Dear Mrs. ——–

You have asked me about the cause of your mood disorder, and whether it is due to a “chemical imbalance”. The only honest answer I can give you is, “I don’t know”—but I’ll try to explain what psychiatrists do and don’t know about the causes of so-called mental illness, and why the term “chemical imbalance” is simplistic and a bit misleading.

By the way, I don’t like the term “mental disorder”, because it makes it seem as if there’s a huge distinction between the mind and the body—and most psychiatrists don’t see it that way. I wrote about this recently, and used the term “brain-mind” to describe the unity of mind and body.1 So, for lack of a better term, I’ll just refer to “psychiatric illnesses.”

Now, this notion of the “chemical imbalance” has been much in the news lately, and a lot of misinformation has been written about it—including by some doctors who ought to know better 2. In the article I referenced, I argued that “…the “chemical imbalance” notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.”1 Some readers felt I was trying to “re-write history”, and I can understand their reaction—but I stand by my statement.

The question of whether or not you should start taking antidepressants is complex and difficult to answer. But even fuzzier is the question of when or if you should stop. Last May, NPR ran a piece called Coming Off Antidepressants Can Be Tricky Business.

Joanne Silberner writes:

Several top psychiatrists say there’s just not enough data to say for sure when to try coming off an antidepressant. Drug companies generally test their new products for a few months or up to a year. They don’t spend much time looking into how to taper off their products. The dense informational inserts that come with prescription drugs have a lot of information on how to take the product, but no information on how to stop.

Seems to me the basic conflict between men and women, sexually, is that men are like firemen.  To men sex is an emergency, and no matter what we are doing we can be ready in two minutes.  Women, on the other hand, are like fire.  They are very exciting, but the conditions have to be exactly right for it to occur.”
~ Jerry Seinfeld

I just couldn’t decide if he was really sponge worthy.
~ Elaine, Fictional character on the TV show. Seinfeld

There seems to be rather compelling evidence that semen may be a natural antidepressant for women.  The intriguing feature about this finding is that it emerged from research with lesbians.

In the September issue of Scientific American an article (see source below) focused on the many virtues of semen.  No kidding.  It would seem an article like this would be a comic’s dream to find.  But even Jerry Seinfeld would have to give the facts a second look.

Perhaps we’ve seen the rise and fall of psychotherapy treatment. At least when it comes to depression, the most common mental disorder diagnosed today.

The numbers don’t lie, according to multiple nationally-representative surveys conducted over the past two decades.

At the start of the 1990s, psychotherapy was the treatment of choice for depression, with 71.1 percent of depressed people saying they had been treated with psychotherapy. By 1997, with the newer SSRI antidepressants firmly taking hold in prescribers’ toolboxes, that number had dropped to 60.2 percent.

When the latest research when conducted, they found 53.6 percent of depressed people surveyed in 1998 were in psychotherapy. When they looked again in 2007, that number had dropped to a new all-time low — to only 43.1 percent.

In two decades, psychotherapy went from being the primary treatment employed for depression, to becoming a minority treatment. What happened?

I’m still bothered by all the hype awhile back about antidepressants not working any better than sugar pills (otherwise known as placebo) because I know that the people who need treatment — possibly those that will go on to take their lives — read that story and decided there was no hope in medicine.

That’s why I like to publish insightful articles like the one I found in John Hopkin’s newsletter, “Hopkins Brain Wise.” They included an interview with Glenn Treisman, professor of psychiatry and internal medicine who is best known internationally for his care of HIV-infected patients who also suffer from a psychiatric illness.

Here’s the interview…

In her national bestseller “Potatoes Not Prozac,” Kathleen DesMaisons offers a seven-step dietary plan for sugar-sensitive people like me. I’ve tried to implement her suggestions into my diet because, as a recovering drunk and depressive, sugar can throw me into an emotional mess that gets downright ugly.

A diet rich in fiber and protein is crucial to my mental health — but for me, it’s Prozac AND potatoes.

Here’s what DesMaisons proposes:

You’ve been diagnosed with a mental disorder and have been in treatment now for years. You’ve done both psychotherapy and psychiatric medications, and now it’s time to try to live life drug-free. You’ve successfully ended your psychotherapy treatment, but now you’re looking for advice and information about how to end your psychiatric medications.

My first suggestion to you would be to talk to your doctor or psychiatrist. Nobody should go off of any medication without first getting their doctor’s consent and, hopefully, cooperation (or, if not their consent, at least their grudging acceptance that it’s your body and you can do with it what you want). Ideally, you’re seeing a psychiatrist for your psychiatric medications and not just your family doctor. If you are just seeing your family doctor, you may need a little more help than someone seeing a psychiatrist, because psychiatrists have much greater familiarity with helping people get off of the medications they previously prescribed to them. (In my experience, I’ve found many family doctors simply have little clue about the idiosyncrasies of discontinuing psychiatric medications, because of their unique tapering properties.)

Can omega 3 help treat depression? According to new research, the answer is yes.

In one of the largest studies on omega-3 supplements done to date, Canadian researchers found that for people who don’t also have an anxiety disorder with their depression, the popular omega-3 fish supplements helped improve depression symptoms.

The improvements the researchers found in this study were similar to improvements found in studies of antidepressants, suggesting that for some people, omega-3 may be an inexpensive antidepressant alternative.

I will dutifully report on yet another professional’s opinion about the research literature on antidepressants. This time the “antidepressant is just a placebo effect” argument comes from a psychologist.

Irving Kirsch, a professor of psychology at the University of Hull in the U.K., says that antidepressants are nothing more than fancy and expensive placebos. He, of course, does not say this in a vacuum. No, of course not. He’s saying this in promoting his new book, The Emperor’s New Drugs (which, you know, is a “funny” play on the phrase “the emperor’s new clothes”).

Read on for a quick deconstruction of his argument (his argument as presented in an interview online, anyways).

It’s not been a good news week for SSRIs, a popular and common class of antidepressants that are widely prescribed by family physicians, interns and psychiatrists alike.

A study released in the journal Ophthalmology showed that in seniors, SSRIs can increase the risk of developing cataracts in your eye by 15 percent in general. But researchers found it was even worse for some specific kinds of antidepressants — Fluvoxamine (Luvox) increases the risk by 39 percent, venlafaxine (Effexor) increases the risk by 33 percent and paroxetine (Paxil) increases the risk by 23 percent.

A separate study also published this week found that taking SSRI antidepressant medications (and the SNRI Effexor) significantly increased — by 68 percent — the risk of miscarriage.

Read on for the details…

Andrew Solomon offers this brilliant paragraph in his classic, “The Noonday Demon” about the relationship between medication and therapy, when we should make Herculean efforts to break free from depression or rather lie listless on our beds as victims of a loathsome illness: