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Polemical Imbalance

Today is an exciting day for me. I got argued against on Mad In America. This one is going straight to my resume.

Mad In America apparently doesn’t like being called an anti-psychiatry blog, so let’s call it a blog…that discusses psychiatry…and doesn’t usually like what it sees. They were heavily involved in popularizing the idea that psychiatry erred grieviously in overselling “chemical imbalance”, and they didn’t much like my post on the same topic:

Alexander argues that the notion that psychiatrists once promoted the idea of low serotonin as a cause of depression and Selective Serotonin Reuptake Inhibitors (SSRIs) as proper treatment for that deficiency is all simply a false “narrative” invented by “antipsychiatry” activists. These activists then “frame it as ‘proof’ that psychiatrists are drug company shills who were deceiving the public.” Alexander points to quotes of American Psychiatric Association officials in a post by MIA Blogger Philip Hickey, and notes that none of the quotes specifically describe a low-serotonin explanation for depression. The Hickey post cited is not actually about that topic, but about the promotion of the phrase “chemical imbalance”; nevertheless, Alexander broadly refers to Hickey and all of Mad in America as “antipsychiatry”, and he then writes, “If the antipsychiatry community had quotes of APA officials saying it’s all serotonin deficiency, don’t you think they would have used them?” Alexander argues, “The idea that depression is a drop-dead simple serotonin deficiency was never taken seriously by mainstream psychiatry.” There seems to be a lot of evidence to the contrary still today readily available even on the web, though.

This is exactly the sort of fight I probably shouldn’t get involved in continuing. But I’m going to do so anyway, because I think Mad In America’s counterargument is actually going to end up supporting my point and maybe shed more light on the situation.

Up there, when they say “Alexander points to quotes of American Psychiatric Association officials in a post by MIA Blogger Philip Hickey, and notes that none of the quotes specifically describe a low-serotonin explanation for depression [but] the Hickey post cited is not actually about that topic, but about the promotion of the phrase ‘chemical imbalance'” – that’s where I get pretty confident they’ve missed my point.

Remember, the thesis of my last post was that the “chemical imbalance” argument hides a sort of bait-and-switch going on between the following two statements:

(A): Depression is complicated, but it seems to involve disruptions to the levels of brain chemicals in some important way

(B): We understand depression perfectly now, it’s just a deficiency of serotonin.

If you equivocate between them, you can prove that psychiatrists were saying (A), and you can prove that (B) is false and stupid, and then it’s sort of like psychiatrists were saying something false and stupid.

Given that this is my thesis, it’s exactly right for me to debate a post on “chemical imbalance” by showing that none of the quotes involved reduce the problem to just a basic serotonin deficiency!

And when Rob Wipond from MIA says he’s found “a lot of evidence to the contrary still readily available even on the web”, well, spoiler, he’s found more people saying A.


Let’s go through his examples:

For example, a 2004 Washington University in St. Louis press release, about a study published in Biological Psychiatry, states that the “brain’s serotonin receptors” are “at abnormally low levels in depressed people” and that antidepressants “work by increasing serotonin levels in the brain.”

I assume he’s talking about this press release about a study that shows abnormally low levels of serotonin receptors in depressed people. First of all, the study actually did show this. I don’t think it’s irresponsible to mention that a study shows low levels of serotonin receptors in depressed people when a study actually shows this. Second of all, the press release makes it extremely clear that they don’t know exactly what’s going on: “Little is understood about how depression makes people feel sad, but neuroscientists do know that the brain chemical serotonin is involved.” They mention that SSRIs appear to work for depression, but admit that “The bad news is that beyond that first step of increasing serotonin, we understand very little about how these drugs relieve symptoms of depression”. Finally, this study actually found something much more complicated than the prevailing narrative – a serotonin deficiency model of depression would have predicted high levels of serotonin receptors in related brain structures (more chemicals = fewer receptors) but in fact it found the opposite. This fits with the emerging theory that depression may be related to increased serotonin levels in certain parts of the brain, which SSRIs provoke a compensatory response against.

This press release is actually as good as the harshest critic could have wished for. It admits we don’t really know how depression works, it admits we don’t really know how SSRIs treat it, and then it presents the result of a study that shows that serotonin is implicated but not in the way the “serotonin deficiency” theory would expect.

The only way Mad In America turned this into a poster child for psychiatry deceiving people about serotonin was to quote from it extremely out of context.

Let’s go to their next example:

And there is prominent psychiatrist Richard Friedman writing in the New York Times in 2007 that psychiatrists were soon going to be able to conduct “a simple blood test” to determine “what biological type of depression” a person had and then treat them with the right drug. “For example,” writes Friedman, “some depressed patients who have abnormally low levels of serotonin respond to S.S.R.I.’s, which relieve depression, in part, by flooding the brain with serotonin.”

Okay, but Friedman starts with a story about how SSRIs often don’t work for patients, then says that this is because some people have depression that doesn’t seem to be serotonergic: “Some depressed patients who have abnormally low levels of serotonin respond to SSRIs, which relieve depression, in part, by flooding the brain with serotonin. Other depressed patients may have an abnormality in other neurotransmitters that regulate mood, like norepinephrine or dopamine, and may not respond to SSRIs”. He says (correctly!) that “in everyday clinical practice, we have little ability to predict what specific treatment will work for you”.

These are not the words of a drug company shill who says that depression is 100% serotonin in order to put everyone on SSRIs! These are the words of someone who agrees with me that depression is somehow related to neurotransmitters, but it’s still very uncertain which ones and how. His only sin seems to be an overly optimistic view of the speed at which we would come out with genetic tests.

Next example:

There’s also a lot of evidence that the low-serotonin theory of depression is still today being taken seriously by mainstream psychiatry and is still being promoted to the public. A current University of Bristol public education website on depression explains that, “Low serotonin levels are believed to be the cause of many cases of mild to severe depression.”

That appears to be this University of Bristol public education website. The site says it’s by “Claire Rosling”, so I searched her name and I get this roster of people’s sophomore chemistry projects. Ms. Rosling’s is…the website Mad In America cited. Apparently this was part of some college chemistry assignment where people write about molecules to compete for a £50 prize. Ms. Rosling’s was serotonin.

So Mad In America argues that the entire psychiatric establishment is pushing the “depression = serotonin” argument, but the best example they can come up with is some poor woman’s undergraduate chemistry homework?

(in case you’re wondering, she didn’t win. Some girl named Anna won for her webpage on Recycling Plastic.)

Next example!

A current Harvard Medical School special health report, “Understanding Depression”, explains that, “Research supports the idea that some depressed people have reduced serotonin transmission. Low levels of a serotonin byproduct have been linked to a higher risk for suicide.”

Once again, holy !@#$, they’re reporting the results of actual studies. It’s dishonest to do studies on serotonin and find that it is linked to depression? Anyway, when I look up the actual report it starts with the following paragraph: “It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It’s believed that several of these forces interact to bring on depression.”

