Confessions of a Renegade Psychiatrist
I felt this sensation in the pit of my stomach – it was a combination of sympathy and anger – listening to Annie tell me, through tears, about her postpartum journey into the world of psychiatry.
Three separate psychiatrists dismissed me when I expressed concerns about taking an addictive medication like Klonopin. It’s been two years, I can’t get off it, I’m on 4 psych meds and I feel worse than I ever did before I started this treatment.
Annie was ushered into the promise-filled halls of psychiatry 3 months after the birth of her first baby when she began to experience racing heart, insomnia, vigilance, irritability, and a host of physical complaints including joint pain and hair loss. No one did blood work, asked about her diet, or cared about any of the myriad observations about her body and its changes in functioning. This was a “head-up” intervention. I believe women deserve better. People deserve better.
Most patients who come to me for treatment of depression and anxiety do so because they want answers. They want to know WHY they are struggling. The closest they will be offered by their prescribing psychiatrist or primary care doc is some reductionist hand waving about serotonin imbalances. I think it is time to speak to these patients with respect, truthfulness, and to offer them more than a life-long relationship with a pill (or pills as it will inevitably become over the years). First, let’s review some basics:
Depression is Not A Serotonin Deficiency
Thanks to direct-to-consumer advertising and complicit FDA endorsement of evidence-less claims, the public has been sold an insultingly oversimplified tale about the underlying driver of depression. Here’s how we know depression is not a serotonin deficiency corrected by Zoloft:
- There has never been a single study, in humans, to validate the theory of low serotonin in depression. Low levels are found in a minority of patients.
- An antidepressant marketed as Stablon, increases reuptake of serotonin (reducing serotonin activity) and appears to be equally effective as those that decrease it or have no effect on it at all.
- Manipulation of serotonin levels (depletion or enhancement) do not consistently result in a depressive syndrome.
- These medications are used to treat an impossibly non-specific and broad array of illnesses from obsessive compulsive disorder to anorexia to premenstrual dysphoria to bipolar depression to irritable bowel syndrome.
- Antidepressants of all categories seems to work about the same regardless of their presumed mechanism of action with about 73% of the response unrelated to pharmacologic activity.