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July 22nd, 2022 | #1 |
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SSRI drugs: Have millions been taking antidepressants with harmful side-effects for decades - when there's no scientific evidence they do what they claim?
Have millions been taking antidepressants with harmful side-effects for decades - when there's no scientific evidence they do what they claim? Some experts have suspected it for years. Now patients have been left reeling by a groundbreaking study
-New research shows the theory justifying antidepressants is just a myth -The research confirms what some medical professionals have suspected -Depression being a chemical imbalance has been proven to be unfounded By JONATHAN GORNALL FOR THE DAILY MAIL PUBLISHED: 22:33 BST, 20 July 2022 | UPDATED: 11:35 BST, 21 July 2022 Like millions of patients who seek help from their GPs for depression, Emma Ward was repeatedly told she was suffering from ‘an imbalance of chemicals in the brain’. If Emma wanted to get better, her doctors said the 26-year-old should keep taking the antidepressants she had been prescribed since she was 15 — even though the drugs did not seem to improve her mood, and left her feeling perpetually numb emotionally. Now, shocking new research published yesterday shows that the theory justifying the millions of prescriptions for antidepressants handed out every month to patients such as Emma, is simply not true. The research confirms what some medical professionals have increasingly come to suspect. That the ‘chemical imbalance’ theory — that depression is due to a lack of the brain chemical serotonin — is nothing more than a myth. Shocking new research published yesterday shows that the theory justifying the millions of prescriptions for antidepressants handed out every month to patients such as Emma, is simply not true This myth was created more than 35 years ago by pharmaceutical companies to justify their products, and has been perpetuated ever since by the training and practice of doctors around the world. In the most comprehensive review of the research on links between depression and serotonin ever carried out, researchers from the UK, Italy and Switzerland looked at 17 major international reviews that had documented the findings from more than 260 studies, involving 300,000 patients. Their findings, published in the journal Molecular Psychiatry, undermine the basis for decades of prescribing of the most commonly used antidepressants, Selective Serotonin Reuptake Inhibitors, or SSRIs. ‘For years, people have been led to believe that depression is caused by a chemical imbalance in the brain, due to a deficiency of the chemical serotonin,’ the lead researcher, Professor Joanna Moncrieff, a professor of psychiatry at University College London and a consultant psychiatrist at North East London NHS Foundation Trust, told the Mail. ‘We can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities.’ Serotonin is a neurotransmitter, a chemical that transmits messages between nerve cells. The NHS website says that while ‘it would be too simplistic to say depression and related mental health conditions are caused by low serotonin levels . . . it is thought SSRIs work by increasing serotonin levels in the brain’. The findings are a major upset, since SSRIs account for the majority of antidepressants prescribed in the UK, and millions of Britons rely on them. Their use is rising inexorably — of the record 7.4 million antidepressant prescriptions issued in England in March alone, almost four million were SSRIs. The majority of patients prescribed antidepressants are women. There are currently eight different SSRIs prescribed in the UK, among them fluoxetine, the mother of all SSRIs — better known as Prozac. Fluoxetine was developed by U.S. pharmaceutical giant Eli Lilly in the early 1970s, based on ‘the hypothesis’ that boosting serotonin would help treat depression, and it soon became apparent that the company had struck gold. According to a 2005 paper, by two of Fluoxetine’s inventors, ‘revenue from antidepressant sales was valued at less than $200 million in the first eight months of 1975’. Prozac was approved for the treatment of depression in the U.S. in 1987, and by 2002 it had been prescribed to more than 40 million patients worldwide, with total sales of $22 billion. ‘Part of the reason why the story of chemical imbalances in depression has become so prevalent is because it was propagated by drug companies when they were marketing new antidepressants,’ says Dr Mark Horowitz, a co-author of the new study. ‘Antidepressants have been blockbuster drugs for the pharmaceutical industry, frequently ranking among their most profitable.’ Yet in recent years, the ‘chemical imbalance’ theory has been increasingly questioned. In a position statement on antidepressants in 2019 the Royal College of Psychiatrists said ‘the original idea that antidepressants “correct a chemical imbalance in the brain” is an oversimplification’. But the theory is still taught at medical schools and in psychiatric textbooks. In its guidance on treating depression in adults, NICE says SSRIs ‘modify neuronal transmission in the brain’ — in other words, they work on serotonin levels. Just a few weeks ago, during an interview on BBC Radio 4’s Woman’s Hour, Dr Nighat Arif, resident GP on both ITV’s This Morning programme and BBC Breakfast, was asked why she thought more women than men were being put on antidepressants. Women, she said, were not only more likely to ask for help, but also ‘understand that there is a chemical imbalance and antidepressants given at the right time will help with that imbalance’. And yet ‘it has been suspected for some years that the evidence for this “brain imbalance” doesn’t stack up,’ says Professor Moncrieff. ‘But no one has got the evidence together and really looked at it properly. ‘However, now we have and it confirms that there is no convincing evidence that serotonin is linked with depression, and certainly not that low serotonin is a cause of depression. ‘We suggest it is time to acknowledge that the serotonin theory is not empirically substantiated.’ If the drugs don’t work by tackling a mythical ‘imbalance’, this could explain previous research which has found that SSRIs and other antidepressants are no better than a placebo for mild to moderate depression. Certainly, according to the new review, antidepressants ‘work’ mainly because people believe they do. The researchers write: ‘It is often assumed that the effects of antidepressants demonstrate that depression must be at least partially caused by a brain-based chemical abnormality, and that the apparent efficacy of SSRIs shows serotonin is implicated. ‘Other explanations for the effects of antidepressants have been put forward, including the idea they work via an amplified placebo effect.’ Even if antidepressants do have a placebo effect, they are active drugs that can have unpleasant side-effects, including loss of libido and emotional numbness. Some people can also struggle to come off them because of severe withdrawal symptoms. Take Emma Ward — she’s an NHS psychologist, which makes the way she was treated all the more incredible. We’ve changed her name to protect her identity at her request. Several times over the years, Emma had tried to wean herself off the various antidepressants she was put on as a teenager, but she was always defeated by the side-effects of withdrawal: ‘it felt like my brain was submerged in water in a really choppy sea’. Then, two months ago, desperate for help to come off the antidepressant fluoxetine, she spoke to her Community Mental Health Team, only to be told ‘bizarrely, and infuriatingly, I was just being “resistant to getting better” ’. By this stage, she’d done her own research and questioned the chemical imbalance theory — ‘but I was told not believing in it was an indication of paranoid thoughts, because the theory was “scientifically proven”. On that basis, they recommended I should start taking anti-psychotics’. Stevie Lewis, 66, a former business consultant was prescribed antidepressants after being told she had developed a chemical imbalance. Now a campaigner against the overuse of antidepressants and a board member of the International Institute for Psychiatric Drug Withdrawal, Stevie was on an SSRI for 17 years, most of which she spent ‘trying and failing to stop’ because the withdrawal effects were so severe. ‘I am outraged that I and so many other people have been persuaded to take a drug based on unproven science,’ says Stevie, from Catbrook, Monmouthshire. Women are more likely to be paying the price for the medical profession’s adherence to the myth of chemical imbalance, for the simple reason that more women than men are prescribed antidepressants. A survey by the Women’s Nutritional Advisory Service in 2019 found that 40 per cent of women experiencing perimenopause were prescribed antidepressants to help manage their (hormonal) symptoms. A study this year found women were more than twice as likely to be diagnosed with anxiety and prescribed antidepressants. Professor Martin Marshall, chair of the Royal College of GPs (RCGP), said this was because women are ‘more comfortable seeking help for mental health conditions’ than men. Stevie Lewis was first prescribed antidepressants in 1996, when she was 41, and began suffering intermittent insomnia and unexplained anxiety once a month. ‘I now know I was going through the classic perimenopause, but it wasn’t discussed in those days. Instead, I was told I was on the edge of a nervous breakdown, that I had a chemical imbalance in my brain and that these tablets would correct it. ‘What astonishes me is that doctors, who are supposed to be scientists, have perpetuated this story for the best part of 30 years. It is shameful.’ Shown the new research by Good Health, Dr Arif said that like legions of doctors before her, she’d been taught ‘that depression is caused by low serotonin’. She added: ‘If newer research is correcting this long-held belief, then I welcome the discussion and will look again at how I communicate how antidepressants work with my patients.’ Lead researcher behind the new review, Dr Horowitz, a training psychiatrist and clinical research fellow in psychiatry at University College London, said that during his training he, too, was taught depression was caused by low serotonin — ‘I even taught this to students in my own lectures’. Now, he says, ‘it feels like everything I thought I knew has been flipped upside down’. Professor Moncrieff says: ‘We do not understand what antidepressants are doing to the brain, and giving people misinformation prevents them from making an informed decision about whether to take them or not.’ What emerged from the new research was ‘how strong an effect adverse life events played in depression, suggesting low mood is a response to people’s lives and cannot be boiled down to a simple chemical equation’, the researchers noted. Yet surveys have shown the vast majority of patients believe their depression is caused by low serotonin or a chemical imbalance. ‘This belief,’ say the authors, ‘has been shown to lead to a pessimistic outlook on the likelihood of recovery.’ In June 2022, NICE issued its first new guidance in 12 years on treating depression, indicating that SSRIs should be considered as the first-choice antidepressant for more severe patients. It says its recommendations were ‘arrived at after careful consideration of the evidence available’, and a spokesperson told the Mail that ‘our recommendations were based on the evidence of effectiveness’. The Royal College of Psychiatrists said: ‘Antidepressants are an effective, NICE-recommended treatment for depression. We would not recommend for anyone to stop taking their antidepressants based on this review.’ Professor Marshall of the RCGP said: ‘This research is challenging, and it’s important it is taken into account as clinical guidelines are developed and updated. ‘Patients should not be concerned about taking antidepressants as a result, but if they are, they should continue to take them as prescribed and discuss this with their doctor at their next appointment.’ https://www.dailymail.co.uk/news/art...no-reason.html |
July 22nd, 2022 | #2 |
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Depression is probably not caused by a chemical imbalance in the brain – new study
