Why Has The Misleading Chemical Imbalance Theory of Mental Illness Persisted For So Long

Recently, one of my friends messaged frantically, asking if I had seen the big serotonin study that had been published by scientists at University College London. The study, an umbrella review critically evaluating pre-existing research, concluded that there was little support for the idea that depression was related to abnormally low levels of serotonin. As a philosopher of medicine and psychiatry, I had to confess that I had seen the study and was utterly unsurprised at the results.

It’s true that the authors of the study are controversial figures, vocal to sometimes vituperative critics of the mental health status quo, leaving heated debates in their wake with each new publication. But the authors’ conclusion has been an open secret within mental health circles for at least a decade. The very public dispelling of this “serotonin model” has also removed a key plank in the widely believed but oversimplified myth of mental illness being caused by a “chemical imbalance.” My friend was devastated.

The chemical imbalance myth has its roots in the late ’70s and ’80s when psychiatry was dominated by the desire to understand mental illness in primarily biological terms—as deviations in brain structure, neurochemistry, and genetics. When the first generation of selective serotonin reuptake inhibitors (or SSRI) antidepressants such as Prozac was introduced in the late ’70s, a key part of their marketing claimed that they targeted specific neurochemical imbalances.

Psychiatry is now interested in a wider range of factors contributing to mental illness—including genetics, gut microbiome, environmental influences, socioeconomic factors, and interpersonal stressors—and the marketing of psychiatric drugs is more tightly regulated.

However, as the authors of the new study point out, this initial starting point has already crept into everything from public health messaging to popular websites. For instance, though the American Psychological Association takes no stance on the serotonin model when describing SSRIs, Australia’s Department of Health, describes antidepressants in terms of the chemical imbalance model.

In the past year, 8.3 million people in the U.K. (about 12 percent of the population) took antidepressants. The most recent figures from the United States, collected between April and May by the National Center for Health Statistics, show that approximately 23 percent of adults took prescription medication for their mental health.

The vast majority of these prescriptions, including the one taken by my friend, are for SSRIs. And it’s no surprise that many people who have been prescribed an SSRI believe that they work by increasing the availability of serotonin, thereby correcting the abnormally low levels of serotonin responsible for her depression. Finding out that this story of how SSRIs work was unsubstantiated made her question whether she should be taking them in the first place.

This is a common reaction. As I write this, my social media channels are full of patients who say they now want to stop taking SSRIs. The response by concerned mental health professionals and skeptical commentators has been twofold: First, they are poking holes in the study—usually an important part of scientific method. But in this case I suspect it is sort of pointless, given that many experts already thought the serotonin model to be a nonstarter, and this is a review of existing work rather than new research. Second, they are correctly noting that though we are unsure how SSRIs and other psychiatric drugs work, we have reason to believe that they do—an important distinction.

Medical treatments, including psychiatric drugs, are primarily tested for efficacy, usually via randomized controlled trials rather than more primary research into how or why they work. In many ways, this makes sense: When there is a problem, especially with one’s health, the priority is fixing the problem rather than working out why this particular fix works. Indeed, there are many common medicines and treatments where we are not entirely sure how they work, despite being fairly certain that they do—including acetaminophen (or, as we call it in the U.K., paracetamol).

There are many people who swear SSRIs have improved their lives, and pooled reviews and meta-analyses point toward their efficacy. Based on such reviews,  they are recommended treatments for depression (and a host of other mental illnesses) via the U.K.’s National Health Service and the American Psychological Association. On the other side, critics point to a number of deep issues with this research such as the failure to publish negative results, the fact that trials tend to be funded by pharmaceutical companies, and the exclusion of severely depressed patients from the trials.

And then there is the perennial problem of taking experimental results about a broader population or group and applying them to a particular individual. I am inclined to think the debate over the efficacy has distracted from the main point of the study—in the case of mental health, how and whether something works both matter.

