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Depression is not a Prozac Deficiency…and Other Fallacies of Western Medicine

Depression is not a Prozac Deficiency…and Other Fallacies of Western Medicine

When people come to me for holistic health advice, my main objective is to provide evidence-based health information supported by the scientific literature. One of the quintessential pillars of my mission is to share those practices with empirical validation in order to elevate therapeutic nutrition to the same perceived mainstream legitimacy as any other science-based discipline.

Oftentimes, however, people thank me and say that they will see what their primary care physician, or worse yet, their specialist, has to say about it. Although I always advocate that you run any intervention or modality past a licensed physician for contraindications and medical advice, I can't help but flat-out cringe when they tell me they will solicit natural health advice from their allopathic doctor, due to the shortcomings of biomedical education in true lifestyle- and diet-based preventative medicine.

Truth be told, anything other than the provision of surgery or drugs is simply not the wheelhouse of a conventional provider. More often than not, an endocrinologist will not be versed in the use of selenium with myo-inositol to return TSH to normal concentrations in Hashimoto's patients with subclinical hypothyroidism (Nordio & Raffaella, 2013). It is similarly unlikely that a neurologist will prescribe cannabis, which is supported by the literature for migraine headaches, before resorting to more dangerous triptans, muscle relaxants, and non-steroidal anti-inflammatory drugs (Baron, 2015). Nor will a cardiologist be familiar with the use of berberine from goldenseal to lower cholesterol, reduce hypertension, mitigate oxidative stress, and improve cardiometabolic parameters (Hunter & Hegele, 2017).

A rheumatologist is unlikely to be acquainted with the literature demonstrating that fasting ameliorates the manifestations of systemic lupus erythematosus by enhancing populations of regulatory T cells, which invoke peripheral immune tolerance (Liu, Yu, Matarese, & La Cava, 2012). Likewise, most dermatologists will be unfamiliar with findings that high dose vitamin D in concert with a calcium-restricted diet results in dramatic clearance of skin lesions and significant re-pigmentation in psoriasis and vitiligo, respectively (Finamor et al., 2013). You would also be hard pressed to find a psychiatrist aware that a multi-center double-blind human study elucidated that passionflower extract reduces anxiety in generalized anxiety disorder as well as mexazolam, a benzodiazepine, or that rose oil exerts anxiolytic properties comparable to diazepam in an animal model (Mori et al., 1993; de Almeid et al., 2004).

Over the years, before my foray into functional medicine, I saw a revolving door of specialists, each compartmentalized into their respective silos, as a consequence of the Cartesian dualism and reductionism that prevails in conventional medicine. This isn't my first time at the rodeo.

I have been dismissed, demeaned, and downright disparaged when I have implicitly questioned the culturally constructed authority of the man in the white coat, who we anoint with almost religious reverence as the guardian of a sacred body of privileged knowledge. When I have brought abstracts from the scientific literature to their attention, I have at times been greeted with frank hostility if the findings presented contradicted their pre-existing beliefs, formulaic treatment algorithms, and literal indoctrination.

I have heard medical physicians attempt to masquerade misinformation as fact, stating that autoimmune disease is just luck of the draw and that it is un-related to diet and lifestyle variables, when in fact the scientific literature, such as an article published in the prestigious Public Library of Science One (PLoS One) entitled "Genetic factors are not the major causes of chronic diseases," directly contradicts this claim. In fact, research has revealed that chronic disease is only 16.4% genetic, and 84.6% environmental (epigenetic and exposome-related) (Rappaport, 2016).

I have witnessed gastroenterologists tell patients with severe inflammatory bowel disease (IBD) to eat whatever they want, and claim that ulcerative colitis is unrelated to the commensal gut flora, when studies have demonstrated that high potency, multi-strain probiotics such as VSL #3 used in conjunction with standard therapies result in remission in 93% of subjects compared to 36% of controls (Miele et al., 1999). I have had neurologists tell me straight-faced that Lyme disease is exceedingly rare, when in actuality, the Centers for Disease Control and Prevention (CDC) reports that the number of new cases each year is approaching 300,000, a number rivaling that of breast cancer (CDC, 2013).

