Dr Moncrieff on depression and drugs: dopey but not cured

Could psychiatric drugs, such a antidepressants, cause rather than cure mental disorders? Is chemical cure a myth? This was the topic of Joanna Moncrieff's talk at the Lewes Skeptics in the Pub's monthly event this week.

Dr. Moncrieff is a clinical lecturer in the department of mental health sciences at University College of London. Her book The Myth of Chemical Cure is published by Palgrave Macmillan.

Her talk was centred on the current mainstream view that an emotional or mental disorder is a result of a chemical imbalance, which drugs can help correct . However, these drugs have a psychoactive effect, just like alcohol or narcotics, which create a drug-induced state, altering the way we think, feel and behave. These effects, says Dr Moncrieff, may end up numbing or masking actual psychological and emotional problems.

This short discussion on the Today programme between Joanna Moncrieff and consultant psychiatrist Trevor Turner from 2009 gives you a good taster of the controversies round this topic.

Informed consent
Joanna Moncrieff did not say drugs can't or don't help. He concern is that patients are not always being given the full picture on the unpleasant or harmful effects psychiatric drugs may have on their bodies and mind. The emphasis is heavily on the pro-drug view that they will fix some sort of underlying chemical imbalance they have in their brain.

In truth, science still knows very little about how the brain actually works, or what the chemical makeup is of emotions, elation, depression, love, what have you. Not enough research has been done on how drugs work (apparently, the effect of antidepressants have been shown not to be that different from a sugar pill's), their mental and physical impact, their long and short term side effects, side-effects, and the withdrawal symptoms when you stop taking them.

A modern malaise
Statistics show that over the past decade there has been a four fold increase in the use of drugs in mental health treatment. It does not come as a surprise. We are all popping "happy pills" prescribed without hesitation by our GPs, as nonchalantly as if they were sweets.

Someone in the audience asked, "Are antidepressants overprescribed these days, or are more people depressed now?" Dr Moncrieff's answer made me sigh and prompted me to write this post:

"As a society we tend to see our problems through the prism of depression. Life now is far more demanding now than 50 years ago."

She pointed out, quite rightly, that performance expectation in all areas of our lives is much higher these days, and drugs like Prozac are even promoted as making you perform above normal levels.

Balancing act
No wonder we are all so depressed. We are balancing12-hour shifts in the office with school runs for the kids, trips to the gym (because everyone else is doing it), the obligatory visit or call to a parent, the mustn't-forget drinks with friends you haven't seen in a while, the grocery shopping, the hoovering, the laundry, the ironing, the cooking and the planing of the next holiday. All this, while looking amazing, showing top poductivity and staying emotionally balanced.

Even if you haven't got children, your parents are dead or don't talk to you, and you never cook or clean, in your head, you are still responding to someone's expectations: your boss's, your spouse's, your parents (even if they are no longer alive), society's. We do not like letting people down, and maybe therein lies the problem. Are we constantly trying – and failing – to be the perfect colleague, the perfect boss, the perfect wife or husband, someone's dutiful child or parent?

No labels
I am surrounded by people who have overstretched themeslves physically, mentally or emotionally and have suffered nervous breakdowns as a result, people who needed to take long sabbaticals before they were able to work again, others who regularly rely on drugs and/or alcohol to keep functioning in the high-speed autobahn of life. I have personally experienced a near-breakdown on a number of occasions for having demanded too much of myself. I do it again and again; I never seem to learn...

Why do we try so hard? Why can't we embrace our limitations and admit we can't please everyone all of the time? That we have widely varying stress tolerance levels, and none of us are super-heroes?

Vulnerability
I want to applaud Joanna Moncrieff for her belief that people should not be universally labelled as "depressed" and given random chemicals to suppress its symptoms, that they ought to be seen as individuals with specific problems for which different solutions are possible. Maybe the pharmaceutical industry, colluding with pychiatrists and politicians, have bundled us all into one large nut case sac, and called us depressed, psychotic or bipolar to suit their own agendas, doping us with drugs to keep us sweet and troublefree. Who knows?

Acute cases of mental illness excepted, let's face it: we are all prone to some degree of gloom and melancholy at times. Just because pills are readily available that make you feel happy and confident, we should not shy away from a more important debate – on how we can change attitudes in society, and in ourselves, that could lead to less depression and a better understanding of ourselves and our vulnerability.

After all, being vulnerable is part of being human. Give us licence to fail.