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Kajanoja J, Valtonen J. A Descriptive Diagnosis or a Causal Explanation? Accuracy of Depictions of Depression on Authoritative Health Organization Websites. Psychopathology 2024; 57:389-398. [PMID: 38865990 DOI: 10.1159/000538458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/12/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Psychiatric diagnoses are descriptive in nature, but the lay public commonly misconceives them as causal explanations. It is not known whether this logical error, a form of circular reasoning, can sometimes be mistakenly reinforced by health authorities themselves. In this study, we investigated the prevalence of misleading causal descriptions of depression in the information provided by authoritative mental health organizations on widely accessed internet sites. METHODS We searched for popular websites managed by leading mental health organizations and conducted a content analysis to evaluate whether they presented depression accurately as a description of symptoms, or inaccurately as a causal explanation. RESULTS Most websites used language that inaccurately described depression as a causal explanation to depressive symptoms. CONCLUSION Leading professional medical and psychiatric organizations commonly confound depression, a descriptive diagnostic label, with a causal explanation on their most prominently accessed informational websites. We argue that the scientifically inaccurate causal language in depictions of psychiatric diagnoses is potentially harmful because it leads the public to misunderstand the nature of mental health problems. Mental health authorities providing psychoeducation should clearly state that psychiatric diagnoses are purely descriptive to avoid misleading the public.
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Affiliation(s)
- Jani Kajanoja
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Valtonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Theatre Academy, University of the Arts Helsinki, Helsinki, Finland
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Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry 2023; 28:3243-3256. [PMID: 35854107 PMCID: PMC10618090 DOI: 10.1038/s41380-022-01661-0] [Citation(s) in RCA: 256] [Impact Index Per Article: 256.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 12/31/2022]
Abstract
The serotonin hypothesis of depression is still influential. We aimed to synthesise and evaluate evidence on whether depression is associated with lowered serotonin concentration or activity in a systematic umbrella review of the principal relevant areas of research. PubMed, EMBASE and PsycINFO were searched using terms appropriate to each area of research, from their inception until December 2020. Systematic reviews, meta-analyses and large data-set analyses in the following areas were identified: serotonin and serotonin metabolite, 5-HIAA, concentrations in body fluids; serotonin 5-HT1A receptor binding; serotonin transporter (SERT) levels measured by imaging or at post-mortem; tryptophan depletion studies; SERT gene associations and SERT gene-environment interactions. Studies of depression associated with physical conditions and specific subtypes of depression (e.g. bipolar depression) were excluded. Two independent reviewers extracted the data and assessed the quality of included studies using the AMSTAR-2, an adapted AMSTAR-2, or the STREGA for a large genetic study. The certainty of study results was assessed using a modified version of the GRADE. We did not synthesise results of individual meta-analyses because they included overlapping studies. The review was registered with PROSPERO (CRD42020207203). 17 studies were included: 12 systematic reviews and meta-analyses, 1 collaborative meta-analysis, 1 meta-analysis of large cohort studies, 1 systematic review and narrative synthesis, 1 genetic association study and 1 umbrella review. Quality of reviews was variable with some genetic studies of high quality. Two meta-analyses of overlapping studies examining the serotonin metabolite, 5-HIAA, showed no association with depression (largest n = 1002). One meta-analysis of cohort studies of plasma serotonin showed no relationship with depression, and evidence that lowered serotonin concentration was associated with antidepressant use (n = 1869). Two meta-analyses of overlapping studies examining the 5-HT1A receptor (largest n = 561), and three meta-analyses of overlapping studies examining SERT binding (largest n = 1845) showed weak and inconsistent evidence of reduced binding in some areas, which would be consistent with increased synaptic availability of serotonin in people with depression, if this was the original, causal abnormaly. However, effects of prior antidepressant use were not reliably excluded. One meta-analysis of tryptophan depletion studies found no effect in most healthy volunteers (n = 566), but weak evidence of an effect in those with a family history of depression (n = 75). Another systematic review (n = 342) and a sample of ten subsequent studies (n = 407) found no effect in volunteers. No systematic review of tryptophan depletion studies has been performed since 2007. The two largest and highest quality studies of the SERT gene, one genetic association study (n = 115,257) and one collaborative meta-analysis (n = 43,165), revealed no evidence of an association with depression, or of an interaction between genotype, stress and depression. The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, London, UK.
