"There is just absolutely no evidence that anyone with any mental disorder has a chemical imbalance of any sort...Absolutely None...And if we are telling that to our patients we're being dishonest I believe."
Joanna Moncrieff, (vid lecture)
Joanna Moncrieff, MD, is Professor of Critical and Social Psychiatry at University College London
Although antidepressants are regarded as effective and specific treatments, they are barely superior to placebo in randomised trials, and differences are unlikely to be clinically relevant. The conventional disease-centred understanding of drug action regards antidepressants as targeting an underlying brain process, but an alternative ‘drug-centred’ view suggests they are psychoactive substances that modify normal mental states and behaviour. These alterations, such as numbing of emotions, may reduce feelings of depression, and also create amplified placebo effects in randomised trials. Patients should be informed that there is no evidence that antidepressants work by correcting a chemical imbalance, that antidepressants have mind-altering effects, and that evidence suggests they produce no noticeable benefit compared with placebo. Declaration of interest The author is co-chairperson of the Critical Psychiatry …
The serotonin and noradrenaline theories of depression, which appear to explain the action of antidepressants in a disease-centred manner, are not supported by evidence or expert opinion. 15 , 16 Moreover, numerous randomised trials have shown that drugs that are not considered as antidepressants, and have actions on other neurotransmitter systems, including benzodiazepines, opiates, stimulants and antipsychotics, are as effective as recognised antidepressants in people with depression. 15
vid
Chapter 11 highlights how effective the drug industry has been in expanding the uses of antipsychotics into areas where the costs far outweigh the benefits for the individuals taking them, at the same time as psychiatry has effectively expanded the definition of mental illness. In particular, “off label” prescribing, i.e. prescribing a drug for a condition for which is not licensed, has grown at a phenomenal rate, particularly in the USA, whilst the numbers of people being diagnosed as having bipolar disorder, and more alarmingly the numbers of children being diagnosed with a serious mental illness (in some cases as young as 3 years of age) has rocketed. Indeed, it could be argued that bipolar disorder has become as fashionable a diagnosis for the gifted yet troubled soul in the 21st century as consumption was for the romantic poet and artist in the early 20th century. The problem with this shift in thinking about diagnosis is that it risks diminishing the suffering of those with a very real mental illness, and labelling and treating some unnecessarily.
https://www.psychiatrictimes.com/view/psychiatry-and-human-condition-joanna-moncrieff-md
The Bitterest Pills: The Troubling Story of Antipsychotic Drugs
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