Key Opinion Leader Contradicts Himself

In depression, is there a serotonin deficiency or not? Let’s ask a key opinion leader. Dr. Charles Nemeroff stated in a continuing medical education piece released in March 2007 that

There is a large body of evidence that the serotonin system is awry in depression in many, if not most, patients. There is truly a real deficiency of serotonin in depressed patients.

In the same piece, he stated that

Taking this together, one would suggest that the overwhelming evidence is of a relative deficiency of serotonin in the brains of patients with depression.

Yet in an article published in the Journal of Psychiatric Research in April 2007 (accepted for publication in May 2006), Nemeroff states

It is likely that no single fundamental neurobiological defect underlies severe depression.

Oh, so there is a serotonin deficiency and there is likely not a serotonin deficiency. Now I get it. That clears it up. Sounds like doublethink.

How could one contradict oneself on such an issue? This is a core problem in medicine. If these are the leaders of medicine, the scientific gurus whose opinions are thought to influence the practice of physicians throughout the world, then shouldn’t their thoughts be consistent from one day to the next? My humble guess is that this instance was due to one or both pieces being ghostwritten and the author not checking the final version of the paper. If it has your name on it, then shouldn’t you be responsible for the content of the piece? This is a lesson recently learned through the “commercial piece of crap” incident reported first on the excellent Carlat Psychiatry blog, with a similar incident being discussed on this site. The CME piece mentioned in this post is the same article on which Dr. Nemeroff did not disclose a highly relevant conflict of interest, as reported here.

For more on Dr. Nemeroff, please see this post.