It's in peer-reviewed print: no mental illness "chemical imbalance"

Great Debates
141

Being insulted by something doesn’t mean it isn’t true.

No, it’s very different. When you claim that your emotional problems are caused by a chemical imbalance, you’re making a scientific claim, not a religious one.

I don’t think anyone in this thread holds the opinion that psych drugs should be outlawed, or even that ECT should be outlawed (I certainly don’t). Nor is anyone in this thread promoting a “Make Guinastasia mentally ill” agenda. So calm down.

Let’s do trout fishing next, just for a change of pace.

142

I’m aware that environmental situations can serve as triggers, but never have I seen a reputable source claim that all causes of depression originate outside of the brain in the environment. I don’t think anyone understands the full complexity of the causes yet. They do know that changing the functioning of the nerve pathways in the brain can relieve some depression.

Google: “Harvard Medical Schools” “Consumer Health Information” “The Future of Depression Treatment”

Do you also think that all causes of Parkinson’s originate outside the brain? Is it possible that…

  1. Thinking of Parkinson’s Disease like it’s a physical disease absolves the patient of responsibility?
  2. Thinking of Parkinson’s Disease like it’s a physical disease absolves others in the patient’s life of responsibility?
  3. Thinking of Parkinson’s Disease as a physical disease means pharmaceutical companies can make a LOT of money?
    Of course my questions are outrageous. Your statements upon which I based them seem as ignorant to me.
143

This is a great example of how a closed mind operates to perpetuate ignorance. No matter how safe the procedure, no matter how severe the disease, this poster is just too freaked out by the concept that it is electricity. No other facts would matter.

Did you know that kids are treated with radiation too? For some conditions that radiation is focused into a concentrated beam at the growing brain. They are also pumped with toxic chemicals that nearly kill them. Sometimes injected directly into the fluid around their brains. Some will have learning difficulties as a result forever. Some heart problems. And they have no say in it. Their parents and doctors are deciding for them that their cancer is a severe enough disease to warrant treating them with effective measures.

Get over your being freaked out over the word “electricity.” What matters is risk versus benefits. The evidence there is solid. For appropriate indications, the significant risk of side effects (in particular on memory) are slight compared to the benefits in effecitively treating an extremely severe disease that is not responding to other measures.

144

“All causes”? Probably not. “Most causes”? I believe so. Do you think most people with severe depression go from happy and well-adjusted to waking up one morning and say “Gee, I feel like killing myself today.” or do you think they can identify one or more events in their life that are precipitated their downward spiral? They may have biological (e.g., genetic) or psychological risk factors that make it more likely they’ll actually develop depression as a result of the event, of course.

So? The fact that physical treatments work doesn’t mean that environmental causes aren’t predominate.

No. We’re talking about mental illness here. Parkinson’s disease ain’t in the DSM.

145

Cancer will kill a child if left untreated. Depression–on its own–won’t. Apples and oranges. And don’t you think that some of the depression a kid faces might not, I don’t know, be because they’re going through a lot of hormonal and social changes? The point is, we don’t know whether a child (or adult’s) depression is due to physical causes, psychological causes, or a combination of the two. We DO know the mechanisms of cancer. It’s a fallacy to compare the two.

I think kids should have the right to refuse cancer treatment, too. But that’s a whole other story.

146

Correct. Because they’re suffering from cancer, a physical disease that will kill them unless they’re treated.

However, mental illness isn’t a physical disease, and their deaths could also be prevented by more expensive psychosocial interventions (e.g., a secure facility) that kept them from harming themselves. Of course, that would be a great deal more expensive.

Now, let’s go back to the cancer analogy: Let’s say Phizer invents a new pediatric cancer drug, Elysioft, that has 25% chance of instantly curing cancer in children with no side effects. Unfortunately, Elysioft costs $1,000,000 per course of treatment.

Would Elysioft get routinely used? I’d be inclined to say “yes.” Would a depression-relieving psychosocial intervention that cost $1,000,000 (like, say, putting the depressed kid under round-the-clock care by a team of psychologists and social workers) by used? I doubt it.