Although medical doctors worship at the altar of evidence-based standards of care, they frequently engage in cognitive dissonance and confirmatory bias, as the mantle of science upon which they hang their hats and derive their legitimacy is anything but objective fact (Morris, Wooding, & Grant, 2011). This is underscored by studies which have demonstrated that there is an average 17 year lag time between what is illuminated in scientific research to be translated into clinical practice (Morris, Wooding, & Grant, 2011).

​​As catalogued in psychiatrist Dr. Kelly Brogan's seminal book, A Mind of Your Own, a 2013 article from the Mayo Clinic Proceedings advocated that 40 percent of current medical practices should be completely discarded (Prasad et al., 2013; Brogan, 2016). Similarly, she cites how an analysis of Cochrane reviews, one of the highest forms of research, arrived at the conclusion that 62 percent of medical treatments were negative or had no evidentiary support for efficacy (Berman et al., 2001).

Likewise, Dr. Brogan (2016) highlights how a 2011 meta-analysis performed by the British Medical Journal of 2,500 medical treatments found that only 36 percent of treatments were likely to be beneficial (Garrow, 2007). Thus, when you receive care from a licensed medical physician, there is a 64 percent chance that you will receive a treatment that is neither scientifically supported to be beneficial nor likely to be beneficial (Garrow, 2007).

The flawed premise of the allopathic model is exemplified by a public statement Dr. Brogan unearthed from Dr. Richard Horton, editor-in-chief of the esteemed scientific journal, the Lancet, who stated, "The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness" (Horton, 2015; Brogan, 2016).

The Fallacy of the Serotonin Theory of Depression

Especially culpable are the oncologists, profiteering off of the carcinogenic therapies of radiation and chemotherapy in the cancer industrial complex; however, the vast majority of allopathic physicians with whom I have interacted are peddling the silver bullet wares of Big Pharma and demonstrate little receptivity to deviance from their uniformly applied, algorithmic treatment approaches. I have encountered doctors within the medical fraternity with open minds, but by and large, due to the protocols and lenses through which they are trained to operate, medical doctors do not stray from their quick fix philosophies and magic bullet approaches.

For example, although there is no scientific validity to the serotonin deficiency hypothesis of depression, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft are administered like candy, with flagrant disregard for their long-term ramifications and adverse side effects (Brogan, 2016). In 2010 alone, 254 million prescriptions were written for antidepressants, and according to the Center for Disease Control, 1 in 10 Americans over age 12 takes antidepressants (Insel, 2011).

But everyone knows that depression is a chemical imbalance, right? Wrong. If you are wondering why everybody mindlessly repeats this mantra, engendering an echo chamber where everyone is thinking alike, yet no one is thinking---look no further than Big Pharma direct-to-consumer marketing.

According to Lacasse and Leo (2015), "Such advertisements [do] not accurately reflect the scientific status of the serotonin theory in the psychiatric research community" (p. 206). For instance, psychiatrist and historian Healy (2004), states, "Indeed, no abnormality of serotonin in depression has ever been demonstrated" (p.12). Instructor of Psychiatry at Harvard Medical School, Joseph Glenmullen, similarly articulates, "A serotonin deficiency for depression has not been found" (Glenmullen, 2000, p.197).

Further, biochemist and Nobel Prize Winner Julus Axelrod concluded that, "Whatever was wrong in depression, it was not lowered serotonin" (Healy, 2004, p. 12). Another Nobel Prize winner, Avrid Carlson, likewise advocates abandonment of the over-simplified theory where a neurotransmitter excess or deficiency leads to mental illness given the lack of evidence to this effect (Shorter, 2009). In fact, as Dr. Brogan underscores in A Mind Of Your Own, animal studies, imaging studies, and human studies have never confirmed a link between neurotransmitter levels and depression (Brogan, 2016).