In many ways my friend and I are very similar: prone to severe depression, from the same ethnic background, of similar ages, both philosophers. We have both spent the vast majority of our adult lives in precarious environments that incentivized a certain kind of relentless pursuit of achievements. But unlike my friend, I made the choice, not just once but at many critical junctures in my life, not to take antidepressants. Because I knew that depression doesn’t necessarily come from a chemical imbalance, I knew that SSRIs would hardly be a silver bullet or the only thing that would help.

I also thought about what side effects they would have. One of the primary reasons I avoided antidepressants is because a common side effect of SSRIs is disruption to sleep. My mood is very responsive to sleep, and I worried that I would just be creating a whole new set of problems for myself; a number of people end up with prescriptions for both sleeping pills and SSRIs. The possibility of sleep disruptions, the fact that my mood was very responsive to other interventions, and other potential side-effects led me to my decision.

I do not think there is a correct answer to the question of whether any particular individual should take SSRIs. I can imagine someone in my shoes whose symptoms were more severe and had tried other options making a different decision. But the persistence of the chemical myth of depression obfuscates this kind of decision-making. Though mental health professionals and academic researchers understand the distinction between whether and how a treatment works, these two things come hand in hand for patients, and it has been disingenuous to pretend otherwise.

One of the main reasons my friend was so upset about the serotonin study was because she was now left with a great many questions. If she wasn’t depressed because of serotonin levels, how was she to understand her propensity to depression? Was something else wrong with brain? Her genetics? Most heartbreakingly, she wondered whether it was that she was simply weak. The serotonin model of depression had not only played a part in her decision to take antidepressants; it shaped how she thought about herself.

I have spent a great many years biting my tongue when friends or acquaintances described their depression in terms of chemical imbalances. I hesitated in part because I was fearful of affecting their treatment, something I did not feel professionally qualified to weigh in on. But my biggest fear was intruding on the way in which they understood themselves and their lives.

Because I have seen myself and my tendency toward depression in different terms, the results of the study have not disrupted my understanding of myself. Though I have sometimes wondered why I seem more inclined to low mood than other people and idly wonder whether it some variation in my particular neurochemistry or genetics, for the most part, when I am going through a depressive period, I recognize its relationship to something that is happening in my life which needs resolving or the fact that I work in a particularly demanding field.

I am not suggesting that SSRIs prevent people from considering what might underlie their depression, or that in all cases depression is situational. But when such a compelling story is put forward by authoritative sources, one that explains so tidily why someone feels the way they do and what can be done about it, people tend not to look elsewhere for explanations or solutions. Just as the chemical imbalance myth has clouded making choices about treatment, it has altered how people understand themselves and their lives.

It is a platitude to say that different treatments work for different people, but I find it interesting that both me and my friend have ended up in similar contented places. One of the reasons the study has been so painful for so many people is the sheer variety of experiences. Those who, like me, have refrained from taking SSRIs feel faintly resentful for the many years that they have been made to feel irrational about their choice.

More tragic are the people like my friend who are now questioning their choices and their understanding of themselves. More tragic still are those patients who had an adverse reaction to SSRIs and have spent many years trying to make the psychiatric establishment acknowledge the myth and the way in which it has hidden the trade-offs associated with SSRIs and other psychiatric drugs. Then there are the many patients for whom SSRIs have been beneficial and continue to advocate for their use in the fear that others will miss out on life changing treatment.

On the other side of the fence, I have colleagues I trust and respect with a wide spectrum of views. What is striking is that once you put the bruised egos and the usual financial vested interests aside, the debates, vicious as they are, seem mostly conducted in utter good faith. Both sides convinced that the other is not only mistaken but in danger of harming vulnerable patients either by peddling dangerous, ill-evidenced treatments or through vilifying treatments that many had found helpful. Though it has been upsetting, I cannot help but find it moving that for most parties involved, the priority is the patient and their well-being.

State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.

By Sahanika Ratnayake

Source: Why has the misleading chemical imbalance theory of mental illness persisted for so long?

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IMF Warns Of ‘Gloomy Outlook’ For Global Economy, Slashing Growth Estimates

The International Monetary Fund warned on Tuesday of a slowdown in global economic growth as the world economy continues to take a hit from “increasingly gloomy developments in 2022,” including high inflation, a slowdown in China caused by Covid lockdowns and ongoing fallout from Russia’s war in Ukraine.

