In this paper, I explore the questions of how and to what extent new antidepressants (selective serotonin-reuptake inhibitors, or SSRIs) could possibly affect the self. I do this by way of a phenomenological approach, using the works of Martin Heidegger and Thomas Fuchs to analyze the roles of attunement and embodiment in normal and abnormal ways of being-in-the-world. The nature of depression and anxiety disorders — the diagnoses for which treatment with antidepressants is most commonly indicated — is also explored (...) by way of this phenomenological approach, as are the basic structures of self-being. Special attention is paid in the analysis to the moods of boredom, anxiety and grief, since they play fundamental roles in depression and anxiety disorders and since their intensity and frequency appear to be modulated by antidepressants. My conclusion is that the effect of these drugs on the self can be thought of in terms of changes in self-feeling, or, more precisely, self-vibration of embodiment. I present the idea of a spectrum of bodily resonance, which extends from the normal resonance of the lived body, in which the body is able to pick up a wide range of different moods; continuing over various kinds of sensitivities, preferences and idiosyncrasies, in which certain moods are favored over others; to cases that we unreservedly label pathologies, in which the body is severely out of tune, or even devoid of tune and thus useless as a tool of resonance. Different cultures and societies favor slightly differently attuned self-styles as paradigmatic of the normal and good life, and the popularity of the SSRIs can therefore be explained, not only by defects of embodiment, but also by the presence of certain cultural norms in our contemporary society. (shrink)

Major depressive disorder (MDD) is a severe mental illness that affects 5 to 20% of the general population. Current antidepressant drugs exerts only a partial clinical efficacy because approximately 30% of depressed patients failed to respond to these drugs and antidepressants produce remission only in 30% of patients. This can be explained by the fact that the complex pathophysiology of depression has not been completely elucidated, and treatments have been mainly developed following the “monoaminergic hypothesis” of depression without considering (...) the key role of other factors involved in the pathogenesis of MDD, such as the role of chronic stress and neuroinflammation. Chronic stress acts as a risk factor for the development of MDD through the impairment of neurotrophins signaling such as brain-derived neurotrophic factor (BDNF) and transforming-growth-factor-β1 (TGF-β1). Stress-induced depressive pathology contributes to altered BDNF level and function in MDD patients and, thereby, an impairment of neuroplasticity at the regional and circuit level. Recent studies demonstrate that aerobic exercise strongly increases BDNF production and it may contribute as a non-pharmacological strategy to improve the treatment of cognitive and affective symptoms in MDD. Here we will provide a general overview on the possible synergism between physical activity and antidepressants in MDD. Physical activity can synergize with antidepressant treatment by rescuing neurotrophin signaling in MDD patients, promoting neuronal health and recovery of function in MDD-related circuits, finally enhancing pharmacotherapeutic response. This synergism might be particularly relevant in elderly patients with late-life depression, a clinical subgroup with an increased risk to develop dementia. (shrink)

Traditional understanding of how psychotropic drugs work emphasize highly specific actions at subcellular levels. This model appears to have implications that seriously conflict with our usual view of human agency and autonomy, raising not just theoretical quandaries but contributing to patient reluctance to utilize these drugs. Furthermore, it discourages both meaningful treatment integration and appreciation of the uniqueness of patients. Through a consideration of antidepressants in particular, this paper argues for a more comprehensive model based on nonlinear dynamics and chaos (...) theory that can be applied across multiple domains. This model yields important suggestions for reconciling perspectives in neuroscience with traditional views of human agency. It also encourages real integration of clinical and research approaches in psychiatry, and further defines the components of respectful treatment of patients. (shrink)

