OR: How Does This Crap Get Into Reputable Journals?
Moncrieff J, Cohen D. (2006). Do antidepressants cure or create abnormal brain states? PLoS Med. 3:e240 [Epub ahead of print]Here we have a rare example of the anti-psychiatry movement in the realm of academic medicine. Another strain of this movement is represented by Tom Cruise.
Antidepressants are assumed to work on the specific neurobiology of depressive disorders according to a "disease-centred" model of drug action. However, little evidence supports this idea. An alternative, "drug-centred," model suggests that psychotropic drugs create abnormal states that may coincidentally relieve symptoms. Drug-induced effects of antidepressants vary widely according to their chemical class—from sedation and cognitive impairment to mild stimulation and occasionally frank agitation. Results of clinical trials may be explained by drug-induced effects and placebo amplification. No evidence shows that antidepressants or any other drugs produce long-term elevation of mood or other effects that are particularly useful in treating depression.
The essay's argument is incoherent and relies entirely on the following analogy:
Alcohol can relieve symptoms of social phobia, but this does not mean that alcohol corrects a chemical imbalance underlying social phobia.
The authors skip right over their (unstated) assumption that depression has nothing to do with the brain. Hmm, so moods and thoughts are not caused by the brain? Perhaps they are caused by "spooky stuff" -- Cartesian souls or spirits that exist in the ether somewhere.
The last sentence of the essay:
We have proposed an alternative drug-centred model of drug action that is consistent with a demedicalised approach to depression.
Um, no they haven't. They gave absolutely no evidence that we should abandon a disease-centered model of psychotropic drug action. It's not clear how antidepressants work, true, but that doesn't mean they're useless. And the concept of "demedicalization" isn't mentioned until that final sentence.
...abandoning the disease-centred model of antidepressant action squarely challenges the notion of depression as a biologically based medical disease. The argument presented here supports claims that the medical concept of depression obscures the diversity of problems and experiences that come to be so labelled, and that social explanations and interventions have been undervalued.That statement about social explanations came out of the blue. But you can read all about it here:
Moncrieff J. (2006). Psychiatric drug promotion and the politics of neo-liberalism. Br J Psychiatry 188:301-2.Sure, overpromotion of psychiatric drugs is bad, the history of psychiatry is littered with many instances of abuse, and really, I'm left-wing and anti-consumption, but... this whole line of reasoning is like creationism, but in the guise of progressive political thought.
The pharmaceutical industry has popularized the idea that many problems are caused by imbalances in brain chemicals. This message helps to further the aims of neo-liberal economic and social policies by breeding feelings of inadequacy and anxiety. These feelings in turn drive increasing consumption, encourage people to accept more pressured working conditions and inhibit social and political responses.
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