The Myth of the Chemical Cure


‘The myth of the chemical cure’

Dr Joanna Moncrieff
Mental health expert

Taking a pill to treat depression is widely believed to work by reversing a chemical imbalance.

Medication is a mainstay of mental health therapy
But in this week’s Scrubbing Up health column, Dr Joanna Moncrieff, of the department of mental health sciences at University College London, says they actually put people into “drug-induced states”.

If you’ve seen a doctor about emotional problems some time over the past 20 years, you may have been told that you had a chemical imbalance, and that you needed tablets to correct it.
It’s not just doctors that think this way, either.

Magazines, newspapers, patients’ organisations and internet sites have all publicised the idea that conditions like depression, anxiety, schizophrenia and bipolar disorder can be treated by drugs that help to rectify an underlying brain problem.

People with schizophrenia and other conditions are frequently told that they need to take psychiatric medication for the rest of their lives to stabilise their brain chemicals, just like a diabetic needs to take insulin.

The trouble is there is little justification for this view of psychiatric drugs.

Altered states
First, although ideas like the serotonin theory of depression have been widely publicised, scientific research has not detected any reliable abnormalities of the serotonin system in people who are depressed.
Second, it is often said the fact that drug treatment “works” proves there’s an underlying biological deficiency.

Psychoactive drugs make people feel different

But there is another explanation for how psychiatric drugs affect people with emotional problems.

It is frequently overlooked that drugs used in psychiatry are psychoactive drugs, like alcohol and cannabis.

Psychoactive drugs make people feel different; they put people into an altered mental and physical state.

They affect everyone, regardless of whether they have a mental disorder or not.

Therefore, an alternative way of understanding how psychiatric drugs affect people is to look at the psychoactive effects they produce.

Drugs referred to as antipsychotics, for example, dampen down thoughts and emotions, which may be helpful in someone with psychosis.

Drugs like Valium produce a state of relaxation and a pleasant drowsiness, which may reduce anxiety and agitation.
Drugs labelled as “anti-depressants” come from many different chemical classes and produce a variety of effects.

Prior to the 1950s, the drugs that were used for mental health problems were thought of as psychoactive drugs, which produced mainly sedative effects.

‘Informed choice’
Views about psychiatric drugs changed over the course of the 1950s and 1960s.

They gradually came to be seen as being specific treatments for specific diseases, or “magic bullets”, and their psychoactive effects were forgotten.
However, this transformation was not based on any compelling evidence.
In my view it remains more plausible that they “work” by producing drug-induced states which suppress or mask emotional problems.

If we gave people a clearer picture drug treatment might not always be so appealing

This doesn’t mean psychiatric drugs can’t be useful, sometimes.
But, people need to be aware of what they do and the sorts of effects they produce.
At the moment people are being encouraged to believe that taking a pill will make them feel better by reversing some defective brain process.
That sounds good. If your brain is not functioning properly, and a drug can make it work better, then it makes sense to take the pill.
If, on the other hand, we gave people a clearer picture, drug treatment might not always be so appealing.
If you told people that we have no idea what is going on in their brain, but that they could take a drug that would make them feel different and might help to suppress their thoughts and feelings, then many people might choose to avoid taking drugs if they could.
On the other hand, people who are severely disturbed or distressed might welcome these effects, at least for a time.
People need to make up their own minds about whether taking psychoactive drugs is a useful way to manage emotional problems.
To do this responsibly, however, doctors and patients need much more information about the nature of psychiatric drugs and the effects they produce.

One response to this post.

  1. Posted by Dorothee Krien on October 30, 2009 at 8:34 am

    Reading the section on breathing and the central nervous system and psychiatric illnesses at by Artour Rakhimov, a Buteko breathing expert, I discovered that a number of psychiatrists did research into hyperventilation and depression, panic attacks, phobias in the eighties.

    Br Med J (Clin Res Ed). 1985 May 11; 290(6479): 1387–1390.

    PMCID: PMC1415586
    Copyright notice
    Respiratory and psychiatric abnormalities in chronic symptomatic hyperventilation.
    C Bass and W N Gardner

    Many physicians believe that the hyperventilation syndrome is invariably associated with anxiety or undiagnosed organic disease such as asthma and pulmonary embolus, or both. Twenty one patients referred by specialist physicians with unexplained somatic symptoms and unequivocal chronic hypocapnia (resting end tidal Pco2 less than or equal to 4 kPa (30 mm Hg) on repeated occasions during prolonged measurement) were investigated. All but one complained of inability to take a satisfying breath. Standard lung function test results and chest radiographs were normal in all patients, but histamine challenge showed bronchial hyper-reactivity in two of 20 patients tested, and skin tests to common allergens were positive in three of 18. Ventilation-perfusion scanning was abnormal in a further three of 15 patients studied, with unmatched perfusion defects in two and isolated ventilation defects in one. None of the 21 had thyrotoxicosis, severe coronary heart disease, or other relevant cardiovascular abnormalities. Ten of the 21 patients were neurotic and suffered from chronic psychiatric disturbance characterised by anxiety, panic, and phobic symptoms. The remainder had no detectable psychiatric disorders but reported proportionately more somatic than anxiety symptoms. Severe hyperventilation can occur in the absence of formal psychiatric or detectable respiratory or other organic abnormalities. Asthma and pulmonary embolus must be specifically excluded.


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