Anti-depressants are guesswork. What does that mean for those suffering from depression?
In her enlightening new book, Blue Dreams, Lauren Slater covers the history of psychotropic drugs.
For over thirty-five years, Lauren Slater has taken drugs to treat depression. A psychologist by training, this mood disorder hasn’t slowed her prolific career. The author of nine books, Opening Skinner’s Box (2004) was nominated for a Los Angeles Times Kirsch award. In her latest outing, Slater reports on what's been going inside of her body—and what these drugs do to all of our bodies.
Blue Dreams: The Science and the Story of the Drugs That Changed Our Minds is a history of psychotropic drugs covering our clinical (and not-so-clinical) attempts of treating psychological disorders. Beginning with Thorazine, Slater dives into the origins of lithium, antidepressants, and SSRIs, devoting a chapter to the placebo effect and two to psychedelics.
Even though we’ve spent two centuries chemically intervening with human biology to treat anxiety and depression—or, as they were previously known, “nerves”—we know surprisingly little about how to treat them. In many ways, the diagnoses create the disease, which creates lucrative opportunities for Big Pharma. The most enlightening (and frightening) detail Slater reveals is how much guesswork occurs in this multibillion-dollar industry.
Part of the problem, Slater told me from her Massachusetts farm, is that unlike many physical diseases, there are no means for physiologically measuring depression. The one potential marker, cortisol (which is implicated in a recently proposed assessment, melancholia), was rejected for inclusion in the psychiatric bible, DSM-V. As she writes,
Lacking blood, tissue, or cells, psychiatry has had no choice but to retreat into pure description.
That means the 300 million people suffering from depression worldwide are being treated without an accurate assessment of their problem. This is particularly troubling in an industry in which psychiatrists see four to six patients an hour when scribbling down scripts—doctors interrupt patients within twelve seconds of an explanation, making a thorough examination impossible—instead of engaging with one patient in talk therapy. The financial incentive is not there even though the latter has proven to be a more potent therapy.
Still, the general public imagines medicine on a continual forward march toward better care, even though it’s been decades since we've experienced a pharmacological breakthrough. We tend to treat the past, even the recent past, as the dark ages, she says.
An upward trail of progress is really a myth. There were treatments in the past that we may look upon as barbaric or as ill-found, but that worked, and there are treatments in the present that are barbaric and don’t have any real science behind them. And sometimes those work too [laughs]. Psychiatry has been looking at the somatic substrates of suffering for thousands of years and there’s been hits and there’s been misses—more misses than hits, but it’s not like now we’re in the age where all we have are hits.
Lobotomies, she continues, were barbaric but still helped some people. Today bilateral cingulotomies, a close cousin to lobotomies, are still used to treat depression. Our most prescribed treatment, antidepressants, appear to suffer from novelty bias: a recent meta-analysis of 522 trials with over 116,000 participants discovered that newer drugs perform better than older ones, but the effects wear off as time goes by.
Which is a problem Slater addresses, both through her own experiences with Prozac (and other drugs) and her reporting on clinical studies. As with lobotomies, the most popular drugs on the market are speculative since specificity is impossible given the fact that there are no measurable biological markers to target.
Consider selective serotonin reuptake inhibitors (SSRIs), which are used to treat major depressive disorder, obsessive-compulsive disorder, PTSD, chronic pain, eating disorders, and a host of anxiety disorders. As Slater puts it, the category “does more to conceal than to reveal.” That’s because 95 percent of the body’s serotonin is produced in the gut, not the brain. Serotonin interacts with many systems, including those producing dopamine, norepinephrine, and acetylcholine, making it impossible to target how serotonin is interacting with the rest of your body.
This has not slowed prescriptions. By 2020 the global depression market is predicted to generate revenues of $16.8 billion. Lithium, a chemical element that, in precise doses, has had clinical success in treating depression, has never been approved by the FDA (except for manic-depressive disorder). As with script-writing psychiatrists, the profit motive is gone—you can’t patent an element.
Amazingly, we are born with an extremely powerful polypharmacy right inside of our heads: the placebo effect. Simply believing a drug is working releases a cascade of endogenous opioids with potent healing properties. While the meta-analysis above revealed that antidepressants perform slightly better than placebo (albeit with a caveat: most of the studies included were funded by the pharmaceutical industry), time and again inert substances heal.