Northwestern University hospital psychiatrist David Kaiser states this most eloquently with, "...Patients have been diagnosed with 'chemical imbalances' despite the fact that no test exists to support such a claim, and there is no real conception of what a correct chemical imbalance would look like...Yet conclusions such as 'depression is a biochemical imbalance' are created out of nothing more than semantics and wishful thinking of scientists/psychiatrists and a public that will believe anything now that has the stamp of approval of medical science" (Kaiser, 1996).

In 2011, Ronald Pies, psychiatrist at Tufts University and former editor of the prestigious trade journal Psychiatric Times, explained that over-booked psychiatrists employ the chemical deficiency explanation to justify their dispensation of medication, knowing full well the inaccuracy of this theory (Lacasse & Leo, 2015). Pies states, "In truth, the 'chemical imbalance' notion was always a kind of urban legend—never a theory seriously propounded by well informed psychiatrists" (Lacasse & Leo, 2015). In 2014, Levine named this phenomena, "Psychiatry's Manufacture of Consent".

"My impression is that most psychiatrists who use this expression feel uncomfortable and a little embarrassed when they do so. It’s kind of a bumper-sticker phrase that saves time, and allows the physician to write out that prescription while feeling that the patient has been 'educated'" (Pies, 2011).

The pharmaceutical industry has taken advantage of this erroneous serotonin deficiency theory in order to promote patient compliance with antidepressant medication regimens and to acquire lifetime users. Studies have shown that when depressed individuals are told that they have a confirmed deficiency of serotonin underlying their depression, they find the idea of antidepressant medication more credible than psychotherapy and also anticipate its effectiveness, ushering in a placebo effect (Deacon & Baird, 2009). However, outcomes suffer, as "They also had more pessimism about their prognosis and a lower perceived ability to regulate negative mood states, yet experienced no reduction in self-blame" (Lacasse & Leo, 2015, p. 208).

From a medical anthropology perspective, when you lift the veil on psychiatry, you discover the irreproducibility of diagnoses and their arbitrary nature, in that they are not based on objective biochemical biomarkers. The famous Rosenhan experiment, where subjects feigned hallucinations and then were admitted into psych wards, concluded that we cannot differentiate the sane from the insane in psychiatric hospitals, revealed the subjective nature of psychiatric diagnostic categories, and also illuminated the dehumanization produced by psychiatric labels (Rosenhan, 1973).

A Novel Model of Depression

Instead of being a discrete disease entity, depression is a symptom, like nausea, tremors, sweating, or a cough. The evidence points to an inflammatory cytokine model of depression, whereby inflammatory intercellular signaling molecules like interleukin-1 (IL-1), IL-6, interferon (IFN) gamma, and tumor necrosis factor (TNF)-alpha, produced by the innate immune system, penetrate the blood brain barrier and create mood disorders including anxiety, panic attacks, and depression---which are symptomatic of systemic inflammatory processes (Dantzer, 2008).

In fact, elevations in inflammatory cytokines are observed in subjects with major depressive disorder, and a concomitant "resolution of a depressive episode is associated with normalization of levels of circulating inflammatory cytokines" (Hannestad, DellaGioia, & Bloch, 2011). Likewise, administration of the cytokines, such as IFN-gamma, which is given as a treatment for hepatitis C, induces a predictable major depressive episode in one fourth of patients (Udina et al., 2012).

The inflammatory model of depression is further buttressed by studies demonstrating that the pro-inflammatory cytokines IL-6 and TNF-alpha are significantly higher in depressed patients compared to controls (Dowlati et al., 2010). Further, inflammation, as indicated by elevations in serum high sensitivity C-reactive protein (hsCRP), is an independent risk factor for de novo major depressive disorder in women, which researchers posit, "supports an aetiological role for inflammatory activity in the pathophysiology of depression" (Pasco et al., 2010, p. 372).

Another line of evidence is that the intravenous injection of Salmonella abortus equi endotoxin is accompanied by increased circulating levels of cytokines such as IL-6 and TNF-alpha, the levels of which are significantly correlated with transient escalations in anxiety and depression (Reichenberg et al., 2001.

