Letters: September 2024

Antidepressants in balance

In this interdisciplinary field one has to propose comments based on partial knowledge, or else stay silent. However, I think the recent article on antidepressants distorts too many aspects, including the invented conflict between biochemical and social views. Not a word on the suffering and death.

It’s always been known that you can’t easily explore serotonin’s neurotransmitter function in intact humans. Most body serotonin is in the gut lining, from which it is easily released, and blood platelets dump their load at, so to say, the sight of a needle. With neurochemical transmission, the synaptic cleft is usually tightly shielded from its surroundings, so the little neurotransmitter that leaks out gives little information.

Since the 1960s, numerous clinicians have insisted that effective treatment of affective disorders requires both a drug and a lot of social and psychological care (not classical psychotherapy). This was the basis of the opposition of Medical Research Council research unit director Alec Coppen to policies on lithium in bipolar disorder that arose from the 1968 scandal: ‘One lesson we learned is that simply prescribing treatment is not effective.’ Half a century later, too many people still can’t get their heads round this fact.