The British Medical Journal (BMJ) sent the U.S.Food and Drug Administration documents submitted by an anonymous source that seem to show a link between Eli Lilly and Co.'s Prozac (fluoxetine) and suicide attempts and violence. (Photo by Stephen Chernin/Getty Images)
Slater writes about the incredible case of Mr. Wright, who was so riddled with orange-sized tumors from advanced lymphatic cancer in 1957 that his doctor wrote him off for dead. Then a new potential cancer cure, Krebiozen (horse serum) was being entertained. Wright begged for and received a dose. Three days later he was walking around with tumors the size of golf balls. Another week passed. His tumors were gone.
Two months later a news report labeled Krebiozen a failure. Wright’s tumors returned. On his next visit, his doctor lied and informed him that that news report was actually false; he then injected Wright with sugar water, telling him it was Krebiozen. Incredibly, Wright went into remission again. A few months pass, another news report, another hospital visit. Before his doctor tried another trick, Wright passed away.
Our brains are capable of producing some endorphins in such quantity and have such quality that we could undergo extreme surgeries with no pain. What it suggests is that our brains are so much more amazing than we think or are even able to think. We can’t even begin to conceive of the power that is within our brains.
What if these drugs are the most expensive placebos on earth? Problem is, the side effects are real. Slater might be suspicious about the intention of the pharmaceutical industry and the psychiatrists that feed on it, but she also credits these pills for saving her life. Depression might not currently be measurable, but it is real.
Which is the same dilemma hundreds of millions of people across the planet are facing. Some find effective relief from antidepressants. Others do until they don’t. The shortened lifespan, metabolic disorders, memory issues, suicidal tendencies, and immune problems that coincide with sustained usage is all too real for many. As Slater notes, every year the number of prescriptions rise, yet so do rates of depression. Our current interventions are not as effective as we need them to be, which means we need to look elsewhere.
Slater does believe hope is around the corner in the form of the burgeoning clinical literature of psychedelics such as psilocybin, MDMA, and ketamine—a topic I’ll address in part two of this story next week.
Derek Beres is the author of Whole Motion and creator of Clarity: Anxiety Reduction for Optimal Health. Based in Los Angeles, he is working on a new book about spiritual consumerism. Stay in touch on Facebook and Twitter.
What would happen if you tripled the US population? Join Matthew Yglesias and Charles Duhigg at 1pm ET on Monday, September 28.
Whether or not women think beards are sexy has to do with "moral disgust"
- A new study found that women perceive men with facial hair to be more attractive as well as physically and socially dominant.
- Women tend to associate more masculine faces with physical strength, social assertiveness, and formidability.
- Women who display higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, are more likely to prefer hairy faces.
Beards and perceptions of masculinity<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg0MC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NzkxMjM3N30.cH-GqNwP5GVqvstgJWAhBPn1B_lYpVEAI0I7iax7EQw/img.jpg?width=1245&coordinates=0%2C1900%2C0%2C849&height=700" id="caae6" class="rm-shortcode" data-rm-shortcode-id="cb0a355a4e8e1899789bc45f3f7aef56" data-rm-shortcode-name="rebelmouse-image" />
Photo Credit: Wikimedia<p>The study used 919 American (mostly white) women ages 18-70 who rated 30 pictures of men they were shown with various stages of facial hair growth. The photographs depicted men with faces that had been digitally altered to look more feminine or more masculine, with a beard and without a beard. The women rated the men according to perceived attractiveness for long-term and short-term relationships. The study found that the more facial hair the men had, the higher the men were rated on their attractiveness, particularly for their suitability for a long-term relationship.</p><p>Part of this might be attributed to facial masculinity — i.e. protruding brow ridge, wide cheekbones, thick jawline, and deeply set narrow eyes — which conveys information to a woman about a man's underlying health and formidability. Women tend to associate more masculine faces with physical strength and social assertiveness. It can also indicate a man with a superior immune response. The researchers suggested that their findings favoring bearded men could be due to the fact that facial hair enhances the masculine facial features on a man's face, like creating the illusion of a thicker jaw line. This could communicate direct benefits to women like resources and protection that would enhance survival among mothers and their infants. In other words, while a beard doesn't mean superior genetics in and of itself, it might be a primitive, ornamental way of saying, "Hey girl, I'm a testosterone-fueled lean, mean, pathogen fighting machine." <br></p><p>It could also be that a beard becomes its own destiny. The researchers in this study cite prior research that found that by growing a beard, men felt more masculine and had higher levels of serum testosterone, which was linked to a higher level of social dominance. They also tended to subscribe to more old-school beliefs about gender roles in their relationships with women as compared to men with clean-shaven faces.<span></span><br></p>
