A new psychological study explores the psychological/neural mechanisms that may facilitate human rights atrocities. The authors claim that we fail to think about the internal life of those who evoke disgust in us. Here is a press release:
A brain’s failure to appreciate others may permit human atrocities
A father in Louisiana bludgeoned and beheaded his disabled 7-year-old son last August because he no longer wanted to care for the boy.
For most people, such a heinous act is unconscionable.
But it may be that a person can become callous enough to commit human atrocities because of a failure in the part of the brain that’s critical for social interaction. A new study by researchers at Duke University and Princeton University suggests this function may disengage when people encounter others they consider disgusting, thus “dehumanizing” their victims by failing to acknowledge they have thoughts and feelings.
This shortcoming also may help explain how propaganda depicting Tutsi in Rwanda as cockroaches and Hitler’s classification of Jews in Nazi Germany as vermin contributed to torture and genocide, the study said.
“When we encounter a person, we usually infer something about their minds. Sometimes, we fail to do this, opening up the possibility that we do not perceive the person as fully human,” said lead author Lasana Harris, an assistant professor in Duke University’s Department of Psychology & Neuroscience and Center for Cognitive Neuroscience. Harris co-authored the study with Susan Fiske, a professor of psychology at Princeton University.
Social neuroscience has shown through MRI studies that people normally activate a network in the brain related to social cognition — thoughts, feelings, empathy, for example — when viewing pictures of others or thinking about their thoughts. But when participants in this study were asked to consider images of people they considered drug addicts, homeless people, and others they deemed low on the social ladder, parts of this network failed to engage.
What’s especially striking, the researchers said, is that people will easily ascribe social cognition — a belief in an internal life such as emotions — to animals and cars, but will avoid making eye contact with the homeless panhandler in the subway.
“We need to think about other people’s experience,” Fiske said. “It’s what makes them fully human to us.”
The duo’s previous research suggested that a lack of social cognition can be linked to not acknowledging the mind of other people when imagining a day in their life, and rating them differently on traits that we think differentiate humans from everything else.
This latest study expands on that earlier work to show that these traits correlate with activation in brain regions beyond the social cognition network. These areas include those brain areas involved in disgust, attention and cognitive control.
The result is what the researchers call “dehumanized perception,” or failing to consider someone else’s mind. Such a lack of empathy toward others can also help explain why some members of society are sometimes dehumanized, they said.
For this latest study, 119 undergraduates from Princeton completed judgment and decision-making surveys as they viewed images of people. The researchers sought to examine the students’ responses to common emotions triggered by images such as:
a female college student and male American firefighter (pride)
a business woman and rich man (envy)
an elderly man and disabled woman (pity)
a female homeless person and male drug addict (disgust)
After imagining a day in the life of the people in the images, participants next rated the same person on various dimensions. They rated characteristics including the warmth, competence, similarity, familiarity, responsibility of the person for his/her situation, control of the person over their situation, intelligence, complex emotionality, self-awareness, ups-and-downs in life, and typical humanity. Participants then went into the MRI scanner and simply looked at pictures of people.The study found that the neural network involved in social interaction failed to respond to images of drug addicts, the homeless, immigrants and poor people, replicating earlier results.
“These results suggest multiple roots to dehumanization,” Harris said. “This suggests that dehumanization is a complex phenomenon, and future research is necessary to more accurately specify this complexity.”
The sample’s mean age was 20, with 62 female participants. The ethnic composition of the Princeton students who participated in the study was 68 white, 19 Asian, 12 of mixed descent, and 6 black, with the remainder not reporting.
More information: The study, “Dehumanized Perception: A Psychological Means to Facilitate Atrocities, Torture, and Genocide?” appears in a recent issue of the Journal of Psychology: DOI:10.1027/2151-2604/a000065
Laurie Penny came to the US to cover Occupy Wall Street. Instead she got spider bights and a first-class lesson in what it means to be among the 99% in America, worrying how you’re going to pay for that unexpected medical bill:
A New York spider gave me an insight into US private healthcare Occupy Wall Street is right – a rash of bites showed me how private healthcare keeps Americans cowed and compliant
By Laurie Penny
It started with a spider. Someone with a taste for narrative justice might call it retribution, but there’s really no moral correlation between the wisdom of absconding with a relative stranger after a party and waking up the next morning in Brooklyn with a rash of poisonous bites on your arm. When the angels of sexual continence want to punish you, they send crabs not spiders.