Published: July 20, 2022 6.12am BST Updated: July 21, 2022 11.32am BST Authors Joanna Moncrieff Senior Clinical Lecturer, Critical and Social Psychiatry, UCL Mark Horowitz Clinical Research Fellow in Psychiatry, UCL For three decades, people have been deluged with information suggesting that depression is caused by a “chemical imbalance” in the brain – namely an imbalance of a brain chemical called serotonin. However, our latest research review shows that the evidence does not support it. Although first proposed in the 1960s, the serotonin theory of depression started to be widely promoted by the pharmaceutical industry in the 1990s in association with its efforts to market a new range of antidepressants, known as selective serotonin-reuptake inhibitors or SSRIs. The idea was also endorsed by official institutions such as the American Psychiatric Association, which still tells the public that “differences in certain chemicals in the brain may contribute to symptoms of depression”. Countless doctors have repeated the message all over the world, in their private surgeries and in the media. People accepted what they were told. And many started taking antidepressants because they believed they had something wrong with their brain that required an antidepressant to put right. In the period of this marketing push, antidepressant use climbed dramatically, and they are now prescribed to one in six of the adult population in England, for example. For a long time, certain academics, including some leading psychiatrists, have suggested that there is no satisfactory evidence to support the idea that depression is a result of abnormally low or inactive serotonin. Others continue to endorse the theory. Until now, however, there has been no comprehensive review of the research on serotonin and depression that could enable firm conclusions either way. At first sight, the fact that SSRI-type antidepressants act on the serotonin system appears to support the serotonin theory of depression. SSRIs temporarily increase the availability of serotonin in the brain, but this does not necessarily imply that depression is caused by the opposite of this effect. There are other explanations for antidepressants’ effects. In fact, drug trials show that antidepressants are barely distinguishable from a placebo (dummy pill) when it comes to treating depression. Also, antidepressants appear to have a generalised emotion-numbing effect which may influence people’s moods, although we do not know how this effect is produced or much about it. First comprehensive review There has been extensive research on the serotonin system since the 1990s, but it has not been collected systematically before. We conducted an “umbrella” review that involved systematically identifying and collating existing overviews of the evidence from each of the main areas of research into serotonin and depression. Although there have been systematic reviews of individual areas in the past, none have combined the evidence from all the different areas taking this approach. One area of research we included was research comparing levels of serotonin and its breakdown products in the blood or brain fluid. Overall, this research did not show a difference between people with depression and those without depression. Another area of research has focused on serotonin receptors, which are proteins on the ends of the nerves that serotonin links up with and which can transmit or inhibit serotonin’s effects. Research on the most commonly investigated serotonin receptor suggested either no difference between people with depression and people without depression, or that serotonin activity was actually increased in people with depression – the opposite of the serotonin theory’s prediction. Research on the serotonin “transporter”, that is the protein which helps to terminate the effect of serotonin (this is the protein that SSRIs act on), also suggested that, if anything, there was increased serotonin activity in people with depression. However, these findings may be explained by the fact that many participants in these studies had used or were currently using antidepressants. We also looked at research that explored whether depression can be induced in volunteers by artificially lowering levels of serotonin. Two systematic reviews from 2006 and 2007 and a sample of the ten most recent studies (at the time the current research was conducted) found that lowering serotonin did not produce depression in hundreds of healthy volunteers. One of the reviews showed very weak evidence of an effect in a small subgroup of people with a family history of depression, but this only involved 75 participants. Very large studies involving tens of thousands of patients looked at gene variation, including the gene that has the instructions for making the serotonin transporter. They found no difference in the frequency of varieties of this gene between people with depression and healthy controls. Although a famous early study found a relationship between the serotonin transporter gene and stressful life events, larger, more comprehensive studies suggest no such relationship exists. Stressful life events in themselves, however, exerted a strong effect on people’s subsequent risk of developing depression. Some of the studies in our overview that included people who were taking or had previously taken antidepressants showed evidence that antidepressants may actually lower the concentration or activity of serotonin. Not supported by the evidence The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants. Most antidepressants now in use are presumed to act via their effects on serotonin. Some also affect the brain chemical noradrenaline. But experts agree that the evidence for the involvement of noradrenaline in depression is weaker than that for serotonin. There is no other accepted pharmacological mechanism for how antidepressants might affect depression. If antidepressants exert their effects as placebos, or by numbing emotions, then it is not clear that they do more good than harm. Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact, research has shown the opposite, and also that people who believe their own depression is due to a chemical imbalance are more pessimistic about their chances of recovery. It is important that people know that the idea that depression results from a “chemical imbalance” is hypothetical. And we do not understand what temporarily elevating serotonin or other biochemical changes produced by antidepressants do to the brain. We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe. If you’re taking antidepressants, it’s very important you don’t stop doing so without speaking to your doctor first. But people need all this information to make informed decisions about whether or not to take these drugs. https://theconversation.com/depressi...w-study-186672 |
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