The IMF slashed its global growth projections, now expecting global GDP to grow 3.2% this year and 2.9% in 2023, down from previous estimates in April of 3.6% GDP growth for both years.

The group cited a slowdown in the world’s three largest economies—the United States, China and the euro area—as a reason for the revised estimates, warning that the risks to the outlook remain “overwhelmingly tilted to the downside.”

Several “shocks” have hit the global economy as it tries to recover from the pandemic, including higher-than-expected inflation worldwide––especially in the United States and Europe, a worse-than-anticipated slowdown in China caused by Covid lockdowns and “further negative spillovers” from the war in Ukraine.

The IMF also said that high inflation remains a “major problem” as prices have continued to rise in 2022, led by soaring food and fuel costs, arguing that “taming inflation should be the first priority for policymakers” worldwide.

The group now expects global inflation to hit 6.6% in advanced economies and 9.5% in developing economies this year, though prices are expected to return to near pre-pandemic levels by the end of 2024.

The IMF also slashed its growth estimates for the U.S. economy, now forecasting GDP to rise 2.3% this year and 1% in 2023, down from previous estimates of 3.7% and 2.3%, respectively, amid the impact of tighter monetary policy and reduced household purchasing power.

“The outlook has darkened significantly since April,” IMF chief economist Pierre-Olivier Gourinchas said in a statement. “The world may soon be teetering on the edge of a global recession, only two years after the last one.”

“The slowdown in China has global consequences,” the IMF said. “Lockdowns added to global supply chain disruptions and the decline in domestic spending are reducing demand for goods and services from China’s trade partners.” The group now sees China’s economy growing 3.3% in 2022—its lowest pace in four decades and down over 1% from previous estimates.

The World Bank similarly slashed its forecasts for the global economy last month, predicting GDP growth in 2022 of just 2.9%, down from an earlier estimate of 4.1%.

I am a senior reporter at Forbes covering markets and business news. Previously, I worked on the wealth team at Forbes covering billionaires and their wealth.

Source: IMF Warns Of ‘Gloomy Outlook’ For Global Economy, Slashing Growth Estimates

Critics by Pierre-Olivier Gourinchas

The global economy, still reeling from the pandemic and Russia’s invasion of Ukraine, is facing an increasingly gloomy and uncertain outlook. Many of the downside risks flagged in our April World Economic Outlook have begun to materialize. Higher-than-expected inflation, especially in the United States and major European economies, is triggering a tightening of global financial conditions.

China’s slowdown has been worse than anticipated amid COVID-19 outbreaks and lockdowns, and there have been further negative spillovers from the war in Ukraine. As a result, global output contracted in the second quarter of this year. Under our baseline forecast, growth slows from last year’s 6.1 percent to 3.2 percent this year and 2.9 percent next year, downgrades of 0.4 and 0.7 percentage points from April.

This reflects stalling growth in the world’s three largest economies—the United States, China and the euro area—with important consequences for the global outlook. In the United States, reduced household purchasing power and tighter monetary policy will drive growth down to 2.3 percent this year and 1 percent next year.

In China, further lockdowns, and the deepening real estate crisis pushed growth down to 3.3 percent this year—the slowest in more than four decades, excluding the pandemic. And in the euro area, growth is revised down to 2.6 percent this year and 1.2 percent in 2023, reflecting spillovers from the war in Ukraine and tighter monetary policy.

Despite slowing activity, global inflation has been revised up, in part due to rising food and energy prices. Inflation this year is anticipated to reach 6.6 percent in advanced economies and 9.5 percent in emerging market and developing economies—upward revisions of 0.9 and 0.8 percentage points respectively—and is projected to remain elevated longer. Inflation has also broadened in many economies, reflecting the impact of cost pressures from disrupted supply chains and historically tight labor markets.

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Understanding 51% Attacks on Bitcoin and Blockchain

A 51% attack doesn’t mean the attacker can send BTC from your wallet or account; it only means the blockchain has been compromised, and double-spending of crypto is imminent. Blockchains like Bitcoin and its contemporaries, with larger mining nodes and hash power, are less likely to be attacked due to the financial cost involved.