I assumed, at first, that the maddeningly itchy marks were the work of common-or-flophouse New York bedbugs, but 12 hours later, with my right arm swollen to the width and purplish colour of a prize turnip, my friend identified the hallmarks of the brown recluse spider, and uttered words I had hoped never to hear on this side of the Atlantic: “You should really get that checked out by a doctor.”
I first came to New York to write about the emerging social justice movements associated with Occupy Wall Street. Through my conversations with the protesters in Zucotti Park, I began to understand how profoundly the stranglehold of American private healthcare keeps ordinary people cowed and compliant in the land of the notionally free.
It’s not just the 59 million Americans living without health insurance and unable to access treatment for everyday maladies without crippling expense. It’s the millions more who dare not risk a dispute with their boss for fear of losing their medical cover, who expect to remortgage their homes in old age to meet the costs of failing health, or who live in fear of bankruptcy should they develop a chronic condition or have an accident.
The notion of a society that sanctions companies to profit from sickness feels barbaric enough, without then forcing ordinary people to choose between medical treatment and the financial future of their families. President Obama’s attempt to reform the system in 2009 roundly failed to remove healthcare as a source of perennial anxiety for most American citizens, or to lighten the dead hand of the market on medical provision in the US.
Socialised healthcare is in my blood but, unfortunately last Wednesday, so was a hefty dose of spider venom and several billion extra bacteria – the unfriendly sort that make an infected limb sweat and swell like a rotten root vegetable. I had travel insurance, but no idea if it stretched to the snacking habits of urban arachnids. So I uttered the words familiar to any uninsured or precariously insured American: “I’ll just wait for a little bit and see if it gets better.”
Had I waited another 24 hours, I might have lost my arm. By the time I was persuaded to go to the emergency response unit at Beth Israel hospital I could no longer move the limb, which was developing worrying purple track-marks. The triage nurse sent me straight through to ER, where I was given a bunk next to a groaning man in his mid-30s who, like me, had been so worried about the cost of treatment that he had allowed an infection to spread, in this case from a rotten tooth. He was already missing several teeth. He told me he was a postal worker with no health insurance, and that he wouldn’t have come for treatment had his girlfriend not driven him to hospital when he collapsed with a fever.
Compared to the accident and emergency unit at my local London hospital, the waiting period was civilised; it was a mere hour before a stern-looking registrar arrived to take my money. He explained the covering clauses of my travel insurance and showed me where to sign on several complicated forms. When I explained I was unable to do so because my arm wasn’t working, he gave me a look that suggested I’d have had to find a way to sign even if I’d come in with all four limbs off. I signed with my left hand.
After that, the service was exceptional. I was whisked off to intensive care for intravenous antibiotics. I was put in a quiet bed near a window, with no cracks or mildew in the walls, and brought cool water and a clean towel. And when, in the middle of the night, I went into near-fatal anaphylactic shock, the staff’s reaction was swift and efficient. I felt, in other words like a valued customer. But it also meant that, at 2am and thousands of miles from home, I was already wondering how I would afford the prescription for all the antibiotics I needed.
This is the difference that social medicine makes to the fabric and quality of life in a civilised country. When I finally wobbled out of the shiny lobby of the Beth Israel, clutching a bag of drugs, follow-up advice and complimentary hospital toiletries, I understood what it really means to be without means in America. Those who are wealthy enough to afford decent healthcare have their needs met in relative luxury, while those who are poor live in fear of getting ill, worrying that one misadventure might leave you with yet more debts to pay off.
No amount of fresh towels and edible breakfasts can make up for the feeling that your health is less important than the capacity of your chequebook. Which is why children and pensioners are still standing in Manhattan’s financial district with placards telling the world they cannot afford healthcare, as police patrol the perimeter. And why, when I got out of hospital, I went straight back down to Liberty Plaza to stand with them.
The Tuskegee Syphilis Study was one of those formative events that triggered the modern era of research protections. But these protections aren’t working when it comes to poor minority families.
In shades of Tuskegee, word comes of a study conduced at Johns Hopkins in which families with African-American children may have been deliberately induced to move into lead-tainted public housing so the lead levels in the children could be assessed. Families of those showing elevated lead levels were never told and were never offered treatment.