Beck et al. (2013) submits this and several other lines of evidence in his ground-breaking paper where he discusses that, "Depression is associated with a chronic, low-grade inflammatory response and activation of cell-mediated immunity... It is similarly accompanied by increased oxidative and nitrosative stress (O&NS), which contribute to neuroprogression in the disorder". Rather than a Prozac or Zoloft deficiency, Beck (2013) provides scientific proof that depression is induced by systemic inflammation related to factors such as vitamin D deficiency, psychosocial stressors, smoking, obesity, nutrient-poor diets, a sedentary lifestyle, leaky gut, atopy, dental caries, and impaired sleep (Beck et al., 2013).

Cytokine induced sickness behavior---a more accurate description of clinical depression---is a phenomenon characterized by relapsing-remitting aches, pains, lethargy, apathy, loss of appetite, attenuation of parasympathetic tone, altered thermoregulation, flattening of diurnal rhythms (adrenal 'fatigue'), and social withdrawal, which evolved as an adaptive mechanism to facilitate the retreat from society required for the body to slow down and heal (Dantzer, 2008).

This is the evolutionary reason behind the depression and self-imposed social isolation that frequently accompanies autoimmunity and other chronic illnesses. It is also one of the contributory factors behind the comorbidity of autoimmune disease, neurodegenerative diseases, and infection with depression, and the reason why depression often accompanies acute, inflammatory illnesses such as colds and flus (Dowlati et al., 2010; Reichenberg et al., 2011).

Cytokine induced sickness behavior leads to endocrine, autonomic, perceptual and behavioral changes which enable ill individuals to better cope with infections (Dantzer, 2001).

Depression is now being re-conceived of as a decompensation of the mechanisms that regulate sickness---and because a pathogen is often behind chronic, dysregulated immune responses in autoimmunity---some researchers such as Turhan Canli are suggesting depression be re-branded an infectious disease.

In the opinions of many researchers, however, a neuro-inflammatory model, with pathologic neural microglial activation in the brain, better characterizes depression (Brites & Fernandez, 2015).

 

Depression is not a Prozac Deficiency…and Other Fallacies of Western Medicine

​​The Implications of the Flexner Report for 'Alternative' Medicine

Most of us can acknowledge the historical malfeasance of psychiatry; however, limitations exist when it comes to diagnosis and treatment of traditionally somatic diseases as well. The knowledge deficit when it comes to anything other than pill-for-every-ill Big Pharma-driven, conflict of interest-ridden medicine is exemplified from a passage extracted from my recent piece, 'How Functional Medicine can Reverse Your Autoimmune Disease':

"Any historian of the evolution of medicine understands the inextricable marriage between the pharmaceutical industry and the conventional medical establishment.

Business magnate and philanthropist, John D. Rockefeller, funded the earliest American medical schools on the condition that synthetic, petroleum-based drugs from which his businesses would profit be the cornerstone of disease treatment.

He also hired Abraham Flexner to submit his famous early twentieth century report to Congress, which made illegal the practice of medicine by 'itinerant healers' such as hydropaths, chiropractors, naturopaths, and herbalists. This produced a climate of warring practitioners and fostered "sectarian antagonism," "internecine hatreds," and "mutual hostility" in the medical profession, and led to the concerted dissemination of propaganda dismissing their healing modalities as "quackery" (McKeown, 1979).

The American Medical Association sponsored a massive smear campaign such that natural medicine practitioners were marginalized and barred from inclusion in orthodox medical societies, forbidden from formal licensure, and stripped of prestige and legitimacy. For instance, "A committee of the AMA recommended that the Massachusetts Medical Society, which continued to harbor homeopaths among its members, lose representation until it purged itself of heretics" (McKeown, 1979).

Thus ushered in the era of chemotherapy and synthetic pharmaceutical drugs, the magic bullet solution to all of humanity's ills.

