Why do antidepressants work only for the deeply depressed? A neuroskeptical look : Neuron Culture

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I write on science, medicine, nature, culture and other matters for the New York Times Magazine, The Atlantic, Slate, National Geographic, Scientific American Mind, and other publications. (Find clips here.) Right now I'm writing my fourth book, The Orchid and the Dandelion, which explores the hypothesis that the genetic roots some of our worst problems and traits — depresison, hyperaggression, violence, antisocial behavior — can also give rise to resilience, cooperation, empathy, and contentment. The book expands on my December 2009 Atlantic article exploring these ideas. I've also written three books, including Reef Madness: Charles Darwin, Alexander Agassiz, and the Meaning of Coral, which traces the strangest but most forgotten controversy in Darwin's career — an elemental dispute running some 75 years.

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Why do antidepressants work only for the deeply depressed? A neuroskeptical look

Posted on: January 26, 2010 8:11 PM, by David Dobbs

Neuroskeptic ponders the growing evidence that antidepressants significantly best placebo only in the more (or most) depressed patients. His take is that:

antidepressants treat classical clinical depression, of the kind that psychiatrists in 1960 would have recognized. This is the kind of depression that they were originally used for, after all, because the first antidepressants arrived in 1953, and modern antidepressants like Prozac target the same neurotransmitter systems.

Yet in recent years "clinical depression" has become a much broader term. Many peopleattribute this to marketing on the part of pharmaceutical companies. Whatever the cause, it's almost certain that many people are now being prescribed antidepressants for emotional and personal issues which wouldn't have been considered medical illnesses until quite recently. Antidepressants also have a long history of use for other conditions, like OCD, but this is a separate issue.

There's a chicken-egg puzzle in here, of course: Did the expansion of the Dx encourage the rise in Rx, or did the availability (and marketing of) the drugs encourage the expansion of the Dx? I suspect the latter.

Later: D'oh! Neuroskeptic's post is at http://neuroskeptic.blogspot.com/2010/01/severe-warning-for-psychiatry.html. Thanks to ericbohlman for pinging me about the oversight. Apparently the hazards of blogging by iPhone are many.

Posted via email from David Dobbs's Somatic Marker

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