Neuroenhancement offers the prospect of improving the cognitive, emotional and motivational functions of healthy individuals. Of all the conceivable interventions, psychopharmacology provides the most readily available ones, such as antidepressants which are thought to make people “better than well”. However, up until now, whether they possess such an enhancing ability remains controversial and therefore in this systematic review we will evaluate the effect and safety of modern antidepressants in healthy individuals. A search of MEDLINE and EMBASE databases and cross-references was (...) carried out and the pharmaceutical industry was contacted for suitable data. Trials published in any language through the third week of July 2007 were regarded. Included were single or double blind randomised or quasi-randomised controlled trials that compared a placebo to one or more of the following antidepressants: bupropion, citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, moclobemide, paroxetine, reboxetine, sertraline or venlafaxine in any dose or dosing schedule. Eligible studies were those involving healthy people of any age and either sex who showed no evidence of a psychiatric disorder, cognitive decline or other disease. One hundred thirty-five articles met our inclusion criteria reporting single dose trials and trials with repeated drug administration. Sixty-five of these articles were eligible for a statistical analysis. Based on a linear mixed model, a meta-analysis and a fixed effects meta-regression were performed. Pooling of results by meta-analysis was stratified by the outcome measures mood, emotional processing, wakefulness, attention, memory, and executive functions. On a significance level of p < 0.05 the following significant results emerged: After a single dose of an antidepressant, a significant effect was shown in two of the analysed outcomes. Firstly, there was a small yet significant negative effect on wakefulness. On memory, a positive effect after several measurements was found, but this result could be traced to the results of the one study out of all included studies, which had that many assessment points. The analysis of trials with repeated drug administration yielded the following effects: on mood, a non-significant positive effect was detected that was continuously increasing and reached significance at the last assessment point. Regarding attention, a fluctuating effect was found, while for memory, the fact that the two groups started with a group difference confounded the results. For wakefulness there was no significant effect in any particular assessment point, while for emotional processing and executive functions, the small number of studies did not allow for any effect to emerge. In summary, no consistent evidence for enhancing effects of antidepressants could be found. There is little evidence so far to support the popular opinion that antidepressants have a positive effect on the mood of healthy individuals after repeated administration. No evidence of a significant adverse event profile could be found. The studies included in this systematic review not only provide insufficient evidence for or against any effect in healthy people, but they are inapt to be used for answering this question. This may be explained by the fact that most of them were not designed to examine neuroenhancement effects. The growing public interest in neuroenhancement stands in stark contrast to the paucity of data on enhancement effects of available psychopharmacological agents. (shrink)

The documented efficacy and long-term benefit of antidepressants in patients with recurrent forms of severe anxiety or depressive disorders support their use in those individuals with these disorders, who experience suicidal thoughts or behavior. In general, it is assumed that antidepressants are beneficial for all symptoms of depression, including suicidality. However, some evidence suggests that Selective Serotonin Reuptake Inhibitors [SSRIs] may cause worsening of suicidal ideas in vulnerable patients. Systematic reviews and pooled analysis of experimental, observational, and epidemiological studies have (...) investigated the use of SSRIs and their association with suicidality. Taking account of the methodological limitations of these studies, the current evidence fails to provide a clear relationship between their use and risk of suicidality in adults. However, in children and adolescents, there appears to be a bit of increased risk of suicidal ideations and attempts, but not of completed suicides. This risk can be anticipated and managed clinically. Clinicians are, therefore, advised to maintain a close follow-up during the initial treatment periods and remain vigilant of this risk. This advisory, however, should not deter clinicians from the use of effective dosages of antidepressants for a sufficient period of time, in every age group of patients, when clinically needed, and if found suitable otherwise. (shrink)

This contribution to the “antidepressant debate” focuses on the validity of randomized controlled trials. We argue that: randomized controlled trials do everything possible to methodologically stamp out high placebo response rates rather than reveal the clinical implications, assessing a psychoactive drug’s effects greatly exceeds the purpose of a randomized controlled trial, requiring substantial investigation on normal volunteers, made-up psychiatric diagnostic categories destroy the purpose and logic of the randomized controlled trial as a medical experiment, and adverse drug reactions remain (...) under-studied, under-recognized, and under-appreciated, in parallel with the muting of subjects’ voice and the reliance on surrogate measures of efficacy. The standard psychopharmacotherapy trial has lost virtually all clinical and scientific relevance, and needs complete revamping. The backdrop for the discussion is American biopsychiatry’s insistence that personal difficulties must be viewed as the expression of idiopathic somatic diseases, and the pharmaceutical industry’s dominance of the entire drug treatment research enterprise. (shrink)

