Posted by psychobot5000 on January 27, 2009, at 11:33:00
In reply to Re: Review Article Trashing Serotonin Hypothesis + Adv, posted by Larry Hoover on January 27, 2009, at 10:18:45
> I finally had time to read the paper, and if I was grading it, I'd give it at most a B-.
>
> The big problem is the recurrent conflation between two separate concepts, serotonin deficiency and chemical imbalance. They're not interchangeable concepts, and yet they treat them as if they are.
>I'd say that's true. However, isn't this conflation largely the fault of the advertisers they're covering? It seems to me that when 'chemical imbalance' is mentioned in reference to depression...the speaker (prescribing physicians and drug company reps etc) is almost inevitably talking about serotonin. Reading the paper, I understood immediately how the two concepts are frequently conflated. Now, granted, the authors of this paper don't actually make the point, instead seeming to conflate them themselves, which weakens their argument. But still, because of common assumptions about this in the medical community, I don't think the terms 'chemical imbalance' and 'serotonin deficiency' are actually very distinct the way they're used in practice (in reference to unipolar depression, at least). When someone says 'chemical imbalance'...everyone knows what chemical they're talking about. ...However, obviously the paper needed to do better work laying that out and not smooshing it all together themselves.
> Now, I'm not supporting the pharmaceutical advertisements literally, but given that mental illness remains heavily stigmatized, and that only 30% of depressed individuals obtain treatment for it, I think that anything that gets people to see their doctors is a good thing. A doctor prescribes not because a patient claims chemical imbalance, but because an examination and medical history yields a clinical diagnosis that may benefit from treatment.
>Hmm. That is a good point. I'm not against drug advertising either. However, here's one problem (in my view). I've talked with psychiatrists and psychiatric NPs who, based on the idea of a 'chemical balance' which I imagine they got from some combination of hopeful theorizing, direct-to-physician advertising, and conventional wisdom within the medical establishment, will refuse to prescribe -anything- -but- SSRIs. If you finished all four or five or six that were on the market without an adequate response, well then it was time to start over with the first one, which 'might work this time around.' ...Seems to me that the serotonin paradigm distorts prescriber practices, preventing them from using more effective 2nd and 2rd and 4th line treatments, and that to-physician advertising mirrors to-patient advertising. The former may distort physicians' understanding of the illness, and their understanding of how it ought to be treated. Through this, it also ends up marginalizing patients who -don't- respond to SSRIs (or those who can't tolerate them). Granted, advertising to (and group-think among) physicians, is outside the scope of this article. But I think it's all connected.
Merely a few quibbles. Good points, nice analysis.
Psychbot
poster:psychobot5000
thread:876214
URL: http://www.dr-bob.org/babble/20090104/msgs/876543.html