The fact that this study could be conducted at a major university is further evidence that the system of research protections is broken. These protections often appear to be protections only for the researchers and institutions, not those subject to the research, who apparently are considered expendable. Dr. Gary W. Goldstein, the head of the institute where the research was conducted said the
“research was conducted in the best interest of all of the children enrolled.”
Evidently, in his view, poisoning young children with lead and keeping knowledge of their poisoning from them is in the “best interests” of poor African-American children. We need have no doubt that “Dr.” Goldstein would never consider such treatment appropriate for his children or the children from his social circle.
One wonders how this study got funded and how it got approved. The “Informed Consent Form,” which would better be called a “Disinformation Form,” lists no risks of participating in the study. Nor does it list any procedures should participating children be found to have elevated lead levels, as happened to some of the children.
Racial Bias Seen in Study of Lead Dust and Children
By Timothy Williams
A class-action lawsuit was filed Thursday against a prominent Baltimore medical institute, accusing it of knowingly exposing black children as young as a year old to lead poisoning in the 1990s as part of a study exploring the hazards of lead paint.
Lawyers for the plaintiffs say that more than 100 children were endangered by high levels of lead dust in their homes despite assurances from the Kennedy Krieger Institute that the houses were “lead safe.”
The institute, a research and patient care facility for children that is affiliated with Johns Hopkins University, periodically tested the children’s blood to determine lead levels.
But, the lawsuit said, Kennedy Krieger provided no medical treatment to the children, who ranged in age from 12 months to 5 years old. Lead exposure was a significant cause of permanent neurological injuries in some of the children, according to the suit. Johns Hopkins, which approved the study, is not a defendant in the lawsuit.
“Children were enticed into living in lead-tainted housing and subjected to a research program which intentionally exposed them to lead poisoning in order for the extent of the contamination of these children’s blood to be used by scientific researchers to assess the success of lead paint or lead dust abatement measures,” said the suit, filed in state court in Baltimore. “Nothing about the research was designed to treat the subject children for lead poisoning.”
Dr. Gary W. Goldstein, president and chief executive of the Kennedy Krieger Institute, said in a statement on Thursday that the “research was conducted in the best interest of all of the children enrolled.”
“Baltimore city had the highest lead poisoning rates in the country, and more children were admitted to our hospital for lead poisoning than for any other condition,” he said. “With no state or federal laws to regulate housing and protect the children of Baltimore, a practical way to clean up lead needed to be found so that homes, communities, and children could be safeguarded.”
“Over all, the blood lead levels of most children residing in the study homes stayed constant or went down,” the statement read, “even though in a few cases, they rose.”
The lead paint study, which started in 1993 and continued for six years, was designed to determine how well various levels of lead abatement would reduce lead in the blood of young children. The buildings where the study was carried out were generally in poor neighborhoods of Baltimore. Litigation surrounding the research has gone on for more than a decade, and in 2001 the Maryland Court of Appeals compared the study to the Tuskegee syphilis experiment, which withheld medical treatment for African-American men with syphilis.
According to the lawsuit, Kennedy Krieger helped landlords get public financing for lead abatements and helped select families with young children to rent apartments where lead dust problems had been only partly eliminated so that the children’s blood could be measured for lead over a two-year period, according to the lawsuit.
“What they would do was to improve the lead hazard from what it was but not improve it to code,” said Thomas F. Yost Jr., one of the lawyers who filed the suit.
Mr. Yost said that although parents signed consent forms, the contracts failed to provide “a complete and clear explanation” about the research, which aimed to measure “the extent to which the children’s blood was being contaminated.”
David Armstrong, the father of the lead plaintiff in the lawsuit, David Armstrong Jr., said that after his son, age 3, was tested for high levels of lead in 1993, he went to a Kennedy Krieger clinic for help. The father said the family was provided state-subsidized housing by Kennedy Krieger and was told they would be part of a two-year research project. Mr. Armstrong said he was not told that his son was being introduced to elevated levels of lead paint dust.
Mr. Armstrong said blood was collected from his son for two years, but that no one told him the lead levels had increased. After the two-year mark passed, Mr. Armstrong said he continued to live in the two-bedroom apartment but did not hear from Kennedy Krieger.
