What Underlies Psychopharmacology?

[Altostrata]

This is a review of recent medical history by Allan M. Leventhal, Professor Emeritus of Psychology at American University in Washington, DC and co-author of The Myth of Depression as Disease, Praeger, 2006.

 

Dr. Levanthal was also co-author of “Just How Effective are Antidepressant Medications? Results of a Major New Study”, criticizing the STAR*D study, published in the June 2009 Journal of Contemporary Psychotherapy, and Efficacy and effectiveness of antidepressants: current status of research. http://survivingantidepressants.org/index.php?/topic/324-papers-about-antidepressant-effectiveness/page__view__findpost__p__3433

 

This article has an excellent list of citations.

 

http://dissidentvoice.org/2011/05/what-underlies-psychopharmacology/

What Underlies Psychopharmacology?

Three Systems

 

by Allan M. Leventhal / May 4th, 2011

 

The 20th century witnessed the development of three quite divergent explanatory systems to account for mental illness, each offering a distinctly different approach to treatment: psychoanalytic theory and treatment by psychoanalysis and its variants; a genetic theory of chemical imbalances of neurotransmitters in the brain, with treatment by prescription of psychiatric drugs; and a behavioral learning theory, offering treatments designed to eliminate the behaviors that characterize the mental disorders. Enough time has now passed to allow for a good reading as to the value of these different systems.

 

....

The Chemical Imbalance Theory

 

Psychiatry, which had boomed as a professional choice after WW II, began having considerable difficulty recruiting medical students to the field as psychiatric practices waned in the face of unsatisfactory results with psychoanalytic treatment and stiff competition from other professions. Medical students viewed specializing in psychiatry as a poor way to make a living.3 This crisis, which threatened the continued existence of psychiatry, produced a revolution in the field. In the early 1980s biologically oriented psychiatrists, despite being a small minority, persuaded their psychiatric colleagues to replace the field’s reliance on psychoanalytic (psychological) explanations for mental disorder with a theory based on neurotransmitters in the brain (a biological explanation) as the true cause. Overcoming stiff resistance from the analysts, they argued successfully that survival of the specialty of psychiatry required psychiatrists to practice like “real doctors” by treating their patients with medicine, not talk.

 

The change entailed explaining mental disorders as being due to genetic defects causing neurotransmitter imbalances in the brain. Four neurotransmitters were cited as being the cause of psychopathology: norepinephrine, dopamine, serotonin, and GABA. A wide array of mental disorders, such as schizophrenia, depression, anxiety, obsessive-compulsive disorder, as well as alcoholism, eating disorders, sleep difficulties, and shyness now were described as resulting from such chemical imbalances. Each disorder was attributed to a chemical imbalance correctable by prescription of drugs targeting particular neurotransmitters.

 

Psychiatrists, a good number of whom had been allowed to skip a medical internship because of their choice of psychiatry, abandoned their psychoanalytically-oriented practices and began espousing a neurochemical, genetic basis for their patients’ problems and treating their patients with drugs. Psychiatrists in charge of the NIMH reorganized the institute around this basic change in orientation, including eliminating the Psychotherapy Branch, which had supported research on psychotherapy. And a new Diagnostic and Statistical Manual of Mental Disorders (DSM-III) was published in line with this biological explanation for mental illness.

 

In testimonial to how successful this revolution has been, prescription of psychiatric drugs is now the “gold standard” for treating mental illness; psychiatry has regained its attraction to medical students as a specialty; psychiatric residencies concentrate on teaching brain neurochemistry and provide little training in psychotherapy; other medical practitioners have fully bought into this change, with an estimated 40% of the prescriptions for psychiatric drugs being written by non-psychiatric physicians; and psychiatric drugs now are among the biggest blockbusters in pharmaceutical industry sales, indicative of how the public has been led to embrace this theory and treatment.

 

What is the evidence for the chemical imbalance theory? The theory arose from observations by researchers in the 1950s of the side effects of several drugs being tested for other purposes. Miltown (meprobamate), the first drug marketed to treat anxiety, was discovered during research aimed at finding an effective agent against gram-negative microorganisms. Marsilid (iproniazid), the first drug offered as an antidepressant, was discovered during research on V-2 rocket fuel. Lithium, the drug still used to treat bipolar disorder, was discovered because of its industrial usefulness in metallurgy and ceramics. Researchers noticed that some of these compounds appeared to induce a sedative effect and others an energizing effect when people were exposed to them. Psychiatric researchers (many of whom were supported by the drug companies) began studying these compounds and when it was discovered that these drugs had an influence on neurotransmitters in the brain they speculated that an imbalance in neurotransmitters is the cause of mental illness. This was the prime basis psychiatry invoked in making the transformation from a psychological to a biological explanation for mental disorder.

