Thread by @Altostrata

Monoamine hypothesis aka "chemical imbalance" & other synonyms, arose circa 1965, but was known to only #psychiatrists, who were unhappily prescribing TCAs and MAOIs to a niche market. Patients hated the many adverse effects of the drugs. /1

Until mid-1990s, monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency" etc.) was not circulating as a "folk model", not in medicine or in the general public. 1990 is ~center of this chart, when #psychiatrists, many paid by pharma, started churning out papers. /2

As a meme or "folk model", monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency", "neurohormone imbalance", etc.) was diligently planted by dozens of #psychiatrists -- not a few -- many paid by pharma. Not something that arose organically out of nowhere. /3

In the mid-2000s, the pharma bribes I mean payments to Key Opinion Leaders (KOLs) in #psychiatry became so egregious that this emerged as a big scandal in medicine, causing many journals to insist on conflict-of-interest statements from authors of papers. /4

When pharma backed out of #antidepressant development in the mid-2000s, there was much weeping among #psychiatrists because the gravy train was over. healthmanagement.org/c/healthmanage… /5

Among the reasons for pharma backing off from #antidepressant development was the cost of lawsuits & the declining ROI for clinical trials (lack of drug efficacy). drugwatch.com/ssri/paxil/law… /6

"...models of #psychiatric disorders are unsatisfactory. Diagnosis of #psychiatric disorders is mainly based on subjective assessments [the heterogeneity problem]...large-scale clinical trials of #psychiatric drugs have not shown any promising results." healthmanagement.org/c/healthmanage… /7

Meanwhile, the "chemical imbalance theory" (aka "monoamine hypothesis", "serotonin deficiency", "neurohormone imbalance", etc.) became an "everybody knows" trope, embedded in publications from #psychiatry professional organizations, mental health campaigns -- everywhere. /8

Although pharma no longer funds promulgation of the "chemical imbalance" meme, it's out in the wild, taking on a life of its own. People have integrated this in their understanding of themselves. It's sold millions of #antidepressant prescriptions, many of them unnecessary. /9

Having been informed by decades of material produced by pharma & pharma-paid #psychiatrists, many doctors still soberly tell their patients they need #antidepressants because of a "chemical imbalance" -- "like a diabetes patient needs insulin". /10

#Psychiatry, however, has not issued a peep in protest of this widespread "chemical imbalance" misinformation, though dozens of #psychiatrists worked hard to inject it into common knowledge. No matter the history, it's squarely in psychiatry's domain to correct it. /11

Why do you suppose @APAPsychiatric, for example, cannot run an editorial for the edification of prescribers everywhere that "chemical imbalance" & its synonyms is an inappropriate description of clinical need for #antidepressant treatment? /12

Here's why: Too many of the leaders of #psychiatry are still invested in this slogan, having collected quite a bit of money from pharma in the heyday. One way for an institution to manage a scandal is to ignore it until it goes away, to avoid embarrassing any KOLs. /13

Tiresome as it is, scandal of "chemical imbalance", #psychiatry's active role in promoting this misinformation, & its denial of responsibility for correcting it is an eternal irritant, as the meme keeps circulating from #psychiatrists to doctors to patients & among patients. /14

Here's the face of contemporary #psychiatry, endorsed by @APAPsychiatric a few days ago. This Miami #psychiatrist says: "Yet many of us will never take medication that can help correct the chemical imbalance in our brains due to medication stigma". medscape.com/viewarticle/96… /15