Another difference that bothers me greatly is that, with cancer, the parent’s (who are making those major decisions) didn’t cause the cancer. With major depression, it’s very likely that the parents had a great deal to do with causing the depression. Somehow, letting the parents approve of brain-damaging therapies that will make their child more amenable to living in the shitty environment they’ve created just doesn’t seem just to me.

147

Why isn’t mental illness a physical disease? Why do drugs that upregulate dopamine receptors help treat positive symptoms (delusions, hallucinations) in schizophrenia? Why do drugs that block reuptake pumps for dopamine, norepinephrine or serotonin treat depression? Why does the metal lithium change a person’s personality when they are in a manic state? Depression is 40-70% genetic, the idea that it is due solely to behavioral and cognitive situations isn’t true. Some people are depressed no matter what and some people never get depressed no matter what. Some people respond to a setback or lifestyle change by developing a mental illness, and some people do not. Cognitive and behavioral situations alone do not cause mental illness unless the biochemistry making the mental illness possible already exists. If it did then everyone who had ‘situation X’ (losing a job, abuse) would respond exactly the same. But they do not. However on the other hand behavioral situations can play a major role in depression since homosexuals have rates of depression about 3-5x higher than non homosexuals. If homosexauls were not reviled and mocked I doubt their rates of depression or suicide would be any higher than the public at large. Obesity is also tied into depression.

Cancer on the other hand is a disease of lifestyle. Roughly 2/3rds of cancer deaths could be avoided with proper screening, healthy diet, regular exercise and not smoking. Combine that with other ways to decrease cancer (taking statins, taking aspirin, leading a low stress lifestyle, using nutritional supplements) and cancer death rates could be cut by 80-90%.

So the line between cancer being a ‘physical’ disease vs mental illness being a ‘cognitive’ disease is not really true. Cancer is due (in part) to bad lifestyle and depression is due (in part) to neurotransmitter imbalances.

Elysioft would be rarely used. Even if it is a miracle cure most people aren’t going to spend a million dollar for a 25% cure rate for cancer.

148

Yeah, lay another guilt trip on Mom.
I’ve not heard or read any reputable source that confirms this.
I am here to tell you that my own depression had nothing, zip, nada, zero to do with my upbringing. The only possible connection is that my mother had depression, too, except that in her day one did not speak of such things.

149

Nope, not trout fishing, into the nature/nurture etiology of illness, in particular mental illnesses. Both at least include people casting out lines and perhaps baiting a bit?

Diabetes: caused by both inheritied biologic factors and by environmental factors such as diet, exercise, and various habits/exposures, many of them learned at parents’ knees.

Hypertension: same.

Autism: in DSMIV and is mainly tracked to inheritable factors, despite the heyday of Bettelheim’s blaming it on “refrigerator mothers.”

Schizophrenia: in DSMIV and is mainly tracked to inheritable factors and perhaps certain environmental exposures but certainly not parenting style.

Depression: multiple twin studies documenting a large inheritable component with environmental triggers. Hormonal triggers. Situational triggers. Crappy parenting? Certainly can be a trigger in some but let’s face it, most of us can find many events in our lives that were lousy and have lots to complain about. As a parent I can tell you, I am lucky that most kids will turn out okay despite all the mistakes we all make.

I can go and pull up the cites documenting the large inheritable nature of depression and many other mental illnesses independent of environment. If any of you believe that “most” mental illness is caused by parenting style or social factors, then please provide the evidence for that or admit that it is just you pulling it out of your ass.

Risk/benefit analysis is something that we do for all potential interventions whether they are potentially fatal or not and whether they are caused by intrinsic biologic factors or environmental ones. Of course, the more severe the disease and the greater the benefit of the intervention, the greater the risk that is tolerable. On the one hand we have your proposed option of lockdown possibly forever feeling miserable and hopeless. On the other hand we have a few sessions of unilateral ECT and the very real risk of spotty memory loss of maybe a year of your life or more. And then being able to function again. Feeling better. Able to be a wife and mother or husband and father. Or in rare cases, able to go to your Prom and to college and to fall in and out of love and in again and live a life.

I know what I’d choose.

150

So because we don’t know what causes depression, we shouldn’t treat it?