The expert clinical community is split about whether the difference between antidepressant treatment and treatment with placebos stems from the efficacy of the drug or from subjects’ heightened expectancy enhanced by side effects—i.e., enhanced placebo effects. Proving whether pharmacological efficacy has been established reliably by randomized controlled trials of antidepressant drugs is difficult, primarily because substituting a placebo for an effective treatment in the control arm of a trial is ethically questionable. I argue that clinical equipoise permits the (...) use of active placebo controls in trials that test antidepressants. Placebo controls for drug trials are ethically defensible and scientifically justified when we have evidence that a standard treatment might only work because of enhanced placebo effects, and when a respectable minority of the expert clinical community endorses these concerns. (shrink)

There is a growing interest among scientists and the lay public alike in using the South American psychedelic brew, ayahuasca, to treat psychiatric disorders like depression and anxiety. Such a practice is controversial due to a style of reasoning within conventional psychiatry that sees psychedelic-induced modified states of consciousness as pathological. This article analyzes the academic literature on ayahuasca's psychological effects to determine how this style of reasoning is shaping formal scientific discourse on ayahuasca's therapeutic potential as a treatment for (...) depression and anxiety. Findings from these publications suggest that different kinds of experiments are differentially affected by this style of reasoning but can nonetheless indicate some potential therapeutic utility of the ayahuasca-induced modified state of consciousness. The article concludes by suggesting ways in which conventional psychiatry's dominant style of reasoning about psychedelic modified states of consciousness could be reconsidered. (shrink)

Cognitive reappraisal is one of the core treatment components of cognitive behavioral therapy and is the gold standard treatment for major depressive disorders. Accumulating evidence indicates that cognitive reappraisal could function as a protective factor of cognitive vulnerability to depression. However, the neural mechanism by which CR training reduces cognitive vulnerability to depression is unclear. There is ample evidence that the prefrontal–amygdala circuit is involved in CR. This study proposes a novel cognitive bias model of CR training which hypothesizes that (...) CR training may improve the generation ability of CR with altered prefrontal–amygdala functional activation/connectivity, thus reducing negative cognitive bias and alleviating depressive symptoms. This study aims to explore whether there is abnormal CR strategy generation ability in individuals who are cognitively vulnerable to depression; test the hypothesis that CR training alleviates depressive symptoms through the mediators of cognitive bias ; explore the neural mechanism by which CR training may enhance the ability of CR strategy generation; and examine the short- and long-term effects of CR training on the reduction in depressive symptoms in individuals who are cognitively vulnerable to depression following intervention and 6 months later. The study is promising, providing theoretical and practical evidence for the early intervention of depression-vulnerable individuals. (shrink)

Drawing on an analysis of Irving Kirsch and colleagues’ controversial 2008 article in PLoS [Public Library of Science] Medicine on the efficacy of SSRI antidepressant drugs such as Prozac, I examine flaws within the methodologies of randomized controlled trials (RCTs) that have made it difficult for regulators, clinicians and patients to determine the therapeutic value of this class of drug. I then argue, drawing analogies to work by Pierre Bourdieu and Michael Power, that it is the very limitations of (...) RCTs — their inadequacies in producing reliable evidence of clinical effects — that help to strengthen assumptions of their superiority as methodological tools. Finally, I suggest that the case of RCTs helps to explore the question of why failure is often useful in consolidating the authority of those who have presided over that failure, and why systems widely recognized to be ineffective tend to assume greater authority at the very moment when people speak of their malfunction. (shrink)

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of.

This study is rooted in the research traditions of cultivation theory, construct accessibility, and availability heuristic. Based on a survey with 221 subjects, this study finds that familiarity with direct-to-consumer (DTC) print advertisements for antidepressant brands is associated with inflated perceptions of the prevalence and lifetime risk of depression. The study concludes that DTC advertising potentially has significant effects on perceptions of depression prevalence and risk. Interpersonal experiences with depression coupled with DTC advertising appear to significantly predict individuals’ perceived (...) lifetime risk of depression. The study ultimately demonstrates that DTC advertising may play a role in constructing social reality of diseases and medicine. The findings strongly suggest that the social cognitive effects of DTC advertising are far-reaching, impacting pharmaceutical marketing strategy as well as presenting issues regarding public health and the business ethics of advertising drugs to consumers. (shrink)

