Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

It is likely that no single fundamental neurobiological defect underlies severe depression.

Oh, so there is a serotonin deficiency and there is likely not a serotonin deficiency.Now I get it.That clears it up. Sounds like doublethink.

How could one contradict oneself on such an issue?This is a core problem in medicine.If these are the leaders of medicine, the scientific gurus whose opinions are thought to influence the practice of physicians throughout the world, then shouldn’t their thoughts be consistent from one day to the next?My humble guess is that this instance was due to one or both pieces being ghostwritten and the author not checking the final version of the paper.If it has your name on it, then shouldn’t you be responsible for the content of the piece?This is a lesson recently learned through the “commercial piece of crap” incident reported first on the excellent Carlat Psychiatry blog, with a similar incident being discussed on this site.The CME piece mentioned in this post is the same article on which Dr. Nemeroff did not disclose a highly relevant conflict of interest, as reported here.

6 comments:

As always, I do enjoy your informative commentary and the placing of the needles in the Voodoo doll. Dr. Nemeroff’s numerous improprieties aside I personally do believe in the theory of bio-neuro-chemical malfunctioning within the brain causing serious mood disorders and I too come away with continuing confusion from “the scientific gurus”.

I read many of the studies put forth relating to depression and I’ve come to learn to look for the keywords within the documents. Words such as may, suggests, consider, further investigation is necessary, insight, we believe, in our opinion etc, etc. Lacking in most all of the documents are definitive statements that I as a support person and health care advocate can hang my hat upon and rest assured in order to make an informed medical decision. Then again, I also muse at the fact that even the professionals differ in their interpretation and understanding of the same study document(s).

Aside from what I’ve learned from the eye opening commentary on this and similar forums you’re sharing has added much to my skepticism and the knowledge that the neuroscience of the brain has a very long way to go and for which I thank you.

Herb: "Words such as may, suggests, consider, further investigation is necessary, insight, we believe, in our opinion etc, etc. Lacking in most all of the documents are definitive statements...I also muse at the fact that even the professionals differ in their interpretation and understanding of the same study document(s)."

Right. What else can be expected?We are in a realm (the humanbrain and mind) that is far toocomplex for anything else. "May","suggests", etc... these can becalled, pejoratively, "weasel-words". But I suggest that theyare REALITY words. They are theclosest we can come to representinga complex, seemingly irreduceablereality.

: Friday, September 14, 2007 : : Key Opinion Leader Contradicts Himself : : In depression, is there a serotonin deficiency or not? : Let's ask a key opinion leader. Dr. Charles Nemeroff : stated in a continuing medical education piece released in : March 2007 that : : "There is a large body of evidence that the serotonin : system is awry in depression in many, if not most, : patients. There is truly a real deficiency of serotonin in : depressed patients." : : In the same piece, he stated that : : "Taking this together, one would suggest that the : overwhelming evidence is of a relative deficiency of : serotonin in the brains of patients with depression."

OK. Clear enough so far.

: Yet in an article published in the Journal of Psychiatric : Research in April 2007 (accepted for publication in May : 2006), Nemeroff states : : "It is likely that no single fundamental neurobiological : defect underlies severe depression." : : Oh, so there is a serotonin deficiency and there is likely : NOT a serotonin deficiency. Now I get it. That clears it : up. Sounds like doublethink.

Huh?!

There was no contradiction in what he said.

Read again. He said that the serotonin system is (usually)awry in depression, and that serotonin is deficient. Fine.Then he said that probably no single neurobiological defectunderlies severe depression. Fine, too. Where's thecontradiction? He didn't say that the serotonin problem wasthe sole ("single") defect underlying depression. He only saidwhat he said -- that it is clearly disordered and deficient inmany if not most people with depression. And he is right.There's overwhelming evidence for that. (There's also greatevidence for the therapeutic value of serotonergicinterventions in depression, which he did not mention.) That'snot to say that other things are not playing a role, or thatserotonin is the sole problem area -- the "single fundamentalneurobiological defect". He only said what he said. And thisblogger is jumping all over him. Why?

: How could one contradict oneself on such an issue?

He didn't contradict himself.

I agree with Nemeroff on both his assertions: 1) the serotoninsystem is involved and it is important in many, if not mostdepressions, and 2) the serotonin system is not ALL that isimportant; it is not the "single fundamental neurobiologicaldefect" (there will likely never be identified a "singlefundamental neurobiological defect").

Nemeroff may be a shill for Big Pharma, he may be a liar, hemay be -- for all I know -- a contemptible person for 19different reasons. I'm not defending Nemeroff, generally. I'monly saying what I am saying -- that the two quoted commentsare not inconsistent.

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...