Detail from The Extraction of the Stone of Madness by Hieronymus Bosch (c. 1488 – 1516)
Depression is a symptom, not a diagnosis. That is not to say that a depressed person does not experience real suffering, but when does normal human misery become a mental illness? Clearly, it is a matter of degree. I have seen patients in hospital overwhelmed by depression who were unable to do anything for themselves – even get out of bed.
As I have discussed before, antidepressant medicines do seem to help some people, and I occasionally prescribe them myself.
However, the notion that depression is due to a chemical imbalance in the brain is nothing more than a theory. Any indirectly observed or inferred changes in the levels of serotonin, dopamine or other brain neurotransmitters may be the result, rather than the cause, of the symptoms.
How do antidepressants work? The short answer is that we do not know. They are empirical, that is, trial-and-error, treatments. Further, if you take an antidepressant you feel something – commonly dizziness, weakness or drowsiness. These are side-effects of the drug though they may be mild and usually diminish as patients get used to them. Many patients find these symptoms a small price to pay for feeling less depressed. Could this be a placebo effect? You can tell the drug is doing something and you hope and expect to feel better, so you do.
Even if we accept that depression is associated with some kind of imbalance of neurotransmitter chemicals, is it desirable or safe to compound this with an additional disturbance of brain chemistry by the use of drugs? It should be kept in mind that the way antidepressants produce side-effects is through causing a drugged state affecting the brain.
This being so, how much more cautious should we be about using drugs which are well known to cause major disturbances in the brain and which can and do result in psychoses. I am referring to hallucinogenics: LSD, mescaline, psilocybin and the like.
Yet this is what is actually being proposed by the well-named Professor David Nutt, who was dismissed in 2009 as chair of the government’s Advisory Council on the Misuse of Drugs for saying that ecstasy, cannabis and LSD are less dangerous than alcohol and tobacco.
He is back in the news after having treated a small number of patients with ‘resistant depression’ with psilocybin and now wants to carry out a larger trial using this dangerous drug. Incidentally, Professor Nutt works in collaboration with Amanda Feilding, whom I’ve met, who in 1970 drilled a hole through her skull (trepanation) in an attempt to enhance her level of consciousness.
Such procedures are reminiscent of the era of drastic – even heroic – physical treatments for mental illnesses: insulin coma therapy, electro-convulsive therapy (ECT) and lobotomy. These are now rightly discredited except for ECT which is still occasionally used for severe depression.
Is the pendulum swinging too far? It is all very well doing research into the physical underpinnings of mental illnesses and thereby to try and find more effective treatments. But the pioneering efforts of around one hundred years ago, when Sigmund Freud and C G Jung looked into the psychological causes of mental illness, should not be forgotten.
Text © Gabriel Symonds
This entry was posted in C G Jung, Freud, Medical, Psychiatry and tagged Amanda Feilding, Beckley Foundation, David Nutt, depression, LSD, psilocybin, trepanation on October 5, 2016 by Gabriel Symonds. Edit