Mental disorders: a complex interplay of different factors

[Translate to English:] Puzzlestücke

Since emovis was founded in 2001, we have conducted more than 50 clinical studies on depression. In the process, we have had intensive discussions with a great number of people affected by this disorder. We know that dealing with depression, or mental disorders in general, is often an enormous challenge. Due to the fact that several different factors interact in the development of mental disorders, there is no single solution for their treatment - rather, it is necessary to consider several treatment options. This is now the general consensus.

We were all the more surprised when we stumbled across this Telepolis article. Among other things, the author criticizes the alleged excessive use of psychotropic drugs and calls one of our ads a "search for human guinea pigs." We - and, based on the article’s comments, a number of other people believe the author incompletely portrays the origins and treatment of mental disorders. Read our blog post to learn more about our views on this important topic.



Mental disorders - there is no ONE single cause. 

Why, what for, how come? It is human nature to strive to get to the bottom of things, to find out their cause(s). This tendency is already evident at a very young age: Parents, in particular, can tell you a thing or two about the incessant curious questions of their children. It makes sense to want to find out why our world is the way it is. Why we humans are the way we are. Only when we know about causes, we can succeed in influencing, changing, controlling, and predicting ourselves and our behaviour.

Mental disorders, such as depression, are no exception, but rather a vivid example: The question of their causes, particularly the so-called unlerlying causes, has preoccupied experts ever since psychiatry came into existence. Understanding their causes and effects makes it possible to search for effective treatments - with the aim of curing or at least alleviating the suffering of those affected.

However, knowledge and science are not fundamentally fixed, they are not set in stone. This is also the case with regard to mental disorders- over the course of the last few decades, many models, theories, and ideas have taken turns to be in the foreground, each with its own advocates and opponents. In the process, the original term mental illness has been replaced by the more neutral term mental disorder in order to reflect the realization that our knowledge of the origins and causes is still incomplete.

At this point, you may be wondering what exactly mental disorders are in the first place. There are many definitions of this term - all of them essentially boil down to the fact that disorders represent clinically significant (i.e., highly deviant from the norm) patterns of experience and behavior that cause suffering, impairment, loss of freedom, and/or loss of control in those affected.

With regard to mental disorders, especially depression, there is now a consensus that the combination and interaction of many different factors - genetic, biological, psychosocial, internal, and external – all play a role. Thus, mental disorders do not have ONE single cause, but are caused by a unique and, above all, dynamic combination of all the aforementioned factors - each of them represents a piece in the "puzzle", so to speak. Accordingly, one should not fixate on just ONE (supposed) solution or treatment - rather, it makes sense to consider several treatment options, including the use of psychotropic drugs.



Increase in psychological-psychiatric diagnoses

The Telepolis article mentions the increase in psychological-psychiatric diagnoses. How can this be explained? It should be self-evident that the influences of society as a whole play a role: The more pressure is built up, the more fears are stirred up - whether they be of the broader future or specifically of doomsday, strangers, financial collapse, or unemployment - the more uncontrollable life becomes, the less freedom of action, connections, and security there are, the more people develop psychological disorders and the higher the numbers of corresponding diagnoses become.


But as previously mentioned, several factors are involved in the development of mental disorders, including biological ones. Although no specific underlying biological factor has yet been identified that can be held responsible for mental disorders in the medical sense, there is no denying the effect of chemical compounds on the underlying biological factors. For thousands of years, people have been using alcohol and various psychotropic plants and mushrooms to alter their states of consciousness. The modern pharmaceutical industry is no different: with the help of chemical substances, it tries to correct psychological states that are undesirable or cause suffering in the most effective way possible. The fact that the effectiveness of these substances often leaves much to be desired only shows how complex the reality is - and that although the biological or chemical factor is important, it is not the single determining factor.


In this respect, psychotropic drugs, for example antidepressants, are seen less as "happy pills" and more as a "crutch": They give sufferers the chance to cushion and bridge their worst states and phases - they can at least stabilise the mood to such an extent that further treatment steps, for example psychotherapy, become possible.

Even the author of the Telepolis article cannot avoid acknowledging biological influences: Interspersed here and there in his critique are brief sentences such as "Of course biology, genes and the brain play a role." or "In the case of very severe symptoms medication can alleviate suffering and enable people to live independently." In this respect, it is unjustified to claim that all the psychotropic drugs are only the result of lobbying and financial interests of the pharmaceutical industry. It is clear that the development of psychotropic drugs, or drugs in general, is partly linked to financial aspects - after all, there is hardly any industry that is not partly driven by financial interests.