During those two years, he said his son, now 20 years old, received no medical treatment for lead. Later, when Mr. Armstrong took his son to a pediatrician, the doctor detected blood lead levels two and a half to three times higher than they had been before the family moved into the apartment.
“I thought they had cleaned everything and it would be a safe place,” Mr. Armstrong said. “They said it was ‘lead safe.’ ”
On Friday afternoon, as brave and committed activists continued their non-violent civil disobedience outside the White House in protest of the tar sands pipeline that would lead to a massive increase in global warming pollution, President Obama ordered the EPA to abandon its pursuit of new curbs on emissions that worsens disease-causing smog in US cities. Earlier this year, the EPA’s administrator, Lisa Jackson, wrote that the levels of pollution now permitted — put in place by the Bush-Cheney administration– are “not legally defensible.” Those very same rules have now been embraced by the Obama White House.
Instead of relying on science, President Obama appears to have bowed to pressure from polluters who did not want to bear the cost of implementing new restrictions on their harmful pollution—even though economists have shown that the US economy would benefit from the job creating investments associated with implementing the new technology. The result of the White House’s action will be increased medical bills for seniors with lung disease, more children developing asthma, and the continued degradation of our air quality.
The US commission investigating STD research unwittingly conducted on Guatemalans in the 1940s has concluded that “at least 83 people died as a result of the “study” AFP reports We are still waiting for a comparable investigation of, and governmental apology for, similarly unethical CIA torture research.
Unethical U.S. research killed 83 in Guatemala: panel
WASHINGTON — At least 83 people died as human guinea pigs in macabre US research on sexually transmitted diseases in Guatemala in the 1940s, a commission ordered by President Barack Obama concluded Monday.
Nearly 5,500 people were subjected to diagnostic testing and more than 1,300 were exposed to venereal diseases by human contact or inoculations in research meant to test the drug penicillin, the presidential commission found.
Within that group, “we believe that there were 83 deaths,” said Stephen Hauser a member of the commission, which has pored over 125,000 documents linked to the shocking episode since being set up by Obama last November.
Among the 1,300 people exposed to STDs during research between 1946 and 1948, “under 700 received some form of treatment as best as could be documented,” Hauser said.
Obama personally apologized to Guatemalan President Alvaro Colom in October before ordering a thorough review of what happened. Secretary of State Hillary Clinton described the experiments as “clearly unethical.”
This sentiment was clearly expressed by the commission, which said US government researchers must have known they were contravening ethical standards by deliberately infecting mental patients with syphilis.
Commission president Amy Gutmann called it an “historic injustice,” and said the inquiry aimed to “honor the victims and make sure it never happens again.”
“It was not an accident that this happened in Guatemala,” Gutmann said. “Some of the people involved said we could not do this in our own country.”
The US researchers “systematically failed to act in accordance with minimal respect for human rights and morality in the conduct of research,” she said, citing “substantial evidence” of an attempted cover-up.
A Guatemalan study, which was never published, came to light in 2010 after Wellesley College professor Susan Reverby stumbled upon archived documents outlining the experiment led by controversial US doctor John Cutler.
Cutler and his fellow researchers enrolled 1,500 people in Guatemala, including mental patients, for the study, which aimed to find out if penicillin could be used to prevent sexually transmitted diseases.
Initially, the researchers infected female Guatemalan commercial sex workers with gonorrhea or syphilis, and then encouraged them to have unprotected sex with soldiers or prison inmates.
Neither were the subjects told what the purpose of the research was nor were they warned of its potentially fatal consequences.
Cutler, who died in 2003, was also involved in a highly controversial study known as the Tuskegee Experiment in which hundreds of African-American men with late-stage syphilis were observed but given no treatment between 1932 and 1972.
The Guatemalan president has called the 1946-1948 experiments conducted by the US National Institutes of Health “crimes against humanity” and ordered his own investigation.
In cool scientific news, MIT scientists are investigating a drug with the potential to attack virtually any virus. Such a broad spectrum antiviral, should it pan out, would be an amazing development.
n a development that could transform how viral infections are treated, a team of researchers at MIT’s Lincoln Laboratory has designed a drug that can identify cells that have been infected by any type of virus, then kill those cells to terminate the infection.
