Informed Consent Isn't Pill-Shaming Or Moral Panicking

BUT: Amazon is your doctor now, ghosts are common, and beavers are a/c units

So much antidepressant drama this week, ya’ll!

Critical psychiatrists Joanna Moncrieff and Mark Horowitz put out an umbrella review (like a super-review of studies) on the serotonin theory of depression, compiling every study they could find on the subject and concluding that the idea of chemical imbalance is not supported by evidence.

This will not be a surprise to most of you, because I’ve been writing about it for a while now, and psychiatrists have been jumping in to remind everyone it’s not a surprise to them either.

Moncrieff and Horowitz wrote an article about their study in The Conversation which, as the kids say, popped the fuck off. It’s been written up in a bunch of major news outlets and the discourse is now aflutter on the tweeting machine.

Mark Horowitz @markhoro

The idea that the chemical imbalance is a straw man argument of little consequence cannot explain why a million people have read the Conversation article bit.ly/3B8tIMy or driven the paper into the top 700 papers ever shared (out of 21 million) go.nature.com/3OwzRoH

Mark Horowitz @markhoro

The main criticism of our paper has been that the ‘serotonin hypothesis’ (or chemical imbalance) is a straw man argument. But for the public this explanation has been no straw man but something that has guided the direction of their choices, health and lives.

Lucy Johnstone 💙 @ClinpsychLucy

Extraordinary. To be clear: no one is denying the reality of distress, or benefits of drugs for some. We’re correcting a decades-long public disinformation campaign, with damaging impacts on prescribing rates, informed consent, & willingness to address known psychosocial causes.

I will not rehash all the finer points of the debate over chemical imbalance and SSRI efficacy (if you’re interested in that I would recommend starting with Irving Kirsch’s work), what interests me most is all the pearl-clutching I have seen happening over the “dangers” of widely publicizing these critiques.

Professionals are quick to jump on social media and remind everyone this is “harmful rhetoric” which will scare people into suddenly quitting their SSRIs, despite the fact that every article I read about this (even the shitty Daily Mail!) pointed out that it is dangerous to do so and a doctor should be consulted first.

“This paper may just add to public confusion regarding what depression is and what it isn't,” a philosopher of psychiatry said in Vice.

When professionals like doctors and academics say things like this, they’re implying that the public is ignorant and that some things are better left unsaid for our own good, because we cannot properly understand them. It strikes me as profoundly elitist and condescending.

This is the same idea behind drug prohibition arguments against harm reduction strategies — they say that educating people about drugs and how to safely use them is dangerous because citizens can’t be trusted with bodily autonomy.

It’s not “pill-shaming” to discuss risk, because all drugs have them, and every single drug you take involves a risk-benefit analysis that you can’t adequately make without all the information.

Discussing the harms of SSRIs is also now being called “far-right” — Rolling Stone wrote recently that antidepressants are their “next bullshit moral panic”.

Dr James Davies PhD @JDaviesPhD

@RoslynByfield Critics are always being labelled: anti-psych, scientologist, anti-med, anti-science, now we have 'far-right'....The aspersions grow proportionately to the degree of duress the status quo is under. Doubtless, new labels wait in the wings to take centre stage & woo the audience.

This isn’t coming out of nowhere — right-wing figures like Tucker Carlson and Marjorie Taylor Green both have blamed school shootings on SSRI side effects, suggesting that they’re making people violent. Rolling Stone conflates this with leftist arguments about the harms of SSRIs, calling a recent article by P.E. Moskowitz on antidepressant withdrawal “highly controversial”.

I don’t really see what’s controversial about listening to the stories of people who have been harmed by medication and asking questions about how we treat depression, and it’s frustrating to see these two arguments lumped together, because I think there’s a huge difference.