Sunday, November 06, 2011

What if the drugs don't work?

Article in the Independent with this title. It mentions a debate between Ian Anderson (see previous blog entry) and Irving Kirsch (see another previous blog entry) with the motion "Antidepressants are useful in the treatment of depression" coming up at the 4th International Congress on Psychopharmacology of the Turkish Association for Psychopharmacology.

There's also a quote from Daniel Carlat (who blogs at The Carlat Psychiatry blog), who admits that, "When I find myself using phrases like 'chemical imbalance' and 'serotonin deficiency', it is usually because I'm trying to convince a reluctant patient to take a medication. Using these words makes their illness seem more biological, taking some of the stigma away." As I wrote in a BJPsych eletter, patients are able to understand that the chemical imbalance theory is only a theory. What they find more difficult to appreciate is why they are told that the theory has been proven when this is clearly not the case (see another previous blog entry).

Pleased also to see that Irving Kirsch is talking more about the nocebo effect from coming off antidepressants, as I have for some time (eg. summarised in my chapter in recent book Demedicalizing misery) . To quote from the Independent article, "If you expect to feel bad when you come off antidepressants, you will, because 'we tend to notice random small negative changes and interpret them as evidence that we are in fact getting worse', Kirsch says".


Adzcliff said...

Rightly or wrongly, I sympathise for GPs who are so often expected to prescribe pharmaceutical solutions to people's distress/unhappiness, but it seems that if they think biochemical explanations reduce stigma, then they might want to think again (taken from Ben Goldacre's Bad Science column:

"People who believed more in a biological or genetic cause were more likely to believe that people with mental health problems are unpredictable and dangerous, more likely to fear them, and more likely to avoid interacting with them. An earlier study in 1999 by Read and Law had similar results.

In 2002 Walker and Read showed young adults a video portraying a man with psychotic symptoms, such as hallucinations and delusions, then gave them either biogenetic or psychosocial explanations. Yet again, the “medical model” approach significantly increased perceptions of dangerousness and unpredictability.

In 2004 Dietrich and colleagues conducted a huge series of structured interviews with three representative population samples in Germany, Russia and Mongolia. Endorsing biological factors as the root cause for schizophrenia was associated with a greater desire for social distance."

Madeleine, London Marriage Counsellor said...

Thank you for the interesting blog and the comment by Adzcliff above.
In my practice as psychotherapist I see both sides of the spectrum, though I would agree with Adzcliff that perhaps the greater number of my clients have been anxious about anti-depressants, fearing "addiction" as well as stigma or the fear of becoming numb (and then not being able to work thorough the root causes).Others reported good outcomes on antidepressants when in deep crisis.
Equally, some have feared the term "psychotherapy" as implying that something is 'seriously wrong' (which would not be my interpretation at all) and preferred 'counselling'. I guess we have to remember that all these terms carry powerful associations, which in themselves could lead to placebo and nocebo effects.

Altostrata said...

Yes, there may be the nocebo effect coming off antidepressants for some people.

But for others, there also can be very severe long-lasting withdrawal symptoms that arise from a dysregulated nervous system. If you've experienced these, you know nothing nocebo about them!

I hope you did not intend to imply that antidepressant withdrawal syndrome is "all in the mind." I have a Web site full of suffering people who beg to differ, at