In a paper published July 27 in the journal PLoS One, the researchers tested their drug against 15 viruses, and found it was effective against all of them — including rhinoviruses that cause the common cold, H1N1 influenza, a stomach virus, a polio virus, dengue fever and several other types of hemorrhagic fever.
The drug works by targeting a type of RNA produced only in cells that have been infected by viruses. “In theory, it should work against all viruses,” says Todd Rider, a senior staff scientist in Lincoln Laboratory’s Chemical, Biological, and Nanoscale Technologies Group who invented the new technology.
Because the technology is so broad-spectrum, it could potentially also be used to combat outbreaks of new viruses, such as the 2003 SARS (severe acute respiratory syndrome) outbreak, Rider says.
Of course, it will be a long while till we know if this really works.
A major problem with the nuclear power industry is the strong incentives the industry and governments have to minimize — lie about — problems. The New York Times reports that the Japanese government and nuclear industry systematically withheld information on fallout from the damaged Fukushima nuclear plant:
The day after a giant tsunami set off the continuing disaster at the Fukushima Daiichi nuclear plant, thousands of residents at the nearby town of Namie gathered to evacuate.
Given no guidance from Tokyo, town officials led the residents north, believing that winter winds would be blowing south and carrying away any radioactive emissions. For three nights, while hydrogen explosions at four of the reactors spewed radiation into the air, they stayed in a district called Tsushima where the children played outside and some parents used water from a mountain stream to prepare rice.
The winds, in fact, had been blowing directly toward Tsushima — and town officials would learn two months later that a government computer system designed to predict the spread of radioactive releases had been showing just that.
But the forecasts were left unpublicized by bureaucrats in Tokyo, operating in a culture that sought to avoid responsibility and, above all, criticism. Japan’s political leaders at first did not know about the system and later played down the data, apparently fearful of having to significantly enlarge the evacuation zone — and acknowledge the accident’s severity.
….
The computer forecasts were among many pieces of information the authorities initially withheld from the public.
Meltdowns at three of Fukushima Daiichi’s six reactors went officially unacknowledged for months. In one of the most damning admissions, nuclear regulators said in early June that inspectors had found tellurium 132, which experts call telltale evidence of reactor meltdowns, a day after the tsunami — but did not tell the public for nearly three months. For months after the disaster, the government flip-flopped on the level of radiation permissible on school grounds, causing continuing confusion and anguish about the safety of schoolchildren here in Fukushima.
….
The group [Atomic Energy Society of Japan] added that the authorities had yet to disclose information like the water level and temperature inside reactor pressure vessels that would yield a fuller picture of the damage. Other experts have said the government and Tokyo Electric Power Company, known as Tepco, have yet to reveal plant data that could shed light on whether the reactors’ cooling systems were actually knocked out solely by the 45-foot-tall tsunami, as officials have maintained, or whether damage from the earthquake also played a role, a finding that could raise doubts about the safety of other nuclear plants in a nation as seismically active as Japan.
This lack of honesty and transparency is likely to be, and should be, the end of the nuclear industry. Until and unless officials have a nearly fail-safe way of assuring that information from the nuclear industry is accurate and complete, this technology, with all its potential and all its risks, should remain unused. The potential for catastrophe is too great and cannot be accurately assessed in an atmosphere of deceit.
Bioethicist Carl Elliott, in a New York Times op ed, calls attention to a type of “research” which is devoted simply to exposing physicians to new drugs, not to acquiring knowledge. That is, research as marketing ploy, and a marketing ploy that5 leads to patient deaths. He points out that the increasingly ineffective research regulatory structure is unwilling and incapable of dealing with these abuses.
Useless Studies, Real Harm
By Carl Elliott
LAST month, the Archives of Internal Medicine published a scathing reassessment of a 12-year-old research study of Neurontin, a seizure drug made by Pfizer. The study, which had included more than 2,700 subjects and was carried out by Parke-Davis (now part of Pfizer), was notable for how poorly it was conducted. The investigators were inexperienced and untrained, and the design of the study was so flawed it generated few if any useful conclusions. Even more alarming, 11 patients in the study died and 73 more experienced “serious adverse events.” Yet there have been few headlines, no demands for sanctions or apologies, no national bioethics commissions pledging to investigate. Why not?
One reason is that the study was not quite what it seemed. It looked like a clinical trial, but as litigation documents have shown, it was actually a marketing device known as a “seeding trial.” The purpose of seeding trials is not to advance research but to make doctors familiar with a new drug.
