Even if we accepted the proposition that these drugs are helpful for some people, extrapolating a medical cause from this observation would be akin to saying that shyness is caused by a deficiency of alcohol, or that headaches are caused by a lack of codeine. And what about a genetic vulnerability? Is there such thing as a depression gene? In 2003, a study published in Science suggested that those with genetic variation in their serotonin transporter were three times more likely to be depressed.26 But six years later this idea was wiped out by a meta-analysis of 14,000 patients published in the Journal of the American Medical Association that denied such an association.27 Dr. Thomas Insel, director of the National Institute of Mental Health, commented with the following: “Despite high expectations, neither genomics nor imaging has yet impacted the diagnosis or treatment of the 45 million Americans with serious or moderate mental illness each year.”28 Dr. Carlat speaks the truth in his own words: “And where there is a scientific vacuum, drug companies are happy to insert a marketing message and call it science. As a result, psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.”29
Suffice it to say the data has poked so many holes in the serotonin theory that even the field of psychiatry itself is putting down its sword. In a 2005 essay for PLOS Medicine by Drs. Jeffrey R. Lacasse and Jonathan Leo, the authors gathered sentiments from influential thinkers in the field, including conventional clinicians and researchers who have expressed doubt on the entirety of what psychiatry has to offer around antidepressants (see tables on the following pages).30
The medical-pharmaceutical complex has constructed quite a few houses of cards, and far too many of its treatments—very profitable treatments—are offered without solid evidence to support doing so. In fact, only two studies are required for FDA licensure of most pharmaceuticals, essentially leaving the population to participate in a post-marketing experiment in which adverse effects—causalities—are monitored passively. It’s a fabrication of science to think these drugs have a place in medicine, what is meant to be the art of healing. It could be argued that antidepressants are the new tobacco, and, like the tobacco industry, Big Pharma can wield a lot of power through clever marketing to seduce and influence us in stealthy, seemingly benign ways that are anything but.
DIRECT-TO-CONSUMER ADVERTISING
Sadly, direct-to-consumer advertising (DTCA) in America has allowed pharmaceutical companies to “teach” the public about brain chemical imbalances and serotonin deficiencies via sound bites and cleverly worded taglines that escape FDA policing. I have patients who come in believing that the solution is in a pill—what they’ve learned essentially from commercials. It’s been calculated that DTCA advertising is responsible for nearly half (49 percent) of requests for drugs.31 And fully seven out of ten times doctors prescribe based on appeals made by patients who learned through their computers and televisions that they have an “imbalance” that must be fixed with a pill.32
“Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse,” Behavior Therapist 38, no. 7 (October 2015): 206–213. Reprinted with permission.
In the ten-year period between 1999 and 2008, DTCA tripled, from $1.3 to $4.8 billion, their efforts at educating patients about their need for psychiatric medication. The modern drug business has been built on “brain” medicines. Valium was the first blockbuster, selling 2 billion tablets in 1978. Then in the 1990s came Prozac, which defined the industry. The pharmaceutical industry spent $4.53 billion on direct-to-consumer advertising in the United States alone in 2014, up 18 percent from the previous year.33
The flagrant disconnect between the advertisements and scientific literature has been written about for more than a decade now, but you probably haven’t read about it. It was clearly stated by Drs. Lacasse and Leo in their 2005 paper: “These advertisements present a seductive concept, and the fact that patients are now presenting with a self-described ‘chemical imbalance’ shows that the [advertising] is having its intended effect: the medical marketplace is being shaped in a way that is advantageous to the pharmaceutical companies.”34 As far back as 1998, at the dawn of consumer advertising of SSRIs, Professor Emeritus of Psychology and Neuroscience Elliot Valenstein of the University of Michigan summarized the scientific data by concluding, “What physicians and the public are reading about mental illness is by no means a neutral reflection of all the information that is available.”35
The United States and New Zealand are the only countries in the world that allow advertisement on television for prescription drugs. In 1997, a change to an FDA regulation opened the floodgates on direct-to-consumer advertising, allowing drug makers to promote their wares on television. This also paved the way for celebrities, athletes, models, and aging baby boomers to dominate those ads.
Given these forces, along with the number of symptoms listed under antidepressant use, it’s really no surprise that more than $11 billion is spent each year on these medications.36 Pharmaceutical companies have more than six hundred lobbyists, and they finance more than 70 percent of FDA trials.37 They court physicians, toss them copious free samples, pay consultants to speak at scientific meetings, advertise in medical journals, fund medical education, and ghostwrite, selectively choosing and redundantly submitting data for publication. Psychiatric studies funded by Big Pharma are four times more likely to be published if they report positive results. Only 18 percent of psychiatrists disclose their conflicts of interest when they publish data.38 Their studies allow for all kinds of indiscretions, such as removing people who are likely to respond to placebo before the study to strengthen the perceived benefit and using sedative medications with the study’s medications, thereby skewing results in favor of the drug (more on this shortly).
A now famous 2008 study in the New England Journal of Medicine led by Dr. Erick Turner at Portland VA Medical Centers sought to expose the extent of data manipulation.39 Through valiant efforts to uncover unpublished data, he and his team determined that from 1987 to 2004, twelve antidepressants were approved based on seventy-four studies; thirty-eight were positive, and thirty-seven of these were published. Thirty-six were negative (showing no benefit), and three of these were published as such, while eleven were published with a positive spin (always read the data, not the author’s conclusion!), and twenty-two were unpublished.
The FDA requires only two studies for drug approval, so you can see how these companies are tossing the coin over and over again until heads comes up and hoping no one is looking when it’s tails. To get a sense of just how misleading the pharmaceutical industry can be, consider the largest study to date funded by the National Institute of Mental Health, conducted at the University of Texas in 2006.40 It cost the public $35 million for researchers to follow more than four thousand patients who were treated with Celexa over twelve months. This was not a double-blind placebo controlled study, so the people knew what they were getting. Half of them reportedly improved at eight weeks. Those who didn’t were switched to Wellbutrin, Effexor, or Zoloft or “augmented” with Buspar or Wellbutrin. Guess what? It didn’t matter who took what, because the same percentage of the group allegedly improved (18 to 30 percent) no matter what drug they were on. Only 3 percent of patients were supposedly in remission at twelve months. Now here’s where the story gets interesting.
In February 2012, a suit was filed against