The Serotonin Monster Strikes Again

Last Halloween, I discussed the legendary Serotonin Monster, that is, the alleged chemical imbalance that causes depression, anxiety, aggression, and God only knows what else. I ranted briefly and referred interested readers to an excellent article in PLoS Medicine from Jeffrey Lacasse and Jon Leo.

Turns out that Leo and Lacasse are still on the case of the Serotonin Monster. They have a newer article, recently published in the journal Society, that sheds further light on this mysterious creature. The full text of the article is freely available online; I encourage everyone to read it. They are concerned that most people get their information from magazines or newspapers, which they believe presents the overly simplistic "chemical imbalance" theory of depression as if it were based on solid science. Here's what they did to investigate how the media presented such theories:

To determine the evidence behind the media’s claims about chemical imbalances, for approximately 1 year we performed weekly Internet searches of the media for “chemical imbalances” and sent e-mails to the authors asking them for the evidence they were basing their statements on.

Can you guess their results? I bet you can. Think for a minute. OK, here's one example of what they found:

In an article for the Sacramento Bee (3/9/07), about how to handle teenagers with depression, the author states: “Act promptly and accept that they may have a chemical imbalance [italics added] or need help with coping skills.”In reply to our questions, the author mentioned that: psychiatrists would be the best people to talk with about chemical imbalances; mental illnesses have been linked to chemical imbalances; psychiatrists are trained to figure this out through a variety of tests; and that “numerous studies have been done” and “the research is definitely available.” We pointed out to her that, if there are “numerous studies” which are “definitely available,” then it should be relatively easy to cite at least one article. She did not reply. We also mailed a copy of our e-mails to an editor at the Sacramento Bee.

Another example:

In another New York Times article (6/19/07), “On the Horizon, Personalized Depression Drugs,” Richard Friedman, the chairman of psychopharmacology at the Weill Cornell Medical College, stated: “For example, some depressedpatients who have abnormally low levels of serotonin respond to SSRIs, which relieve depression, in part, by flooding the brain with serotonin.” For his evidence he supplied a 2000 paper by Nestler titled, “Neurobiology of Depression,” which focuses on the hypothalamic pituitary system but not on serotonin.

One more:

The Bradenton Herald (3/24/07), published an article entitled, “Seniors Sought for Depression Study.” The primary source for the article was Dr. Andrew Cutler, the director of the Florida Clinical Research Center, who is extensively quoted and referred to by the reporter. “True depression,” Cutler says, “has its roots in a chemical imbalance in the brain.” Neither the reporter nor Dr. Cutler replied to e-mails.

Sidebar: Dr. Cutler. Andrew Cutler has appeared previously on this site.

• One was about a misleading statement he made when stumping for Seroquel. He spoke of a Seroquel trial having several advantageous features, including its inclusion of Bipolar II patients. The problem, however, that was unacknowledged by Dr. Cutler, was that Seroquel was no better than a placebo for this group of patients.
  
• I think that if a researcher makes a statement that "true depression has its roots in a chemical imbalance in the brain," that researcher should respond to emails asking him to back up his argument.
  
• I also found it curious that he noted that he keeps his placebo response low when running clinical trials. Some of his patient recruitment practices also raised potential ethical questions, at least in my mind. These were just questions -- I'm not saying what he was doing was either right or wrong.
• Standard disclaimer: For all I know, Cutler is a great guy. I am not issuing a personal attack here -- Just noticing a few things that raised questions for me.
  

Back to the Article. In the piece, there were several other examples of bogus claims about chemical imbalances in the media. In not a single instance was a journalist able to drum up convincing evidence to support the claims regarding a serotonin deficit. Here are some questions for the media to ponder...

Considering the media’s inability, or unwillingness, to cite evidence in support of their own statements, can the same group really be expected to go one step further and actively investigate these issues? The solution is not simply for the media to modify, or tone down, their own statements about the chemical imbalance theory, but is for them to take a more analytical approach with those who promote the chemical theory as ineluctable truth. In other words, rather than us questioning the media, shouldn’t the media be doing the questioning? It’s almost as if these reporters are blinded by the term, “peer reviewed,” and operate under the mistaken assumption that the words are some sort of stamp declaring that the results are unquestionable and that they can check their skeptical radars at the door when given a press-release mentioning a peer-reviewed article.

The article then mentions that Pfizer tried to pimp the chemical imbalance theory to a reporter who was interested in Lacasse and Leo's prior investigation. To encourage my audience to read the article, I won't discuss it here, but will mention that Leo and Lacasse's dissection of Pfizer's evidence is intriguing, as it involves conflicts of interest, buried data, and other such tricks that have been discussed often on this blog.

Enter Judith Miller. As I was reading this article, I had thoughts of Judy Miller, so I was apparently on the same wavelength as the authors when they wrote toward the end of their paper:

A comparison of the media’s reporting about mental illness to the biased reporting in the New York Times about the events leading up to the Iraq War does not seem far-fetched. In hindsight, as the Times editors now acknowledge, Judith Miller’s war coverage was overly one-sided. Her fundamental flaw could be described as a lack of professional skepticism toward the Bush administration, as she willingly parroted what those pushing for war were saying, while giving little credence to the stance of the other side. Writing in the New York Review of Books, Michael Massing commented that the Times and Miller’s reporting were examples of media “submissiveness.”

This depiction could just as well apply to the media’s reporting of mental health issues. As just one example, in some cases, the media still go to the people responsible for the original problems. For instance, several of the researchers involved with the studies of SSRIs in children are still cited in the press even though the following information has come out about their published studies: they downplayed the suicide risk; they exaggerated the benefits; and the papers published under their names were actually written by ghostwriters paid by the pharmaceutical industry.

Indeed, SSRIs for child/adolescent depression will make fodder for the ages; the role of key opinion leaders/leading lights in child psyshciatry as either "dupes" or willing co-conspirators should be read by EVERYONE (1, 2, 3, 4, 5).

In sum, another nice piece of work from Leo and Lacasse. I understand that being a journalist is not an easy job. Essentially, one is tasked with writing on a wide variety of topics, generally outside of one's areas of expertise. Thus, journalists must rely on their sources, but at the same time, it is quite important that journalists do more than simply accept whatever their sources tell them without any sort of thoughtful evaluation.