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posted by CoolHand on Friday April 24 2015, @03:11AM   Printer-friendly
from the the-big-corps-would-never-lie dept.

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.

Serotonin myth

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?

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  • (Score: 2, Insightful) by OrugTor on Friday April 24 2015, @05:01PM

    by OrugTor (5147) Subscriber Badge on Friday April 24 2015, @05:01PM (#174731)

    YES. Psychiatry is almost entirely empirical. There are no substantive models that explain the hardware/software complex that is the human brain. Don't knock DSM; of course it's just a dictionary, that's how clinicians can at least use the same diagnosis for the same cluster of symptoms. If ever psychiatry becomes a science then DSM will have to shape up.
    On a side note (mark me troll) I have no use for a DSM that has no code for religious belief.

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  • (Score: 1, Insightful) by Anonymous Coward on Saturday April 25 2015, @07:14PM

    by Anonymous Coward on Saturday April 25 2015, @07:14PM (#175129)

    You must have meant to say “not empirical” since empiricism [] is based on experience, revision, and falsification.