Anti-depressants are guesswork. What does that mean for those suffering from depression?

Author: Derek Beres / Source: Big Think

Donald Rayfield, known on the street as ‘Detroit’, smokes crack cocaine and looks at a pornographic magazine in an underground storm drain on January 18, 2006 in Los Angeles, California. (Photo by David McNew/Getty Images)

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.

The best science says depression is a social ill, not an individual flaw Johann Hari

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The best science says depression is a social ill, not an individual flaw

Johann Hari

Author, ‘Lost Connections’

05:42

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.