In a typical seeding trial, a pharmaceutical company will identify several hundred doctors and invite them to take part in a research study. Often the doctors are paid for each subject they recruit. As the trial proceeds, the doctors gradually get to know the drug, making them more likely to prescribe it later.
In an age of for-profit clinical research, this is the new face of scandal. Pharmaceutical companies promote their drugs with pseudo-studies that have little if any scientific merit, and patients naïvely sign up, unaware of the ways in which they are being used. Nobody really knows how often companies conduct such trials, but they appear with alarming regularity in pharmaceutical marketing documents. In the marketing plan for the antidepressant Lexapro for the 2004 fiscal year, Forest Laboratories described 102 Phase IV trials — the classification under which seeding trials fall — in a section labeled “Marketing Tactics.”
Oversight bodies like the Food and Drug Administration generally don’t view seeding trials as research scandals: seeding trials are not illegal, and the drugs in question have already received F.D.A. approval. But even after particularly egregious seeding trials have been exposed, the F.D.A. has not issued sanctions. Take the notorious Advantage study, a seeding trial of the pain reliever Vioxx conducted by Merck. According to a 2008 report in the Annals of Internal Medicine, litigation documents show that the Advantage study was conceived and managed by Merck’s marketing department. Three subjects died in the Advantage trial; five more subjects experienced heart attacks. Oversight bodies should treat the Advantage study as a violation of research ethics.
How can studies that endanger human subjects attract so little scrutiny? Forty years ago, when most clinical research took place in academic settings, the main dangers to research subjects came in service to genuine scientific aims. A large regulatory apparatus was developed to protect human subjects from the ambitions of overweening academic researchers. In the early 1990s, however, pharmaceutical companies realized that it was faster and less expensive to conduct trials in the private sector, where the driving force is not knowledge, but profit. And the regulatory apparatus designed for the old era has proved woefully inadequate for the new one.
The main source of protection for research subjects is a patchwork system of ethics committees known as institutional review boards, or I.R.B.’s. These are small, federally empowered bodies that review research proposals before they are carried out, to ensure that the studies are ethically sound. But they don’t typically pass judgment on whether a study is being carried out merely to market a drug. Nor do most I.R.B.’s have the requisite expertise to do so. Even worse, many I.R.B.’s are now themselves for-profit businesses, paid directly by the sponsors of the studies they evaluate. If one I.R.B. gets a reputation for being too strict, a pharmaceutical company can simply go elsewhere for its review.
Last week, the federal government announced that it was overhauling its rules governing the protection of human subjects. But the new rules would not stop seeding trials. It is time to admit that I.R.B.’s are simply incapable of overseeing a global, multibillion-dollar corporate enterprise. They should be replaced with an oversight system that is financially and administratively independent of the research it oversees. The system must have the power to impose sanctions, and its responsibilities must extend to fraud, bribery and corruption.
Many patients volunteer for research in the hope that the knowledge generated will benefit others. When a company deceives them into volunteering for a useless study, it cynically exploits their good will, undermining the cause of legitimate research everywhere.
*******
Carl Elliott teaches bioethics at the University of Minnesota and is the author of “White Coat, Black Hat: Adventures on the Dark Side of Medicine.”
A number of recent research studies have raised questions regarding the efficacy of many commonly prescribed psychotropic medications, including antidepressants. In some studies, these drugs do not perform better than placebo, when the placebo is selected to mimic the side effects that frequently allow participants in “double blind” randomized drug trials to tell whether or not they were given the active drug.
Now a new study adds to concerns by suggesting that antidepressant use may cause harm by significantly raising the likelihood of relapse upon cessation of medication in patients receiving them. In a meta-analysis quantitatively combing data from a number of published studies, Paul Andrews of McMaster University found that antidepressant use increased the risk of relapse from 25% among those not receiving drugs to 42% among those who received antidepressants, as described in a McMaster press release.
They [Andrews and colleagues] analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.
Andrews says anti-depressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.
Andrews, an evolutionary biologist, uses these results as the basis for speculation about the nature of depression and whether it should be conceptualized as a disease or “disorder”:
“There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he says.
Longitudinal studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives.
Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep and social connectivity, to focus its effort on coping with the traumatic event.
Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress.