Once again, this is the best you can do to find psychiatrists pushing an oversimplified version of the chemical imbalance theory??!

Next example:

WebMD’s “Depression Center” states that, “There are many researchers who believe that an imbalance in serotonin levels may influence mood in a way that leads to depression. Possible problems include low brain cell production of serotonin, a lack of receptor sites able to receive the serotonin that is made… According to Princeton neuroscientist Barry Jacobs… common antidepressant medications known as SSRIs, which are designed to boost serotonin levels, help kick off the production of new brain cells, which in turn allows the depression to lift.”

First of all, this page does not use the classic “serotonin deficiency” theory of depression. This is the hippocampal neurogenesis theory, which in my last post I specifically contrasted with the classic serotonin deficiency theory. Yes, it involves serotonin in some way, but since one of the most important facts about depression is that SSRIs treat it, every theory is going to involve serotonin in some way.

Further, right after this paragraph, WebMD continues: “Although it is widely believed that a serotonin deficiency plays a role in depression, there is no way to measure its levels in the living brain. Therefore, there have not been any studies proving that brain levels of this or any neurotransmitter are in short supply when depression or any mental illness develops. Blood levels of serotonin are measurable — and have been shown to be lower in people who suffer from depression – but researchers don’t know if blood levels reflect the brain’s level of serotonin. Also, researchers don’t know whether the dip in serotonin causes the depression, or the depression causes serotonin levels to drop.”

Once again, I see nothing here to indicate that they are covering up flaws in this theory, pushing it to unsuspecting consumers, or claiming that exploratory research is settled science. They’re presenting the best theories we’ve got, then noting how tentative they are and what the flaws are.

(on the other hand, the article does say that there are “40 million” brain cells, when in fact there are about 90 billion. I’m not saying you should trust WebMD, just that they don’t bungle depression in that particular way)

Next example:

And if the theory was never taken seriously and isn’t being taken seriously, no one has apparently told the National Academy of Sciences or two news media outlets with expert psychiatric editorial boards yet. Psychiatry Advisor’s February 12, 2015 headline for a report about a Duke University study is, “Serotonin Deficiency May Up Depression Risk.” Psychiatry Advisor explains that, “(m)ice with normal serotonin levels, the control group, did not demonstrate depression symptoms a week after the social stress, while the serotonin-deficient rodents did(.)” The study, appearing in the Proceedings of the National Academy of Sciences, states that, serotonin deficiency has been “implicated in the etiology of depression” though a cause-effect relationship has not yet been “formally established.” The researchers write that their results, “provide additional insight into the serotonin deficiency hypothesis of depression.” Medical News Today headline their report on it even more strongly: “Mouse study finds that serotonin deficiency does increase depression risk.” (Medical News Today notes in passing that an earlier, somewhat similar study by a different team came to the exact opposite findings.)

At this point Mad in America’s examples are self-refuting. I am getting the impression they will never be happy unless no news media ever covers the dozens of studies that come out each year linking depression to serotonin. I know this sounds mean, but what other conclusion am I supposed to come to? Here we have a study that provides some evidence for serotonin’s involvement, says very specifically that “a cause-effect relationship has not been formally established”, mentions that other studies have shown the opposite – and yet Mad In America still wants me to accept this as an example of irresponsibly pushing the serotonin theory!

Look. Hundreds of studies have shown some sort of relationship between serotonin and depression. At this point that’s not controversial. What’s controversial is the importance of the relationship, whether it’s causal, whether other things matter more, et cetera. Every single one of Mad In America’s examples has been pretty exemplary in saying that all of these things are still uncertain and need to be investigated further. What more could they do to be more responsible? A total blackout on all news coverage of the new evidence for serotonin’s involvement that keeps coming in?

Ironically, if people had done that, we would have far less evidence that depression was not just a simple serotonin deficiency. The most important nail in that theory’s coffin was that tianeptine, a medication that lowers serotonin levels, effectively treats depression. But that’s a study about serotonin of exactly the same sort as the University of Washington study Mad In America complains about! One of the most convincing alternatives to a purely serotonergic picture is the BDNF-neurogenesis theory. But that’s exactly the theory being pushed in the WebMD article Mad In America complains about!


I raised some of these issues in a comment on the Mad in America blog, and author Rob Wipond kindly responded to me:

Let me address some of these objections piece by piece:

Yes, you’re right, many psychiatrists, media, pharmaceutical companies and others promoting the serotonin deficiency theory of depression have often included generalized, softening “qualifiers” and “equivocations” such as the ones you quoted, even as they have also made those very bold, unequivocal claims explicitly intended to persuade that I quoted. Taken in full context, then how are such qualifiers different than brash infomercials on television with legal disclaimers like, “not all results will be the same for all people”?


Okay. Sorry. I shouldn’t have yelled like that. More seriously: there are a lot of things we don’t totally understand, but which scientific research suggests some weak preliminary theories about. For example, we don’t understand fibromyalgia, but if I were writing a textbook on fibromyalgia, or if a patient asked me what it was, then after some appropriate caveats and equivocations, I would say it has something to do with some sort of inflammation in the fascia which causes central sensitization to pain stimuli. Could I end up being totally wrong? Yeah. But at this point I think there’s enough evidence in this direction that, insofar as it’s important to satisfy patients’ curiosity about what’s going on with them, that it’s proper to mention the current best guess. Likewise, if I am a researcher or a scientific publication, I don’t think I have some duty to carefully hide my results. A big part of scientific progress is people saying “I just got some small amount of evidence which makes me think it’s this” and then other people trying to confirm or refute that with more evidence, until eventually it comes together into a strong theory.

I think researchers and psychiatrists were pretty responsible in coming up with the serotonin deficiency theory. It was inspired by the effectiveness of serotonergic drugs. Then a bunch of studies – Wipond agrees there were hundreds – provided results that seemed to confirm it. Given all of this information, I don’t think it was negligent to say that there was quite a bit of evidence pointing to serotonin, as long as you followed this with caveats that the evidence was still preliminary and lots of other things seemed to be involved too. As I’ve been arguing all along, that’s exactly what most people did.

I know of no one (certainly not me) who has ever said that there were never any studies making tenuous, feeble attempts to draw links between serotonin levels and depression in different ways — there were hundreds, I believe (I haven’t counted) as the psychiatric community and pharmaceutical industry made enormous efforts to try to prove the theory or buttress its apparent validity in the public eye. And as I note, those are still being produced today. What critics have often correctly pointed out, however, is that the main, strongest argument that psychiatrists have often used in support of the low-serotonin theory has always been that SSRIs allegedly boost serotonin levels. Of course, most of the public has never known that SSRIs have barely beaten placebos in clinical trials, so they’ve not been able to understand the true spuriousness of even that argument.

