And I try, and I try, but I can’t get no Satisfaction…

Welcome once again to the Peter Hitchens remedial school for people who don’t know how to argue. Your homework has been marked. First, let us consider ‘Curtis’, who writes ‘You are entitled to your view on depression and antidepressants. But when all is said and done, you are not a doctor. Don’t you think it is best to leave medical matters to doctors? I don’t suppose that they are all in the pay of the drug companies.’

No, I don’t.  In this case, apart from anything else, I am by no means convinced that this is a medical matter. These drugs are not like antibiotics, or painkillers, or even chemotherapy, where there are varying degrees of knowledge of cause and effect. They are guesswork in an area of which doctors know virtually nothing. And no, they aren’t all ‘in the pay of the drug companies’, but any honest doctor will admit that many are influenced by the perks and benefits which the drug companies give to those who prescribe their pills. And many more are influenced by the need to get the patient out of the surgery quickly, with some form of apparent reassurance. How will you know if you are on the receiving end of either of these factors? You won’t.

Doctors, as it happens, are mostly no more qualified to make judgements on how chemicals will affect an individual’s brain than are the Ayatollah Khamenei,  or David Beckham.  Why?  Because there simply is no reliable objective knowledge on this matter. We know that these things change moods. We don’t know how or why they do it, or what the long-term effects may be.  In many cases, it may be a placebo effect. The real effect, perhaos dismisssed as a 'side-effect', initially disguised by the placebo effect, may well be the more important effect. As I have laboriously pointed out, we trust doctors (I trust them less than some people do, and about as much as most doctors do, as i explain in an earlier post) because  they are supposed to have studied anatomy, physics, biology, chemistry and biochemistry. They are supposed to be able to identify diseases, fractures and other injuries. They are then supposed either to treat them themselves or – and this is one of the most important responsibilities they have -  to know enough to admit that their knowledge is insufficient and refer the patient to a specialist.

Now, as I have demonstrated here, and as my links show, the level of objective scientific knowledge about the operation of antidepressants is pitifully small. And these are not just aspirins, but highly potent drugs which are in some cases officially accompanied by grave warnings about possible side-effects.  It also shows that the usual logic of medicine – that it is developed to cure a disease, is shown to do so and is then prescribed for it – has not been followed in the case of antidepressants. Rather the contrary. The pills were often developed for other purposes, were found to affect the moods of patients (knowing that they do, and knowing *how* they do are two wholly different things, in case you hadn’t noticed).

I would add that, as I constantly reiterate, the true objective medical study of the brain is restricted to the discipline of neurology, whose practitioners will all readily admit that they have very limited knowledge of how the brain works, or of how drugs operate upon it. 

Then  here comes ‘Elaine’ who says in a contradictory post ‘I once read that the way that Prozac works is that it keeps whatever serotonin there is in the brain circulating for a longer period of time.’

**Well, she may have once read that. And it may well be the case that this happens in the brains of people who take this drug. But is that why it has the effect that it does? And what effect does it have?  The makers are no doubt anxious to emphasise its mood-altering properties, though yet again I cannot see how these can be measured objectively. But are the things they call ‘side-effects’ in fact its main effects? How would we judge?

‘Elaine’ continues:’ I've wished that I could speak to a neurosurgeon or psychiatrist at greater length because I have wondered how some of the other psychiatric drugs work.’

**Well, a neurosurgeon would, I suspect, admit that he knew very little. Psychiatrists might also be rather sceptical, because the growth of the antidepressant industry has rather sidelined psychiatry as it was once practised. I don’t have much time for Freudianism myself, but at least it stuck to telling people that their problems were all caused by an unconfessed lust for their mothers, or an obsession with potty training,  etc etc, rather than giving them powerful pills.

Elaine then gets into really contentious territory, thus ‘ But there is no question that they do. Consider how much more likely it is that someone with schizophrenia or bipolar can function normally nowadays. 50 years ago someone with schizophrenia had very little chance of living outside of an institution. They haven't found any other cure, yet. Drugs are pretty much the only way that such things are treated, so these drugs must be doing something to stabilize the brain chemistry.’

**There is no question that antidepressants and (in this case antipsychotics) do *something* . But what is it? And is what it does treatment of the supposed (and rather ill-defined) complaint, or is it a numbing, or dulling of the senses. And what about the ‘side-effects ‘? I ask again *Are these in fact the principal effects?*. Can anyone else explain to Elaine what is wrong with the logic of  her statement ‘the fact that these chemicals are pretty much the only way that such things are treated, so these drugs must be doing something to stabilize the brain chemistry.’ Let me try, in the meantime. Surely we have to ask a) how they operate b) what they do? C) whether the unwanted side-effects are too high a price to pay for the benefits they bring? d) how – or if - we know that the theory of serotonin imbalance is true. The fact that something is the *only* treatment being used doesn’t mean that it is the *right* treatment, or that no other treatment might be better.

Then, she perceptively asks : ‘But the other thing that I wonder is how much of it has to do with chemicals and how much has to do with other more physical aspects within the brain. I once watched a program that said that the brains of identical twins had been autopsied after their death. One of them had schizophrenia, the other didn't. They found actual physical damage to the brain of the schizophrenic.’

**Yes, there is a connection between the physical brain and mental disturbance. But what is it?  Our knowledge and understanding are very limited.  It is possible to link certain areas of the brain to certain functions. Physical injury to the brain is often followed by mental illness of varying kinds.  And PET scans can show physical brain alterations under certain conditions. One is the expansion of one part of the brain in (for example) London taxi-drivers who are required in their work to develop a very large number of exact memories. I would be grateful for information on physical evidence of schizophrenia, about which I am ignorant (though I do know that it is not generally ‘diagnosed’ on the basis of physical evidence). But I am quite well-informed about claims that sufferers from ‘ADHD’ have physically different brains from those who do not. So far as I know, these studies invariably involve scans of persons who have taken the drugs prescribed for this phantasmal complaint. The brain alterations are almost certainly the consequence of the drugs, not of the ‘ADHD’.

She asks : ‘Also, why does electro shock treatment work ? (specifically to this argument it seems to work best on severely depressed people, which says to me that depression as a physical illness does exist)’.

**This is a large assertion. In what way does it work ‘well’? Where is the objective, measurable evidence that it ‘works’ at all? How would you tell?  Itis this sort of amazing asserton, impossible to exaine or disprove by objective study, which worries me so much about this feild of medicine. This extraordinary and disturbing procedure has been described to me by doctors as the medical equivalent of bashing the TV when it goes on the blink. And I would add that for many years the hideous mutilation known as pre-frontal lobotomy was also said to ‘work’ in a similar way. I think we all know in what way *that* ‘worked'.

‘Elaine’ argues ‘If the seizures induced in the treatment are improving the depression, then it would seem like there is some physical aspect to the illness. 

**This is the same backwards logic as that applied to ‘antidepressant’ medicines. The application of electrical current to the brain *appears* to make people better, though an objective measure is elusive . Therefore depression must in some way have a physical presence in the brain.’ This does not seem to me to be proper science.

As to her request ‘Is there a neurosurgeon in the house? I have lots of questions’, I would endorse the plea.

By the way, as a footnote, Peter Reeve, the man believed to have shot dead Pc Ian Dibell in Clacton earlier this week, and who later killed himself,  is persuasively said to have been taking ‘antidepressant’ medication. According to several newspaper reports today, Mr Reeve worked as a volunteer handyman at Clacton Gun Club. The club owner, Andy Riva, said: "He had a troubled past, he suffered from depression. You could tell from his mood swings if he was taking his medication.’ I found this fact because I was looking for it.