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Questioning the use of antidepressants

In his 2010 book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, investigative journalist Robert Whitaker argues psychiatric medications are often ineffective and that the idea of chemical imbalance is unproven. His book was controversial, but it won the 2010 Investigative Reporters and Editors Book Award and his ideas have support from prominent psychiatrists. His work is profiled in this CBC article and you can hear him in this radio interview with Michael Enright on The Sunday Edition.

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I point out in this article that CBC and Robert Whitaker have misrepresented the views of Dr. Thomas Insel:


As well, the views of Dr. Ronald Pies were also misrepresented and he has written into CBC explaining the misrepresentation of his comments; below is a link to his comment. However, since it's hard to locate, I've pasted it in below:


Dear Mr. Enright,

Since I am quoted, somewhat out of context, in this posting, I would like to clarify my position re: the "chemical imbalance" metaphor. The article asks:

"...what if mental illnesses like depression aren’t really caused by chemical imbalances, and that millions of the people who are prescribed those drugs derive no benefit from them? And what if those drugs could actually make their mental illness worse and more intractable over the long term?"

There is a big difference between saying that the "chemical imbalance" idea is simplistic--a statement I would support--

and claiming that people derive "no benefit" from antidepressant--a claim I do not endorse and is in fact wrong. There is no question that for moderate-to-severe major depression, people do get significant benefits from these medications, though their exact mechanism of action is not clear, and is undoubtedly more complicated than correcting a "chemical imbalance." The claim that antidepressants or antipsychotic agents make mental illness worse in the long term has never been substantiated in carefully controlled studies.

It is extremely difficult to prove that medication, as opposed to the patient's natural course of illness, caused any "worsening" that might be seen, and it is premature and speculative to blame medications.

The best we can do is to use the lowest effective dose of these medications, for the shortest clinically-feasible time.

For more details on the efficacy of antidepressants, please see

my article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/

Ronald Pies MD
Posted on 10/06/14 5:46 PM.

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