I don’t really understand this objection. There was a strong piece of evidence in favor of serotonin in the form of SSRI-effectiveness, scientists pursued that lead by doing hundreds of studies implicating serotonin using different methodologies, most were in favor and so scientists thought the theory had some merit…what exactly is wrong here? This sounds like every scientific theory – Wegener noted that continents looked like they fit together in a way that implied continental drift, geologists did hundreds of other studies that all pointed to continental drift, therefore they started believing in continental drift.

While Wipond may not know of the people saying there was no evidence for serotonin besides SSRI effectiveness, these people certainly exist and provide one of his side’s major arguments. Indeed, many of the articles I linked to on my original post made exactly that argument. The BBC said that: “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.” New York Review Of Books says: “Instead of developing a drug to treat an abnormality, an abnormality was postulated to fit a drug…But the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed”.

To learn more about the claim that SSRIs barely beat placebo, see my article on this.

I notice that your argument has now changed to “far fewer people” and “less important” psychiatrists made such claims, rather than none at all made such claims. Very well; apparently we would now only potentially disagree on subjective notions such as how many is “fewer” and how unimportant is “less important”, rather than disagreeing on the main issue at hand. And then Leo and Lacasse’s question becomes all the more significant: Where is the evidence that the “important” psychiatrists were vigorously trying to correct the public record and clarifying that these were only weak hypotheses with no compelling evidence to support them instead of weighty theories with ever mounting evidence to support them?

In retrospect, “no one has ever said” is a stupid thing for me to have said. I do not deny that a sophomore at University of Bristol once said low serotonin caused depression. And you can find individual psychiatrists who believe a lot of stupid stuff. Some psychiatrists believe in homeopathy. Some psychiatrists believe in reincarnation (the guy in that article conducted my job interview at the University of Virginia. I tried to be very polite.) Some psychiatrists believe that after losing hundreds of thousands of dollars to online Nigerian scammers, it makes perfect sense to give hundreds of thousands more dollars to other Nigerian scammers, because “these were different Nigerians”. But I will venture to say none of these are consensus positions in the psychiatric community.

And this is why I wanted to continue this discussion here on this blog. If I had selected a set of statements from eminent psychiatrists that had lots of caveats and were extremely responsible, I could be justifiably accused of cherry-picking. Instead, Mad In America selected some statements, probably intending to cherry-pick the other way, but when looked at more closely, they’re all pretty responsible and say exactly what I would have said at the time – SSRIs seem to work, there’s some evidence pointing to serotonin being involved, but the whole thing is terribly complicated. To me, this establishes the consensus position in a way much more clearly than I could have done on my own.

And yes, this consensus position got simplified and distorted. I have no doubt that drug companies drew from it to do exactly the sort of infomercials that Mr. Wipond describes. I have no doubt that individual psychiatrists, when faced with low-functioning patients who are bad at understanding complicated systems but who really wanted to know what was going on, said “serotonin” and left it at that. And I have no doubt that to a public who still largely think evolution means “once upon a time a chimp gave birth to a human baby”, complicated caveats about how serotonin levels are linked to depression but might not cause depression largely went over their heads except for the single word “serotonin”.

(“That’s the happiness molecule! Right?”)

But in general I think my point stands. “Chemical imbalance” as generally used points to a sophisticated model of interacting metabolic pathways which goes far beyond serotonin, and which as far as I know is still very much on the table. While serotonin was justifiably pointed to as a promising candidate early on, it was generally done with appropriate caveats that turned out to be warranted, and the research community has now retreated from some of that earlier language while still considering serotonin a promising lead. And SSRIs continue to be moderately effective antidepressants in the people for whom they are indicated.

(ie somewhere less than half of the people for whom they are prescribed).

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120 Responses to Polemical Imbalance

  1. Steve Johnson says:

    (on the other hand, the article does say that there are “40 million” brain cells, when in fact there are about 90 billion.

    This is an accurate statement – there are 40 million brain cells… and 89.96 billion more, too – but there are 40 million.

  2. Tracy W says:

    I once as a very junior person wrote replies to correspondence for someone very senior and overloaded with letters. I once wrote a reply that included the line “A commercial bank cannot create money like a central bank can.” And went on to explain the differences. This got quoted as [very senior person] says “a commercial bank cannot create money”!

    • Jon Gunnarsson says:

      Aha! Tracy W just admitted to being a counterfeiter: “I…create money like a central bank.”

    • Joe says:

      “An empirical test is conducted, whereby money is borrowed from a cooperating bank, while its internal records are being monitored, to establish whether in the process of making the loan available to the borrower, the bank transfers these funds from other accounts within or outside the bank, or whether they are newly created.

      This study establishes for the first time empirically that banks individually create money out of nothing. The money supply is created as ‘fairy dust’ produced by the banks individually, “out of thin air”.”

      Just for you. 🙂

      • Tracy W says:

        I find myself wondering how the author of that article explains how banks very fail.

        Or bankers at all. Why not set up a bank, issue yourself 100 billion, and head home? Is the hypothesis that bankers are all public-spirited sorts who head into the office each day for the purpose of handing out loans to the deserving poor?

        • Tracy W says:

          Darn it, “how banks *ever* fail.”

        • Joe says:

          Banks **don’t** fail.

          Haven’t you noticed?

          Every time something goes wrong they get someone with a great credit rating to create even more money to keep it trucking.

          • Tracy W says:

            No, I hadn’t noticed that.

            And I also haven’t noticed massive hyperinflation in the countries I live in from bankers creating money to pay themselves like crazy. This either implies that bankers can’t create money, or they are all incredibly public-spirited.

            If you wish to present some evidence that bankers are all incredibly public-spirited and would never use an ability to create free money out of thin air for their own benefit, I would be interested to hear it.

          • Tracy W says:

            No, I hadn’t noticed banks never failing. What I had noticed is the US’s Lehmans Brothers failing in 2008, or the British Baring Banks failing in 1995, or the Swedish Gota bank failing in 1992, or the German Herstatt Bank failing in 1974. Along with numerous other cases. (I tried to do individual hyperlinks, but they’re not going through).

            If your theory depends on banks never failing, then you have an awful lot of history to explain away.

      • Salem says:

        Yeah, as Tracy W says, that article is stupid. The bank can “create” deposits but those deposits are the bank’s liabilities. Those deposits can fly to other banks or out of the banking system altogether. The bank’s liabilities can be called in (and hence the bank can fail). This means that a bank cannot create deposits at will, in the same way that Lloyd ‘ s cannot write insurance policies at will. The limit is not technical within the bank, but systemic.

        The reason banks are called financial intermediaries is because their ability to lend (“create deposits”) is limited by their ability to honour those liabilities, which in turn is determined by their ability to obtain funds from other sources (deposits, interbank lending, etc). The author doesn’t seem to understand the position he’s arguing against. Of course when a bank makes a loan, it normally does so by crediting that person’s account. To think any deep magic follows from that is absurd.