The paper presents major ethical, legal and methodological problems related to the use of placebo in mental disorders, especially in depression. It is pointed out that although authoritative groups of experts and numerous publications in the field of psychopharmacology indicate advisability of the double blind design with placebo in clinical trials of antidepressants, in recent years there have been more and more voices questioning legitimacy of this method. Objections of an ethical nature are raised, and reliability of this approach is (...) put into doubt from the methodological viewpoint. These issues are discussed in more detail in the paper. Available alternative solutions should be implemented in psychotropic drug studies. The author shares these objections and doubts of an ethical nature, and believes that the placebo procedure is not a necessity in clinical trials of antidepressants. (shrink)

BackgroundDepressive disorders are a common form of psychiatric illness and cause significant disability. Regulation authorities, the medical profession and the public require high safety standards for antidepressants to protect vulnerable psychiatric patients. Ketamine is a dissociative anaesthetic and a derivative of a hallucinogen. Its abuse is a major worldwide public health problem. Ketamine is a scheduled drug and its usage is restricted due to its abuse liability. Recent clinical trials have reported that ketamine use led to rapid antidepressant effects (...) in patients suffering from treatment-resistant depression. However, various flaws in study designs, and possible biased reporting of results, may have influenced those findings. Further analyses of ketamine use are needed to ensure patient safety.DiscussionThe use of ketamine in research and treatment of depressive disorders is controversial. Recently, mental health professionals raised ethical concerns about an ongoing ketamine trial in the UK. Also, a Canadian agency reviewed the existing evidence and did not recommend prescribing ketamine to treat depressive disorders. Findings obtained from tightly controlled research settings cannot be easily translated to clinical practice as substance abuse is commonly comorbid with depressive disorders. An effective antidepressant should reduce severity of depressive symptoms without liability problems. Although the US FDA has not approved the use of ketamine to treat depressive disorders, some psychiatrists offer off-label repeat prescription of ketamine. Prescribing ketamine for treating depressive disorders requires substantial empirical evidence. Clinicians should also consider research findings on ketamine abuse. Depressive disorders can be chronic conditions and the current evidence does not rule out the risk of substance abuse after repeat prescription of ketamine. Off-label ketamine use in treating depressive disorders may breach ethical and moral standards, especially in countries seriously affected by ketamine abuse. This article presents two real-world clinical vignettes which highlight ethical principles and theories, including autonomy, nonmaleficience, fidelity and consequentialism, as related to off-label ketamine use.ConclusionWe urge clinicians to minimise the risk of harming patients by considering the empirical evidence on ketamine properties and attempting all standard antidepressant therapies before considering the off-label use of ketamine. (shrink)

In this paper, I offer one moral reason to eschew antidepressant medication in favor of cognitive therapy, all other things being equal: taking antidepressants can be a form of self-objectification. This means that, by taking antidepressants, one treats oneself, in some sense and some cases, like a mere object. I contend that, morally, this amounts to a specific form of devaluing oneself. I argue this as follows. First, I offer a detailed definition of “objectification” and argue for the possibility (...) of self-objectification on this definition. I then explain why this form of self-objectification is morally problematic. (Morally problematic does not mean morally impermissible. It means, instead, that there is a moral reason opposing the activity in question). After, I describe how taking antidepressants can count as self-objectifying. Finally, I defend my thesis against a key objection offered by Levy. Thus, assuming that antidepressants and cognitive therapy are equally efficacious, and that all other things are equal, the self-objectifying character of antidepressants is a compelling reason to regard cognitive therapy as a first-choice treatment for depression. (shrink)

In A Logic in Madness, Aaron J. Hauptman presents the case of Mr. A, a college-age man suffering from the unexpected and cruel severance of a romantic relationship. This breakup caused Mr. A to become severely depressed, harboring a desire to starve himself. However, Mr. A adamantly refused any sort of pharmacotherapy for his condition. Being someone who has “a doggedness with rationality” and who cares deeply about being logical, he offered several arguments and reasons for his refusal. One of (...) these was: “I am depressed for a very good reason and if, because of that, I have these feelings then it is right for me to have these feelings”. He further regarded drug therapy as “dishonest,”... (shrink)

