A New umbrella review challenging long-held public beliefs about the cause of depression has caused a stir in the psychiatric community, but has failed to advise people to stop taking their antidepressants.
The serotonin Theory of Depression: A Systematic Review of the Evidence was published in the magazine 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 study’s underlying questions explore why the chemical imbalance theory of depression remains the standard in both the medical community and the wider public, despite its alleged lack of evidence, and how that theory became dominant in the first place.
dr. Joanna Moncrieff, a professor at University College London and a 30-year consultant psychiatrist for the National Health Service in the UK, is one of the lead authors of the paper. She spoke to UKTN about the study, its implications, and the response the study has received from the medical community and the public.
What does the study actually say?
In the simplest terms, the study found that there was insufficient evidence to support the prevailing 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 prescribing antidepressants to patients without a better understanding of the drugs’ long-term health effects.
“The theory of the chemical imbalance of depression is still being advanced by professionals, and the serotonin theory in particular has formed the basis of a significant research effort in recent decades,” the study concluded.
“The general public widely believes that depression is convincingly the result of serotonin or other chemical abnormalities, and this belief determines how people understand their moods, leading to a pessimistic view of the outcome of depression and negative expectations about the possibility of self-regulation. of the vote.
“The idea that depression is the result of a chemical imbalance also influences decisions about taking or continuing antidepressants and may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.”
In a blog post following the publication of the study and in her interview with UKTNemphasized Dr. Moncrieff said that individuals who are taking antidepressants such as SSRIs and are considering whether or not to continue with their treatments should do so with the continued guidance of a physician and should come off them alone in a controlled, supported, and gradual process.
In other words, people should not respond 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 response to the survey
Despite those warnings, the study has encountered some resistance within the medical community. A slew of doctors have drawn their carts around the use of antidepressants, arguing that it’s well understood in the medical community that depression is caused by a confluence of factors, not just a chemical imbalance, and that those treatments are still effective. in managing those symptoms.
dr. David Curtis, an honorary professor at the University College London Genetics Institute, told the Science Media Centre: “This paper does not present new findings but only reports results published elsewhere and it is certainly not news that depression is not caused by ‘low serotonin levels’. . The idea that depression is the result of a “chemical imbalance” has become outdated, and the Royal College of Psychiatrists wrote that this was an oversimplification in a position statement published in 2019.
“It is also not the case that SSRI antidepressants increase serotonin levels. Their immediate action is to alter the balance between serotonin concentrations inside and outside neurons, but their antidepressant effect is likely due to more complex changes in neuronal functioning that occur later as a result.” of this .
“It is very clear that people who suffer from depressive illness have an abnormality in brain function, even though we don’t know what this is yet, and that antidepressants are effective treatments for major depression, while interventions such as exercise and mindfulness are not. It is important that people with severe depression are not discouraged from getting the right treatments, which can make a huge difference to themselves and those around them.”
dr. Moncrieff said she was not surprised by the response to the study and agreed that the theory presented probably wasn’t news to academia, but probably to the general public.
“Some psychiatrists have said publicly that no, there’s not really any evidence for it… [the serotonin theory of depression] for a while, but nobody wanted to emphasize it or certainly emphasize it for the public,” she said.
Furthermore, Dr. Moncrieff agrees that antidepressants can be beneficial to individuals who take them, whether that’s by attenuating intense emotional states caused by depression or the placebo effect. However, she cautioned that the medical community needs to better understand what the drugs actually do when used.
“It’s crucial for people to understand that we don’t really know what the effects — the mental and behavioral — effects of these drugs are,” she said. “They have mental and behavioral effects, one of which is probably emotional numbing, which may or may not be helpful. I think it’s probably not helpful in the long run for most people, but there may be people who are in crisis or find an emergency that might help.”
She also said that antidepressants have “absolute” placebo effects, and those effects have been confirmed in clinical trials.
“We know that the majority of the response that people show in antidepressant studies is the placebo response,” she said. “There is research showing that people who suspect they are taking an active drug do significantly better than those who suspect they are taking the placebo, even if they are not actually taking 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 theorized that there was a link between serotonin levels and individuals experiencing depressive states. That remained the prevailing theory until the 1990s, when drug companies began advertising SSRIs — which increase serotonin levels in the brain — directly to consumers, at least in the US. They also sell the drugs directly to doctors, which Dr. Moncrieff is a contributing factor to their dominance as a primary treatment for depression.
“In the ’90s and early vices, there was a huge marketing effort aimed at doctors — you’d walk into a doctor’s office and there were just Prozac mugs and pens everywhere,” she said. “And I think that’s another reason doctors didn’t really doubt it, they were just bombarded with the idea that this is the fact, this is the situation. If you repeat something enough, people like to believe it. That is it real .”
However, as the UK’s National Health Service points out in its guidelines, SSRIs are also used specifically because their short-term side effects are not as severe as other antidepressants. As Dr. Moncrieff has stated, the drugs are effective in helping people who suffer from depression, but she states that based on the results of the study, it is clear that they alone cannot provide the basis for fighting depression. While the medical community largely agrees with that sentiment, that message isn’t as well known to the public.
After the paper’s publication, a TikTok user named Liv Speakman — who graduated from Oxford with a focus on psychology and neuroscience — praised the research in a video that garnered more than 460,000 views. She argued it was a positive step in the fight against pessimism in people who are depressed and think they are doomed to suffer from their condition forever.
Her comment section was filled with laymen expressing their confusion and some trepidation at the news. They asked if this meant that their antidepressants were ineffective and whether they should continue treatment. In a follow-up video, she explained that SSRIs and other antidepressants were still helpful, and people should continue to work with their doctors to manage their depression. Ms Speakman compared the drugs to painkillers and said that people don’t take painkillers because they don’t have enough painkillers in their bodies, but because the drugs numb the pain and allow them to live their lives.
Another content creator, Rebecca Watson, who runs a medical disinformation exposing YouTube channel and website called Skepchickhad a more critical view, but her focus was primarily on news websites with headlines suggesting that antidepressants were ineffective in treating depression.
She quoted a Daily mail story that ran with a line that read: “Millions have been taking antidepressants with harmful side effects for decades – if there’s no scientific evidence, do they do what they claim? Some experts have suspected it for years. Now patients have been staggered by a groundbreaking research .”
“To reiterate, everything I just read to you is wrong. So unbelievably, stupidly, wildly wrong. ‘There is no scientific evidence (antidepressants) that do what they claim?’ Wrong,” she said in a recent YouTube video. “There are HUNDREDS of randomized controlled trials showing that antidepressants help people with depression faster than placebo. There is no ‘new study’ to disprove this. None.”
Reporting on complex health and scientific issues is often ridiculed by experts for misrepresenting and misleading the public, either by misunderstanding the facts or by making them sensationalized to attract readers.
dr. Moncrieff says she has undertaken the work specifically to emphasize the fact that what the public knows and what experts know about depression are not congruent, and that rectifying that fact through further research should be a priority for communicators and researchers alike.