- Research and Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK.
| | - Ruth E Cooper
- Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK
| | | | - Simone Amendola
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Mark A Horowitz
- Division of Psychiatry, University College London, London, UK
- Research and Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, UK
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Mavragani A, Sandsdalen V, Manskow US, Småbrekke L, Waaseth M. Internet Use for Obtaining Medicine Information: Cross-sectional Survey. JMIR Form Res 2023; 7:e40466. [PMID: 36729577 PMCID: PMC9936360 DOI: 10.2196/40466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. OBJECTIVE The objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. METHODS This is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. RESULTS A total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. CONCLUSIONS Norwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.
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Affiliation(s)
| | - Vilde Sandsdalen
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
| | - Unn Sollid Manskow
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Lars Småbrekke
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- Department of Pharmacy, UiT The Artic University of Norway, Tromsø, Norway
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Gøtzsche PC, Healy D. Restoring the two pivotal fluoxetine trials in children and adolescents with depression. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2022; 33:385-408. [PMID: 35786661 DOI: 10.3233/jrs-210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fluoxetine was approved for depression in children and adolescents based on two placebo-controlled trials, X065 and HCJE, with 96 and 219 participants, respectively. OBJECTIVE To review these trials, which appear to have been misreported. METHODS Systematic review of the clinical study reports and publications. The primary outcomes were the efficacy variables in the trial protocols, suicidal events, and precursors to suicidality or violence. RESULTS Essential information was missing and there were unexplained numerical inconsistencies. (1) The efficacy outcomes were biased in favour of fluoxetine by differential dropouts and missing data. The efficacy on the Children's Depression Rating Scale-Revised was 4% of the baseline score, which is not clinically relevant. Patient ratings did not find fluoxetine effective. (2) Suicidal events were missing in the publications and the study reports. Precursors to suicidality or violence occurred more often on fluoxetine than on placebo. For trial HCJE, the number needed to harm was 6 for nervous system events, 7 for moderate or severe harm, and 10 for severe harm. Fluoxetine reduced height and weight over 19 weeks by 1.0 cm and 1.1 kg, respectively, and prolonged the QT interval. CONCLUSIONS Our reanalysis of the two pivotal trials showed that fluoxetine is unsafe and ineffective.
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Affiliation(s)
| | - David Healy
- Department of Family Medicine, McMaster University, Hamilton, Canada
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Ang B, Horowitz M, Moncrieff J. Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the academic literature. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Davis JE. 'The Explanation You Have Been Looking For': Neurobiology as Promise and Hermeneutic Closure. Cult Med Psychiatry 2022; 46:76-100. [PMID: 34351549 DOI: 10.1007/s11013-021-09737-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/26/2022]
Abstract
The biomedical aspiration of psychiatry has fundamentally reoriented clinical practice since the DSM-III in 1980 and reverberated in the public sphere. Over time, lay public understanding of the causes of mental suffering has increasingly endorsed biological conceptions. In this paper, I explore the sources from which a neurobiological model for mental suffering reaches ordinary people, and investigate its rhetorical appeal, personal appropriation, and consequences. Drawing on interviews and other data, I show that these sources-physicians, popular media, and advertising-share common ontological and moral assumptions. These assumptions, in turn, influence how people take up neurobiological explanation to account for their suffering, and how, paradoxically, they join it to their projects of self-determination. I conclude by considering how, from a phenomenological perspective, a neurobiological account fails to enhance self-knowledge or determination but leads to a hermeneutic dead end.
