$21 billion antidepressant industry is built more on marketing hype than medical science

A letter to the editor seen in the WSJ

Depressed About Results? Science May Explain It
WSJ January 26, 2008; Page A9

Word comes that unpublished studies of antidepressants show the drugs are overrated ("Antidepressants Under Scrutiny Over Efficacy," Personal Journal, Jan. 17). This isn't a surprise to many of us who have prescribed them. Sadly, the $21 billion antidepressant industry is built more on marketing hype than medical science.

The medicalization of depression dates to a "chemical imbalance" theory of the late 1950s, when some patients taking the anti-hypertensive drug reserpine got depressed. Reserpine was known to partially deplete catecholamines, a kind of neurotransmitter in the brain, of which serotonin is one example. This led to the theory that depression was caused by low catecholamine levels. Drugs have been successfully marketed as antidepressants by showing that they enhance catecholamine activity.

While this looks like a neuroscience success story, the truth is that no case of depression has ever been shown to be caused by low catecholamine levels. If you find this hard to swallow, ask your physician what your serotonin level is and how it compares to a group of depressed, suicidal patients. The honest answer is that they are the same.

Psychiatrists can promulgate chemical imbalance theories and sleep well at night because they are devout biochemical determinists, for whom every thought or feeling is caused by chemical reactions in the brain.

To the true believer, good feelings come from good chemistry, bad feelings from bad chemistry. If the science hasn't been worked out yet, it is only a matter of time. What is important is that depressed people keep those catecholamines "balanced." Whether bad theories arise from bad chemistry has not, to this point, generated much interest.

To be sure, antidepressants can be helpful. The sedating ones, for instance, often benefit depressed people who can't sleep. But the real harm of these drugs is the theoretical baggage that comes with them. The more a patient believes that pills are the cure for depression, the less likely he is to think seriously about the meaning of his life.

Michael J. Reznicek, M.D.
Psychiatrist
Spokane, Wash.

Note the the apparent benefit seems to be from the side effects, not the primary effects, as noted by the sedative example.