 

Such backward reasoning, however, is not good science and subsequent research results bear this out. Contrary to the ads frequently seen on TV, studies have shown these claims to be without scientific merit. As Valenstein has pointed out the fact that aspirin helps to relieve headaches does not mean there is an aspirin deficiency in the brain. We now know there are not four neurotransmitters, there are hundreds, interacting with billions of neurons and trillions of synapses in complex and largely unknown ways. After more than fifty years of research, no single neurotransmitter or combination of neurotransmitters (serotonin, norepinehphrine, dopamine, acetylcholine) has been shown to be the cause of anxiety, depression, or schizophrenia.4

 

Depression, today’s prime psychiatric diagnosis, provides a ready example of the failure of the theory to be validated. Although antidepressant drugs are prescribed to boost serotonin, most depressed patients do not have low levels of serotonin or norepinephrine and some have very high levels; patients with no history of depression have been found to have low levels of serotonin and norepinephrine; studies have shown that reducing the levels of these neurotransmitters (with cocaine, for example) doesn’t cause depression, nor does increasing these neurotransmitters reduce depression. Reviewers of the scientific literature have reported not being able to find a single peer-reviewed study that supports the serotonin chemical imbalance theory for any mental disorder.5

 

The Physicians’ Desk Reference (PDR) is the main resource doctors use for information on drug actions and safety. Examination of the PDR discloses that regardless of which psychiatric drug is being reviewed, the evidence for a neurochemical explanation for effectiveness is described as “suggestive.” This characterization has about as much substance as red traffic lights in Naples, which drivers and the local police regard as “suggestions.” In science, when observations are suggestive one is at the level of hypothesis generation, not at a conclusion.

 

Thus, research results show that the chemical imbalance theories, just as was the case with psychoanalytic theories, are hypotheses, not verified statements of actions or outcomes – hypotheses that have failed when tested scientifically.

....

[cinephile]

In short, while the biological revolution in psychiatry shows little evidence of being beneficial for patients, it has been very good for business for psychiatrists and extraordinarily profitable for the pharmaceutical industry. The situation is analogous to the alliance of Wall Street bankers and traders, who with the help of some esteemed economists, established acceptance of a rationale for a financial system of great benefit to them personally. In the end the one-sided nature of the transactions led to an economic crash causing great financial losses for the public. Similarly, psychiatry and Big Pharma have perpetrated a utopian pharmaceutical mythology that serves their interests very well but has served the public very poorly. Drug treatment has not yet crashed, but there are ominous signs that we may be headed toward widespread mental disability as a consequence of this misguided treatment of mental disorder.

This is a brilliant point, one that I've come to realize. That is, seemingly more and more of our country's deepest problems (the economic crash due to housing crisis, the corruption of medicine by big pharma, the student loan crisis and the skyrocketing rates of higher education tuition) are related by one common denominator and surprise, it's not greed: it's DEREGULATION! Greed comes AFTER the deregulation. It's the deregulation and lack of watchdog oversight and restrictions that opens the floodgates for bottomless greed which of course leads to tremendous human suffering.

 

Tracing the roots of deregulation that has caused these crises is really fascinating: a lot of it started in the Clinton years (you'd intuitively think it would be the free-market conservatives). It continued, of course, into the Bush years and, most shockingly, continues today!

 

I really do think it's all related and we should learn, once and for all, that deregulation on this scale that affects our most precious commodities (our homes, our bodies/minds, and our higher education) DOES NOT WORK AND CAN CAUSE TREMENDOUS SUFFERING TO THE MASSES AND BENEFITS ONLY THE TOP 1% OF THE NATION'S WEALTHIEST.

 

God, how much evidence does this country need to wake up and take action?

[compsports]

Hi Surviving,

 

I was lucky to meet Dr. Leaventhal as he came to the Bob Whitaker presentation I went to last year. Great person.

CS

[nz11]

Excellent Thread...having a McDonalds moment ...'just lov'n it!