The current model of chemical imbalance, recognized since the early 70s, is referred to as the 'Pax Medica' model. This is the model conceptualized by pharmaceutical companies, specifically upon the advent of Prozac in 1974. The Pax Medica model uses the pharmaceutical theory that indicates certain drugs will 'correct' a 'chemical imbalance' within the brain. At the time, this theory was backed by well-controlled drug trials. Applied to explain an underlying biological component to psychological conditions, the Pax Medica model is becoming obsolete with the advance of neuroimaging technology and neuroscientific research. This research and technology is beginning to tell a vastly different story (Linford, Arden, 2009). The intellectual basis of psychiatry is shifting from reliance on psychological principles and theory, to newly applied neuroscientific research and understanding.
Mental Disorder Treatment With Medications
Unfortunately for the topic at hand, chemical imbalance relates heavily to treatment with medication. Henceforth, a complete discussion of the issue must include both of these factors in order to build a coherent dialogue.
Psychiatric medication has shifted from first generation to second generation, manifesting fewer or novel side effects. Yet, with few exceptions, the overall treatment outcome appears to remain the same across the board. This stance is supported by statistics showing suicide rates in the United States from 2005. The last recorded mortality rates were approximately 32,000 deaths per capita. This figure did not change during the switch from first generation to second generation medication, medication which cited efficacious treatment of a chemical imbalance (Insel, 2009).
What this suggests, is that medication may not be a first-line treatment option for Posttraumatic Stress Disorder (PTSD) as many people have been led to believe. However, medication does positively impact a percentage of individuals, and as such should not simply be disregarded. The facts are: It works for some individuals, but we are unaware of the mechanism involved in the positive outcome of their treatment.
Studies are showing diverse results. Through reading further, you will also become aware of much publication bias that is clearly manifested in articles and research regarding so-called 'chemical imbalance'. For example, a Cochrane systematic review found no major difference in efficiency between SSRIs and Tricyclic anti-depressants (Geddes, Freemantle, Mason, Eccles, Boynton, 2006). A randomized controlled trial using buproprion (Wellbutrin) and reboxetine (Edronax, Vestra) showed that SSRIs and tricyclic anti-depressants are equally as effective in the treatment of Depression (Lacasse, Leo, 2005). St. John's Wort and placebos (Placebo Effect), have both outperformed SSRIs in randomized controlled trials (Fava, Alpert, Nierenberg, Andrew, Mischoulon, et al., 2005).
If you are beginning to notice a contradiction in information, you are reading things correctly. How can a chemical imbalance of serotonin be occurring if placebos, naturopathic remedies, serotonin compounds, and non-serotonin compounds are equally as effective on what is proposed as a chemical imbalance? This brief summary leads us unto the next subject, the downfall of Pax Medica.
Pax Medica Downfall
Here is the issue in generalized terms: The chemical imbalance model (a self-fulfilling prophecy of its own down-fall) has been applied across many disorders. The chemical imbalance model claims all of these disorders are a treatable chemical imbalance, despite the fact that some have nothing to do with the regulation of serotonin, cortisol, dopamine or other neurochemical. Pharmaceutical companies have realistically raised this red-flag within the psychiatric community on their own, by pushing chemical medications such as SSRIs (Selective Serotonin Reuptake Inhibitors) across a vast degree of disorders. These disorders can range from Social Anxiety Disorder (SAD) and Obsessive-Compulsive Disorder (OCD), to premenstrual dysphoric disorder. These disorders are behaviorally incompatible with the idea that a singular neurochemical abnormality is responsible for their emergence.
Two primary events provide evidence that the Pax Medica model is on its way out:
Both of these instances do not do anything to further the cause of an already framed industry of corruption. The pharmaceutical industry however is doing better than ever through clever marketing strategies.
- Researchers in Portland, Oregon, USA, 2008, subpoenaed the U.S government to release all of the studies on antidepressant effectiveness in their archives. Whilst the results were not surprising, what was surprising was that the ratio of negative studies (which outline the failure of medication to treat depression) was 12:1. This means that for every positive study which was published, there were twelve studies behind it which showed blatant contrast to the publicized information. This indicates that publication bias has inflated the public impression that SSRIs are effective, by about a third. This accounts for outright failures, versus inconclusive studies (Turner, Matthews, Linardatos, Tell, Rosenthal, 2008).
- The "Take Two" study in 2006, by three psychologists, obtained and reanalyzed data from the largest study on treatments for depression ever conducted. They focused on the outcomes of treatment by medication in a segment of the "Treatment of Depression Collaborative Research Program of the National Institute of Mental Health (NIMH)", in 1989. The original study did not include the power of the prescribing relationship as a variable within the study. Instead, it focused on comparing the effects of anti-depressant medication. The published results outlined the power of the pill.
In the reanalysis of data that the study performed, it became apparent that the most effective psychiatrist achieved better results with placebos than the worst-performing psychiatrist achieved with anti-depressants (McKay, Imel, Wampold, 2006).
Present & Beyond
If our current knowledge is being replaced with more current data obtained through technological advancement, what classifies as current data? Without delving too deep into the subjective area of brain functionality, the simple answer is that neuroscience is now leading us toward the pre-frontal cortex as the origin of PTSD (Insel, 2009). Neuroimaging is leading us into that region for depression, and many other disorders as well.
There is not one official study to date which definitively underlines a chemical imbalance responsible for psychiatric illness, outside of the theories generated by pharmaceutical companies. In fact, not one study acknowledges that there is a chemical balance to begin with. Neuroimaging completely discredits these existing theories by showing distinctive counter-evidence to the explanation of "neurotransmitter deficiency (Lacasse, Leo, 2005)." Saying this, there is not one conclusive shred of evidence to back any one biological marker, to date, that explains the origin of PTSD (Rosen, Frueh, 2010, Clinician's Guide to Posttraumatic Stress Disorder, p108). Time will tell with more empirical research.
Using Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT), and Functional Magnetic Resonance Imaging (FMRI), the synaptic pathways involved in the transmission of serotonin and dopamine can now be seen and studied (Decety, Cacioppo, 2010). Brain imaging techniques also show us finite aspects within specific areas of the brain. As a result, an understanding of how alterations in brain function contribute to the manifestation of behavioral traits (ie. the symptoms of PTSD), is slowly being obtained (Friedman, Keane, Resick, 2007, Handbook of PTSD: Science and Practice, p 155).
As outlined above, there is zero empirical evidence which suggests that a chemical imbalance (like the one which pharmaceutical industries have propagated over the last 30+ years) truly exists. Aside from there being no evidence to support this theory, there also exists evidence which directly contradicts this theory. This evidence comes from neuroimaging technology and the study of the behavior of neurons, which is captured by current technology whilst monitoring the behaviors neurologically as they occur within the sufferer.
Current technological and prior statistical data also outlines the gross negligence that this perception involves within pharmaceutical companies. Whilst conspiracy theorist or pro-naturopathic individuals may feel enlightened with the information here, medication is still effective for a significant number of individuals. Therefore, it should not be disregarded based solely on facts now being found.
Current facts do not suggest that medication should be stopped or disregarded, but instead that we learn through history. These changes have only occurred within the last five or so years, and realistically, we are only starting to gain empirical evidential support within the last year or two.
Evidence that PTSD is not a chemical imbalance, and that no such balance exists to begin with.
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