Blockchain technology is no longer a new word in this digital era. The name prevalently comes to mind anytime Bitcoin cryptocurrency is mentioned in any discourse. Unfortunately, the connection between blockchain and Bitcoin can’t be ruptured because the Bitcoin cryptocurrency brought blockchain to the limelight in 2008.

For clarity’s sake, Bitcoin is a blockchain on its own, while its native cryptocurrency that is used to incentivize miners is BTC—Bitcoin cryptocurrency. The cryptocurrency was birthed through one of the several use cases of blockchain in the finance industry.

Consensus Mechanisms

A consensus mechanism is when the majority agrees on something or disagrees. Imagine you conduct a survey with 100 different people from different locations about how sweet a particular cookie is. If all 100 say it is sweet or otherwise, their opinion is unanimous, which marks a consensus.

The consensus mechanisms employed in all blockchain networks are similar to the example above. In the case of blockchain, miners replicate the audience that took the cookie survey. Back to Bitcoin mining.As mentioned earlier, the consensus mechanism of bitcoin is the PoW, where miners compete to solve complex cryptographic puzzles with their mining machines. Whoever can solve this puzzle faster and produces the winning hash wins the right to add the newly verified transaction data to a block.

Such a validator will be rewarded with the native crypto of the blockchain—BTC.What usually determines who wins the right to fill a new block with transaction data is having a mining machine with a high hash rate—i.e., machines that can produce more hashes per second. This can be achieved by having more machines and combining their mining power or getting machines with higher mining power to mine faster than your competitors.This suggestion can be likened to participating in a raffle where having more tickets increases your chances of winning. Now, what if an unscrupulous or malevolent actor has a higher mining power than other miners? Then, a 51% attack is imminent!

What Is a 51% Attack?

A 51% attack occurs when a malevolent miner in a blockchain network gains control of the blockchain mining power. This means that the miner—in this case, an attacker— will be able to mine faster than other miners because the attacker now controls more than 50% of mining power.

Having 51% control—which is the least percentage required to take over a blockchain network—is ominous.

Difference Between a 51% Attack and a 34% Attack

A 34% attack is known with the Tangle consensus algorithm. The attacker only falsifies the blockchain’s ledger by approving or disapproving transactions. In contrast, the 51% attack gives attackers control of a blockchain such that they can disrupt mining and the entire blockchain.

Implications of a 51% Attack on Blockchain and Bitcoin

When an attacker controls 51% mining power in a blockchain, then the security of such a blockchain has been compromised, leaving the attacker in control of transactions. Below are the implications of what’s bound to happen due to a 51% attack:

  1. Network Disruption by Delaying Validation of Transactions: The attacker disrupts the blockchain network by attacking the miner’s computing resources. In such a scenario, there’ll be a delay in the validation and storage of transactions in a block. As a result, the blockchain is hampered, causing the attacker to process transactions faster than the miners or even prevent another miner from adding blocks.
  2. Double Spending: Double spending occurs when miners spend their crypto twice on a particular blockchain network.How?
    Imagine if the attacker had previously purchased a Ferrari 250 GTO with 1,600 BTC; he paid for the car and got the delivery of the vehicle. During a 51% attack on the BTC blockchain, the attacker can reverse the 1,600 BTC transferred to the seller’s wallet such that he keeps the car and the BTC. The BTC can then be spent for another purpose. This is known as double-spending.
  3. Reduction in Miner’s Reward: Since miners are usually rewarded for validating transactions on a blockchain, in the wake of a 51% attack, the attacker steals the shares of other miners, making them earn less than what they’re supposed to earn.

Diminishes Blockchain’s Credibility

A 51% attack on a blockchain network will diminish the credibility of such a blockchain. Both miners and investors will not trust the security framework anymore. This might lead to abandoning the project or some exchanges delisting the crypto from their market.

