Notes from the 'Lost Connections Uncovering the Real Causes of Depression'

I am including some bits of this revelatory book - I highly recommend this book.


Lost Connections Uncovering the Real Causes of Depression - and the Unexpected Solutions by Johann Hari


1) Page 34 - The numbers showed that 25 percent of the effects of antidepressants were due to natural recovery, 50 percent were due to the story you had been told about them, and only 25 percent to the actual chemicals. “That surprised the hell out of me,” Irving told me in the front room of his home in Cambridge, Massachusetts. They assumed they had gotten their numbers wrong—that there was some mistake in their calculations. Guy was sure, he told me later, “there’s got to be something wrong with this data,” and so they kept going over it, again and again, for months. “I got so sick of looking at spreadsheets and data and analyzing it every which way possible,” he said, but they knew there must be a mistake somewhere. They couldn’t find any errors—so they published their data, to see what other scientists made of it.


2) Page 36 - Irving and Guy realized—using these, the real figures—they could calculate how much better the people on antidepressants were doing than the people on sugar pills. Scientists measure the depth of someone’s depression using something named the Hamilton scale, which was invented by a scientist named Max Hamilton in 1959. The Hamilton scale rages from 0 (where you’re skipping along merrily) to 51 (where you’re jumping in front of trains). To give you a yardstick: you can get a six-point leap in your Hamilton score if you improve your sleeping patterns. What Irving found is that, in the real data that hadn’t been run through a PR filter, antidepressants do cause an improvement in the Hamilton score— they do make depressed people feel better. It’s an improvement of 1.8 points.


3) Page 36 - Yet the data showed something else. The side effects of the drugs, by contrast, were very real. They make many people gain weight, or develop sexual dysfunction, or start to sweat a lot. These are real drugs, with a real effect. But when it came to the effects they are intended to have—on depression and anxiety? They are highly unlikely to solve the problem for most people.


4) Page 37 - When Irving published these figures in a scientific journal, he expected a big fightback from the scientists who had produced all this data. But in fact, in the months that followed, he found there was—if anything—a feeling of shamefaced relief from many of them. One group of researchers wrote that it had been a “dirty little secret” in the field for a long time that the effects of these drugs on depression itself were in reality tiny. Irving thought, before he published, that he had a scoop, a previously unknown shocker. In fact, he had only discovered what many people in the field had privately known all along.


5) Page 38 - The internal discussion within the company from this time was also later leaked. A company insider had warned: “It would be commercially unacceptable to include a statement that efficacy has not been demonstrated, as this would undermine the profile of Paroxetine.” In other words—we can’t say it doesn’t work, because we’ll make less money. So they didn’t. In the end, in court, they were forced to pay $2.5 million in New York State for the lie after New York attorney general Eliot Spitzer sued them. But I had been prescribed the drug as a teenager by then, and I had continued to take it for more than a decade. Later, one of the world’s leading medical journals, the Lancet, conducted a detailed study of the fourteen major antidepressants that are given to teenagers. The evidence— from the unfiltered, real results—showed that they simply didn’t work, with a single exception, where the effect was very small. The journal concluded they shouldn’t be prescribed to teenagers any more. Reading this was a turning point for me. Here was the drug I started taking as a teenager, and here was the company that manufactured it, saying, in their own words, that it didn’t work for people like me—but they were going to carry on promoting it anyway.


6) Page 42 - After twenty years researching this at the highest level, Irving has come to believe that the notion depression is caused by a chemical imbalance is just “an accident of history,” produced by scientists initially misreading what they were seeing, and then drug companies selling that misperception to the world to cash in. And so, Irving says, the primary explanation for depression offered in our culture starts to fall apart. The idea you feel terrible because of a “chemical imbalance” was built on a series of mistakes and errors. It has come as close to being proved wrong, he told me, as you ever get in science. It’s lying broken on the floor, like a neurochemical Humpty Dumpty with a very sad smile.

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