What does disgust have to do with beard preference?<p>Obviously, not all women dig beards. The researchers were particularly interested in what traits make a women prefer bearded men over clean-shaven faces. They looked into several factors including a woman's disgust levels on various concepts, her desire to become pregnant, and her exposure to facial hair in her personal life. </p><p>According to the study, women who were not into facial hair were turned-off by potential parasites or other critters they imagined could be in the hair or skin. Women ranking high on this "ectoparasite disgust" scale might have viewed beards as a sign of poor grooming habits. However, women who ranked higher in levels of "pathogen" did find the bearded men to be desirable, possibly because they perceived beards as a signal of good health and immune function. An intriguing discovery in the study was links to morality. Women who displayed higher levels of "moral disgust," or feelings of repugnance toward taboo behaviors, were more likely to prefer hairy faces. The authors opined that this could reflect a link between beardedness, politically conservative outlooks, and traditional views regarding performances of masculinity in heterosexual relationships.</p>
Additional findings<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjU5OTg1My9vcmlnaW4uZ2lmIiwiZXhwaXJlc19hdCI6MTYyNDI1NjUyOX0.P9B8WbmJR0q4nfzYZKbuNSA-2SAigVWJgrQE-_Gxlds/img.gif?width=980" id="49143" class="rm-shortcode" data-rm-shortcode-id="2ed3b1d6f20fc170bf2974646e565e8d" data-rm-shortcode-name="rebelmouse-image" />Giphy<p>The correlations that existed between married and single women's rating on the attractiveness of beards were not particularly clear, although the researchers noted that single and married women who wanted children tended to find beards more attractive than the women who didn't want children. They also found that women with bearded husbands found beards to be more attractive, which might indicate that social exposure to beards influences how desirable they are perceived of as being. Or it could be that men with wives who like beards grow beards.</p><p>It's important to note that culture plays a huge role in how attractive women perceive certain male characteristics as being. This study looked at a small, culturally specific group of American women, so no big, universal claims should be made about masculinity, facial hair, and male desirability to women. However, research like this is important in highlighting how human grooming decisions are driven by much more than fashion trends. Sociobiological, economic, and ecological factors all play a part in the way we choose to present ourselves.</p>
Dominique Crenn, the only female chef in America with three Michelin stars, joins Big Think Live.
Having been exposed to mavericks in the French culinary world at a young age, three-star Michelin chef Dominique Crenn made it her mission to cook in a way that is not only delicious and elegant, but also expressive, memorable, and true to her experience.
Controversial physics theory says reality around us behaves like a computer neural network.
- Physicist proposes that the universe behaves like an artificial neural network.
- The scientist's new paper seeks to reconcile classical physics and quantum mechanics.
- The theory claims that natural selection produces both atoms and "observers".
Vanchurin interview:<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="539759cbfd8fcd5b6ebf14a3b597b3f9"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/bmyRy2-UhEE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Vanchurin on “Hidden Phenomena”:<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="18886ffd5e5840bb19d4494212f88d82"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/2NDVdNwsHCo?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>Vitaly Vanchurin speaking at the 6th International FQXi Conference, "Mind Matters: Intelligence and Agency in the Physical World." The Foundational Questions...
43% of people think they can get a sense of someone's personality by their picture.
If you've used a dating app, you'll know the importance of choosing good profile pics.
Quarantine rule breakers in 17th-century Italy partied all night – and some clergy condemned the feasting
17th-century outbreaks of plague in Italy reveal both tensions between religious and public health authorities.