Below are the examples of blockchains that have suffered a 51% attack:• BSV—Bitcoin Satoshi Vision—was attacked in August 2021• ETC—Ethereum Classic—was attacked thrice in August 2020

BTG—Bitcoin Gold— was attacked twice; once in 2018 and then in 2020

• GRIN was attacked in 2020, the attacker controlled about 58% of GRIN’s hash rate

VTC—Vertcoin—was also attacked twice in 2019

How to Prevent 51% Attack

i. Limited Hash Power – Blockchains running on the PoW mechanism should limit the hash power of each miner to 50% or lesser. This will pre-empt such an attackQuintex3-1-2-2-1-1-1-1

ii. Using PoS or DPoS A PoS- Proof-of-Stake- the mechanism is another consensus mechanism for validating blockchain transactions. It is eco-friendly because no power is needed, and it doesn’t require a sophisticated machine. PoS uses coin owners’ machines to mine crypto. Investors stake their coins in return for an opportunity to validate blocks.DPoS, on the other hand, means Delegated Proof-of-stake. It is a decentralized PoS where the crypto community appoints validators by voting. If a validator is perceived to be compromising the network, they are also voted out by the community.

Conclusion

A 51% attack doesn’t mean the attacker can send BTC from your wallet or account; it only means the blockchain has been compromised, and double-spending of crypto is imminent. Blockchains like Bitcoin and its contemporaries, with larger mining nodes and hash power, are less likely to be attacked due to the financial cost involved.

By Abubakar Maruf

Source: Understanding 51% Attacks on Bitcoin and Blockchain | HackerNoon

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Summer Travel Forecast: Plenty Of Flight Delays And Cancellations, With Higher Airfares

Yesterday, 462 flights within, into or out of the U.S. were cancelled and 6,623 were delayed, according to FlightAware, an app that provides real-time, historical, and predictive flight tracking data.

That wasn’t just a blip. Thousands of flights were delayed or canceled the day before, as well as the day before that.

While many of these disruptions can be chalked up to staffing shortages, it’s worth noting that pilots from Delta Air Lines and Alaska Airlines have been picketing in the past week. “That means there’s a systemic issue that isn’t going away by summer in terms of flight crew or pilot shortages,” says Kathleen Bangs, a former commercial airline pilot and spokesperson for FlightAware.

Symptomatic of the same problem is that carriers like JetBlue and Alaska Airlines have been cutting back on routes — not just for a few days or weeks, but months into the future as they try to manage staff shortages.

One airline pulling out or reducing frequency on a route can greatly impact airfares. “We’ve seen that when lower-cost carriers, such as JetBlue, enter a new route, it can drive down prices overall on the route by about 20%,” says Berg, lead economist at the deal-finding site Hopper. “However, when there’s less competition on a route because that carrier exits, prices tend to rebound by about 12%.”

“In one-off instances this won’t have a significant impact on airfare,” says Berg. “But extended and far-reaching cancellations will have a more pronounced impact on demand and put upward pressure on airfare.”

This partly explains why some carriers are backpedaling on their initial peak-season projections. “Some airlines like Alaska Airlines were forecasting even greater capacity than in pre-pandemic 2019, but have had to scale back sky high expectations slightly due to labor shortages and increased pilot attrition and pilot shortages,” says Bangs. “Other airlines such as Southwest are reporting seeing similar issues with not being able to get enough pilots trained and back online.”

For the airlines and their customers, staffing problems couldn’t come at a worse time. As infections from the original omicron variant fell in February and March, travel demand came roaring back. Currently, U.S. airline passenger volume is averaging about 92% of the pre-pandemic levels, according to Transportation Security Administration (TSA) throughput data.

Surging demand, coupled with a 30% rise in fuel prices since Russia invaded Ukraine, is sending airfares skyward as we head into the summer travel season.

As of now, domestic airfare is trending 7% above 2019 prices at $330 round-trip, according to Hopper’s data. “That is the highest average domestic airfare we’ve seen since we started collecting this data,” says Berg. “International airfare is matching 2019 prices at $810 round trip.”

Bangs doesn’t see a quick fix on the horizon. “What we’re seeing is not just a growing pilot shortage,” she says. “For some carriers it’s attrition to other rival airlines that pilots view as having better working conditions, greater pay, or a more favorable union contract.”

