The AMA and the chemical imbalance myth

Edited by Jill Wright, 15 November 2014

The Australian Medical Association - the professional association for our doctors and medical students - says that it is committed to "enduring professional values, excellence in teaching and research and the delivery of high-quality health care to all".

You'd therefore expect, when it comes to giving advice to young people on mental health, that it would be particularly careful about what it tells them, particularly when it claims to be helping them to make "informed choices" about depression.

Unfortunately, the information that it is giving young people is wrong, and potentially harmful.

Depression, it tells them, "is linked to a chemical imbalance in the part of the brain thought to control mood. This changes the way the brain normally functions and causes many of the signs and symptoms of depression".

That theory was comprehensively knocked on the head way back in 2011, when Dr Ronald Pies, editor-in-chief emeritus of the Psychiatric Times acknowledged "In truth, the 'chemical imbalance' notion was always a kind of urban legend - never a theory seriously propounded by well-informed psychiatrists." Three years later, he was suggesting that it was all a simplistic misinterpretation by "anti-psychiatry groups and bloggers".

The AMA clearly doesn't fall into either of those categories, and obviously doesn't realise that what it is dispensing to young people is a simplistic misinterpretation and urban legend.

And what does it tell young people to do, in the event that they believe they are suffering from severe depression? It tells them to visit a GP, who can prescribe medication to "help him or her to recover more quickly". Antidepressants, the AMA writes, "can help correct the chemical imbalance in the brain".

The AMA also assures young people that these medications are "not addictive". Two years ago, a Danish meta-analysis of research data indicated there were serious problems with any such assertion. [Since writing this, more recent research has verified the difficulties many patients encounter trying to come off antidepressants.]

You only have to read patients' reports of their struggles coming off these medications after years of trying to wonder where the AMA is getting its information from. Could it be the drug companies?

The AMA material sticks to the line that the drug companies constantly push. The fact is, there is absolutely no solid evidence whatsoever that any mental health condition, including depression, is caused by biochemical imbalances, or for that matter genes or any indentifiable physical cause in the body or brain.

This notion has impeded helpful research on the more realistic biopsychosocial model. Even many psychiatrists and researchers who once entertained this theory have long since dismissed the idea that the treatment of mental disorders is just a simple matter of artificially adjusting levels of neurotransmitters etc. as "antiquated".

But when the peak body for the medical profession doesn't seem to have caught up with this fact, one can scarcely have confidence that the message is getting through to our primary care practitioners.

Even the very fact that our doctors are telling patients that they are suffering from a chemical imbalance in the brain is harmful. Recent experiments show that telling people this makes them more pessimistic about the future and less likely to believe they can be helped by psychological therapy.

Just last week someone sent me the latest statistics on the prescription of mental health prescriptions in Australia, based on data from 2012-2013.

Those figures suggested very firmly that along with the AMA, a lot of GPs still believe in that chemical imbalance theory and that the first recourse when a patient is experiencing mental health problems is to prescribe medication.

In 2012-13, there were 31.1 million prescriptions written for those medications in Australia - 66 per cent of them antidepressants. That accounted for 11.4 per cent of all prescriptions - a staggering percentage, when you think about the number of prescriptions that must have been written for chronic conditions like hypertension, high cholesterol etc.

And the sheer scale is mind-boggling: those prescriptions were provided to 3.6 million patients - 151 patients per 1000 population - for an average of 9.6 prescriptions per patient.

Even more worrying is the fact that a total of 86 per cent of those prescriptions was provided by GPs, who have little specialist training in mental health. That figure might help explain why research shows that a significant number of patients who were prescribed anti-depressants in fact were not suffering from depression, or for that matter, any other condition identifiable by psychiatric diagnosis.

Of the total number of prescriptions, psychiatrists wrote only 8 per cent, which indicates that the situation here is even worse than in the US, where 20 per cent of prescriptions were written by psychiatrists.

They were a significant contributor to the total cost of mental health care services, which amounted to more than $7.2 billion, or $322 per person.

Psychologists collectively are horrified by these trends. They know that in cases of mild to moderate depression there are better treatment options which don't have the side-effects - massive weight gain, suicidal or homicidal thoughts - associated with many psychiatric drugs.

They also know that, ironically, while people with mental health conditions don't start with a chemical imbalance in their brain, once they start taking those drugs, they are likely very quickly to develop one.

Someone in the AMA needs to look at the latest research.

Tags

• ama
• health psychology