’ve worked for you or someone you know, try substituting ‘opioids’ for antidepressants, and see if that does the trick.
For the more pressing issue of climate change, it doesn’t really matter.
The stories of Big Pharma & antidepressants/opioids, and Big Oil & fossil fuels, demonstrate how feeble science and facts can be when competing with well-funded and sophisticated multi-media manipulation by companies that profit from suppressing science.
But they also offer a clue as to how best to address such ignorance, wilful or otherwise.
Let’s learn from them. Let’s not just rely on ‘education’, ‘raising awareness’ and other fact-based approaches.
Let’s tell better stories.