Benzodiazepines and antidepressants have been shown to change responses to unfairness; however, the effects of their combined use on unfairness evaluation are unknown. This study examines the effects of concomitant benzodiazepines and antidepressants long-term use on the evaluation of fair and unfair offers. To analyze behavioral changes on responses to unfairness, we compared the performance of medicated participants and healthy controls in the Ultimatum Game, both in the proposer and in the respondent role. The results showed that long-term psychotropic users (...) had the worse economic strategy by accepting less offers than control subjects. However, in the proposer role, the unfair offers made by participants were similar between groups. The present results suggest that long-term use of psychotropic medication, specifically the combination of benzodiazepines and antidepressants, may increase the sensitivity to unfairness, resulting in higher rejection rates in conditions where this strategy is the most disadvantageous. (shrink)

The lingering controversy concerning the usefulness and safety of antidepressants for children and adolescents is likely to confuse clinicians. Recent papers perpetuate the claim that antidepressants are shown to be safe and effective in randomised controlled trials. Others claim that antidepressants have been shown to prevent suicides. In this editorial we address the manipulation of outcomes that result from academics’ alliance with industry. We explain how industry and key opinion leaders have distorted the clinician’s perception of the safety and usefulness (...) of antidepressants for the treatment of depression in children and adolescents through publication bias, poor methodology, and selective reporting. (shrink)

This paper explores the differences between bringing about self-change by way of antidepressants versus psychotherapy from an ethical point of view, taking its starting point in the concept of authenticity. Given that the new antidepressants (SSRIs) are able not only to cure psychiatric disorders but also to bring about changes in the basic temperament structure of the person—changes in self-feeling—does it matter if one brings about such changes of the self by way of antidepressants or by way of psychotherapy? Are (...) antidepressants a less good alternative than psychotherapy because antidepressants are in some way less authentic than psychotherapy? And, if so, what does this mean exactly? In this paper I try to show that the self-change brought about by way of antidepressants challenges basic assumptions of authentic self-change that are deeply ingrained in our Western culture: that changes in self should be brought about by laborious ‘self-work’ in which one explores the deep layers of the self (the unconscious) and comes to realise who one really is and should become. To become oneself has been held to presuppose such a journey. While the assumed importance of self-work appears to be badly founded on closer inspection, the notions of exploring and knowing oneself appear to be more promising in fleshing out an ethical distinction between psychopharmacological and psychotherapeutic practice with the help of the concept of authenticity. Psychotherapy, to a much greater extent than psychopharmacological interventions, involves the whole profile of the self in its attempts to effect a change, not only in the temperament but also in the character of the person in question, and this is important from an ethical point of view. In the article, the concepts of self-change, authenticity, temperament and character are presented and used in order to understand and flesh out the relevant ethical differences between the practice of psychotherapy and the use of antidepressants. Looping, collective effects of psychopharmacological self-change in a cultural context are also considered in this context. (shrink)