“Many airlines are building up relationships with aviation universities and with regional carriers to create a pipeline of pilots they can draw from, but right now that well is getting dry as the regionals struggle to keep their top-tier pilots long enough to meet the demands of their schedules,” explains Bangs.

For travelers who haven’t booked their summer vacations yet, Berg recommends not waiting too much longer, since the combination of booming demand, higher jet fuel prices and airline staff shortages will only drive summer airfares higher still.

“Prices are on the rise overall this summer, so you should use a price monitoring app like Hopper to start tracking fares now so you can buy at the right time,” she advises. “In general, you’ll want to book summer trips by the first week of May.”

I watch trends in travel. Prior to working at Forbes, I was a longtime freelancer who contributed hundreds of articles to Conde Nast Traveler, CNN Travel, Travel + Leisure, Afar, Reader’s

Source: Summer Travel Forecast: Plenty Of Flight Delays And Cancellations, With Higher Airfares

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Palladium Steadies After 5% Jump on Russia Supply Risks

Palladium steadied after jumping as much as 5% on Monday on supply concerns following a recent suspension on trading of the metal sourced from Russia in the London hub, while gold was buoyed by inflation fears.

Palladium was steady at $2,425.04 per ounce by 2:14 p.m. ET (1814 GMT) in choppy trading, having earlier scaled a peak since March 24 at $2,550.58. Platinum fell 0.2% to $973.40.

Newly refined Russian platinum and palladium was suspended from trading in London from Friday, denying access to the metals’ biggest trade hub because of the Ukraine war. read more

“The underlying fundamental support of concerns about supply disruptions remains the main focal point of the market,” said David Meger, director of metals trading at High Ridge Futures.

Spot gold was up 0.1% at $1,947.80 per ounce after hitting its highest since March 14 at $1,968.91. U.S. gold futures settled up 0.1% at $1,948.2.

Gold gave up some gains after Chicago Federal Reserve President Charles Evans signalled he would not oppose getting interest rates up to a neutral setting, which would require a couple of 50 basis-point rate hikes at the central bank’s upcoming meetings. read more

“The real question is are (the Fed) truly going to take a strong enough stance against these inflationary pressures to stave off potentially what we believe is still a very supportive gold market?” High Ridge’s Meger added.

While gold is considered a hedge against inflation, rate hikes increase the opportunity cost of holding the non-yielding bullion. Focus was now on the March U.S. consumer price report due on Tuesday, with traders expecting further rises due to the impact of the Ukraine war on energy costs. read more

“The war is continuing and without a clear solution and it’s becoming evident it’s becoming a long term matter,” supporting gold, said Carlo Alberto De Casa, external market analyst at Kinesis.

Spot silver rose 0.5% to $24.87 per ounce.

By

Critics:

By: Edward Spence & Ranjeetha Pakiam

The airspace closure is disrupting exports of Russian palladium,” said Giovanni Staunovo, a commodity analyst at UBS Group AG’s global wealth management unit. “Further price support is likely coming from investor-and-consumer-led buying trying to secure physical palladium.”

Putin said again on Sunday the war will continue until Ukraine accepts his demands and halts resistance, dimming hopes for a negotiated settlement. The U.S. is now considering an embargo on Russian oil supplies as it tries to ratchet up pressure on the Kremlin.

“With low above-ground inventories, palladium, which was under-supplied for nine years until 2020, is very sensitive to supply disruption risks,” Staunovo said. Already premiums on sponge palladium — used by industrial users — are surging.

One buyer was paying as much as $15 an ounce over the spot price last week, according to a person familiar with the matter Still, shipments from Russia. Spot palladium climbed as high as $3,442.47 an ounce, surpassing a previous record set in May. The metal traded up 10.3% at $3,322.14 an ounce at 12:09 p.m. in London. In other precious metals markets, spot gold topped $2,000 an ounce for the first time since August 2020.

Bullion is extending gains after posting its biggest weekly advance since July 2020 amid mounting concerns that the raft of penalties against Russia could dim global growth and further stoke inflation. Silver steadied and platinum advanced.

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