As a consequence, here we stand today, in the largest chronic disease epidemic in human history, where only one third of medical doctors receive a single course in nutrition during their professional training (Adams et al., 2006). Among that third who receive nutrition instruction, the average time spent learning nutrition-related material is a mere 23.9 hours (Adams et al., 2006).

Thus, if you are seeking advice on therapeutic nutrition and holistic lifestyle interventions from your conventional physician, you're barking up the wrong tree."

Where Conventional Medicine Fails, Functional Medicine Succeeds

Dr. Sidney Baker, one of the founding fathers of the functional medicine paradigm, employed a metaphor of a tacks in one's foot to describe how functional medicine removes the tacks, one by one, that are allowing disease to manifest, whereas biomedicine ignores the tacks and administers xenobiotic poisons, or prescription pharmaceuticals, in a symptom-suppressive manner to mask the ache. In another metaphor, functional medicine looks to the origins of the "check engine light" that appears on your dashboard, rather than putting masking tape over it to conceal the harbinger of malfunction.

Our health care system is, in at its essence, a disease management system, entangled and enmeshed with corporate agendas and conflicts of interest.  During one of my extended hospitalizations, during a massive health crisis, it struck me that one of the nurses attending to my care said, “You don't go to the hospital to get better". By the same token, I've learned over my three decades of escapades with chronic illness, that you don't go to the [regular] doctor to get well.

This is revealed by studies which have found that at least 44,000 and up to 98,000 Americans die in hospitals each year as a result of medical errors. Deaths due to iatrogenesis, or harm inflicted by the medical establishment, kill more people than motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516), and exceed the number attributable to the 8th leading cause of death (Institute of Medicine (US) Committee on Quality of Health Care in America, 2000). Moreover, the total national costs of adverse events are between $37.6 billion and $50 billion dollars (Institute of Medicine (US) Committee on Quality of Health Care in America, 2000).

Worse yet, is that conventional medicine belittles nutraceuticals as unsafe and unproven and relegates natural medicine to realm of make-believe, despite the litany of high quality peer-reviewed literature supporting their use. Of the 136 million emergency room (ER) visits each year, only 23,000 (0.019%) are attributed to dietary supplements, whereas 731,000 (thirty one times that number) are associated with adverse events resulting from the correct, prescribed use of medical drugs---not overdoses (Geller et al., 2015).

Of these ER visits resulting from supplement use, 20% were owing to accidental ingestion by children under the age of four, and 60% of the 3000 visits attributed to people over age 65 were due to swallowing issues (Geller et al., 2015). Products responsible for 42% of the total ER visits were supplements advertised for energy and weight loss, many of which contained stimulants and ingredients that were undeclared active pharmaceuticals rather than dietary supplements (Geller et al., 2015). Hence, authentic, high-quality, professional-grade nutraceutical supplements have excellent safety profiles, whereas the medical use of pharmaceuticals is a major source of morbidity and mortality.

In addition, whereas Western medicine excels at acute, emergency care, it fails when it comes to the burden of non-communicable disease, with an infant mortality rate higher than 27 other developed countries, and a fifth-time ranking as the worst health care system among all industrialized nations (Helman, 2014; Ingraham, 2014). Although the United States has the most expensive health care system in the world, it ranks lowest in terms of "efficiency, equity and outcome" (Helman, 2014).

Depression is not a Prozac Deficiency…and Other Fallacies of Western Medicine

Further, the marriage between the pharmaceutical companies, insurance carriers, and medical system dictates the treatments offered to patients, which are patentable and profitable pharmaceutical drugs. The file drawer phenomenon, where publication bias favors the reporting of positive findings, means that negative drug trials which yield unfavorable results can be permanently shelved and never revealed to the Food and Drug Administration (FDA) in the process of drug approval.

For example, a 2008 article published in the New England Journal of Medicine showed how 37 out of 38 positive studies on antidepressants were published, whereas only 3 of 36 negative studies, demonstrating no benefit, were published as such (Turner et al., 2008; Brogan, 2016). The author states, "Selective publication of clinical trials, and the outcomes within those trials, can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio" (Turner et al., 2008).