This article examines the way in which selfhood is constructed in direct-to-consumer advertisements for antidepressant medications. The sample consists of advertisements that appeared in nine popular magazines between 1997 and 2005, television commercials that ran between 2003 and 2005, and online promotional Web sites. The analysis is divided into three sections. First, it is argued that the ads rely on metaphors of communication, information exchange, and plenitude to construct a relationship between biology and selfhood. Second, in offering the choice (...) for antidepressant treatment, the ads grant individuals a new capacity for the exercise of personal agency. Third, the author describes antidepressants as pills that perform a narrative “magic.” In contrast to religious and psychoanalytic narratives that required individuals to incorporate disavowed elements of their selves into an ongoing life narrative, antidepressants are medications that allow individuals to put aside, or jump over, inexplicable and painful moments in their life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 239-242 [Access article in PDF] The Uses of Borrowed Knowledge: Chaos Theory and Antidepressants Stephen H. Kellert Keywords chaos, metaphor, rhetoric, values Ever since the popularization of chaos the-ory in the 1980s, there has been an explo-sion of interest in work in nonlinear dynamics generally and the study of strange attractors in particular. From law to economics to theology, researchers in the social (...) sciences and the humanities have sought to make use of the concepts, methods, and results of chaos theory. Previous generations have seen similar attempts to explore the consequences of relativity theory or quantum mechanics for their own areas of inquiry. In examining the implications of chaos for the treatment of mental illness, Douglas Heinrichs provides an example of this phenomenon, which I call "borrowed knowledge." Lacking expertise in the areas of psychotherapy or psychopharmacology, I view his suggestions as a case study in the ways that knowledge gets used across disciplinary boundaries. In these remarks, I examine some of the different functions that borrowed knowledge can serve in order to argue that although cross-disciplinary borrowing can be a fruitful source of new insights, it is not without its dangers. I look at the persuasive function that borrowed knowledge can serve in making one's ideas plausible candidates for further exploration, as well as in motivating methodological change. I look at the conceptual work performed by metaphors, paying special attention to the question of how we can judge whether or not a nonliteral use of knowledge from the natural sciences is fruitful. And finally, I look at the ways in which borrowed knowledge can be used to address evaluative questions—in this case, questions about autonomy and appropriate therapeutic practice. I do not mean for these various functions to be thought of as exclusive categories. Instead, they overlap, interact, and combine in various ways. Rhetorical Functions, Disciplinary Prestige, and Methodologic Change In examining the persuasive uses of chaos theory, I should make it clear that by "persuasive" I do not mean illegitimate or deceptive. When Heinrichs points out that what he calls the traditional model of brain function is used to [End Page 239] present and explain the use of antidepressants (ADs) to clinicians and the general public, it becomes clear that he believes an alternative model can be useful for explicating and justifying the use of ADs for clinicians and patients. This descriptive function of the metaphorical appeal to a chaotic "attractor landscape" shows up where Heinrichs discusses the use of the chaotic model for patient education and the "rationale for pharmacotherapy," giving patients "appropriate expectations."But the rhetorical functions of chaos theory also come into play with audiences other than patients; they apply to the audience for the scholarly article itself, perhaps attracting attention because of the novelty or promise of a new field of research, but also harnessing the considerable disciplinary prestige that the natural sciences wield in our culture. All of these functions are useful in directing attention to the author's suggestions for further research, especially where he suggests that it would provide the clinician with guidance in working with an individual patient. Here I take it that Heinrichs has made fruitful use of the work of Thelen and others on the variability of individual developmental trajectories. This proposal for methodological change suggests that focusing on the dynamics of system and its evolution through time may be important in addition to focusing on equilibrium states. The disciplinary prestige of the natural sciences can provide a valuable and legitimate resource for the persuasive task of encouraging one's colleagues to explore a new methodological approach.A further rhetorical use is found in the appeal to the unpredictability of chaotic systems to account for the variability of results in the application of ADs. We see this where Heinrichs says, "a meaningful science of persons is possible even in the face of their ultimate unpredictability" (2005, 221). The disciplinary prestige of the natural sciences, which in studying chaotic systems are able to achieve genuinely "scientific" status without being able... (shrink)

This afterword extends and refines the arguments presented in Cohen and Jacobs . The main point made by the authors is that the antidepressant randomized controlled trial world is a make-believe world in which researchers act as if a bona fide medical experiment is being conducted. From the assumed existence of the “disorder” and the assumed homogeneity of the treatment groups, through the validity of rating scales and the meaning of their scores, to the presentations of researchers’ ratings as (...) the genuine outcome of interest — all aspects of such trials are make-believe. The continued acceptance of randomized controlled trials as appropriate mechanisms to ascertain the actual effects of psychoactive drugs on human beings in distress confirms that researchers are inextricably dependent on large-scale organizational and financial interests that require the sustained production of make-believe results about psychoactive drugs. (shrink)

A primary intention of our original manuscript was to provide examples of both harmful and helpful influences of one cultural artifact—depression memoirs—on who female readers take their selves to be, and who they may actually end up being. Bradley Lewis beautifully articulated our strategy as “chart[ing] out … conflicting vectors” : that is, delineating select examples of how certain outer narratives conveyed in depression memoirs may kindle sexist and sanist modes of being. Our hope was that making these vectors explicit (...) could ultimately be liberating for some individuals by “opening up... (shrink)

