The British Medical Journal provides an editorial from Professor David Healy, Head of Psychiatry at the Hergest psychiatry unit in Bangor in which it is stated:
When concerns emerged about tranquilliser dependence in the early 1980s, an attempt was made to supplant benzodiazepines with a serotonergic drug, buspirone, marketed as a non-dependence producing anxiolytic. This flopped. The lessons seemed to be that patients expected tranquillisers to have an immediate effect and doctors expected them to produce dependence. It was not possible to detoxify the tranquilliser brand.
Instead, drug companies marketed SSRIs for depression, even though they were weaker than older tricyclic antidepressants, and sold the idea that depression was the deeper illness behind the superficial manifestations of anxiety. The approach was an astonishing success, central to which was the notion that SSRIs restored serotonin levels to normal, a notion that later transmuted into the idea that they remedied a chemical imbalance. The tricyclics did not have a comparable narrative.
In the 1990s, no academic could sell a message about lowered serotonin. There was no correlation between serotonin reuptake inhibiting potency and antidepressant efficacy. No one knew if SSRIs raised or lowered serotonin levels; they still don’t know. There was no evidence that treatment corrected anything.
This lack of evidence-based practice was apparent to Thomas Insel, Director of the US National Institute Of Mental Health who announced in 2013 that the institute would abandon funding towards the DSM:
While DSM has been described as a "Bible" for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been "reliability" - each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
Does this mean that psychiatry is finally moving away from a practice akin to leeches for everything?
(Score: 0, Disagree) by Anonymous Coward on Friday April 24 2015, @01:49PM
I have a hard time believing anything that takes that long to start working is anything except placebo, especially since the withdrawal - sorry, "discontinuation syndrome" - kicks in after a few days at most of not taking it.
(Score: 3, Informative) by Yog-Yogguth on Saturday April 25 2015, @08:24PM
Well you're wrong in general there. In medicine/biology the usual reason some things takes a long time to give noticeable effect is that you're building up “something” gradually from a depleted low level in order to get it up and over a threshold value or into a range that is considered healthy/normal. It can of course also be about lowering a value or negating a function as with for example Methotrexate [wikipedia.org].
But slipping out of such a range often doesn't take much time if you stop with the medication even though it can take a long time before the last remnants of the medicine and all side effects are removed from the body. In the case of Methotrexate it takes upwards of three months after you stopped, but if you were still ill when you stopped then you are sure to notice the lack of medication much faster and far faster than it took to notice improvements when you started.
What I'm saying is that in most cases where people are sick they are really sick and the changes medicine —and in particular powerful medicine— are used for involve large corrections into relatively narrow ranges: hard to get to due to the illness and easy to slip out of due to the same illness.
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