How Prozac sent the 'science of depression' in the wrong direction

An Article by Jonah Lehrer, as seen in the Boston Globe (Highlights given below)

Note: Of course, maybe the drugs aren't the cure in the first place, because the actual problem is not being addressed at all.

Given the numerous side effects of drugs like prozac, maybe the best therapy would be a national health and exercise program. Not that anyone would actually want to get this into law.

UpDate: Psych Central has also picked up on this

Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me.

Here are some original snippets from the original article as seen in the Globe:

---

Prozac is one of the most successful drugs of all time. Since its introduction as an antidepressant more than 20 years ago, Prozac has been prescribed to more than 54 million people around the world,

[...]

For decades, researchers struggled to identify the underlying cause of depression, and patients were forced to endure a series of ineffective treatments. But then came Prozac. Like many other antidepressants, Prozac increases the brain's supply of serotonin, a neurotransmitter. The drug's effectiveness inspired an elegant theory, known as the chemical hypothesis: Sadness is simply a lack of chemical happiness. The little blue pills cheer us up because they give the brain what it has been missing.

There's only one problem with this theory of depression: it's almost certainly wrong, or at the very least woefully incomplete. Experiments have since shown that lowering people's serotonin levels does not make them depressed, nor does it does not make them depressed, nor does it worsen their symptoms if they are already depressed.

In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain's cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers.

[...]

These discoveries are causing scientists to fundamentally re-imagine depression. While the mental illness is often defined in terms of its emotional symptoms - this led a generation of researchers to search for the chemicals, like serotonin, that might trigger such distorted moods - researchers are now focusing on more systematic changes in the depressed brain.

[...]

The progress exemplifies an important feature of modern medicine, which is the transition from a symptom-based understanding of a disease - depression is an illness of unrelenting sadness - to a more detailed biological understanding, in which the disease is categorized and treated based on its specific anatomical underpinnings.

In the 19th century, the "fever" was a common medical illness. Of course, doctors now realize that a fever is merely a common symptom of many different diseases, from the flu to leukemia.

Likewise, when Richard Nixon declared a "War on Cancer" in 1971, scientists largely defined cancer in terms of its most tangible characteristic: uncontrolled growth leading to a tumor. As a result, every cancer was treated with the same blunt tools. Over time, of course, scientists have discovered that cancer is not a single disease with a single biological cause. Breast cancer, for instance, can be triggered by a wide variety of genes and environmental risk factors. Because doctors can look beyond the superficial similarities of the symptoms - all tumors are not created equal - they are able to tailor their treatments to the specific disease.

Neuroscience is only beginning to catch up. Thanks to a variety of new experimental tools, such as brain scanners and DNA microarrays, researchers are now refining their understanding of mental illness. In many instances, this means recategorizing disorders, so that patients are no longer diagnosed solely in terms of their most obvious symptoms.

"We used to think there was only one kind of anemia," says Arturas Petronis, a scientist at the University of Toronto who investigates the underlying causes of schizophrenia. "But now we know there are at least 15 different kinds. We'll likely learn the same thing about many mental illnesses."

[...]

It is jarring to think of depression in terms of atrophied brain cells, rather than an altered emotional state. It is called "depression," after all. Yet these scientists argue that the name conceals the fundamental nature of the illness, in which the building blocks of the brain - neurons - start to crumble. This leads, over time, to the shrinking of certain brain structures, like the hippocampus, which the brain needs to function normally.

In fact, many scientists are now paying increased attention to the frequently neglected symptoms of people suffering from depression, which include problems with learning and memory and sensory deficits for smell and taste.

Other researchers are studying the ways in which depression interferes with basic bodily processes, such as sleeping, sex drive, and weight control. Like the paralyzing sadness, which remains the most obvious manifestation of the mental illness, these symptoms are also byproducts of a brain that's literally withering away.

"Depression is caused by problems with the most fundamental thing the brain does, which is process information," says Eero Castren, a neuroscientist at the University of Helsinki. "It's much more than just an inability to experience pleasure."

This new scientific understanding of depression also offers a new way to think about the role of drugs in recovery. While antidepressants help brain cells recover their vigor and form new connections, Castren says that patients must still work to cement these connections in place, perhaps with therapy. He compares antidepressants with anabolic steroids, which increase muscle mass only when subjects also go to the gym.

"If you just sit on your couch, then steroids aren't going to be very effective," he says. "Antidepressants are the same way: if you want the drug to work for you, then you have to work for the drug."