On Thu, 7 Aug 2003, Wojtek Sokolowski wrote:
> 1. People with affective disorders often do not have any positive
> expectation about their medication because of its side effects. In
> fact, a frequently expressed opinion by people with such disorders is
> that their medication does not cure, but makes their disorder more
> bearable.
>
I guess I didn't make myself clear. In double-blind studies, depressed people who are randomly assigned to the placebo condition show a reduction in symptoms that is about 75% the size of the true drug effect. (Kirsch & Saperstein, 1998). The data clearly contradict your assumptions above.
> 2. That affective disorders are caused by brain chemistry rather than
> life circumstances or a "wrong attitude" is pretty well established. So
> is the fact that SSRIs do affect that chemistry. Still uncertain is
> what actually causes the "chemical imbalance" that produces affective
> disorders.
You've been reading too much pharma company propaganda. Serotonin metabolism in the brain explains a small proportion of the total variation in depressive symptoms. As with all complex psychological phenomena, depression is a product of the interaction of biological, cognitive, socioeconomic, and cultural factors. Mental disorders are not simply "chemical imbalances" in the brain: you can be depressed, even if you do not have low levels of serotonin metabolism.
>
> 3. A suggestion that affective disorders can be cured by changing the
> person's attitude rather than his/her brain chemistry smells of new age
> quackery - akin to faith healing or efforts to "cure" gay people by
> proper therapy.
>
Again, your reasoning is not based on data. Meta-analyses show that cognitive-behavioral therapy is as effective as or more effective than SSRIs for the treatment of depression (Dobson, 1989; Shea, 1992). In fact, changing a person's maladaptive thinking and behavior is a useful, cost-effective therapy with few side effects.
It's interesting to me that reasonably intelligent people are so enthusiastic about this naive "if you're mentally ill it must be brain chemistry" shtick. I really have to hand it to the ad wonks in the pharma industry.
Miles