And no, it won’t kill someone on its own. It will, however, make you WANT to kill yourself, most of the time.

151

Now that you’re apparently accusing me of trolling (and putting words in my mouth to boot), I think I’m going to bow out of this thread.

I NEVER FUCKING SAID THAT MOST MENTAL ILLNESS WAS CAUSED BY PARENTING.

Read what I said in context. I was speaking specifically of depression in children, and I didn’t even say that it was always caused by crappy parenting. As you said, there are situational and environmental triggers. And guess who has the most control over the environment that children live in? I met an awful lot of severely depressed children, and their families, and I can’t recall a single one that came from a happy home.

This is exactly the kind of attitude I was talking about when I gave reasons for why I thought the biological model was so fervently latched on to: The mere suggestion that crappy parenting is often responsible for depression in children sends you off on a defensive tangent (Depressed kids come from shitty homes created by crappy parents?? NO WAY! It’s genetics. And hormones. It’s just like diabetes!).

I wonder if another reason the biological model is so readily accepted is that it allows mental health care providers to rationalize their actions: They may not be able to make Johnny’s mom stop drinking, but they can write him an Effexor scrip. If you think of depression has a result of the person’s environment, then giving Johnny his happy pills is using chemicals to coerce him into accepting a shitty lot in life; if you think of depression has a biolgical disease, then writing the scrip is curing an illness, just like an ear infection.

I know which one I’d prefer to believe if I was in that position.

152

You shouldn’t bow out, this thread would be boring if everyone agreed on everything.

You do have a point that environment can play a major role in depression. Social stigmas like sexual abuse, feeling different in general or homosexuality can greatly increase the risk of depression.

SUBJECTS: 1189 women were screened and 237 subsequently interviewed; 132 were depressed. RESULTS: 49 (37%) of the depressed interviews and 24 (23%) of the non-depressed interviews reported experience of sexual abuse when they were aged under 16 years.

http://www.diet-blog.com/archives/2005/09/08/teen_obesity_shame_and_depression.php

Also, obese teens were more likely to say they had been treated in a degrading manner, had been ignored or otherwise had shaming experiences within the past three months than were their normal-weight or overweight peers.

Further, adolescents who reported the highest number of shame experiences were more than 11 times more likely to be depressed than those who reported the lowest number of shame experiences, the report indicates.

The association between obesity and major depression disappeared, however, after the researchers took into consideration the adolescents’ gender, parental employment, and parental separation, the report indicates.

Teenagers with unemployed parents and those in families in which the parents were separated were more likely to have depressive symptoms than their peers. In fact, these variables predicted major depression among the study group, the researchers note, and were unrelated to the teens’ weight.

http://www.narth.com/docs/whitehead.html

It concluded that on average, male homosexuals were 5.1 times more likely to exhibit suicide- related behavior or thoughts than their heterosexual counterparts. Some of this factor of 5.1 was associated with depression and substance abuse, which might or might not be related to the homosexuality. (
I know that I myself never suffered from depression before I developed schizophrenia, and it caused alot of damage for 6 years until I got chemical treatment for it. Once these events happen (abuse, shame, whatever) there really isn’t much you can do about them. You can’t go back in time and prevent the acts from happening. Most people can’t work through a problem just through therapy until they reach the point where they are just as mentally healthy now as they were before, they are going to need drugs to undo the damage that the event has done to them.

153

Even though I agree with you, I think this is a great argument and I am going to have to use it sometime.

I just have to take solace in the fact that some of these people have never actually seen what they are debating about. They are picturing one of their friends saying they are on Prozac when things actually get so much more distinctive and dire than that. It is like people that have never seen someone with terminal anorexia. Sounds simple enough, a girl want to be thin so she over diets. Get her to eat. The reality is so much more scary and different than that most people have no business discussing it until they have seen what is really happening.

154

Meta, the “baiting” bit was out of line … I apologize. The trout set-up was just irresistable. No need to yell, though. I can read just fine without caps.

a. Do you think you’d be a happy parent dealing with a chronically mentally ill kid?

b. If mental illness is to a large degree genetic then should it surprise you that other members of the household have some forms of mental illness as well?

c. Given these chicken-egg conundrums we each have to interpret our anecdotal experiences with caution. That is why those twin and adoptive studies are so important. Again, they show that the biggest role is genetics, the next biggest the individual (non-family) environment, and the shared (family) environment less important.

