Kaya Matson is a senior biology major and neuroscience concentrator at Grinnell College. In her experience with neuroscience, she has always been struck by how little we know about the brain. Humans have 100-billion neurons in the brain, with each neuron making between 1-10,000 connections with other neurons; the amount of complexity in this connectivity is greater than the number of stars in the universe. Given our knowledge of the nervous system, we make remarkable assumptions in treating mental illnesses, such as depression. In this blog post Kaya took the opportunity to explore the roots of antidepressants in the United States in order to comprehend the prevailing uninformed trust of antidepressants.
Based on the current numbers of Americans treated for mental illness, it seems as though we are in the midst of a raging epidemic illness. Record numbers of people are being treated for mental illnesses such as depression, with “10 percent of all Americans over the age of 12… on antidepressants.” Over the last 25 years there has been a 350 percent jump in youth mental illness that coincidently aligns with the introduction of the popular antidepressant, Prozac. Antidepressants are seen as the cure for the “chemically imbalanced” brain. However, antidepressants may not be as effective as advertized.
In 2008, Dr. Irving Kirsch from Harvard University conducted a meta-analysis on the effectiveness of antidepressants. He and his colleagues found no significant difference in depressive scores between patients taking an antidepressant or a placebo. Are the effects of antidepressants simply the result of a placebo effect? Despite this evidence contesting the efficacy of antidepressants, antidepressants are continually prescribed.
Most psychiatrists have shifted from “talk therapy” to drugs as the dominant mode of treatment. In Unhinged: The Trouble With Psychiatry—A Doctor’s Revelations About a Profession in Crisis, Dr. Carlat treats a grieving woman whose father died in a car accident while she was behind the wheel. After an hour of consultation, Dr. Carlat prescribes the antidepressant Zoloft and the tranquilizer Klonopin, and refers her to a social worker, but does not offer her psychological counsel:
Carol saw me for mediations, and saw a social worker colleague for therapy. Her symptoms gradually improved, but whether this was due to the medications or the therapy, or simply the passage of time, I cannot say…We have convinced ourselves that we have developed cures for mental illnesses like Carol’s, 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.”[1]
Carol is not alone; even though 10% of Americans over the age of 12 are on antidepressants, less than 1/3 of them have seen a physician in the last year. Therefore, the dominant treatment of depression is a prescription (and only a prescription).
Depression was not always seen as a chemical imbalance. It was not until the modern “psychiatric revolution” that mental illnesses including depression were thought to be “caused by chemical imbalances in the brain that can be corrected by specific drugs.” Before the appearance of Prozac and similar antidepressant medications, depression was characterized in the 19th and 20th century as melancholic and nonmelancholic depression: conditions attributed to biological as well as social and environmental causes.[2] The singular term “major depression” was not defined until the 1980 edition of the Diagnostic and Statistical Manual (DSM), after the rise in popularity of antidepressant medications, which were used to treat all forms of depression, regardless of the root cause.
The transition to a single label for major depression came with a single prescription for depression. In the 1950s, antidepressant drugs such as MAOIs were found to increase levels of the neurotransmitter serotonin in the brain. Thus it was postulated that depression is caused by too little serotonin.[3] The most popular of these antidepressants, Selective Serotonin Reuptake Inhibitors (SSRIs) prevent the reuptake of serotonin by the neurons that release it, so the neurotransmitter remains in the synapse for a longer period, extending the period of excitation. Instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug. Given the small amount known about the brain, and in particular the depressed brain, the “chemical imbalance hypothesis” may be a step too far; using similar logic, one could argue that fevers are caused by too little aspirin. The main difficulty with this theory is that after decades of trying to prove the chemical imbalance hypothesis, researchers have still come up empty-handed.
The history of the treatment of depression in the United States has resulted in a reliance on antidepressant medications despite their increasingly evident ineffectiveness. Using antidepressants alone is a problem because depression is not just an individual problem; it is also a social problem. Depression is exacerbated in an individual, often due to outside factors. People who are most likely to become depressed are poor, unemployed and undereducated.4 By limiting their treatment to an antidepressant, their chances of relief from depression are limited to a placebo effect. Although it may be strong, the placebo effect does not alleviate symptoms caused by poverty, unemployment, or the loss of a loved one. Given recent evidence concerning antidepressants, we should ask the question: if antidepressants are ineffective, then why are they still the most common and singular form of treatment for depression?
*Those who are taking antidepressants right now should continue taking their medications. This blog post is not intended as a source of medical information and should not replace a visit to a doctor or emergency room. This blog post only expresses the opinion of the author and is intended to raise historical questions.
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1. Daniel J. Carlat, Unhinged: the trouble with psychiatry–a doctor’s revelations about a profession in crisis, (New York: Free Press, 2010), 4-5.
2. Laura D. Hirshbein, American melancholy: constructions of depression in the twentieth century, (New Brunswick, N.J.: Rutgers University Press, 2009), 50.
3. Daniel, J. Carlat, Unhinged: the trouble with psychiatry–a doctor’s revelations about a profession in crisis, (New York: Free Press, 2010), 40.
4. Ibid, 35-36.