        This doesn’t apply to central banks in a modern system, and so those are completely different.

        • Joe says:

          I don’t think you read the article (or if you did, you didn’t read it properly.)

          The guy just gets a bank to show how it’s procedures actually work and then reports it.

          Banks create money out of nothing, the only contigency being the borrowers credit rating. not the banks ability to match any new liability, not their deposit levels, not the central banks permission, just purely and simply a credit rating check.

          It just is what it is.

          While I am on though I might add that it’s a bit ridiculous to claim the system cannot possibly work like that because bankers will just create too much money and the system will fail when the bankers did just create too much money and the system did just fail.

          …and then bailed themselves out by creating even more money.

          • Tracy W says:

            Failure because the banks run out of money to cover their liabilities looks rather different from failure from hyperinflation as a bank prints money to cover massive liabilities.

            As someone who was alive and paying her own grocery bill in London in 2008, I think I would have noticed hyperinflation.

  3. FullMeta_Rationalist says:

    So you’re telling me that depression has something to do with complex metabolic pathways? Damn it Scott, I’m a patient not a doctor. I want to know just one thing, and it’s dead simple: is depression caused by serotonin deficiency or not?

  4. Anonymous says:

    > Indeed, many of the articles I linked to on my original post made exactly that argument.

    The series of links after this sentence is botched.

  5. Anonymous says:

    Is it just me or do the Richard Friedman and University of Bristol examples seem egregious enough to warrant some suspicion about Mad in America’s intellectual honesty?

    • Anonymous says:

      It could also be a “feels vs. reals” kind of thing. He uses the “fact” that “the public” misunderstood the implications of the serotonin/depression evidence as his “lynchpin” that… psychiatrists have their heads up their asses? are in league with big phrama to leech money from some of society’s weakest members? are engaged in an active conspiracy to deny massive incompetence in this area of research? Any or all of those are much more palatable than coming to terms with the abysmal depths of his own (and the public’s) scientific illiteracy. Malevolence and incompetence, you know.

    • If he believes strongly enough in his position he could have just Googled for likely phrases, used the best sentences he found, and trusted that the context would support his position. Which, come to think of it, doesn’t really match my definition of intellectual honesty. I think that if he were trying to be deliberately dishonest he could have done a much better job of not picking embarrassing examples.

  6. Jimi Hendrix was definitely a reincarnation of Charlie Christian. Not sure about the other cases.

  7. Lambert says:

    Sophomore is a concept over here!? I thought it was a US thing.

    • Scott Alexander says:

      It isn’t, but it said “Level II” which I interpreted as second year = sophomore. Was that wrong?

      • Deiseach says:

        Had a very quick look and it seems like Level II is indeed the second year of the three-year BSc in Chemistry in the University of Bristol. It just sounds a bit odd (why not say Second Year or Year II)?

        • Lambert says:

          At least it has the number 2 in it unlike ‘sophomore’.This kind of random convention I probably what’s going to lead to the situation in Dick’s ”Flow my Tears’, the Policeman Said’.

        • Anonymous says:

          For my degree, my first year was “Part IA”, my second year was “Part IB”, my third year was “Part II”, and my Master’s/fourth year was “Part III”. Worse, it wasn’t consistent between subjects (which were called “triposes”). Some triposes had a one year part I and a two year part II.

        • Rob says:

          Separating “Levels” out from “Years” makes sense, because people can navigate through the modules in different orders. For example (I didn’t go to Bristol but my university used a similar system) I did a three year undergraduate course, with level 1 modules in first year and level 2 modules in second year, but in third year I did a mixture of level 3 and level 4 modules, and this wasn’t unusual. The level 4 modules were nominally Masters Degree modules, and the classes were a mixture of high-performing third year undergraduates, first year taught masters students who did their undergrad elsewhere, and fourth-year masters degree students who did a 4-year masters degree course (which as far as I can tell was the same as doing an undergrad course immediately followed by a masters in the same subject). So calling it a “Year 4” module wouldn’t fit because more than half the class were in their first or third year.

      • naath says:

        I don’t know about the university of Bristol, but I know that that isn’t always correct – part II of my degree was my 3rd year (yay for Cambridge being weird).

        But it is in any case misleading because “sophomore” somewhat implies “year 2 out of 4 of a liberal arts degree”. This is year 2 out of 3 of a chemistry degree. The two likely involve different levels of chemistry knowledge.

        • Peter says:

          2nd year chemistry…

          If I remember my degree right – strictly speaking it wasn’t Chemistry, it was Natural Sciences, but once again this is Cambridge being Cambridge. By the end of the second year, I’d done a little biological chemistry, but the serious medicinal chemistry course had to wait for the fourth year[1]. I’d also done some biochemistry and physiology, but not as parts of the chemistry course, certainly not compulsory.

          AFAICT “sophomore” just means “second year” – apparently there’s a sophomore year at high school then four years later there’s a sophomore year at university – also Wikipedia doesn’t say anything specifically about liberal arts. There’s also the phrase “sophomore slump” which can refer to the second year of just about anything.

          (If anything I’d naively hope that second-year liberal arts students would have better library skills than second-year chemists, given that in my degree they only really sent you into the library in the third year (the chemists, that is. The biochemists sent you to the library in the second year, also a summer job at the end of my second year was good for this). Certainly the references in the offending web site show little sign of serious scholarship.)

          [1] Apparently it was available in the third year for people doing the three-year degree.

  8. Shenpen says:

    What is their agenda? They just want a better psychiatric industry, or pushed Scientology or some other “alternative”, or what?

    If they just want a better psychiatric industry, why can’t the work on the inside, why attack it from the outside?

    • Scott Alexander says:

      To be fair, I don’t think we make that demand of anyone else. Do we tell anti-police brutality protesters to become cops, or people who say lawyers are slick and dishonest to become lawyers, or people upset about Abu Ghraib to join the military?

      There’s a role for principled external critics of institutions. I’m not sure Mad in America is doing a great job with that role in this post.

      • Lambert says:

        Libertarian / Anarcho-Capitalist Politicians?

      • Shenpen says:

        The parallel isn’t very good – these guys claim to know science better than psychiatrist. So they are less similar people who complain about police brutality and more similar to people who claim more efficient ways of policing exist.

        • Jiro says:

          This is technically true but it only implies superior knowledge in a very limited area. If I tell a restaurant chef that he shouldn’t use spoiled food, I’m not claiming to be better than his chefs except in the specific case of whether or not using spoiled food is a good idea. I may not be able to cook restaurant meals in general–which requires a lot of decisions other than just “should I use spoiled food”, even if I can make the specific decision “should I use spoiled food” better than the chef.

    • bartlebyshop says:

      MiA is a pretty heterogenous group. Some want an end to involuntary psychiatric treatment entirely. Some want an end to involuntary psychiatric treatment for people who pose no threat to others. Some want an acknowledgement that the drugs they were given did harm them and the benefits were oversold. Very few of them are Scientologists and it’s a big debate in the community about whether to work with CCHR (the Scientology organization in this area) at all. Many of these people tried to make changes “from the inside” only to be told their side effects were symptoms of an illness they may never have had in the first place. Lots of people come to MiA’s position after trying, sometimes for years, to be heard by their doctor and being roundly mocked and dismissed at every turn.

      • Honestly says:

        If a community has to have a big debate about whether to work with Scientology, that makes me very suspicious of that community.

        • bartlebyshop says:

          The debate is whether or not to be utilitarians and accept CCHR’s money to achieve ends that require money (such as ballot initiatives). Most MiA people are *not* fans, in any way, of Scientology except to the extent they can take its money and then tell it to go hang.

          • Andrew says:

            Except that taking scientology’s money for pretty much anything is difficult to sell as “being utilitarian”, because unlike in fat man scenarios, taking money from scientology is going to have externalities. The gaze of scientology is going to be fixed on you as an investment. You might as well be taking mob money. I don’t care how noble your ideals, that just sounds like a terrible idea.

            For instance, I’d be surprised and dismayed and consider donating elsewhere if I found out that Against Malaria was taking scientologist money.

          • bartlebyshop says:

            I’m not saying I agree with taking money from Scamontology. In fact I, personally, think that doing it legitimates Scientology by tying it to a movement with real grievances and that this is a very negative thing to do. It also hurts the MiA crowd because then, as in this thread, everyone will just say “oh well they’re Scientologists, why should we listen to them about anything?” Nevertheless, the stated end-goals of CCHR and some of the MiA people are pretty congruent.

            The debates often look like:

            – CCHR is having a protest/legislative session on this day. Are we going to show up, and make it clear we don’t agree with their Scientology stuff, but also use the additional numbers to advance our common goal? Keeping in mind that appearing with them gives them a tacit endorsement.

            – CCHR donated a bunch of money to this recovery house/other campaign we like. We only found out after the fact. Can we still advertise for the campaign?

            CCHR is playing the any-port-in-a-storm role here because anti-psychiatry advocates tend not to have a lot of money and they feel their cause is a desperate one. Many MiA people agree with you and will not appear at events with CCHR people or take any of their money.

            I do slightly disagree with the mob analogy. As far as I know Scientology has never put out a hit on someone for taking their money, not doing X, and failing to pay it back. They have done almost everything short of it, but I don’t think you put yourself in real fear of your life by taking their cash.

            I don’t really see the problem with Against Malaria taking Scientology money and using it to save lives. Is the problem that Scientology will try to corrupt AM? That they will use the donations to whitewash their other extremely awful activities?

            Edit: I realized there may be another problem. Is the issue that people would do what they do here, dismiss all EA arguments because they would be tainted by the associated with Scientology?

          • Zakharov says:

            “Scientology will try to corrupt AM” is precisely what I’d be worried about in that scenario.

          • Anonymous says:

            That’s really unfair to the mob. The mob never whacked anyone taking money from the IACRL.

          • Scott Alexander says:

            If Scientology wanted to donate lots of money to AMF or GiveWell or MIRI, I would have zero concern about it and 100% encourage them to take the money (except concern about the PR implications for the charity)

        • If a community has to have a big debate about whether to work with Scientology, that makes me very suspicious of that community.

          I was dismayed to learn recently that the voice actor who voices Bart Simpson is a Scientologist.

    • Criminal Economist says:

      My impression, based on one friend who wrote for MiA for a while and used to constantly post their pieces to facebook, is that MiA is largely a support group for people who have had bad experiences with psychiatry. My guess is that this:

      I have no doubt that individual psychiatrists, when faced with low-functioning patients who are bad at understanding complicated systems but who really wanted to know what was going on, said “serotonin” and left it at that.

      is what they’re really complaining about.

      • bartlebyshop says:

        It’s a support group that’s also nominally about doing some level of activism. It does less than MindFreedom but more than the thousands of random depression support groups you can find, many of which are pretty anti-psych. I don’t agree with this quote. When I asked why I was being prescribed SSRIs I was told “your brain doesn’t have enough serotonin and these drugs will fix that.” I was a university student with a good GPA, living independently, having lots of conversations about “complicated systems” with my doctors. I know many people with similar experiences. I’m not trying to anecdote you to death here but it does happen. There are many bad and lazy psychiatrists, just as there are many bad and lazy doctors in all specialties. There are even a small minority of actively malicious ones. Psychiatry is relatively unique among medical specialities for its interactions with the legal system. MiA’s complaints about the explanations they received about drugs don’t sound too different to me to how people in the fibromyalgia/CFS communities talk about doctors. But MiA (and the CSM movement more generally) is also addressing the fact that you can be legally compelled to take these drugs with all the attendant stuff about clinical trials, academic-industrial complex, etc.

    • Joe says:

      Is there any way to check their funding?

      A great way to discredit a movement is to lead it and all that.

    • Paul Torek says:

      “They” are working on the inside, too. I quoted former APA president Steven Sharfstein before, in the Chemical Imbalance thread. But I guess my comment was too late to catch Scott’s attention. Sharfstein clearly thinks the problem that Scott is pooh-poohing – psychiatrists oversimplifying mental illness etiology and pushing pills as solutions – is serious.

      We must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model.


      Financial incentives and managed care have contributed to the notion of a ‘quick fix’ by taking a pill and reducing the emphasis on psychotherapy and psychosocial treatments. There is much evidence that there is less psychotherapy provided by psychiatrists than 10 years ago. This is true despite the strong evidence base that many psychotherapies are effective used alone or in combination with medications

      Sharfstein made the above comment in 2005, according to John Read (pdf).

  9. Decius says:

    It looks like a steelman of Mad In America would be that their position is “Depression is caused by experiences and is better treated by therapy than by medication”.

    Granted, there’s not a lot of evidence that therapy is generally effective vs. depression. Coaching certainly is- once I was informed of the consequences of being diagnosed with depression and how it was defined, I never met the diagnostic criteria!

    • shemtealeaf says:

      Yeah, based on reading the comments on that article, I think there’s a bit of a disconnect here. I don’t think they’re only objecting to the serotonin model; they’re objecting to the whole idea of depression as a pharmaceutically treatable disease.

      • ryan says:

        That hits on what I think is conspicuously lacking from this debate/conversation: drug companies.

        More specifically, pharmaceutical sales representatives.

        That proper psychology researchers never flat out said depression is caused by low levels of serotonin doesn’t surprise me. If sales reps never made that point, I’d check the thermostat in hell.

