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it's essentially a PR line that both doctors and the general public have mistaken for science

That sound derogatory.

Did you expect her to go into detail about serotonin, what the latest Science tells us it does, what serotonin uptake inhibitors do, etc?

The woman wrote an article that is really just an ice breaker on how she and her partner dealt with acknowledging that there was a depression problem and getting help for it. She felt that her contribution to the problem of depression was to relay a little of Wil Wheaton's story from her perspective.

but they also fail to help a great number more

No one has said that every case is the same. In fact, TFA specifically mentions that fact as well as anecdotally telling us about how Wil had to change his dosage and medication to meet his specific and dynamic neurological profile.

The problem wasn't that 'medications help to balance out those chemicals' is an oversimplification, it's that the theory doesn't have a lot of support. The evidence for the monoamine hypothesis is far from conclusive. I agree with the parent that 'chemical imbalance' is a PR line if stated as a medical truth. (I am only commenting on the class of medications mentioned in the article)

It's a PR line because everyone wants mechanism explanations, and the truth, "If we poke at people's brains with sticks shaped in these ways, their mood improves" is unpalatable.

That "sticks shaped these ways" happen to affect neurotransmitter levels is a great guide to finding others, especially the great moves in safety from MAO inhibitors -> trycyclics and the like -> 3rd generation started with Prozac, is sort of besides the point. That they make a really significant difference for lots of people is.

http://en.wikipedia.org/wiki/Chemical_imbalance

Not that wikipedia is the last word, but, "[...] companies such as Pfizer continue to promote drugs like Zoloft with advertisements asserting that mental illness may be due to chemical imbalances in the brain, and that their drugs work to "correct" this imbalance. Most academics believe that the advertisements are oversimplified and don't fully explain what is happening."

Oversimplifications

I didn't say it wasn't an oversimplification, I said oversimplification isn't the problem. You seemed to misunderstand the complaint of the first post you replied to.

You said, "it's that the theory doesn't have a lot of support"

I was simply pointing you to a reference that showed that "academics" use the exact same language regarding chemical balance of neurotransmitters as the original author.

Notice that it didn't say, "Academics disregard the chemical balance explanation because it lacks evidentiary support."

They absolutely do not use the same language. Where did you see that?

>Notice that it didn't say, "Academics disregard the chemical balance explanation because it lacks evidentiary support."

A lack of explicit critique in a rephrasing on wikipedia should not be used as evidence.

The cited article for that sentence (http://www.medscape.com/viewarticle/516262) is from 2005 and includes the following:

> Numerous studies to identify reproducible changes in neurotransmitter levels in the cerebrospinal fluid of clinically depressed patients, or to induce or correct depression by manipulating brain serotonin levels, were inconclusive and fraught with methodological limitations.

> Gordon McCarter, PhD, an assistant professor of biological sciences at the College of Pharmacy of Touro University in Vallejo, California, agreed that the evidence for an "imbalance" in neurotransmitters causing depression is "circumstantial" and "more and more tenuous." He noted the dearth of studies showing any measurable difference in serotonin or norepinephrine between depressed patients and controls

> "The Diagnostic and Statistical Manual of Mental Disorders does not list serotonin as a cause of any mental disorder; it is simply one neurotransmitter that continues to be investigated. And the prescribing information for the SSRIs does not claim that their mechanism of action is to correct a chemical imbalance, although this is exactly what the advertisements claim."

> "We suspect that many consumers believe the serotonin theory to be more scientifically based than it is, and that they might have chosen an alternative approach to their distress if they were fully informed.

"In truth, the “chemical imbalance” notion was always a kind of urban legend- - never a theory seriously propounded by well-informed psychiatrists."

Ronald Pies, MD, psychiatry professor at SUNY Upstate Medical University and Tufts University School of Medicine, and editor of the Psychiatric Times.

http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatr...

The entire "chemical imbalance" model is a lie designed to make drugs easier to sell, and here's a simple pair of facts which prove that the science is bunk:

SSRIs increase levels of serotonin at the synapse when administered by preventing serotonin re-uptake and recycling, improving mood.

SSREs decrease levels of serotonin at the synapse when administered by enhancing serotonin re uptake and recycling, improving mood.

Two drugs with opposite effects achieve the same qualitative result, even though it can't be said that they produce similar quantitative results. Thus, vastly different quantitative profiles are correlated with the same qualitative results; X + 1 = X - 1.

On top of that, there's no way to even measure levels of synaptic neurotransmitters in vivo.

There are multiple serotonin receptor types, and the "selective" types of reuptake modifiers don't affect all of them all the time in all people.

That said, too much or too little serotonin absorbed by a specific set or another can have wildly different effects.

Too much serotonin is not a good thing. So you need to balance it. For some people, this means SSRIs, for some it means SSREs. That's the explanation for the imbalance model, and it does make sense given the science.

It's ridiculous to talk about "balance" when you can't actually measure any of the quantities you're trying to balance and don't even have a clear picture of what "balance" looks like qualitatively, never mind quantitatively.

Sure, blast a brain with drugs that aren't well understood and it'll behave differently, maybe "better" than before, relatively speaking-- but that's not a scientific model so much as a pragmatic clinical solution.

It's ridiculous to talk about "balancing" the flavors of your soup when you can't actually measure any of the quantities you're trying to balance and don't even have a clear picture of what "balance" looks like qualitatively, never mind quantitatively.

Sure, dump in a bunch of spices that aren't measured and it'll taste different, maybe "better" than before, relatively speaking--but that's not a scientific model so much as a pragmatic cooking solution.

Yes. This is dog.

What is your point? That is definitely not a scientific model.

It's obvious you don't know very much about serotonin. Here's why:

SSRIs bind to the serotonin transporter SERT. The 'selective' part means that it has a much higher affinity for SERT than other monoamine transporters (e.g., DAT or NET). Although you're correct that there are various serotonin receptor subtypes, there is only one known SERT (there is only one gene).

SSRIs do exhibit extremely weak affinity to serotonin receptors but it is so low that it doesn't matter which subtype has a higher affinity than another. If you want to latch on to 5HT receptors with interesting ratios and affinities, the correct psychiatric drug would be an antipsychotic.

Please stop defending the chemical imbalance model when you do not understand the science at all. Thank you.

I assume when you say SSRE you are talking about tianeptine? Its affinity for SERT is low and its primary target is believed to be elsewhere.

Do those two drugs achieve the same effect in the same patients? There are plenty of treatments with opposite effects that achieve the same qualitative result, in different patients with different conditions that merit different treatments. Could that simply be the case here, or do both kinds of drugs typically work in the same people?

What is scary is that some doctors / people consider medication a panacea for curing mood disorder when it can actually get worse initially. Clinical results are much better when it is combined with behavioral therapy (skills training on how you talk to yourself in your mind). Antidepressants take weeks to have a consistent effect on serotonin levels and a lot of patients only on medicine might initially feel hopeless because it seems the medicine isn't working, yet it might be working enough increase motivation (but not mood). This is part of why antidepressants may increase risk of suicide (you might have more motivation to take action without yet experiencing enhanced mood). PLEASE - if you or anyone you know is going to start taking antidepressants, combine it with behavioral therapy, and realize the mood changes take time to work.