Serotonin hypothesis of depression was wrong

Move over serotonin; let's exploit glutamate in the treatment of depression. So suggests the journalist, Samantha Murphy, in a New Scientist article. Her argument is that the rise in treatment resistant depression reflects a realisation that antidepressants don't work. She holds out new hope for repetitive transcranial magnetic stimulation (rTMS) (see previous post), cranial electrical stimulation and ketamine. The speculation is that the release of glutamate by these treatments repairs the shrivelled dendrites of depressed people's neurones. She says at least 5 pharmaceutical companies are working on developing ketamine derivatives.

The academic paper to support this journalistic hype may be that by Duman & Aghajanian (2012) in Science. Look out for the promotion of a synaptogenic hypothesis of depression and treatment response. Scientific progress? Surely not.

Is APA prepared to engage with critical psychiatry?

At least Jeffrey Lieberman is prepared to engage with criticism of psychiatry in his role as President of the American Psychiatric Association (see his recent article in Psychiatric News). This is to be welcomed as mainstream psychiatry has tended to marginalise critique (eg. see previous post). True, Lieberman does tend to dismiss questioning of the integrity of psychiatry as Cartesian anti-psychiatry. He clearly has more work to do in taking this issue forward.

He sees psychiatry as a "scientific discipline and full-fledged medical speciality", but then doesn't explain what he means by this. Nor does he say what is meant by "the progress that has been made to deconstruct the almost unfathomable complexity of the brain into its constituent neurobiological mechanisms that mediate emotion, perception, and cognition". If there has been such progress he ought to be able to tell us what it is. He indicates that the technologies of "psychopharmacology, modern neuroimaging methods, and molecular genetics" are what have begun this process, but, again, does not spell out the references. He confidently states that "recent advances in research have shown us that they [mental disorders] are biological in nature and caused by genetics and environmental factors". However, we're clearly supposed to understand more for this claim than the merely tautologous connection.

I agree psychiatry has nothing to be defensive about this "noble mission", unless it's all a myth. Lieberman has a duty to clarify whether he's being realistic or pursuing a wishfulfilling phantasy.

(With thanks to Phil Hickey for a post on his Behaviorism and Mental Health blog).