The benefits of placebos

The Telepolis article mentions the hope of being able to treat mental disorders with the help of alternative methods - the author believes that more attention should be paid to the placebo method, for example. But this idea is already being taken into account: in almost every clinical trial, in addition to the treatment group - i.e. study participants who receive the respective drug to be tested - there is also a placebo group, which only is given a placebo without any pharmacological active ingredients. The placebo group serves precisely as a measure of the efficacy of a drug. Such clinical studies ensure that drugs that are not more effective than the placebo level do not even reach the approval stage.

The placebo approach has even found a therapeutic application in the form of homeopathy. But the effectiveness of this form of therapy is not reliable - otherwise it would have become standard in our health system long ago. The problem: clinicians are looking for calculable, predictable, adaptable and, if possible, objectifiable methods of treatment. The dose of a drug can be increased or decreased. In comparison, it is difficult to increase a placebo effect - in the worst case, the patient completely loses faith in the placebo object or forms negative opinions of the trial. This can have a negative impact on the entire course of therapy. 



Mental disorders, for example depression, pose an enormous challenge - not least due to the fact that they do not have ONE single underlying cause, but are rather the result of a complex interplay of several factors.

Quite a few people suffering from a mental disorder only seek professional help after several years. Once they have taken this step, the question often arises as to whether the use of medication could prove helpful. Many sufferers try several medications until they experience a more or less effective and tolerable relief of their symptoms. For the successful treatment of mental disorders, it is therefore necessary to conduct further research on psychotropic drugs within the context of clinical trials. 


A clinical trial cannot be carried out at the drop of a hat, but only if its expected benefit exceeds the possible risks - this point as well as many other prerequisites are examined in detail, specifically by the ethics committee. Furthermore, participation in a clinical trial is of course always voluntary and can be discontinued at any time - without providing reasons and without negative consequences. In this respect, it is highly inappropriate to describe participants in clinical trials as "guinea pigs".  

There is no doubt about it: psychotropic drugs are not useful in every case and they are rarely the only solution - but they are often an important aspect of treatment, and for some people they are even life-saving. This is clearly shown by the following online forum comments with which we would like to conclude our blog post:


- "[...] You read negative things about psychotropic drugs all the time. Why not about diabetes medication or heart pills? [...] Unfortunately, my life depends on them. Life would be impossible without them. [...]"


- "[...] I have always envied those who have tried it without medication - today I know that anyone who is really seriously mentally ill will not cope without medication any more than someone can cope with a broken leg without pain medication! [...]"


- "[...] Of course, one should always take a critical look at how medicines and their prescription are handled. [...] But on the other hand, they are a blessing and also helpful when used sensibly. I would not be able to live without my psychiatric medication. [...] With a little pill every day, I can lead a largely normal life. And for that I am very grateful. So please don't demonize them across the board. [...]"


- "If you have serious depression, you are glad for every chance you get. [...]"


- "[...] I find it inconceivable how antidepressants and neuroleptics are always demonized without considering the fact that there are people who feel better with the stuff, who can participate in active life again thanks to the medication. [...]"


- "[...] I find it inconceivable how antidepressants and neuroleptics are always demonized without considering that there are people who feel better with the stuff, who can participate in active life again thanks to the medication. [...] People who are depressed don't manage to get out of their despondency in the first place [...] We have to weigh up the benefits. [...]"


- "[...] Antidepressants are usually not a permanent medication, but a crutch that can enable people to seek help, accept offers, and allow therapies to take effect. [...]"


- "[...] That's why I think the image with the crutches is not bad at all. Some people need them and some people manage without them. But every person and especially every mind is different. [...]"


- "[...] Many people demonize medication, but medicate themselves with alcohol or other addictive substances. Better to take well-dosed medication prescribed by a doctor. [...]"


- "[...] There are also people who have to take insulin or blood pressure-lowering medication all their lives. I don't understand why there is always such a 'drama' about antidepressants. Not only the body can get sick, we know that. The mind is also not a 'thing' that can ALWAYS be influenced by willpower. [...]"


- To the statement that one should take what life throws at you.

"[...] That's annoying. YOU think that. Full stop. But there are people who can't live without such medication. And when they read things like this, they feel inferior and shitty [...]."


- "[...] I can sleep again and my life has improved in quality. I owe a lot to this medicine, even my life, because I was really, really depressed. [...]"


- "[...] I have been taking antidepressants for years and they have not changed my personality. On the contrary - they make sure that I don't throw myself off the next cliff [...] I find it dangerous and inappropriate to completely demonize antidepressants. There are enough examples of suicides and attempted suicides that could have been prevented if people had dared to seek help. [...]"


- "[...] I am so grateful that these medicines exist. [...]"


*Note: For ease of reading, we have adjusted the original internet forum quotes for grammar, spelling and punctuation.


Patient voice

"[...] Many people with depression, including myself, find it difficult to talk openly and honestly about the illness. [...]" - said a sufferer who took part in one of our depression studies in 2019. You can read more about her experience as a study participant at emovis here.