Chapter 17: Quiz
1. The Moncrieff et al. (2022) umbrella review concluded:
- A) Antidepressants don't work
- B) Depression doesn't exist
- C) There is no consistent evidence that depression is caused by low serotonin levels or activity
- D) Doctors were deliberately lying about chemical imbalances
Answer: C. The review found no consistent evidence for the serotonin theory of depression's cause. It did not evaluate whether antidepressants are effective treatments — that's a separate question.
2. The Cipriani et al. (2018) meta-analysis of 522 antidepressant trials found:
- A) No antidepressant works better than placebo
- B) All 21 antidepressants studied were more effective than placebo
- C) Only SSRIs work; other antidepressants do not
- D) Placebo is more effective than medication
Answer: B. The largest meta-analysis of antidepressant trials found all 21 studied drugs outperformed placebo, with the strongest effects in moderate to severe depression.
3. The chemical imbalance theory helped reduce stigma by:
- A) Proving depression is caused by serotonin
- B) Framing depression as a brain disease rather than a personal weakness or moral failure
- C) Eliminating all stigma around mental health
- D) Proving that only medication works for depression
Answer: B. The biological framing ("it's a chemical imbalance, not your fault") gave people permission to seek treatment without shame. This was genuinely valuable, even though the specific theory was oversimplified.
4. SSRIs increase serotonin availability within hours, but the therapeutic effect takes 4–6 weeks. This suggests:
- A) The medication doesn't work at all
- B) The mechanism is more complex than simply "restoring serotonin levels" — downstream effects like neuroplasticity may be involved
- C) Patients need to take higher doses
- D) The serotonin theory is fully confirmed
Answer: B. The time delay between pharmacological action and clinical effect is one of the strongest arguments that the mechanism is more complex than the simple "chemical imbalance" model.
5. The placebo response rate in antidepressant trials is approximately:
- A) 5%
- B) 15%
- C) 30–40%
- D) 75%
Answer: C. Approximately 30–40% of depressed patients improve on placebo — involving real neurobiological changes, not just imagination. This large placebo response means the drug-placebo difference is moderate.
6. "A drug can work without the original theory about its mechanism being correct." An example of this principle is:
- A) Aspirin reduces fever even though fever is not caused by an "aspirin deficiency"
- B) Antibiotics kill bacteria because bacteria cause infection
- C) Insulin treats diabetes because diabetes is caused by insulin deficiency
- D) Chemotherapy cures cancer because cancer is caused by too few chemicals
Answer: A. Aspirin effectively reduces fever, but the mechanism is not the reverse of the cause. Similarly, SSRIs may effectively treat depression without the specific "low serotonin" theory being correct.
7. For mild depression, the evidence suggests:
- A) SSRIs are strongly superior to placebo
- B) The advantage of SSRIs over placebo is small, and therapy/lifestyle interventions may be more appropriate first-line treatments
- C) No treatment works for mild depression
- D) Mild depression always becomes severe
Answer: B. The drug-placebo difference is largest for severe depression and smallest for mild depression. Guidelines often recommend therapy and lifestyle interventions as first-line for mild cases.
8. The "harmful oversimplification runs both ways" means:
- A) Only over-medication is harmful
- B) Both "depression is just a chemical imbalance" AND "the chemical imbalance theory was a lie, so medication is useless" are oversimplified and potentially harmful
- C) There are no harmful oversimplifications
- D) Only under-medication is harmful
Answer: B. Overclaiming the chemical imbalance model leads to over-reliance on medication. Overclaiming its debunking leads to medication avoidance. Both oversimplifications cause harm.
9. The biopsychosocial model of depression proposes that:
- A) Depression has only biological causes
- B) Depression has only psychological causes
- C) Depression results from the interaction of biological, psychological, and social factors
- D) Depression has no causes
Answer: C. The biopsychosocial model — now the consensus framework — recognizes that depression involves biological factors (genetics, neurochemistry), psychological factors (cognition, learning), and social factors (poverty, isolation, discrimination).
10. If you are currently taking antidepressants, the chapter's recommendation is:
- A) Stop taking them immediately because the chemical imbalance theory is wrong
- B) Do not change your medication based on this chapter — discuss any changes with your prescribing physician
- C) Double your dose
- D) Switch to alternative medicine
Answer: B. The chapter explicitly states that medication changes should only be made in consultation with a prescribing physician. The failure of one theory about mechanism does not mean the treatment is ineffective.