Saturday, March 10, 2012

Statin drugs, cholesterol, depression and reductionism.

Statin Drugs = Less Depression?

The study then follow the 776 of those patients who were not depressed.

18.5% of the 520 patients on statins became depressed by follow up.
28% of of the 256 not on statins became depressed by follow up.

This was translated into a 38% reduced risk of developing depression.

Statistical Manipulation?

Medical studies do not need to lie to be misleading. Statistics can be manipulated in all sorts of ways. In this case, the 38% reduced risk of developing depression sounds impressive. But lets look at this study using another statistic, the number to treat (NNT).

The NNT is the number of patients who need to be treated in order to prevent one additional bad outcome.
In this case the NNT is 10.5.

So according to this study, 10 ½ people would need to be treated with a statin drug, in order to prevent one incidence of depression.

But Don't Statin's Cause Many Side Effects?

Yes they do! Side effects such as liver damage, elevated liver enzymes, rhabdomyolysis, diabetes and much more! In fact, and reasonable review of the negative effects of statin drugs would be quite lengthy, and beyond the scope of what I wish to write about in this post.

Why might statins lower depression?

Inflammation can divert tryptophan and 5-HTP into inflammatory cytokines instead of serotonin. Therefore, taking anti-inflammatory medications or supplements may improve mood in some people. I don't know if statins make anyone feel better, but this is at least a possible explanation.

However, considering the numerous side effects of statin drugs, and the fact that over 10 people needed to be treated in this study to see one positive outcome, plus the negative effects statins do have on cognitive function, and a plethora of natural anti-inflammatory supplements, using statins in this way would be simply foolish.

Even the study itself says, that this does not mean statins should be used solely as anti-depressants. However, headlines and a few statistics can be taken out of context, to make statin drugs seem like better options when treating high cholesterol.

What is wrong with this approach to medical research?

This study is an example of the extreme reductionism in medicine. A large population is selected, along with a few variables, and then some general result is given.

However, feeling “depressed” is a mulch-factorial phenomena. Contributing factors include psychology, toxicity, infection, inflammation, nutritional statues, and even musculo-skeletal problems. Mufti-factorial problems demand individualized solutions. Even a study showing improvement of 90% of patients, does not necessarily tell a physicians if that treatment will help the patient in-front of them.

You can only treat people, not feelings

Depression is not a disease per se, it is a feeling. It makes no sense to treat a feeling.

You can only treat a person who has those feelings. I'm not saying this to belittle "depression" as if it's a non problem. In fact I take mental symptoms very seriously. My point is, if we really want to develop successful treatment plans then we need to start out by being honest about what we are dealing with.

If one person is depressed due to metal toxicity, and another due to psychological abuse, then very different treatments are needed. Not a generic drug (or supplement) that treats depression.

But this is what psychiatry does, when it calls the feeling "depression" a disease in and of itself and throws mind altering drugs at the feeling.

Language and the distortion of reality

The very thought of "treating" a feeling per se, is mind boggling nonsensical.

Terms such as ""treating depression" become imbedded into language, and changes how we think.

Language is not just a means of communication and thought, but actually sets the boundaries in which thought can take place. If vocabulary assumes a false paradigm, then it may become almost impossible to see the truth.

The distorted idea of treating a feeling, instead of the person who has the feeling, is handed down to us by psychiatry. For example, psychiatrists call DSM labels diagnoses. In truth, the DSM explicitly states that none of its labels is a diagnosis. Psychiatrists know these are not real medical diagnoses. Nonetheless, they use such terms manipulate language and how people understand reality.

This is why I often put terms such as “depression” and “anxiety” in quotes. I do not wish to add to the confusion.

People tell me they have "depression" or "anxiety" all the time. Those terms are mostly useless by themselves. I have to dig deeper. I Ask them to describe these feelings? Is it in the mind? Is it physical? What systems is it related to? What was going on when all this began?

I need things to be clear, that I am helping them, not their "anxiety" or "depression."


Reductionism is the belief that complex systems can be understood as the sum of all their parts. Reductionism works well in many fields. However, it does not work for complex, dynamics, emergent systems such as the human body. To put it quite simply, we are much more than the sum of all our parts. Feeling depressed can not be reduced down to something so simple as serotonin (although both psychiatry and many people in natural health seem to believe that). I do not wish to dismiss the importance of the 5-Htp > serotonin pathway.  It is simply not the entire story.

The “gold standard” double blind placebo controlled study, is based on a reductionist model. This doesn't make such studies worthless. However, these studies do not have the final say in what specific treatments are needed for a specific individual. Especially since such studies only look at symptoms which large groups of people have in common. The "strange and peculiar" symptoms that we see on an individual basis are ignored. But often it is these other symptoms which show what the individual patent actually needs. 

Instead of reductionist models of "mental illness," we need dynamic models. Models that consider all the multi-factorial conditions that may lead an individual to feel depressed. In the real world, the real question is, "what does this individual patient need." Not what random drug or supplement will have a 30% chance of improving symptoms.

No comments:

Post a Comment