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Affiliation(s)
- Joseph E Davis
- Institute for Advanced Studies in Culture, University of Virginia, 3 University Circle, Charlottesville, VA, 22903, USA.
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Fung HW, Leung YHS, Mak WH, Ross CA, Ling HWH. The Need for Acknowledging the Psychosocial Aspects of Voice-Hearing Experiences: Review of Online Information and Implications for Public Mental Health Education. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2020.1852375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hong Wang Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yin Hang Sharo Leung
- Department of Counselling Psychology and Human Resource Development, National Chi Nan University, Nantou County, Taiwan
| | - Wing Hung Mak
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Colin A. Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| | - Henry Wai-Hang Ling
- The Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Gossell-Williams M. Presentation of benefits and harms of antidepressants on websites: A cross sectional study. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:131-132. [PMID: 32568119 DOI: 10.3233/jrs-200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gøtzsche PC. Long-Term Use of Benzodiazepines, Stimulants and Lithium is Not Evidence-Based. CLINICAL NEUROPSYCHIATRY 2020; 17:281-283. [PMID: 34909004 PMCID: PMC8629043 DOI: 10.36131/cnfioritieditore20200503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To study whether three widely differing drug classes, benzodiazepines and similar agents, stimulants and lithium, showed similar patterns of long-term usage. METHOD I constructed usage curves over a ten-year period, from 2007 to 2017, based on data from Statistics Denmark. RESULTS In 2007, a total of 478,097 patients deemed a prescription for a benzodiazepine or similar agent, 13,225 for lithium and 8,800 for a stimulant, corresponding to 8.8%, 0.24% and 0.16%, respectively, of the Danish population of 5,427,459 people. Only 6,2102, 5,339 and 983 of these were first-time users (13.0%, 40.4% and 11.2%, respectively). The percentage of current users who redeemed a prescription for the same or a similar drug in each of the following years fell most quickly for benzodiazepines and similar agents and most slowly for lithium, and after ten years, it was 18%, 40% and 29%, respectively.For first-time users, the drop in usage was much quicker. The percentage of first-time users who redeemed a prescription for the same or a similar drug in each of the following years fell to 12%, 59% and 49%, respectively, already after only two years. CONCLUSIONS We should focus on helping patients withdraw slowly and safely from the drugs they are on instead of telling them that they need to stay on them.
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Affiliation(s)
- Peter C. Gøtzsche
- Institute for Scientific Freedom, Copenhagen, Denmark,Corresponding author Peter C. Gøtzsche Institute for Scientific Freedom Copenhagen Denmark E-mail:
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Gøtzsche PC, Dinnage O. What have antidepressants been tested for? A systematic review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:157-163. [PMID: 32444565 DOI: 10.3233/jrs-200006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Antidepressants are much used and have been tested for many conditions. OBJECTIVE To investigate the type of diagnoses in placebo-controlled trials apart from depression and anxiety. METHODS This was a systematic review. RESULTS We downloaded 5471 records from PubMed and excluded 3017 that contained depression or anxiety. After exclusion of non-eligible studies, meta-analyses and reviews, and records that were unclear, 1273 records remained. We counted 214 unique diagnoses, of which the most common were abuse of drugs or substances (227 records), pain or neuropathy (170), obesity (125), other eating disorders (45), obsessive compulsive disorder (66), sexual dysfunction (41), gastrointestinal disorders (40), menopausal symptoms/hot flashes (36), premenstrual dysphoric disorder (27), urinary incontinence (21), post-traumatic stress disorder (38), schizophrenia (31), dementia or cognition problems (25), insomnia (19), ADHD (17), autism spectrum disorders (14), and stroke or traumatic brain injury (15). CONCLUSIONS Trials of antidepressants may be driven mainly by commercial interests, focusing on prevalent diseases and everyday problems. No one can live a full life without experiencing several of the problems for which these drugs were tested. Antidepressants, sometimes called happy pills, could be seen as the modern version of Aldous Huxley's soma pill intended to keep everyone happy in the "Brave New World".
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