Poety

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OldPsychDoc

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Poety said:
nice article, would be well followed along in the medicalizing unhappiness thread
Nice article (in that it is concise, direct, and written at a relatively accessible level)--but they set up a strawman and beat it to death.

Why not also chastize companies whose ads imply that GERD might be a PPI "deficiency"? Or high cholesterol a "statin deficiency"? Is sepsis a "penicillin deficiency"? If serotonin-active agents improve depressive symptoms, it does not automatically imply that we believe that serotonin is "deficient". Similar articles could be written about the "dopamine hypoothesis" for schizophrenia--a useful generalization at one time, but hardly a complete picture of the disease.

I've never seen direct-to-consumer advertising that claims that "Depression is a serotonin deficiency". Nor have any of the drug reps I see suggested that an SSRI is more effective than a TCA for depression. I've always hated the term "chemical imbalance" because it does rather imply that we can "test the chemicals" and rebalance them somehow--but to the lay public, who are also receiving social messages that their depression is a moral failing, "stress", or something that they can "just snap out of", the term does at least try to put the locus of the disease on the organ of the brain.

And no, I am not "medicalizing unhappiness" either--as psychiatrists you should learn that pharmacological therapies need to be aimed at specific target symptoms. There are specific neurovegetative signs of depression that go along with the sad mood--and these do respond to serotonergic and noradrenergic agents.
 

mosche

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OldPsychDoc said:
Nice article (in that it is concise, direct, and written at a relatively accessible level)--but they set up a strawman and beat it to death.

Why not also chastize companies whose ads imply that GERD might be a PPI "deficiency"? Or high cholesterol a "statin deficiency"? Is sepsis a "penicillin deficiency"? If serotonin-active agents improve depressive symptoms, it does not automatically imply that we believe that serotonin is "deficient". Similar articles could be written about the "dopamine hypoothesis" for schizophrenia--a useful generalization at one time, but hardly a complete picture of the disease.

I've never seen direct-to-consumer advertising that claims that "Depression is a serotonin deficiency". Nor have any of the drug reps I see suggested that an SSRI is more effective than a TCA for depression. I've always hated the term "chemical imbalance" because it does rather imply that we can "test the chemicals" and rebalance them somehow--but to the lay public, who are also receiving social messages that their depression is a moral failing, "stress", or something that they can "just snap out of", the term does at least try to put the locus of the disease on the organ of the brain.

And no, I am not "medicalizing unhappiness" either--as psychiatrists you should learn that pharmacological therapies need to be aimed at specific target symptoms. There are specific neurovegetative signs of depression that go along with the sad mood--and these do respond to serotonergic and noradrenergic agents.
I, too, thought that the article was well written--I think of myself as a "simpleton", and I understood it :D !

I have never heard of a "seratonin deficiency" argument being sold to the general public either. I do think, however, that Madison Avenue ad. execs. have sold the general public the idea that, "If you feel [bad/sad/depressed...] it is possibly the result of a chemical imbalance in the brain". Unfortunately, in a society that wants a quick-fix, the statement is misconstrued to, "...LIKELY a result of...".
 

LM02

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OldPsychDoc said:
And no, I am not "medicalizing unhappiness" either--as psychiatrists you should learn that pharmacological therapies need to be aimed at specific target symptoms. There are specific neurovegetative signs of depression that go along with the sad mood--and these do respond to serotonergic and noradrenergic agents.
The difficulty arises when the same medication is used to target the same Sx in two different people, and one person experiences Sx improvement and the other doesn't. And our current nosology for depression is such a heterogeneous mess - it's no wonder that most treatment studies (pharmacological or psychosocial) only find about a 40-60% response rate, on average.

ETA. Although I'm a clinical psychologist, I work in a Dept. of Psychiatry. And almost all of my patients also see a psychiatrist for med management. I find that, when working with depressed patients, the "chemical imbalance" explanation that is portrayed in the media is a recipe for disaster.

It becomes very hard to acknowledge that there are things that they can, in fact, do to help their depression. And when they tie all of their expectations up in the meds, they are often left feeling disappointed and helpless.
 

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LM02 said:
It becomes very hard to acknowledge that there are things that they can, in fact, do to help their depression. And when they tie all of their expectations up in the meds, they are often left feeling disappointed and helpless.
I don't think that it's "hard to acknowledge" at all, though it's sometimes hard for patients to accept. I probably use the phrase "I don't have a pill that will take away _____" about 3 times a day. If they tie all their expectations up in the meds then all of us--MDs, PhDs, LCSWs, CNSs, PAs, ABDs--are failing to educate patients about what is going on with them.
 

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OldPsychDoc said:
I don't think that it's "hard to acknowledge" at all, though it's sometimes hard for patients to accept. I probably use the phrase "I don't have a pill that will take away _____" about 3 times a day. If they tie all their expectations up in the meds then all of us--MDs, PhDs, LCSWs, CNSs, PAs, ABDs--are failing to educate patients about what is going on with them.
Sorry, I was unclear. I meant that it is hard for the patient to acknowledge (and by default, accept) that there are active things that they can do. As a CBT-oriented therapist, this is actually an ideal moment for intervention, and I often take the time to work with the patient to help challenge this example of "dichotomous thinking."

