Why Tell Us Now?

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Over the last month, one of the biggest news stories in the world has been the news that low levels of serotonin do not cause of depression, and antidepressants don't work as we were told they work. This is a massive story, a large paper has just revealed that we had been led astray by the "science" for some time, and now science was correcting the record. Prominent doctors are even admitting their mistakes here, such as Dr John Campbell. 

One report notes: 

"The study, which gathered evidence from 361 peer-reviewed scientific studies, found no link between depression and serotonin levels in the blood. Similarly, the researchers behind it found no differences in serotonin receptors or transporters in the brains of people with depression compared to brains of people without depression."

The news has been all about how a big revelation has been made, that we misunderstood depression all along. But the problem with this narrative is that it's all wrong. This has not just been revealed, the lack of a connection of serotonin to depression has been known for sometime. As Ethan Watters demonstrates: 

"This was before it was revealed that many of the most influential studies on SSRIs, supposedly by prominent academics, were in fact ghostwritten by private firms hired by drug companies. This was before it was widely known that many academics had taken hundreds of thousands of dollars (sometimes millions) in consulting and speaking fees while at the same time helping to hide or disguise data on the very drugs they were supposedly evaluating. 

It has only been in the past few years, in fact, that these issues have become a public scandal prompting ongoing litigation and an investigation in the US Senate. Many drugs and companies have been implicated in the recent upheaval, but one company and one drug have been at the very heart of the scandal: GlaxoSmithKline and Paxil. 

Under even the mildest scrutiny, the confident marketing messages proclaiming the scientific validity of SSRIs begin to break down. Take for instance the idea, often repeated in ads and promotional material surrounding the launch of SSRIs in Japan, that a depletion of serotonin is the root cause of depression and that SSRIs re-establish the 'balance' of 'natural' chemicals. Pharmaceutical companies have been repeating this idea ever since SSRI's came on the market twenty years ago. On their website the makers of SSRI Lepraxo are still telling the story: 'The naturally occurring chemical serotonin is sent from one nerve cell to the next...In people with depression and anxiety, there is an imbalance of serotonin - too much serotonin is reabsorbed by the first nerve cell, so the next nerve cell does not have enough; as in a conversation, one person might do all the talking and the other person does not get a comment, leading to a communication imbalance.'

Here's how GlaxoSmithKline describes the same idea on its website advertising Paxil CR: 'Normally, a chemical neurotransmitter in your brain, called serotonin, helps send messages from one brain cell to another. This is how the cells in your brain communicate. Serotonin works to keep messages moving smoothly. However, if serotonin levels become unbalanced, communication may become disrupted and lead to depression...Paxil CR helps maintain a balance of serotonin levels.'

Oft repeated as this story is, it turns out there is currently no scientific consensus that depression is linked to serotonin deficiency or that SSRIs restore the brains normal 'balance' of the neurotransmitter. The idea that depression is due to the deficits of serotonin was first proposed by George Aschcorft in the 1950's, when he thought he detected low levels in the brains of suicide victims and in the spinal fluid of depressed patients. Later studies, however, performed with more sensitive equipment and measures, showed no lower levels of serotonin in these populations. By 1970 Ashcroft had publicly given up on the serotonin-depression connections. To date, no lower levels of serotonin or 'imbalance' of the neurotransmitter have been demonstrated in depressed patients. The America Psychiatric Press Textbook of Clinical Psychiatry states simply, 'Additional experience has not confirmed the monoamine [of which serotonin is a subgroup] depletion hypothesis.'

SSRIs don't bring a patient's brain chemistry back into balance, but rather broadly alter brain chemistry. Although that change may sometimes help a depressed patient, the idea that SSRIs restore a natural balance of serotonin is a theory without evidence. Put another way, this idea is more of a culturally shared story than a scientific fact, in the exact same way neurasthenia's invocation of 'frayed nerves' was a story. 

What made this story so popular was that it turned out to be an effective marketing line, first employed in the United States and Europe and then around the world. SSRIs came on the heels of the public scandal about over prescription of benzodiazepines. These drugs, including Valium and Librium, were initially embraced by the medical establishment, until they were revealed to be highly addictive. As SSRIs came to market, the public was understandably wary of psychopharmacological agents. The story that SSRs only helped balance natural chemicals in the brain, therefore, was just what the public needed to hear. This marketing line was useful in a similar way in Japan, where many considered Western psychiatric medicines to be harsh and unnatural" (Crazy Like Us, 2010, pp.257-259). 

This was written in 2010 by a journalist who notes that his wife is a mental health professional. In other words, this information was readily available to medical professionals and others over a decade ago. This new study revealing that SSRIs do not do what we were told they do, and that a serotonin deficiency is not the cause of depression, is not only new, it is a well-known fact in the mental health profession, and has been for some time. Yet people have still been given these drugs, and told they do something, that it is known, they did not do. I know people personally who were told this, by medical professionals. But it was already known that low serotonin levels were not the sum of depression. 

So why tell us now, and why act like it is a big revelation? That is my question. Those of you who are aware of how the media and news work, know that the range of what can become a national or international story is driven by the advertisers on news networks. Their money influences stories, and the pharma industry has a massive hold over the news media, as this brought to you by Pfizer video highlights. This is especially true in America, which has a very dominant influence on the news media shared in the English speaking world. 

So why was this allowed to become big news now? I'll let your imagination run wild there. I wonder what motive the Pharmaceutical companies have to draw people's attention to a dodgy product over here, could it be that they want people to look away from the even more dodgy product over there? I am just surmising here.

Maybe this study was just too much for the medical industry to ignore? Maybe the level of scrutiny on pharma companies is just at an all-time high, and so there is value in sharing a study like the one just released. Maybe this is an entirely natural progression of the medical science correcting itself? Colour me dubious though. If Watters is right, then SSRIs were always known to never do what we were told they did, and this was kept from the general public until this time. Why? Well, because they made big money, that is obvious, they were and are an absolute cash cow. But why reveal now that serotonin was not the cause of depression? Why reveal now that SSRIs do not restore a chemical imbalance? 

We live in an interesting world.