A A new umbrella journal challenging long-held public beliefs about the cause of depression has caused a stir in the psychiatric community, but hasn’t advised people to ditch their antidepressant treatments.
oh Serotonin Theory of depression: a systematic review of the evidence was published in the journal Molecular psychiatryand found that after reviewing a collection of previously published studies examining the link between serotonin levels and depression, there was little evidence to support the established idea that chemical imbalances were the cause.
The underlying questions of the study examine why the chemical imbalance theory of depression remains the norm in both the medical community and the general public despite the alleged lack of evidence, and how this theory became mainstream in the first place. .
Dr. Joanna Moncrieff, a professor at University College London and a consultant psychiatrist for the UK’s National Health Service for 30 years, is one of the lead authors of the paper. she spoke to The Independent about the research, its implications and the response the study has received from the medical community and the public.
What does the study really say?
In simpler terms, the study found that there was not enough evidence to support the prevailing belief in the public and in some medical institutions that a chemical imbalance in the brain causes depression. As a result, the study calls into question the wisdom of clinicians prescribing antidepressants to patients without a more solid understanding of the drugs’ long-term health effects.
“The chemical imbalance theory of depression is still advanced by practitioners, and the serotonin theory, in particular, has formed the basis of considerable research effort over the past several decades,” the study concludes. “The general public widely believes that depression has been convincingly shown to be the result of serotonin or other chemical abnormalities, and this belief shapes how people understand their moods, leading to a pessimistic view of outcome of depression and negative expectations about depression. ability to self-regulate mood. that depression is the result of a chemical imbalance also influences decisions about taking or continuing antidepressants and can discourage people from stopping treatment, which can lead to lifelong addiction to these drugs.
On the inside a blog post after the publication of the study, and in his interview with The IndependentDr. Moncrieff stressed that people using antidepressants such as SSRIs who are considering whether or not to continue their treatments should do so with ongoing advice from a physician and only discontinue them in a controlled, sustained, and gradual process.
In other words, people should not react to this study by suspending their antidepressant medications, but should continue to work with their doctors to address their mental health and any underlying causes that may be contributing to their depression.
Academic reaction to research
Despite these warnings, the study met with some resistance in the medical community. A number of doctors have circled around the use of antidepressants, saying that it is well understood in the medical community that depression is caused by a confluence of factors, not just a chemical imbalance, and that these treatments are always effective in controlling these symptoms.
David Curtis, honorary professor at University College London Genetics Institute, told the scientific media library: “This article does not present new findings, but only reports results that have been published elsewhere and it is certainly not news that depression is not caused by ‘low levels of serotonin’. idea that depression is caused by a “chemical imbalance” is outdated, and the Royal College of Psychiatrists wrote that it was an oversimplification in a position statement published in 2019.
“It’s not even true that SSRI antidepressants increase serotonin levels. Its immediate action is to alter the balance between serotonin concentrations inside and outside neurons, but its antidepressant effect is likely due to more complex changes in neuronal functioning that occur later as a result. . It’s pretty clear that people with depression have abnormal brain function, although we don’t yet know what it is, and that antidepressants are effective treatments for severe depression, unlike interventions like exercise and mindfulness. It is important that people with severe depression are not discouraged from receiving appropriate treatment, which can make a huge difference for them and those around them.
Moncrieff said she was not surprised by the reaction to the study and agreed that the theory presented was probably not new to academia, but likely to the general public.
“Some psychiatrists have said publicly that no, there really is no evidence of [the serotonin theory of depression] for a while, but no one wanted to highlight it or certainly highlight it to the public,” she said.
Additionally, Dr. Moncrieff agrees that antidepressants can benefit people who take them, either by alleviating the intense emotional states caused by depression or the placebo effect. However, she warned that the medical community needs to have a better understanding of what the drugs actually do if used.
“It’s crucial that people understand that we don’t really know what the effects – mental and behavioral – of these drugs are,” she said. which may or may not be useful. I think in the long term it’s probably not useful for most people, but some people may think that in a crisis or an emergency it would be something useful.”
She also said that antidepressants “definitely” have placebo effects, and that those effects have been confirmed in clinical trials.
“We know that most of the responses people show in antidepressant trials are placebo responses,” she said. “Research shows that people who think they’re taking an active drug do significantly better than those who think they’re taking a placebo, even if they’re not actually taking the active drug.”
How did antidepressants become the standard for treating depression?
The serotonin-based theory of depression was introduced in the 1960s when doctors first theorized that there was a link between serotonin levels and individuals suffering from depressive states. This remains the prevailing theory in the 1990s, when pharmaceutical companies began advertising SSRIs – which increase serotonin levels in the brain – directly to consumers, at least in the United States. They also market the drugs directly to doctors, which Moncrieff says is a contributing factor to their dominance as the primary treatment for depression.
“In the 1990s and early 2000s there was a lot of marketing aimed at doctors – you walked into a doctor’s office and there were just cups and pens of Prozac everywhere “, she said. “And I think that’s another reason why the doctors haven’t really questioned it, they’ve just been bombarded with this idea that this is the fact, this is the situation. If you repeat enough something, people tend to believe it.”
However, as the UK National Health Service notes in your guidelines, SSRIs are also used specifically because their short-term side effects are not as severe as those of other antidepressant medications. How Dr. Moncrieff said the drugs are effective in helping people with depression, but she argues that it’s clear from the study results that they alone cannot form the basis of the fight against depression. depression. Although the medical community largely agrees with this sentiment, this message is not as well known to the public.
After the article was published, a TikTok user named Liv Speakman – an Oxford graduate majoring in psychology and neuroscience – praised research in a video which received over 460,000 views. She argued it was a positive step in combating pessimism among people with depression who believe they are doomed to suffer forever from their affliction.
His comments section was full of lay people who expressed confusion and some apprehension over the news. They asked if this meant that their antidepressants were ineffective and if they should continue treatment. In a follow-up video, she explained that SSRIs and other antidepressants are still helpful and that people should continue to work with their doctor to treat their depression. Speakman compared drugs to painkillers, saying that people don’t take painkillers because they have an insufficient amount of painkillers in their bodies, but rather because the drugs dull the pain and allow them to live their lives.
Another content creator, Rebecca Watson, who runs a medical misinformation disavowing YouTube channel and website called Skepchicktook a more critical view, but mainly focused on news sites whose headlines suggested that antidepressants were not effective in treating depression.
She quoted a daily mail story that read, “Millions of people have been taking antidepressants with harmful side effects for decades – when there’s no scientific evidence, do they do what they claim?” Some experts had suspected this for years. Now patients are reeling from a groundbreaking study.
“I repeat, everything I have just read to you is false. So incredibly, stupidly, irritatingly wrong. “No scientific evidence (antidepressants) do what they claim?” Wrong,” she said in a recent YouTube video. “There are HUNDREDS of randomized controlled trials that show antidepressants help people with depression at a higher rate compared to placebo. There is no ‘new research’ disproving this. None.”
Reports covering complex health and science issues have often been derided by experts for distorting and misleading the public, whether by misunderstanding the facts or sensationalising to lure readers.
In fact, Moncrieff says he did the work specifically to point out that what the public knows and what experts know about depression is incongruous, and that rectifying that fact through further study should be a priority for communicators and researchers. .