Symptoms of depression: What a new study does — and doesn’t tell us — about antidepressants and serotonin

a A new comprehensive review that challenges long-established public beliefs about the cause of depression caused a stir in the psychiatric community but did not advise people to give up their antidepressant treatments.

The serotonin Depression theory: a comprehensive systematic review of the evidence It was published in the magazine Molecular Psychiatryand found that after reviewing a set of previously published studies examining the relationship between serotonin levels and depression, there was little evidence to support the well-established notion that chemical imbalances were to blame.

The study’s primary questions examine why the chemical imbalance theory of depression remains the default in both the medical community and the broader public despite an alleged lack of evidence, and how this theory became dominant in the first place.

Dr Joanna Moncrieff, Professor at University College London and a 30-year consultant in psychiatry for the UK’s National Health Service, is one of the lead authors of this paper. I spoke with independent About the research, its implications, and the response the study received from the medical community and the public.

What does the study actually say?

In simpler terms, the study found that there was not enough evidence to support the belief in the public and some medical institutions that a chemical imbalance in the brain causes depression. As a result, the study questions the wisdom of doctors who prescribe antidepressant medications to patients without a stronger understanding of the long-term health effects of the drugs.

The study concluded that “the chemical imbalance theory of depression is still being put forward by professionals, and the serotonin theory, in particular, has formed the basis of a major research effort over the past few decades.”

The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities, and this belief shapes how people perceive their mood, leading to a pessimistic view of the outcome of depression and negative expectations about the possibility of mood self-regulation.

“The idea that depression is the result of a chemical imbalance also influences decisions about taking or continuing to take antidepressant medications and may discourage people from stopping treatment, potentially leading to lifelong dependence on these medications.”

In a blog post after the study was released, and in her interview with independentDr. Moncrieff emphasized that individuals using antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) who are considering whether or not to continue treatment should do so under the constant guidance of their physician and only wean off in a controlled, supported, and gradual process.

In other words, people should not react to this study by suspending their antidepressant treatments, but should continue to work with their doctors to address their mental health and any underlying causes that could be contributing to their depression.

Academic reaction to the research

Despite these warnings, the study met with some resistance within the medical community. A large number of physicians have rolled their wagons around the use of antidepressant drugs, arguing that it is well understood in the medical community that depression is caused by a combination of factors, not just a chemical imbalance, and that these treatments are still effective in managing those symptoms.

Dr David Curtis, Professor Emeritus at University College London’s Institute of Genetics, told the Center for Scientific Information: “This paper does not present any new findings but only refers to findings that have been published elsewhere, and it is certainly not news that depression is not due to depression.” Low serotonin levels.” The idea of ​​depression due to a ‘chemical imbalance’ is outdated, and the Royal College of Psychiatrists wrote that this was an oversimplification in a position statement published in 2019.

“It is not the case that SSRI antidepressants increase serotonin levels. Their immediate action is to alter the balance between concentrations of serotonin inside and outside neurons, but it is possible that their antidepressant effect is due to more complex changes in neuronal function that subsequently occur as a result.”

“It is very clear that people with depressive illness have some abnormality in brain function, even if we do not yet know what this is, and that antidepressants are effective treatments for major depression while interventions such as exercise and mindfulness are not. It is important not to People with major depression are discouraged from receiving appropriate treatments, which can make a huge difference to them and those around them.”

Dr. Moncrieff said she was not surprised by the reaction to the study, and agreed that the theory presented was likely not news to the academic world, but likely to be for the general public.

“Some psychiatrists said publicly that no, there was no evidence of that [the serotonin theory of depression] For a while, but no one wanted to highlight it or definitely highlight it to the public.”

Furthermore, Dr. Moncrieff agrees that antidepressant medications can be beneficial for individuals who take them, whether that is by calming intense emotional states caused by depression or through the placebo effect. However, she cautioned, the medical community must have a better understanding of what the drugs actually do if they are to be used.

She said, “It’s essential for people to understand that we don’t really know what the effects are – the mental and behavioral effects – of these drugs. And they have mental and behavioral effects, one of which is probably emotional sedation, which may or may not be beneficial. I think in the long run Long is probably not useful for most people, but there may be some people who feel in a crisis or emergency that it would be a useful thing.”

She also said that antidepressants “definitely” have placebo effects, and those effects have been confirmed in clinical trials.

“We know that the majority of the response people showed in antidepressant trials was a placebo response,” she said. “There is research showing that people who guess they are taking an active drug do significantly better than those who think they are taking a placebo, even if they haven’t actually taken the active drug.”

How did antidepressants become the standard for treating depression?

The serotonin theory of depression was introduced in the 1960s, when doctors first hypothesized that there was a link between serotonin levels and individuals who had experienced depressive states. This is still the prevailing theory in the 1990s, when drug 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 physicians, which Dr. Moncrieff believes is a contributing factor to their dominance as a primary treatment for depression.

“In the ’90s and early girls, there was a huge marketing effort directed at doctors – you were going to the doctor’s office and there were just Prozac cups and pens everywhere,” she said. “And I think that’s another reason why doctors aren’t really suspicious, they are bombarded with this idea that this is the truth, this is the situation. If you repeat something enough, people will like to believe it. That is really it.”

However, as the UK’s National Health Service notes in its guidelines, SSRIs are also used precisely because their short-term side effects are not as severe as other antidepressants. As Dr. Moncrieff states, the drugs are effective in helping individuals with depression, but she argues that it is clear based on the study results that they alone cannot be a basis for combating depression. While the medical community largely agrees with this sentiment, this message is not well known among the public.

audience reaction

After the research paper was published, TikTok user Lev Speakman – who graduated from Oxford with a focus in psychology and neuroscience – praised the research in a video that has garnered more than 460,000 views. She said it was a positive step toward combating pessimism among depressed individuals who believe they are doomed to suffer forever from their own suffering.

The comment section was full of regular people who expressed their confusion and some fear of the news. They asked if that meant 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 doctors to treat their depression. Ms. Speakman likened the drugs to pain relievers, saying that people don’t take painkillers because their bodies don’t contain enough painkillers, but rather because the drugs numb the pain and allow them to live their lives.

Another creator, Rebecca Watson, who runs medical misinformation debunks YouTube channel and website Skipcheckwas more critical, but its focus was mainly on news sites that reported headlines suggesting that antidepressants were not effective in treating depression.

I was martyred daily Mail A story that ran with the line saying “Have millions been taking antidepressants with harmful side effects for decades — when there is no scientific evidence they do what they claim? Some experts have suspected it for years. And now patients are reeling from a groundbreaking study.”

“To repeat, everything I’ve read to you is wrong. So incredibly, stupid, infuriatingly wrong.” There is no scientific evidence (antidepressants) do what they claim? “There are hundreds of randomized controlled trials showing that antidepressants help people with depression at a higher rate than a placebo,” she said in a recent YouTube video. There is no ‘new research’ that refutes this. no thing”.

Reports covering complex health and scientific issues have often been ridiculed by experts for misleading and misleading the public, either through misunderstanding of facts or through sensationalism to attract readers.

In fact, Dr. Moncrieff says she has undertaken the work specifically to highlight the fact that what the public and what experts know about depression is disproportionate, and that correcting this fact through further study should be a priority for communicators and researchers alike.

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