If these authors’ view that depression is, in most cases, a natural mechanism to deal with stress, then “treating” it with drugs that short circuit the healing process may be counterproductive in many ways.
As with all new research, we should be cautious about interpreting these results until they are critically examined by other researchers. Like with other research methods, there is often no consensus as to whether a meta-analysis has been properly conducted.
If this study holds up after critical examination, these new results should increase concerns that antidepressants are, at best, radically over-prescribed. Physicians, including primary care physicians who often know little about the subtleties of antidepressant use, often use these medicines as the first, and even only treatment for most depressions. Though knowledge about the danger of relapse when discontinuing these drugs has spread among thoughtful psychiatrists in recent years, this knowledge has often not spread to primary care physicians and others who do most of the prescribing of these medications.
Thus, extant evidence suggests that, these medications should be used carefully. This new study ads to evidence that these drugs should be used sparingly and that, once administered, antidepressants should not be discontinued quickly, but should be gradually tapered over a long time to give the brain’s neurotransmitter systems time to adjust.
Current patterns of antidepressant use may be causing serious harm to public health, this and other studies suggest. Thus, the mental health field should seriously reconsider whether antidepressant use should continue to be the first-line treatment for those suffering from depression. If these drugs increase relapse rates while having uncertain efficacy in many cases, they should be used sparingly and with caution.
Alternatively, first-line use of psychological treatment approaches that aid the body’s natural coping processes may avoid the problems with antidepressant use, including difficulty in withdrawing from the drugs and increased likelihood of relapse. Alas, the power of the pharmaceutical industry makes such reconsideration difficult. When there are billions of dollars at stake, science and public health often count for little.
Patients who use anti-depressants are more likely to suffer relapse, researcher finds
Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, concludes a McMaster researcher.
In a paper that is likely to ignite new controversy in the hotly debated field of depression and medication, evolutionary psychologist Paul Andrews concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression.
Andrews, an assistant professor in the Department of Psychology, Neuroscience & Behaviour, is the lead author of a new paper in the journal Frontiers of Psychology.
The meta-analysis suggests that people who have not been taking any medication are at a 25 per cent risk of relapse, compared to 42 per cent or higher for those who have taken and gone off an anti-depressant.
Andrews and his colleagues studied dozens of previously published studies to compare outcomes for patients who used anti-depressants compared to those who used placebos.
They analyzed research on subjects who started on medications and were switched to placebos, subjects who were administered placebos throughout their treatment, and subjects who continued to take medication throughout their course of treatment.
Andrews says anti-depressants interfere with the brain’s natural self-regulation of serotonin and other neurotransmitters, and that the brain can overcorrect once medication is suspended, triggering new depression.
Though there are several forms of antidepressants, all of them disturb the brain’s natural regulatory mechanisms, which he compares to putting a weight on a spring. The brain, like the spring, pushes back against the weight. Going off antidepressant drugs is like removing the weight from the spring, leaving the person at increased risk of depression when the brain’s regulating mechanism, like the compressed spring, overextends before retracting to its resting state.
“We found that the more these drugs affect serotonin and other neurotransmitters in your brain – and that’s what they’re supposed to do – the greater your risk of relapse once you stop taking them,” Andrews says. “All these drugs do reduce symptoms, probably to some degree, in the short-term. The trick is what happens in the long term. Our results suggest that when you try to go off the drugs, depression will bounce back. This can leave people stuck in a cycle where they need to keep taking anti-depressants to prevent a return of symptoms.”
Andrews believes depression may actually be a natural and beneficial – though painful – state in which the brain is working to cope with stress.
“There’s a lot of debate about whether or not depression is truly a disorder, as most clinicians and the majority of the psychiatric establishment believe, or whether it’s an evolved adaptation that does something useful,” he says.
Longitudinal studies cited in the paper show that more than 40 per cent of the population may experience major depression at some point in their lives.
Most depressive episodes are triggered by traumatic events such as the death of a loved one, the end of a relationship or the loss of a job. Andrews says the brain may blunt other functions such as appetite, sex drive, sleep and social connectivity, to focus its effort on coping with the traumatic event.
Just as the body uses fever to fight infection, he believes the brain may also be using depression to fight unusual stress.
Not every case is the same, and severe cases can reach the point where they are clearly not beneficial, he emphasizes.