Which is not to say that family issues and counselling are unimportant, but the claim that childhood depression is “very likely” caused by crappy parents has no evidenciary basis. None. To define a parent as so poor of a parent as to not be compentent to make medical decisions for their children’s best interest, solely on the basis of their child’s having a depression, is, at best, unfair and unjustified.

I’ll grant you one thing. As a doctor I care most about what works. If a condition is caused by an environmental factor that I can’t change but I can safely treat the condition and reduce harm and enable function, guess what, whether it is DM or asthma or mental illness, I’m going to go for getting the indivdual better as my personal bottom line. That’s the medical model for you. We like using what works to get people better. Go figure.

155

Yeah, that’s Western allopathic doctors for you - just treating the disease.

Whereas homeopaths treat the patient.

d&r

156

It isn’t totally caused by it but it plays a role

http://www.cbsnews.com/stories/2003/01/23/world/main537754.shtml

Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study.

That study only found double the risk. And it could just be that those who are genetically prone to mental illness end up with one as a result of living in a broken home.

157

[QUOTE=Wesley Clark]
It isn’t totally caused by it but it plays a role

http://www.cbsnews.com/stories/2003/01/23/world/main537754.shtml

Children growing up in single-parent families are twice as likely as their counterparts to develop serious psychiatric illnesses and addictions later in life, according to an important new study.
/QUOTE]

Did they control for why the family broke up in the first place?

Ah:

“There may also be a genetic element: More irritable people are more likely to become separated, but they are also more likely, whether they are separated or not, to have more irritable children, Scott said.”

Ie the broken home could be just another way genetics plays out rather than environment as such.

Otara

158

And if you stop thinking of depression as an either/or situation and do some open-minded reading on the research, you will find that SSRIs are not “happy pills.” If you are not having physical problems with low seratonin levels, they are not going to make you “high.” They don’t make you “happy” anyway. They help to make your brain chemistry normal – not above normal. Rather than having to accept a “shitty lot in life,” one is more empowered to do something about it.

Certainly lousey parenting can have a depressing effect on a person. It can undermine self-esteem that can take years to rebuild. For many people, the added problem of lower seratonin levels makes the problem even more difficult to grapple with.

BTW, Parkinson’s Disease and depression are related illnesses – “cousins,” so to speak, in their causes. (I don’t mean to imply that depressed people get Parkinson’s or vice versa.)

Adding to the list of physical illnesses that are often associated with depression is polycystic syndrome.

I heard recently that for the first time researchers have been able to detect changes in the brain scan of depressed people. Do any of you know about any of these studies?

159

I’m saying you shouldn’t treat it with controlled brain damage that might make a kid lose a year of his life, which to him would be roughly a twelfth of it.

And Shag, Guin, et al, many of us on the “other side” (Am I on the other side? I’m certainly not as anti-psychiatry as AH3 or Metacom.) have had first-hand experience with serious mental illness or family members diagnosed with it and I feel it’s disingenious to act as though we come from a place of ignorance. I am not going to trot out my whole “pedigree” but suffice it to say that there are seriously mentally ill people in my family, I have been to a mental ward (though not as a patient), and I have struggled with issues that directly or indirectly led to the death of a relationship and several jobs. Hell, I pretty much want to die all the time, including right now. It is not necessary to say “oh, depression isn’t just feeling sad” every fifth post because we already know that. My opposition to ECT is not rooted in thinking depression doesn’t exist; it is because I feel that it is still not safe enough and I feel that patients are rushed into it without knowing all the risks. Two people can have the same information and experiences and still come to different conclusions. It’s happened before.

160

I think the above statement is why these discussions get so heated. Referring to anti-depressants as “happy pills”, unless you’re just kidding around, is really insulting to those who take them to treat legitimate medical conditions. I resent the implication that we just pop pills to avoid a “shitty lot in life.”

:rolleyes: