Re: No danger at all
"It is a rare reaction, yes. But your logic is so flawed its
ridiculous. You put so much emphasis on showing how meditation can cause
physical changes in the body, yet fail to comprehend how sometimes this can
actually not be good for a person."
Why is it then that all real research on meditation is nothing but
positive? If my logic is so "flawed its ridiculous" why can't
you support it with sources?
We in Western Society are a bunch of pill poppers. We look for
something to put in our mouth to cure anything from a headache to a cancer -
just like we did as an infant when we were frustrated only then it was either a
boob or a bottle. It's our first reaction.
When one is addressing something like depression why don't we ever look at
lifestyle? Tobacco use? Alcohol use? BMI (anything over 25 is
a contributing factor)? Exercise? Nope - we would rather take a
pill.
Have never seen anything regarding vitamin d and depression but there is a
great amount of literature on omega 3 and depression. If you read the book
The Omega 3 Connection you will find that the psychiatrist author uses omega 3
in huge quantities for clinical depression with some good results.
The "chemical imbalance" theory is just that. There is no
supporting evidence.
http://chriskresser.com/the-chemical-imbalance-myth
The "chemical imbalance" myth
A theory that is wrong is considered preferable to admitting our
ignorance.” – Elliot Vallenstein, Ph.D.
The idea that depression and other mental health conditions are caused by an
imbalance of chemicals in the brain is so deeply ingrained in our psyche that it
seems almost sacrilegious to question it.
Direct-to-consumer-advertising (DCTA) campaigns, which have expanded the size
of the antidepressant market (Donohue et al., 2004), revolve around the claim
that SSRIs (the most popular class of antidepressants) alleviate depression by
correcting a deficiency of serotonin in the brain.
For example, Pfizer’s television advertisement for Zoloft states that
“depression is a serious medical condition that may be due to a chemical
imbalance”, and that “Zoloft works to correct this imbalance.”
Other SSRI advertising campaigns make similar claims. The Effexor website
even has a slick video explaining that “research suggests an important link
between depression and an imbalance in some of the brain’s chemical
messengers. Two neurotransmitters believed to be involved in depression are
serotonin and norepinephrine.” The video goes on to explain that Effexor works
by increasing serotonin levels in the synapse, which is “believed to relieve
symptoms of depression over time.”
These days serotonin is widely promoted as the way to achieve just about
every personality trait that is desirable, including self-confidence,
creativity, emotional resilience, success, achievement, sociability and high
energy. And the converse is also true. Low serotonin levels have been implicated
in almost every undesirable mental state and behavioral pattern, such as
depression, aggressiveness, suicide, stress, lack of self-confidence, failure,
low impulse control, binge eating and other forms of substance abuse.
In fact, the idea that low levels of serotonin cause depression has become so
widespread that it’s not uncommon to hear people speak of the need to “boost
their serotonin levels” through exercise, herbal supplements or even sexual
activity. The “chemical imbalance” theory is so well established that it is
now part of the popular lexicon.
It is, after all, a neat theory. It takes a complex and heterogeneous
condition (depression) and boils it down to a simple imbalance of two to three
neurotransmitters (out of more than 100 that have been identified), which, as it
happens, can be “corrected” by long-term drug treatment. This clear and
easy-to-follow theory is the driving force behind the $12 billion
worth of antidepressant drugs sold each year.
However, there is one (rather large) problem with this theory: there is
absolutely no evidence to support it. Recent reviews of the
research have demonstrated no link between depression, or any
other mental disorder, and an imbalance of chemicals in the brain (Lacasse &
Leo, 2005; (Valenstein, 1998).
The ineffectiveness of antidepressant drugs when compared to placebo cast
even more doubt on the “chemical imbalance” theory. (See my recent articles
Placebos as effective as antidepressants and A closer look at the evidence for
more on this.)
Folks, at this point you might want to grab a cup of tea. It’s going to
take a while to explain the history of this theory, why it is flawed, and how
continues to persist in light of the complete lack of evidence to support it. I
will try to be as concise as possible, but there’s a lot of material to cover
and a lot of propaganda I need to disabuse you of.
Ready? Let’s start with a bit of history.
The history of the “chemical imbalance” theory
The first antidepressant, iproniazid, was discovered by accident in 1952
after it was observed that some tubercular patients became euphoric when treated
with this drug. A bacteriologist named Albert Zeller found that iproniazid was
effective in inhibiting the enzyme monoamine oxydase. As its name implies,
monoamine oxydase plays an essential role in inactivating monoamines such as
epinephrine and norepinephrine. Thus, iproniazid raised levels of epinephrine
and norepinephrine which in turn led to stimulation of the sympathetic nervous
system – an effect thought to be responsible for the antidepressant action of
the drug.
At around the same time, an extract from the plant Rauwolfia serpentina
was introduced into western psychiatry. This extract had been used medicinally
in India for more than a thousand years and was thought to have a calming effect
useful to quite babies, treat insomnia, high blood pressure, insanity and much
more. In 1953 chemists at Ciba, a pharmaceutical company, isolated the active
compound from this herb and called it reserpine.
In 1955 researchers at the National Institutes of Health reported
that reserpine reduces the levels of serotonin in the brains of animals. It was
later established that all three of the major biogenic amines in the brain,
norepinephrine, serotonin, and dopamine, were all decreased by reserpine (again,
in animals).
In animal studies conducted at around the same time, it was found that
animals administered reserpine showed a short period of increased excitement and
motor activity, followed by a prolonged period of inactivity. The animals often
had a hunched posture and an immobility that was thought to resemble catatonia (Valenstein,
1998). Since reserpine lowered levels of serotonin, norepinephrine and dopamine,
and caused the effects observed in animals, it was concluded that depression was
a result of low levels of biogenic amines. Hence, the “chemical imbalance”
theory is born.
However, it was later found that reserpine only rarely produces a true
clinical depression. Despite high doses and many months of treatment with
reserpine, only 6 percent of the patients developed symptoms even suggestive of
depression. In addition, an examination of these 6 percent of patients revealed
that all of them had a previous history of depression. (Mendels & Frazer,
1974) There were even reports from a few studies that reserpine could have an antidepressant
effect (in spite of reducing levels of serotonin,
norepinephrine and dopanmine).
As it turns out, that is only the tip of the iceberg when it comes to
revealing the inadequacies of the “chemical imbalance” theory.
The fatal flaws of “chemical imbalance” theory
As Elliot Valenstein Ph.D., Professor Emeritus of psychology and neuroscience
at Michigan University, points out in his seminal book Blaming the Brain,
“Contrary to what is often claimed, no biochemical, anatomical or functional
signs have been found that reliably distinguish the brains of mental
patients.” (p. 125)
In his book, Valenstein clearly and systematically dismantles the chemical
imbalance theory:
- Reducing levels of norepinephrine, serotonin and dopamine does not
actually produce depression in humans, even though it appeared to do so in
animals.
- The theory cannot explain why there are drugs that alleviate depression
despite the fact that they have little or no effect on either
serotonin or norepinephrine.
- Drugs that raise serotonin and norepinephrine levels, such as amphetamine
and cocaine, do not alleviate depression.
- No one has explained why it takes a relatively long time before
antidepressant drugs produce any elevation of mood. Antidepressants produce
their maximum elevation of serotonin and norepinephrine in only a day or
two, but it often takes several weeks before any improvement
in mood occurs.
- Although some depressed patients have low levels of serotonin and
norepinephrine, the majority do not. Estimates vary, but a
reasonable average from several studies indicates that only about 25
percent of depressed patients actually have low levels of these
metabolites.
- Some depressed patients actually have abnormally high levels of
serotonin and norepinephrine, and some patients with no history of
depression at all have low levels of these amines.
- Although there have been claims that depression may be caused by excessive
levels of monoamine oxydase (the enzyme that breaks down serotonin and
norepinephrine), this is only true in some depressed patients and not in
others.
- Antidepressants produce a number of different effects other than
increasing norepinephrine and serotonin activity that have not been
accounted for when considering their activity on depression.
Another problem is that it is not now possible to measure serotonin and
norepinephrine in the brains of patients. Estimates of brain neurotransmitters
can only be inferred by measuring the biogenic amine breakdown products
(metabolites) in the urine and cerebrospinal fluid. The assumption underlying
this measurement is that the level of biogenic amine metabolites in the urine
and cerebrospinal fluid reflects the amount of neurotransmitters in the brain.
However, less than one-half of the serotonin and norepinephrine metabolites in
the urine or cerebrospinal fluid come from the brain. The other half come from
various organs in the body. Thus, there are serious problems with what is
actually being measured.
Finally, there is not a single peer-reviewed article that can be accurately
cited to support claims of serotonin deficiency in any mental disorder, while
there are many articles that present counterevidence. Furthermore, the Diagnostic
and Statistical Manual of Mental Disorders (DSM) does not list serotonin as
the cause of any mental disorder. The American Psychiatric Press Textbook of
Clinical Psychiatry addresses serotonin deficiency as an unconfirmed
hypothesis, stating “Additional experience has not confirmed the monoamine
depletion hypothesis” (Lacasse & Leo, 2005).
When all of this evidence is taken in full, it should be abundantly clear
that depression is not caused by a chemical imbalance.
But, as Valenstein shrewdly observes, “there are few rewards waiting for
the person who claims that “the emperor is really nude” or who claims that
we really do not know what causes depression or why an antidepressant sometimes
helps to relieve this condition.”
How have we been fooled?
There are several reasons the idea that mental disorders are caused by a
chemical imbalance has become so widespread (and none of them have anything to
do with the actual scientific evidence, as we have seen).
It is known that people suffering from mental disorders and especially their
families prefer a diagnosis of “physical disease” because it does not convey
the stigma and blame commonly associated with “psychological problems”. A
“physical disease” may suggest a more optimistic prognosis, and mental
patients are often more amenable to drug treatment when they are told they have
a physical disease.
Patients are highly susceptible to Direct-to-Consumer-Advertising (DCTA). It
has been reported that patients are now presenting to their doctors with a
self-described “chemical imbalance” (Kramer, 2002). This is important
because studies show that patients who are convinced they are suffering from a
neurotransmitter defect are likely to request a prescription for
antidepressants, and may be skeptical of physicians who suggest other
interventions such as cognitive behavioral therapy (DeRubeis et al., 2005). It
has also been shown that anxious and depressed patients “are probably more
susceptible to the controlling influence of advertisements (Hollon MF, 2004).
The benefit of the chemical imbalance theory for insurance companies and the
pharmaceutical industry is primarily economic. Medical insurers are primarily
concerned with cost, and they want to discourage treatments (such as
psychotherapy) that may involve many contact hours and considerable expense.
Their control over payment schedules enables insurance companies to shift
treatment toward drugs and away from psychotherapy.
The motivation of the pharmaceutical companies should be fairly obvious. As
mentioned previously, the market for antidepressant drugs is now $12 billion.
All publicly traded for-profit companies are required by law to increase the
value of their investor’s stock. Perhaps it goes without saying, but it is a
simple fact that pharmaceutical companies will do anything they legally (and
sometimes illegally) can to maximize revenues.
Studies have shown that the advertisements placed by drug companies in
professional journals or distributed directly to physicians are often
exaggerated or misleading and do not accurately reflect scientific evidence (Lacasse
& Leo, 2005). While physicians deny they are being influenced, it has been
shown repeatedly that their prescription preferences are heavily affected by
promotional material from drug companies (Moynihan, 2003). Research also
suggests that doctors exposed to company reps are more likely to favor drugs
over non-drug therapy, and more likely to prescribe expensive medications when
equally effective but less costly ones are available (Lexchin, 1989). Some
studies have even shown an association between the dose and response: in other
words, the more contact between doctors and sales reps the more doctors latch on
to the “commercial” messages as opposed to the “scientific” view of a
product’s value (Wazana, 2000).
The motivation of psychiatrists to accept the chemical imbalance theory is
somewhat more subtle. Starting around 1930, psychiatrists became increasingly
aware of growing competition from nonmedical therapists such as psychologists,
social workers and counselors. Because of this, psychiatrists have been
attracted to physical treatments like drugs and electroshock therapy that
differentiate them from nonmedical practitioners. Psychiatry may be the least
respected medical specialty (U.S. General Accounting Office report). Many
Americans rejected Fruedian talk therapy as quackery, and the whole field of
psychiatry lacks the quality of research (randomized, placebo-controlled,
double-blind experiments) that serves as the gold-standard in other branches of
medicine.
Dr. Colin Ross, a psychiatrist, describes it this way:
“I also saw how badly biological psychiatrists want to be regarded as
doctors and accepted by the rest of the medical profession. In their desire to
be accepted as real clinical scientists, these psychiatrists were building far
too dogmatic an edifice… pushing their certainty far beyond what the data
could support.”
Of course there are also many “benefits” to going along with the
conventional “chemical imbalance” theory, such as free dinners, symphony
tickets, and trips to the Caribbean; consultancy fees, honoraria and stock
options from the pharmaceutical companies; and a much larger, growing private
practice as the $20 billion spent by drug companies on advertising brings
patients to the office. Psychiatrists are just human, like the rest of us, and
not many of them can resist all of these benefits.
In sum, the idea that depression is caused by a chemical imbalance is a myth.
Pharmaceutical ads for antidepressants assert that depression is a physical
diseases because that serves as a natural and easy segue to promoting drug
treatment. There may well be biological factors which predispose some
individuals toward depression, but predisposition is not a cause. The theory
that mental disorders are physical diseases ignores the relevance of
psychosocial factors and implies by omission that such factors are of little
importance.