Antidepressant Smoke & Mirrors
by Frederick Ernst, Ph.D.
In a recent edition of the Wall Street Journal, Dr. Peter Kramer writes a defense of antidepressants and does a really nice job of convincing himself that what he is doing, prescribing drugs for people who are not ill, has merit. Unfortunately, he shared his thoughts with the Journal and, even more unfortunately, they published it.
The conclusions he has drawn are simply without merit. A science-informed reader would not have wasted time drifting past the first paragraph of this nonsense unless that reader was curious about the latest marketing-informed propaganda. So first, Dr. Kramer invents a new biochemical imbalance theory, one that not only has no support in science (like the one he’s trying to replace) but also has hardly even been mentioned in the literature of science. Brain resilience? This is a concept you can only find infrequently mentioned in connection with concussion or immune reaction. But according to Dr. Kramer, the “chemical properties of these drugs” (the SSRI’s) are inherently restoring resilience in the brain? (Please ignore here the evidence that these drugs are toxic and actually kill brain cells.)
“Little of the benefit comes from the classical placebo effect.” Says Dr. Kramer. He would be exactly correct if you believe more than 80% to be little. Drs. Joanna Moncrieff and Irving Kirsch should be invited to address this incredible statement! (see for instance http://www.contemporaryclinicaltrials.com/article/S1551-7144(15)30003-3/abstract). Further, Dr. Kramer exclaims, “I read the data with a doctorly eye.” That’s an interesting comment from a doctor identifying with a discipline that continues to wait for science to reveal validation of only one, a first, of its 350 so-called “mental” illnesses after 100 years of trying.
But, rest assured he will not abandon his authoritarian approach to the topic. He turns to a colleague to see if his experiences have been the same. And, of course, they both agree. Depression is getting better in those who are most depressed. Interestingly, and unintentionally, he provides the readers with a perfect example of why depression is not a brain disease that people wake up with one morning. Public health surveys (read, CDC science-based data) “are not fine-grained enough” so he turns to the ultimate science authorities… students and colleagues, and asks them what they see. And then, who does he describe as revealing evidence of this illness? Irma! A lady whose husband and daughter have died and, if things couldn’t get any worse, she now has heart disease. Sounds like an inexplicable endogenous depression to me. Clearly, one of her neurotransmitter systems has come down with something quite coincidentally following these three life events.
The lay public must be informed to understand that doctors are not trained as scientists. Skepticism is not promoted or even encouraged in the training of physicians and probably shouldn’t be. I certainly don’t want the surgeon for my emergency to be thinking about whether or not what he’s doing makes any sense. But of all medical specialties, psychiatry must be taught skeptically or it will never achieve the status of infectious disease medicine or cardiology, the leaders of science-based medicine.
A revolution in medical education is required for psychiatry to achieve the status of its peer disciplines. The foundational pillars of their discipline is marketing, with nearly unlimited underlying financial resources. Remove those dollars and this house of cards collapses under its own weight.
There simply is no science supporting these “treatments.” And, indeed, I will retract this statement in the most humiliating public way if any person on this planet can point to one study revealing that mental illness is an illness with a demonstrable underlying pathophysiology. Just one. Only one. Not much to ask. But as the subtitle of this article suggests, Dr. Peter D. Kramer has seen real benefits from antidepressants. That should be good enough for you.
All my sarcasm aside, the idea that human suffering and distress is a disease has not only long outlived any hoped-for usefulness, it has caused pervasive harm to our population. Mental illness portrayed as physical illness is a flawed idea based on a misconceived extension of metaphor resulting in irreparable harm to the world public. It’s time for a new paradigm and Dr. Kramer’s article is the exclamation point that I would add to the end of this sentence.