Tuesday, September 27, 2011

Pharma-psychology – is it faith based medicine?

I know this is an inflammatory question – but it still needs an answer, is pharma-psychology, the treatment of mental problems by drugs alone - based on faith – pharmaceutical faith? The medicines, the pharmaceutical drugs that have been developed for use in situations when a person’s mind is deemed to be unhinged or they are behaving in a manner considered to be “abnormal”, work up to a point. But no one (psychiatrists, psychologists, neuro-scientists, pharmacologists et al) knows WHY or HOW they work or what the long-term effects of continuous use are. They are adopting a “suck it and see” approach with people’s brains (and minds) – they are in effect using the affected people as guinea-pigs - which I think is both appalling and unethical.

While I have no faith (that word again) in statistics they are useful up to a point, in generalisations. So, generally, if one considers the commonly used Prozac - the results, compared to a placebo (a “sugar pill”), show that only about 50% of people who take the drug appear to benefit. Up to 33% suffer side effects – ranging from insomnia to reduced libido – that is 33 people out of every 100 who take Prozac. This is an astonishing result – so why use them?

In spite of what the pharmaceutical companies would like us to believe, while antidepressants such as Prozac do increase serotonin levels in the brain, this doesn’t mean that depression is caused by a shortage of serotonin. After all, paracetamol may reduce the unpleasant effects of a headache, but this doesn’t mean that a headache is caused by a deficiency of paracetamol!

The truth is that researchers know very little about how antidepressants work. A test that can measure the amount of serotonin in the living brain has yet to be developed. There is no way to even know what a “normal” level of serotonin is, let alone a low level, and it has yet to be shown if or how medication corrects these levels.

Many studies contradict the chemical imbalance theory of depression. Experiments have shown that lowering people’s serotonin levels doesn’t always lower mood, or worsen symptoms for those already depressed. And, furthermore, while some types of antidepressants may raise serotonin levels within hours, it takes weeks before the medication is able to (apparently) relieve depression. If a deficiency in serotonin actually causes depression, this time lag would not exist.

Also it is essential to be aware that the side effects of these drugs, without exception, are unpleasant – in fact some drugs (i.e. lithium) are positively lethal. It is very important to first read the warnings printed on the document inside every box of any medication.

It may be hard to believe but with some people there is the danger that a total reliance on antidepressant medication may cause an increase, rather than a decrease, in depression and with it, an increased risk of suicide. While this is particularly true of children and young adults on antidepressant medication, anyone taking antidepressants should be closely watched for suicidal thoughts and associated behaviour. The suicide risk is particularly great during the first few months of antidepressant treatment.

So, again, why use the stuff in the first place? It is important to recall the fact that no behaviour or misbehaviour (however aberrant - Alzheimer’s and Huntingdon’s accepted) can be categorised as a disease – in spite of the fact that many people now use the term “mental illness”. If you’re suffering from depression, antidepressant medication, used under the guidance of a mental health professional, may relieve, temporarily, some of your symptoms. But antidepressants aren’t a silver bullet for depression. Medication doesn’t cure the underlying problem and is rarely a long-term solution. As mentioned above there are real questions about their effectiveness and the many profound and disturbing side effects.

So to get back to my original question – is the exclusive use of medication to treat mental disturbances based on a faith in pharma-psychology? I believe it is. I also believe this faith is based on a flawed interpretation of the causes and the many issues associated with mental health. It is a false faith and is doing incalculable long term harm to many people.


Unknown said...

I do not understand your comment that we do not know how drugs work that are prescribed for psychological disorders. We most certainly are learning how they work, and we know what they affect.

We understand that hypofrontality is connected to ADHD, for example, and that when the metabolism of this area is low, then the blood flow is slowed as well. When this area (prefrontal cortex) is not able to receive enough blood flow, then the patient suffers from poor impulse control, poor focus ability, and a reduce capacity for future planning.

When stimulants that attack this area are administered, the blood flow increases, and the prefrontal cortex works better.

Another example we are seeing in this field is that serotonin is complicated, and that it affects different areas of the brain differently. However, as we whittle down the types of serotonin deliverance, we see that OCD and PTSD are related to low levels of serotonin. Treating these psychological disorders with both therapy and the right cocktail of 5-HT works better than either 5-HT or therapy alone. Therefore, there is no faith involved; it is science helping therapy.

We even see help from Beta blockers for panic attack/anxiety disorder patients, because they create a better chance for GABA to do its job at the synapse. GABA helps reduce blood pressure, heart rate, and allows for the parasympathetic nervous system to kick in enough for someone with with anxiety to feel some relief.

I could only call pharmapsychology a faith-based activity if I was uneducated. In fact, most of the people I talk to who scoff at psych meds have no idea how they work or have any idea what neurotransmitters are. Since you have degrees, I am incredulous that you would think this. Could it be that the newness of this science is what you are referring to at this point?

I believe that in years to come we are going to see this field grow by leaps and bounds.

Andrewlifecoach said...

Thank you for your informed comment - I appreciate the knowledge you obviously have on this subject. I also apologize for not replying sooner.
My reasons for having no "faith" in pharma-psychology is that the cause and effect aspect of an individuals mental problem has yet to be established. You comment on ADHD - but what causes ADHD? Is it a chemical imbalance(as you suggest), or was some emotional event? No one knows. Find out, first, what caused the ADHD then,address the problem. But what, for example, is the correct level of any chemical in the brain? If someone is told they have a "chemical imbalance" in the brain what does this mean exactly? How is it determined? What is a "normal" balance? Again no one knows.
After over one hundred years of research there is still no objective test for psychosis. As you would know it is a matter of a health professional's judgement regarding the apparent behavioural and thought disorder patterns presented by an individual. How will prescribing drugs solve the problem?
You appear to have "faith" as well - believing as you do that "in years to come we are going to see this field grow in leaps and bounds".