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  1. It is so gratifying to see psychiatry held accountable. Thank you Ang, Horowitz, and Moncrieff for not letting psychiatry off the hook! * Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the scientific literature by Benjamin Ang, Mark Horowitz, Joanna Moncrieff Received 23 November 2021, Revised 26 March 2022, Accepted 9 April 2022, Available online 18 April 2022, Version of Record 25 April 2022. Link to full article, available for free: https://www.sciencedirect.com/science/article/pii/S266656032200038X?via%3Dihub#bib14 * Abstract The theory that depression is caused by a serotonin abnormality or other chemical imbalance has become widely accepted by the public and is one prominent justification for the use of antidepressants. However, it has been increasingly questioned and there is little evidence it has empirical support. In response, leading psychiatrists suggested it was an ‘urban legend’ that was never taken seriously by the psychiatric profession. To interrogate these claims, we examined the coverage of the serotonin theory of depression in a sample of highly cited and influential academic literature from 1990, when the theory started to be popularized, to 2010 when these responses were articulated. We analysed 30 highly cited reviews of the aetiology of depression in general, 30 highly cited papers on depression and serotonin specifically and a sample of influential textbooks. The majority of the aetiology reviews supported the hypothesis, including some that were entirely devoted to describing research on the serotonin system, and those that reviewed the aetiology of depression more broadly. Research papers on the serotonin system in depression were highly cited and most of them strongly supported the serotonin theory. All textbooks supported the theory, at least in some sections, and devoted substantial coverage to it, although some also acknowledged it remained provisional. The findings suggest that the serotonin theory was endorsed by the professional and academic community. The theory is compared to an exhausted Kuhnian paradigm with professional equivocation about it acting as a means of defending it against encroaching criticism. The analysis suggests that, despite protestations to the contrary, the profession bears some responsibility for the propagation of a theory that has little empirical support and the mass antidepressant prescribing it has inspired. *
  2. Here is my prescription history, or what I remember of it and where I'm at now. I don't remember most of the meds I've been put on, but I do remember being put on Paxil by my PCP when I was 19 after going through unbearable depression, or what I thought was unbearable at that time. I was not given any other recommendations, such as seeing a psychologist or LCSW. At 19 years old, I thought my Doctor knows best and I should do what my Doctor tells me. Once I met my husband about 4 years later, I decided to try something else due to a lack of libido, which I had been struggling with before my husband. My PCP prescribed me Zoloft and I had a terrible reaction to that. I was manic; crying and laughing at the same time. My emotions were in overdrive. I can't remember the two or three other scripts I tried, but they weren't good either. Finally, Lexapro worked better. Then, when money was tight I went back to my PCP to see about being put on a generic for Lexapro. There was no generic for Lexapro but she told me the generic for Celexa, Citalopram would be comparable to the Lexapro. I went on that and it worked, but I still had no libido. But, after going through so many pills and the bad episode with Zoloft, I didn't want to experiment anymore. About 5 years later, when life has been good and my husband and I are looking to have a baby, I do not want to be on meds if I get pregnant. I have been wanting to get off meds well before thinking about having a baby, but wanting a child has kicked this in gear. Other than antidepressants, I live a fairly holistic life. I avoid Tylenol, advil or any over the counter drugs. I eat mostly a plant based diet, with the occasional treat if we are somewhere that does not offer plant based choices. I have been off Citalopram for about 3 months now, but am convinced I am still going through withdrawal despite seeing my psychiatrist who has weaned me off slowly. I took even slower than the Dr advised because I was scared to go through what I went through on Zoloft. I was taking 20mg and I followed a cycle of 20/15 each day for one month, 15 for a whole month, 15/10 for one month, 10 for one month, 10/5 for another month, 5 the next month, 5/nothing for the next and eventually nothing. Throughout the weaning off, I had tingly fingers, these jolts in my head, that I later found out through research were brain zaps. Up until last week, which had been 3 months off of Citalopram, I was getting dizzy spells. When driving a few times, I had to pull over because my vision was like looking into a fun house mirror and my head would spin. I am also experiencing extreme anxiety like I have never had before in my life. I was vomiting and feeling like the world was caving in around me and having issues breathing before going to work everyday or when I had a presentation at work. I work in sales and having this debilitating anxiety is not acceptable in my line of work. I am scared I won't keep up and lose my job in the state I am right now. I needed to get back on track fast before things spun out of control. I saw my Psychiatrist on Thursday and I told him about the extensive research my husband and I have done on SSRI Discontinuation Syndrome and my Dr was quick to shut me down and tell me that wasn't it because I've been off my meds for 3 months now. My Psychiatrist gave me a prescription for 0.5 mg of Clonazepam with instructions to take ¼ to 1 tablet twice a day as needed for anxiety. I took a ¼ once each day on Thursday and Friday. I immediately stopped after that because I hated the way I felt. I felt drowsy, sleepy, lethargic and unambitious. This cannot happen with my job in sales where I have to create my own work and leads. I also had issues driving; I felt like the road was curving or weaving where it does not. Luckily, this was happening on my way home where I knew the roads so well that I was able to remember how the roads actually go. After this drive home on Friday, I knew I could not continue taking the Clonazepam. It is Sunday now and I have no idea what to do. Do I go back to the Doctor to try a different benzodiazepine or have it on hand just in case my anxiety gets bad or do I try to continue being off any meds? I really don’t want to be on anything, but I also know it has been very difficult to function and I don’t want to lose my job because I can’t function. My plan of attack for the week is to try to get through the week with no meds and try using breathing techniques, relaxation method and worry beads when I feel an anxiety attack coming on. I am going to look up meditation techniques on You Tube to see if I can find some meditations to calm my mind before bed and in the morning before work. I want to get through this without meds. I am worried the period of time I have been on meds might have done permanent damage. I have an appointment to see an integrative health specialist on Valentine's Day and I hope he has some insight and orders tests that can tell me more about what's going on in my head and with my body. As a side note - ethically, should I officially break up with my Psychiatrist if I don't want to see him anymore? Like write him a letter or tell him when I go to my follow up visit in 3 weeks?
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