THE A new umbrella review challenging long-held public beliefs about the cause of depression has sparked outrage in the psychiatric community, but it did not advise people to stop taking antidepressants.
The serotonin A theory of depression: A systematic umbrella of evidence published in the magazine Molecular psychiatryand after reviewing a collection of previously published studies examining the relationship between serotonin levels and depression, found that there was little evidence to support the idea that a chemical imbalance was the cause.
Key research questions explore why the chemical imbalance theory of depression remains the default of the medical community and the general public, despite a lack of evidence, and how this theory came to dominate in the first place.
Dr Joanna Moncrief, 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. Talked to him The Independent about the study, its implications and responses to the study received from the medical community and the public.
What does the study really say?
Simply put, the study found that there is insufficient evidence to support the prevailing belief in the public and some medical institutions that chemical imbalances in the brain cause depression. As a result, the study questions the wisdom of doctors prescribing antidepressants to patients without a deeper understanding of the drugs’ long-term health effects.
“The chemical imbalance theory of depression is still being proposed by experts, and the serotonin theory, in particular, has formed the basis of significant research efforts over the past few decades,” the study concluded.
“The general public believes that depression is a result of serotonin or other chemical abnormalities, and this belief shapes how people understand mood, leading to pessimism and negative expectations about the outcome of depression. self-regulation of mood.
“The idea that depression is the result of a chemical imbalance also affects the decision to take or continue antidepressant medication and may prevent people from stopping treatment, which can lead to lifelong dependence on the medication.”
In the blog following the release of the study and its interview The IndependentDr. Moncrief emphasized that people using antidepressants such as SSRIs who are considering whether or not to continue treatment should do so under the continued guidance of a physician, who should be monitored, supported, and weaned off of them only gradually.
In other words, people should stop taking antidepressants and not react to this study, but should continue to work with their doctors to address their mental health and any underlying causes that may be contributing to depression.
Academic reaction to research
Despite these caveats, the study has met with some resistance in the medical community. Many doctors have gone around using antidepressants, saying that it is well understood in the medical community that depression is not caused by a chemical imbalance, but by a combination of factors, and that these treatments are still effective in managing them. those symptoms.
Dr David Curtis, emeritus professor at University College London’s Institute of Genetics, told the Science Media Centre: ‘This paper does not present any new findings but simply reports results published elsewhere and it is certainly not new that depression is not a cause. “low serotonin levels”. The concept of depression being linked to a “chemical imbalance” is outdated and the Royal College of Psychiatrists wrote in a 2019 position statement that it was too simplistic.
“SSRI antidepressants cannot be said to increase serotonin levels. Their immediate action is to change the balance between the concentration of serotonin inside and outside neurons, but their antidepressant effect is probably related to more complex changes in the functioning of neurons, which appear later as a result.
“It’s clear that people with major depression have some sort of abnormal brain function, and although we don’t yet know what it is, antidepressants are effective in treating severe depression, while interventions like exercise and mindfulness are not. It’s important not to withhold appropriate treatment that can make a big difference to those around you.”
Dr Moncrief said he was not surprised by the reaction to the study and agreed that the proposed theory was not new to the academic world, but could be to the general public.
“Some psychiatrists have said frankly, no, there really isn’t any evidence [the serotonin theory of depression] for a while, but no one wanted to highlight it or make it public,” he said.
Furthermore, Dr. Moncrief agrees that antidepressant medications can be beneficial for people who take them, either by reducing intense emotional states caused by depression or through the placebo effect. However, he cautioned that the medical community needs to better understand what they do if they are to be used.
“It’s really important for people to understand that we don’t know what the effects — mental and behavioral — of these drugs are,” he said. It can be helpful or useful. In the long run, I don’t think it’s helpful for most people, but some people may find themselves in a crisis or emergency where they’ll be helpful.
He also said that antidepressants “definitely” have placebo effects, and that these effects have been confirmed in clinical trials.
“We know that most of the response that people have in antidepressant trials is a placebo response,” he said. “There are studies that show people who think they’re taking an active drug do significantly better than people who think they’re taking a placebo, even though they’re not actually taking the active drug.”
How did antidepressants become the standard treatment for depression?
The serotonin theory of depression was introduced in the 1960s, when doctors first theorized that there was a link between serotonin levels and depression in people. This remained the prevailing theory until the 1990s, when pharmaceutical companies began promoting SSRIs, which increase serotonin levels in the brain, at least directly to consumers in the US. They sell the drugs directly to doctors, which Dr. Moncrief also believes contributes to their dominance as a primary treatment for depression.
“In the ’90s and the early aughts, there was a huge marketing effort aimed at doctors — you’d walk into a doctor’s office and there were Prozac mugs and pens everywhere,” he said. “I think another reason doctors don’t really ask is that they’re bombarded with the idea that this is a fact, this is a situation. If you repeat something enough, people will believe it. That’s the way it really is. .”
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. According to Dr. Moncrief, drugs are effective in helping people who suffer from depression, but based on the results of the research, he confirms that they cannot be the only way to fight depression. Although the medical community largely agrees with this view, this statement is not well known to the public.
After the paper was published, TikTok user Liv Speakman, an Oxford graduate in psychology and neuroscience, praised the study in a video that has garnered more than 460,000 views. He said it was a positive step in combating the pessimism among people who believe we must suffer from depression forever.
Its comments section is filled with ordinary people expressing their confusion and fear at the news. They asked if this meant their antidepressants were ineffective and if they should continue treatment. In the next video, he explains that SSRIs and other antidepressants are still helpful and that people should work with their doctors to treat depression. The speaker compared drugs to painkillers and said that people do not take painkillers because their bodies do not have enough of them, but because the drugs relieve pain and give them a chance to live.
Another content creator, Rebecca Watson, runs a medical disinformation YouTube channel and website. Skepchickwas more critical, but his focus was primarily on news sites that ran headlines claiming that antidepressants are not effective in treating depression.
He cited a daily mail “Have millions of people been taking antidepressants with harmful side effects for decades – just doing what they’re told in the absence of scientific evidence? Some experts have doubted it for years. Now patients are unsettled by a groundbreaking new study.”
“I repeat, everything I just read to you is wrong. So incredibly, so stupidly, so infuriatingly wrong. “There is no scientific evidence that (antidepressants) do what they say they do? Not true,” he said in a recent YouTube video. “There are hundreds of randomized controlled trials that show that antidepressants help people with depression more than placebo. There is no “new study” that disproves this. None.”
Reports covering complex health and science issues have been derided by pundits for misleading and misleading the public by misunderstanding the facts or sensationalizing to attract readers.
Indeed, Dr. Moncrief says, he has taken on the task of highlighting that there is a discrepancy between what the public knows and what professionals know about depression, and that correcting this fact through further research should be a priority for communicators and researchers.