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Myth persists at RANZCP - College of Psychiatrists still claims that meds rebalance brain chemicals

Updated: Aug 23


Below is a copy of a letter objecting to misleading information on the RANZCP website, claiming that psychotropic 'medications work by rebalancing the chemicals in the brain'. The PsychWatch Australia editorial team sent this letter to the President of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) on 9 August 2022.

On 12 August 2022, we received an email from the RANZCP, advising us that our 'correspondence will be discussed at the upcoming Executive Meeting' and that a response will be provided to us in 'due course'. We subsequently asked (16 August) when the Executive was meeting, and when a response to the substantive issues we raised would be provided. No response has arrived as yet (22 August) and the misleading information remains on the RANZCP website. We will publish the RANZCP response when we get it, and we will monitor the website and advise if/when the misleading information is removed.

In the meantime, we encourage PsychWatch Australia readers to email the RANZCP President, at president@ranzcp.org requesting that the misleading information is removed from the RANZCP website and other publications.

By Martin Whitely 23 August 2022

 

Dear Associate Professor Lakra

President, RANZCP

9 August 2022


Re: Misleading information on the RANZCP website claiming psychotropic 'medications work by rebalancing the chemicals in the brain'


We are writing to request that the Royal Australian and New Zealand College of Psychiatrists (RANZCP) correct its webpage titled Medications for Mental Illness[1] and the linked fact sheet pdf [copy below]. Both foster the false belief that medications address chemical imbalances.


You are probably aware of research recently published that demonstrated that there is ‘no [evidentiary] support for the hypothesis that depression is caused by lowered serotonin activity or concentrations’.[2] This research has been widely accepted as finally debunking the myth that depression is caused by a chemical imbalance.


However, some experts, including Melbourne psychiatrist Professor Christopher Davey, have claimed that the chemical imbalance theory of depression was already known to be invalid well before the research was published. Professor Davey claims ‘few psychiatrists with an understanding of the nuance of brain function believed the chemical imbalance theory’.[3]


It is difficult to reconcile Davey’s claim with the RANZCP’s assertion that medications rebalance brain chemistry. If Davey is correct, and competent psychiatrists have long known that this is false, why does Australia and New Zealand’s peak professional organisation for psychiatrists continue to promote this falsehood?


Although the recent research relates only to antidepressants, the RANZCP webpage and the fact sheet pdf refer to all medications* for mental illness, including amphetamine-like stimulants used to treat attention deficit hyperactivity disorder (ADHD).


For many years, the increasingly discredited dopamine theory was promoted as the likely cause of ADHD.[4] However, research indicates that the extended use of amphetamine-type stimulants may permanently impair dopaminergic pathways.[5] So, rather than normalising or ‘rebalancing’ brain function, the long-term administration of amphetamine-type stimulants appears to cause permanent brain damage.


It is frequently claimed that stimulants affect the brains of people with ADHD differently. However, the truth is that, with a low dose of stimulants, most people (irrespective of their ADHD status) become more compliant.[6] Furthermore, when the drugs wear off, there are often ‘rebound’ or withdrawal effects that can worsen ADHD-type behaviours.[7] Witnessing the rebound effect often reinforces parents’ and teachers’ belief that the child is chemically imbalanced without the drug and that he or she needs to keep taking medication.


It is absurd to assert that amphetamine-type stimulants ‘rebalance’ or in any sense ‘balance’ brain chemistry. Their effects are extremely short-acting. They create inconsistent (i.e. unbalanced) brain chemistry and temporarily interfere with brain and body biochemistry, and behaviour. It is, therefore, grossly irresponsible for the RANZCP to reinforce false beliefs that chemically unbalanced ADHD brains are rebalanced by taking medications.


Similar criticisms could be made for other drugs that the RANZCP suggests rebalance brain chemistry. We therefore contend that, in addition to correcting the misleading webpage and fact sheet pdf, the RANZCP should publicly acknowledge that it has published misleading information.


These criticisms are not the only ones we could make about the webpage and the fact sheet pdf. They put a positive spin on the safety and efficacy of medications that does not reflect reality. Adverse effects are referred to as 'side effects', downplaying their severity. It is claimed that 'Side effects will often feel worst in the first week, then get better over time'. There is no mention of adverse effects that can emerge after months or years, such as tardive akathisia and tardive dyskinesia. Patients deserve more accurate and balanced information.


We intend to publish this letter on the PsychWatch Australia website and we would like to simultaneously publish your response. To give you the opportunity to adequately consider the issues raised, we will delay publication until at least Monday 22 August 2022. In the meantime, we would welcome the opportunity to discuss the issues we raise with you.


Yours sincerely

Dr Martin Whitely and Dr Melissa Raven PsychWatch Australia Editorial Team psychwatchaustralia@gmail.com


*The medications listed on the RANZCP fact sheet pdf that claims 'medications work by rebalancing the chemicals in the brain' include antidepressants, antipsychotics, benzodiazepines, mood stabilisers and [amphetamine type] stimulants.


References

[1] RANZCP Medication for mental illness. https://www.yourhealthinmind.org/treatments-medication/medication

[2] Moncrieff, J, et al.The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatr 2022 https://doi.org/10.1038/s41380-022-01661-0 https://www.nature.com/articles/s41380-022-01661-0

[3] Davey C. The chemical imbalance theory of depression is dead – but that doesn’t mean antidepressants don’t work. The Conversation. 3 August 2022. https://theconversation.com/the-chemical-imbalance-theory-of-depression-is-dead-but-that-doesnt-mean-antidepressants-dont-work-187769

[4] Gonon F. The dopaminergic hypothesis of attention-deficit/hyperactivity disorder needs re-examining. Trends Neurosci. 2009 Jan;32(1):2-8. doi: 10.1016/j.tins.2008.09.010. https://pubmed.ncbi.nlm.nih.gov/18986716/ https://www.cell.com/trends/neurosciences/fulltext/S0166-2236(08)00247-6

[5] Wang G-J et al. Long-Term Stimulant Treatment Affects Brain Dopamine Transporter Level in Patients with Attention Deficit Hyperactive Disorder. PLOS ONE 8(5), e63023. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0063023

[6] Furman L, ‘What is Attention-Deficit Hyperactivity Disorder (ADHD)?’, Journal of Child Neurology, Vol. 20 No. 12, 2005, p. 998. https://journals.sagepub.com/doi/10.1177/08830738050200121301 https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.985.3161&rep=rep1&type=pdf https://www.researchgate.net/profile/Lydia_Furman/publication/7354308_What_Is_Attention-Deficit_Hyperactivity_Disorder_ADHD/links/5555e9b508ae6fd2d8232e29.pdf

[7] Rapoport JL, et al., ‘Dextroamphetamine: cognitive and behavioural effects in normal prepubertal boys’, Science, Vol. 199, No. 4323, (3 February 1978), p. 561. [The dose was 0.5mg/kg.] https://www.researchgate.net/profile/Christy_Ludlow/publication/22798084_DextroamphetamineCognitive_and_behavioral_effects_in_normal_prepubertal_boys/links/5597e85708ae5d8f3933c33a/DextroamphetamineCognitive-and-behavioral-effects-in-normal-prepubertal-boys.pdf


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