However, if the presumption going into treatment is the "chemical imbalance" attribution, then it's much harder to do this than if the patient comes to the room acknowledging that there are multiple factors (biological, interpersonal, what have you) that are related to where they are at that moment in time.

We can certainly educate, but it's extremely hard to challenge a firmly held belief. And if that belief is further reinforced by the press, pharmaceutical advertising, etc., we are fighting a difficult, uphill battle as treatment providers.
 

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OldPsychDoc said:
I've never seen direct-to-consumer advertising that claims that "Depression is a serotonin deficiency". Nor have any of the drug reps I see suggested that an SSRI is more effective than a TCA for depression. I've always hated the term "chemical imbalance" because it does rather imply that we can "test the chemicals" and rebalance them somehow--but to the lay public, who are also receiving social messages that their depression is a moral failing, "stress", or something that they can "just snap out of", the term does at least try to put the locus of the disease on the organ of the brain.
This is what the zoloft website says: "Today, it's widely understood that depression is a serious medical condition. Scientists believe that it could be linked with an imbalance of a chemical in the brain called serotonin. If this imbalance happens, it can affect the way people feel."

And if I remember correctly, the commercial had little cartoon neurons with little cartoon neurotransmitter circles bouncing around, and depressed neuron had less little circles, then zoloft made more little circles, thus returning the depressed neuron to normal. I think the average person would take that to mean that the brain has a serotonin deficiency and zoloft fixes it.

And I totally agree with you: depsite the oversimplification, it's great that lay people are starting to get that this is a brain disease, not a moral failing or weakness of will.

Speaking of the commercial, I noticed that the article used the term "miserable ovoid creature" to describe the zoloft ad. Makes me wonder if the authors hadn't seen this hilarious parody :D
 

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Hurricane said:
Speaking of the commercial, I noticed that the article used the term "miserable ovoid creature" to describe the zoloft ad. Makes me wonder if the authors hadn't seen this hilarious parody :D
Great parody (if one hasn't lost one's sense of humor). I wouldn't watch it with patient's around though, as they might not find it so funny. :D
 

PsychEval

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I thought you guys might find this interesting. We are all familiar with simple measures for depression, i.e. BDI, CES-D, HAM-D. I recently saw a paper/pencil Serotonin Imbalance Test. The test was not created by a pharmaceutical or Test Company, but some company selling a supplement. So now instead of depression tests, folks are taking serotonin imbalance tests.

http://www.serotoninhealth.com/serotonin_imbalance_test.htm
 

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PsychEval said:
I thought you guys might find this interesting. We are all familiar with simple measures for depression, i.e. BDI, CES-D, HAM-D. I recently saw a paper/pencil Serotonin Imbalance Test. The test was not created by a pharmaceutical or Test Company, but some company selling a supplement. So now instead of depression tests, folks are taking serotonin imbalance tests.

http://www.serotoninhealth.com/serotonin_imbalance_test.htm
Wow! According to this test, I'm in trouble. BTW, I answered "sometimes" to almost all of the top part, and fluctuated a bit more on the bottom. My level was 66 -- severe. I need to buy their product so I can make them more money (e.g. fell better about myself).
 

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mosche said:
Wow! According to this test, I'm in trouble. BTW, I answered "sometimes" to almost all of the top part, and fluctuated a bit more on the bottom. My level was 66 -- severe. I need to buy their product so I can make them more money (e.g. fell better about myself).
Ditto. My result:

[font=Verdana,Arial]You are demonstrating signs and symptoms consistent with a severe serotonin imbalance. You should definitely consider a treatment strategy to boost your serotonin levels.


Of course, it doesn't ask me about why I might feel that way.
.
 

Poety

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Miklos said:
Ditto. My result:



Of course, it doesn't ask me about why I might feel that way.
[/color][/size].


Add me to the list, I got the severely serotonin deficient test score too!! :laugh:
 

PsychEval

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Miklos said:
Ditto. My result:



Of course, it doesn't ask me about why I might feel that way.
[/color][/size].
[/B]

True, good point. Unfortunately, increasing numbers of mental health care providers are preoccupied with symptom checklists, and forget to ask their patients why they might be feeling the way they do.
 

PsychEval

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I knew you guys would enjoy the serotonin imbalance test.
 

OldPsychDoc

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Hurricane said:
Heh, the chocolate cravings did me in. I wonder if their supplements come in a chocolate-coated version?
Actually, if you read the ingredients, you'll see that their "propreitary formula" includes cocoa as an active ingredient! :rolleyes:
 

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OldPsychDoc said:
Actually, if you read the ingredients, you'll see that their "propreitary formula" includes cocoa as an active ingredient! :rolleyes:
So, if it has cocoa it must taste good! Well, that certainly changes things! Heck, I've paid $50. for Godiva -- and it didn't come with a serotonin buzz.