Thus, for those who can afford it, I recommend embarking on your healing journey with a functional medicine practitioner for a revolutionary operating system in which antecedents, or predisposing factors, triggers, or instigating factors, and mediators, also known as perpetuating factors, are systemically addressed in order to remove each proverbial tack that is contributing to dysfunction and pathology. Contrary to my dismal experience within Western medicine, all of the functional medicine doctors I have encountered have had a genuine desire to engage in an egalitarian therapeutic partnership and to systematically unearth the root causes of my diseases.

Anyone with training through the Institute for Functional Medicine (IFM) should be well acquainted with the root cause resolution, bio-individualized approach that can help you reverse your autoimmune condition, mood disorder, or other chronic illness.

References

Adams et al. (2006). Status of Nutrition Education in Medical Schools. American Journal of Clinical Nutrition, 83(4), 941S–944S.

Baron, E.P. (2015). Comprehensive review of medical marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip its been. Headache, 55(6), 885-916. doi: 10.1111/head.12570.

Beck et al. (2013). So depression is an inflammatory disease, but where does the inflammation come from? BMC Medicine, 11. doi: 10.1186/1741-7015-11-200

Berman et al. (2001). Reviewing the reviews. International Journal of Technology Assessment in Health Care, 17, 456-466.

Brogan, K. (2016). A Mind Of Your Own: The Truth about Depression and How Women Can Heal Their Bodies to Reclaim Their Lives. New York, NY: Harper Wave.

Centers for Disease Control and Prevention. (2013). Press Release: CDC provides estimate of Americans diagnosed with Lyme disease each year. Retrieved from https://www.cdc.gov/media/releases/2013/p0819-lyme-disease.html

de Almeida et al. (2004). Anxiolytic-like effects of rose oil inhalation on the elevated plus-maze test in rats. Pharmacology and Biochemistry of Behavior, 77(2), 361-364.

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Glenmullen, J. (2000). Prozac backlash. New York: Simon and Schuster.

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Insel, T. (2011). Post by Former NIMH Director Thomas Insel: Antidepressants: A complicated picture. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2011/antidepressants-a-complicated-picture.shtml#_edn2

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Liu, Y., Yu, Y., Matarese, G., & La Cava, A. (2012). Cutting edge: fasting- induced hypoleptinemia expands functional regulatory T cells in systemic lupus erythematosus. Journal Of Immunology, 188(5), 2070-2073. doi:10.4049/jimmunol.1102835

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Nordio, M., & Raffaella, P. (2013). Combined treatmetn with myo-insoitol and selenium ensures euthyroidism in subclinical hypothyroidism patients with autoimmune thyroiditis. Journal of Thyroid Research. http://dx.doi.org/10.1155/2013/42/4163

Pasco et al. (2010). Association of high-sensitivity C-reactive protein with de novo major depression. British Journal of Psychiatry, 197(5), 372-377. doi: 10.1192/bjp.bp.109.076430.

Prasad et al. (2013). A decade of reversal: An analysis of 146 contradicted medical practices. Mayo Clinic Proceedings, 88(8), 790-798.

Rappaport, S.M. (2016). Genetic factors are not the major causes of chronic diseases. PLoS One, 11(4), e0154387.

Reichenberg et al. (2001). Cytokine-associated emotional and cognitive disturbances in humans. Archives of General Psychiatry, 58(5), 445-452.

Rosenhan, D.L. (1973). On being sane in insane places. American Association for the Advancement of Science, 179(4070), 250-258.

Shorter, E. (2009). Before Prozac: The troubled history of mood disorders in psychiatry. New York: Oxford.

Turner et al. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252-260

Udina et al. (2012). Interferon-induced depression in chronic hepatitis C: a systematic review and meta-analysis. Journal of Clinical Psychiatry, 73(8), 1128-1138. doi: 10.4088/JCP.12r07694.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of GreenMedInfo or its staff.
Sayer Ji
Founder of GreenMedInfo.com

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