We present evidence disputing the hypothesis that memories are processed or consolidated in REM sleep. A review of REM deprivation (REMD) studies in animals shows these reports to be about equally divided in showing that REMD does, or does not, disrupt learning/memory. The studies supporting a relationship between REM sleep and memory have been strongly criticized for the confounding effects of very stressful REM deprivation techniques. The three major classes of antidepressant drugs, monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), (...) and selective serotonin reuptake inhibitors (SSRIs), profoundly suppress REM sleep. The MAOIs virtually abolish REM sleep, and the TCAs and SSRIs have been shown to produce immediate (40–85%) and sustained (30–50%) reductions in REM sleep. Despite marked suppression of REM sleep, these classes of antidepressants on the whole do not disrupt learning/memory. There have been a few reports of patients who have survived bilateral lesions of the pons with few lingering complications. Although these lesions essentially abolished REM sleep, the patients reportedly led normal lives. Recent functional imaging studies in humans have revealed patterns of brain activity in REM sleep that are consistent with dream processes but not with memory consolidation. We propose that the primary function of REM sleep is to provide periodic endogenous stimulation to the brain which serves to maintain requisite levels of central nervous system (CNS) activity throughout sleep. REM is the mechanism used by the brain to promote recovery from sleep. We believe that the cumulative evidence indicates that REM sleep serves no role in the processing or consolidation of memory. Key Words: antidepressant drugs; brain stem lesions; dreams; functional imaging; memory consolidation; REM deprivation; REM sleep; theta rhythm. (shrink)

Prominent consumer depression manuals issued in recent years circulate a standard depression script as scientific knowledge. The script, asserting that a broad spectrum of depressions are brain illnesses that require antidepressant treatment, is in fact highly contested among researchers. This paper reviews the logical problematics of these manuals, and how such discourse promotes the diagnosis and pharmaceutical treatment of behaviors ranging from mild symptoms to severe depression. In keeping with the trends of pharmaceutical advertising and State health policy, these (...) manuals encourage consumers to self-scrutinize risky behavior, and to treat common behavioral and mood distresses with antidepressants. Ultimately, these activities of self-management function to produce a more productive citizen population. (shrink)

A good part of the explanation for differences in happiness has to do with genetics. This chapter reviews the scientific data relevant to a heritable component to happiness, and the prospects for using current and future technologies to alter those who have not won the genetic lottery. The chapter looks at the concept of heritability, and then at the heritability of happiness. The notion of heritability is typically seen as a composite of two factors: genetics and the environment. Three promising (...) technologies could be used to change the biological basis of happiness: pre‐implantation genetic diagnosis (PGD), genetic engineering, and advanced pharmacology. Unfortunately, on enhancing the moods of healthy individuals, there is limited research. The fact that two thirds of these “normal and healthy” volunteers felt “better than well” sounds like good news for happy‐people‐pills. The chapter touches upon the paucity of studies of the effects of antidepressants on healthy individuals. (shrink)

The use of placebo as a control condition in clinical trials of major depressive disorder and anxiety disorders continues to be an area of ethical concern. Typically, opponents of placebo controls argue that they violate the beneficent-based, “best proven diagnostic and therapeutic method” that the original Helsinki Declaration of 1964 famously asserted participants are owed. A more consequentialist, oppositional argument is that participants receiving placebo might suffer enormously by being deprived of their usual medication(s). Nevertheless, recent findings of potential for (...) suicidality in young people treated with antidepressants, along with meta-analyses suggesting that antidepressants add no significant clinical benefit over placebos, warrant a re-evaluation of the arguments against placebo. Furthermore, the nature of placebo treatment in short-term clinical trials is often not well understood, and lack of understanding can foster opposition to it. This paper will show how scientific justifications for placebo use are morally relevant. The fundamental ethical importance of placebo controls is discussed in relation to several aspects of clinical trials, including detection of adverse events, accurate assessment of clinical benefit, advancing understanding of the heterogeneity of depression and anxiety disorders and respecting informed consent requirements. Prohibiting the use of placebo controls is morally concerning in that such prohibitions allow for the possibility of serious adverse public health consequences. Moral worries that research participants receiving placebo are being unduly jeopardised will be shown to be exaggerated, especially in relation to the net benefits for end-users to be gained from the quality of data resulting from using placebo controls. (shrink)

We review Side Effects, a 2013 film involving bioethics, pharmaceuticals, and financial conspiracies. After the main character Emily unsuccessfully attempts suicide, she begins receiving care from a psychiatrist, Dr. Banks. Following numerous events, she is placed on a fictional antidepressant, Ablixa, which leads her to suffer from sleepwalking. During an episode of sleepwalking she commits a serious crime. The film poses an interesting dilemma: How responsible would the physician be in this instance? We analyze this question by applying numerous (...) ethical principles. (shrink)