    • Leif says:

      A study just came out linking anxiety to antidepressant exposure in the womb. So here’s another possible steelman: “We don’t have a good picture of how brain chemistry works, so messing with it is too risky.”

      • Ptoliporthos says:

        AFAIK, anti-depressants are not prescribed to women who are, or who are planning on becoming, pregnant unless they present a suicide risk. So psychiatry basically agrees with that, up to the point where they have evidence that antidepressants will save lives.

        • ryan says:

          If that’s the case it’s a very recent development.

          Source, I work for a plaintiffs firm which sues drug companies whose products cause birth defects when taken during pregnancy.

          Heck, women being on 2 or 3 different antidepressant or anti anxiety meds during pregnancy isn’t that unusual.

  10. simon says:

    Nice. I went through all the studies Whitaker cited in his old book and they were….not convincing.

  11. Who wouldn't want to be anonymous says:

    While we are arguing about quackery, would it be a terrible faux pas to to digress slightly to ask what people think about the Dr. Oz brouhaha? I actually didn’t even realize he was an MD, much less a faculty member at Columbia. I just assumed he had a Ph.D in Underwater Basket Weaving and was playing it as close to false advertising as he could with the lab coat or whatever.

    • Irrelevant says:

      I was cured of my implicit trust of “real doctors” when I went to a Deepak Chopra talk at 15, so I never bothered looking to see whether Oz was a real doctor or not. It doesn’t stop them being a crank or crook.

    • Scott Alexander says:

      I wish it surprised me anymore when people who are technically brilliant believe stupid things, but that seems to be the human condition. The Outside The Laboratory effect might be the “Outside The OR” effect in his case.

      • 27chaos says:

        Stupid? Why not evil?

      • mbka says:


        Why is this so surprising? Human behavior is complex, society is complex, the economy is complex. At higher phenomenological level, none of these are governed (as the LW article implies), by “low level mathematical rules”. Most natural scientists are sociologically naive, economically naive, and often enough, psychologically naive too. They seem to have little clues as to why people do things at all. Examples. Why do people consume? Not for (a) material need mostly, but (b) mostly for societal signalling. Why are prices what they are? Not because of (a) cost of production, or value to the end user, or value to the world, but because (b) of the interplay of demand and supply. Why do religions prescribe behaviors such as food taboos, or the removal of pieces of skin of one’s genitals? Not mainly because of (a) hard evidence of health concerns, but mostly because of (b) enforcing adherence to a common group standard and identification.

        In the above examples, the responses (b) are well documented in economics, sociology, and psychology, but the average physicist would probably pick (a). Don’t even get me started on geeky AI discussions. AI discussions should be a matter of psychologists and psychiatrists, NOT of engineers.

        One might reasonably infer that many natural scientists, mathematicians etc., chose their fields precisely because they promise simpler cause-effect rules than the society at large, something that these same scientists probably find bewildering. Physics, and to some extent physiology, has neat, simple, rationality. Life at large doesn’t.

        • Most natural scientists are sociologically naive, economically naive, and often enough, psychologically naive too.

          Add: politically naive.

          I have noticed that extremely high IQ individuals (more often found in hard science and math than anywhere else) tend to gravitate toward crankish, simplistic, and wildly unrealistic political views.

          Politics is not a milieu where abstract reasoning from first principles gets you much of anywhere.

          • mbka says:

            +1. Another biggie.

          • gwern says:

            Larry: cite? When I read results from representative population surveys like the GSS (as opposed to a few anti-academic anecdotes beloved of conservatives), what I am most struck by is how batshit insane the lower-IQ parts of the population consistently are, and how bizarre beliefs are as you go down the spectrum. Consider the examples in Gordon’s “Everyday Life as an Intelligence Test: Effects of Intelligence and Intelligence Context”

            Mao may’ve murdered millions, but it takes masses to marvel at mangos.

          • +1

            An ancilliary award for awesome alteration.

          • Larry: cite? When I read results from representative population surveys like the GSS (as opposed to a few anti-academic anecdotes beloved of conservatives), what I am most struck by is how batshit insane the lower-IQ parts of the population consistently are, and how bizarre beliefs are as you go down the spectrum.

            To be clear, my point was about the tiny population of people with extremely high IQs, say in the 160-plus range.

            This group has been studied, certainly, but in a quick search, I don’t find anything about the detailed political views of people specifically in that range.

            Moreover, the political oddness I have personally observed among that group does NOT include the kind of easily falsifiable “bizarre beliefs” that may be found in the general population.

          • “I have noticed that extremely high IQ individuals (more often found in hard science and math than anywhere else) tend to gravitate toward crankish, simplistic, and wildly unrealistic political views.”

            Could it be that most people who hold what you consider realistic political views hold them because they are the views widely accepted around them, and that what is different about the high IQ individuals is that they are less willing to treat other people’s conclusions as stronger evidence than their own?

            Do you have a definition of “crankish” in mind that comes to more than “not widely accepted?”

          • Could it be that … what is different about the high IQ individuals is that they are less willing to treat other people’s conclusions as stronger evidence than their own?

            Yes, that is the same point in different words.

            The trouble with completely disregarding other people’s conclusions is that it tends to interfere with one’s effective participation in politics (seen here as community decision-making).

            If, right now, a polity is debating between action-A and action-B, a person who rejects both in favor of something entirely different would be generally regarded as irrelevant to the discussion.

            It doesn’t matter in the immediate term if that one person is (in some sense) “right” and everybody else is “wrong”.

            Do you have a definition of “crankish” in mind that comes to more than “not widely accepted?”

            My understanding is that a crank is one who sees a single cause as key to everything important. “Crankish” and “simplistic” are near synonyms.

            Thinking back, I got that definition from this 1996 article, which defines a crank as “a believer in the one great idea that will fix everything.” The term “Esperantist” is also used. Al Gore and Jack Kemp are cited as examples.

            I note that “crank” is defined less specifically and more negatively in some other places.

          • Who wouldn't want to be anonymous says:

            > My understanding is that a crank is one who sees a single cause as key to everything important. “Crankish” and “simplistic” are near synonyms.

            Oh, you mean libertarians!  Why didn’t you say so….

            I actually can’t tell if I am making a bad joke or an insightful observation.  Libertarians do seem to fit the bill you describe pretty closely: they are usually pretty dang smart, discard what everybody else thinks will work in favor of their own system, are accused of being “simplistic” (although if I must choose a word, I think their views are better described as “elegant”), generally have very little traction in politics, and… Well, I think they can be wildly unrealistic.

            If it is even a concept that needs it’s own word, I fail to see the benefit of overloading a word that you admit has an unspecific invective vibe to it.  This is probably closer to what most people would think of as a crank.

          • Oh, you mean libertarians! Why didn’t you say so…

            I didn’t mean libertarians, at all, though I admit that what I wrote could be understood that way.

            I think libertarians are plentiful enough to be considered a political faction, even if sometimes subject to being called unrealistic or simple/elegant.

            I wouldn’t call a libertarian a crank, rather, I would call him or her a libertarian.

            If it is even a concept that needs it’s own word, I fail to see the benefit of overloading a word that you admit has an unspecific invective vibe to it.

            I think the 1996 article transformed my idea of the word “crank.” I took it for granted that I had been misusing it before that. (And apparently I just forgot the author’s qualifier of “Esperanto-type”.)

            Perhaps it’s wrong to use “crank” as a technical term, but as someone who frequently encounters earnest, tireless advocates for single-great-ideas like proportional representation or a dairy-free diet, it seemed a very useful descriptor.

          • Irrelevant says:

            Larry’s definition of crank pretty well fits my existing connotation for it, though I’d never heard it laid out explicitly like that.

        • “Why are prices what they are? Not because of (a) cost of production, or value to the end user, or value to the world, but because (b) of the interplay of demand and supply. ”

          Supply is a result of cost of production, demand of value to the end user. More precisely, in the simple case of perfect competition, price equals both marginal cost of production and marginal value to the consumer.

          • mbka says:

            Well, David, that is covered by “prices result from an interplay between supply and demand”, no? I was trying to make the point that it’s not just from either cost of production or value to the end user, even though both are involved. And if prices change, you can’t tell ceteris paribus why they have changed. The demand curve may have shifted. Or the supply curve. Or both. And in more realistic real life scenarios, there will be imperfect competition, various elasticities, expected future demands and supplies, consumer surpluses, substitutions both perfect and imperfect, multiple equilibria. etc. And yet in the bigger scheme of things, all of these are still just models, imperfect models, of an observed complex reality. Intellectuals, including rationalists, often go for the simple, neat, “perfect” (and wrong) type of explanation. I think it was Christopher Alexander (the architect) who called this “a neurotic desire for neatness”. Oftentimes, there is an implied belief in solution landscapes with single optima. And the bigger picture is often ignored. Just look at the 20th century. How many intellectuals have been holding up communism as a superior, because more “rational”, mode of production? Why, because no competition means better economies of scale and no advertising. And public ownership of the means of production means that goods can be sold at cost without the “greed” of the capitalist. And in this simple model of optimization of cost of production in a single point of time, that would actually be true, if it wasn’t for absolutely everything else, starting with the evolutionary effects of competition due to , of course, “greed”- if you take away “greed” and competition, everything just stagnates. Not to mention all the things not related to economic efficiency.

            Re: politics, Larry and David – there is considerable evidence that high-IQ people have the same opinion landscape as everyone else, but their higher intellectual horsepower enables them to find better rationalizations for their pre-existing biases (paraphrasing Arthur Koestler, “we get our opinions like we get the flu”). This website here has a lot on this: .

          • Intellectuals, including rationalists, often go for the simple, neat, “perfect” (and wrong) type of explanation… “a neurotic desire for neatness”.

            Conceptual neatness is very satisfying. That’s why conspiracy theories have such powerful appeal, even to the non-paranoid. An overarching theory that explains everything, yet is little known, is an awesome thing to hold. Everything fits (or is made to fit), there are no loose ends, and you are one of the few who “knows”.

            I omitted his name from the quote above, but I’m surprised and pleased to see Christopher Alexander referenced here.

          • Cranks have this background assumption that a theory of everything is a rare animal, and if you find one it is probably The theory of everything.

    • Limi says:

      He’s a scam artist, and his dodging around the issue when confronted just makes it worse. Given that you can’t go into a chemist without seeing his smiling mug plastered above his ‘miracle’ fat burner crap, the idea that he only recommends it along with diet and exercise is little more than a hilariously depressing joke.

  12. The link to the Nigerian scam article opens page 2 of that article. I found this rather confusing until I scrolled to the bottom of the page. Otherwise a very interesting read. I felt amazed that such an apparently talented man would fall for such an obvious con for 10 years. I have heard of the sunk costs fallacy but this is ridiculous. Seems that some people just never give up hope??

    • After writing the above, I read the article about the “outside the laboratory effect” that Scott linked to, and I guess this is an example. But still, I am left wondering why this would occur. Perhaps a deep faith in human nature might go with the territory in this case, but this still seems like a stretch. “It’s been 10 years and I’ve lost over a million dollars, but I still trust that there are honest Nigerians who will deposit $20 million into my bank account, really, I expect it’ll happen any day now…”

    • Rob says:

      “Page 2”. Of an online article. Ugh.

      Hey guys did you know that computers are MAGIC and there’s a thing they can do nowadays where the web page can be AS BIG AS YOU WANT!? You never run out of paper so you never have to split up your content! Pretty great huh? Fair enough you haven’t heard of it, it’s only been possible since *the very beginning of the web*.

      • Susebron says:

        That doesn’t make as much ad money, though. More pages means more page views.

      • Fair enough you haven’t heard of it, it’s only been possible since *the very beginning of the web*.

        Not exactly. Those of us who were writing web pages in the previous century were often warned that long HTML files took a long time to transfer and load, and crashed many browsers.

        In one context, I was under constant pressure find ways to break up content into “reasonable sized” pages.

    • gwern says:

      I wouldn’t necessarily judge him too harshly. Note the part where it mentions his age – he would have been 78 when he first began falling for the scam, and that’s more than old enough to be suffering from issues like senile dementia and Alzheimer’s. This is why there’s supposed to be protection for the elderly and why scammers prey on them.

      He may not be officially diagnosable with anything asides from ‘aging’ and the investigator may’ve declared him competent, but that’s very far from saying his fluid intelligence and critical judgment are just as good as they were when he was in his 20s or 30s… (And yes, I know it may seem like writing a book is proof he’s still sharp, but remember the longitudinal studies tend to show that verbal skills and factual knowledge are the last to go even after fluid intelligence, working memory, and other things have dropped by multiple standard deviations. Which fits my limited experience with the very elderly – even if they are still talking fluently, that doesn’t mean they are understanding you very well or won’t get easily confused or can absorb novel information & situations well without getting frustrated & angry.)

  13. W0 says:

    “serotonin deficiency has been implicated in the etiology of depression though a cause-effect relationship has not yet been formally established.”
    I find this quote suggests strongly that serotonin deficiency causes depression; and that the final proof of a cause-effect relationship is just a formality.

  14. Dan says:


    > Washington University v. University of Washington

    The two aren’t the same institution. It’s an unfortunately common mistake, but the former’s in Saint Louis while the latter is in Seattle.

  15. Jared says:

    Ray Peat has a lot to say about serotonin and depression which you may find to be an interesting read:

    Serotonin, depression, and aggression

    • Scott Alexander says:

      I’m not impressed.

      1. He states without further comment that reserpine is antidepressant, but as far as I know the main debate is whether it’s neutral or actively depressogenic.

      2.He says that LSD is anti-serotonin, but as far as I know it’s serotonin-mimetic.

      3. He also says SSRIs cause Alzheimers without any reference, even though AFAIK no one else thinks this.

      4. He says that overdose with SSRIs causes fatal serotonin syndrome, but this is practically impossible unless you’re taking something else much stronger at the same time.

      Normally this would be enough to make me dismiss this guy, but he says he has a Ph. D in biology. Anyone with more targeted pharmacological knowledge want to read this over and tell me if he has any points?

      • Jared says:

        1) The study cited from a 1955 Lancet article was a placebo-controlled one in which reserpine was used “successfully” to treat depression. That’s old, and I can’t get the specific article, but the claim is re-iterated on page 2 in this article

        2) Not that simple

        3) Didn’t see this, only that he was noting a string of correlations. Sure that’s potentially dubious and not causation, but I didn’t see causation claimed.

        4) Didn’t get that either. Quoting directly (emphasis mine): “Overdose with the serotonin reuptake inhibitors, or with 5-hydroxytryptophan, which has effects similar to serotonin, can cause the sometimes fatal “serotonin syndrome.” ” But I can see how that’s a bit “weasel word-y”. I don’t doubt he’s pushing a certain narrative, but I find it useful to entertain different perspectives while detaching them from the narrative.

        Also should note I’m a hobbyist in this area. My PhD is in a different field.

  16. efnre says:

    Why are so many idiots arguing against Scott? Last time it was Noah “Only I understand marginal effects” Smith and now it’s this moron. Are they just not intelligent enough to realize how hard they’ll get schooled?

  17. heteroclitejumble says:

    The only thing that solves my depression is dopaminergic psychostimulants. I do have ADHD.

    • ryan says:

      Dopamine makes everything so simple. We don’t need to worry about the trouble defining a depressed state, a happy state. We can just ask people about their mood. “How do you feel?” “Meh, OK I guess.”

      OK, take two doses of this dopamine reuptake inhibitor. One through each nostril so it can be absorbed through the mucus membrane. Here’s a sterile straw.

      “Now how do you feel?” “Fucking awesome doc!”

  18. Adam says:

    It seems like there actually is a strong prevalence of the chemical imbalance idea. Sort of seems like a cop-out to argue “psychiatrists aren’t saying that, you’re misrepresenting them” when a number of researchers are doing research against the chemical imbalance idea. What are they researching if this message doesn’t actually exist in the real literature? Why are psychiatrists proscribing Zoloft, if psychiatrists don’t believe in a serotonin imbalance?

    Have you seen this latest study that came out?

    It lists a number of claims that support the idea of serotonin being the completely wrong thing to be dealing with.

    Here’s a psychiatrist that is strongly against the chemical imbalance myth.

    • James Picone says:

      When you say ‘chemical imbalance’, what, precisely, do you mean?

      When Scott says ‘chemical imbalance’, here, he means ‘there is either too much or too little of some neurotransmitter/s in specific bits of the brain’. When it comes to depression, there’s a fair amount of evidence that serotonin is involved somewhere, although it’s a bit complicated.

      The thing he’s arguing psychiatrists never claimed is “depression is caused by having too little serotonin present over the whole brain”.

      That is a very different claim. Are you sure you’re not conflating the two?

  19. Amy says:

    You begin by stating MiA’s position as “psychiatry erred grievously in overselling “chemical imbalance””

    You end by conceding that “this consensus position got simplified and distorted. I have no doubt that drug companies drew from it to do exactly the sort of infomercials that Mr. Wipond describes” and “SSRIs continue to be moderately effective antidepressants in the people for whom they are indicated. (ie somewhere less than half of the people for whom they are prescribed)”

    Those statements look pretty much in agreement – the drug companies oversold “chemical imbalance” in order to push their drugs onto people who didn’t benefit from them.

    Your position (if I’m reading you correctly and not just projecting my own opinion) is that psychiatry is doing the best it can. That’s not incompatible with screwing up sometimes and needing to do better.

    You certainly make a good argument that MiA was intellectually dishonest in their quotations. However, it seems futile to hope for scientific rigor in a blog with the word “Mad” in its title when the quoted “Medical News Today” turns correlation into causation.

  20. Paul Torek says:

    Peter C Gøtzsche, Why I think antidepressants cause more harm than good:

    With regard to the benefits of antidepressants, in its large meta-analysis of 100,000 patients, half of whom were depressed, the US Food and Drug Administration (FDA) noted that 10% more patients responded on
    antidepressants than did those on placebo,2 and the Cochrane review of depressed patients reported similar results3 (ie, one patient might benefit for every ten patients treated). I believe those results were exaggerated, however,
    for several reasons.4 Most importantly, the trials were not effectively blinded. Antidepressants have conspicuous side-effects and many patients and their doctors will therefore know whether the blinded drug is active or placebo. A systematic review of 21 trials5 in a variety of diseases that had both masked and non-masked outcome assessors, and which had mostly used subjective
    outcomes, found that the treatment effect was exaggerated by 36% on average (measured as odds ratio) when non-masked observers rather than masked ones assessed the effect.

    In other contexts Gøtzsche has referred to SSRIs as anti-sexuality drugs. I.e., that’s their main effect.

  21. Pingback: FeepingCreature comments on “The Serotonin Levels-Depression Link Is a ‘Marketing Myth,’ Psychiatrist Claims” | Exploding Ads

  22. Mike Johnson says:

    Even though MIA’s examples seem pretty poor, I do seem to remember the focus on Serotonin from the 90s until the mid 2000s.

    An excerpt from a NYT piece I was re-reading today:
    “What is the limit to neuroimaging therapy?” deCharms muses. “Could you learn to target the reward or serotonin system and up-regulate happiness?

    • Mike Johnson says:

      Using this comment thread as a pastebin of examples of how the people I’m reading write about serotonin. In doing so I am not taking a side in this debate. The data I gather is based on what I’m reading and may not reflect what others are exposed to.

      >Although it’s ordinarily fenced off from the body’s infection-fighting agents, the brain has a complementary system, called microglia, capable of clearing away damaged neurons and fending off infection. Specialized microglial cells make up 10 to 15 percent of the brain. When they go to work, you feel it. Active microglia interfere with neurotransmitters like serotonin, which activates the pleasure sensors in the brain. “That’s why when we have a fever, we feel flat in our mood,” Khandaker says.

      Nautilus, “Yes, You Can Catch Insanity”, April 16, 2015.

  23. Mean Square says:

    And SSRIs continue to be moderately effective antidepressants in the people for whom they are indicated.

    What does that mean?
    That they help many people “moderately”?
    Or could it be that they a help few people very much?

    That is what decides how good the following advice is: “If one antidepressant didn’t work, just keep trying different ones, because another antidepressant very probably will work.” (for which I’ve never seen ANY evidence, btw)