- Rachel Schreyer
- Health Editor
A study showing that depression is not caused by low levels of the “happy hormone” known as “serotonin” has become one of the most popular medical articles.
This study sparked a wave of misleading claims about antidepressant drugs, many of which increase the level of serotonin in the body.
And the research doesn’t show that the drugs aren’t effective. But the way it was dealt with raised questions about our view of mental illness.
After Sarah had her first major psychiatric episode, in her early twenties, doctors told her that the medication being prescribed to her was like “insulin for diabetics”. They told her it was necessary, it would correct something chemically wrong with her brain, and she should take it for life.
Her mother had type 1 diabetes, so she took this very seriously.
Sarah continued to take the medication even though it was making her feel worse, and she began to have suicidal thoughts, then began receiving electroconvulsive therapy.
However, the claim that she needs medication as much as a diabetic needs insulin has not been based on any medical evidence.
“It makes you feel betrayed by the people you trust,” Sarah says.
Her reaction to the drugs was severe, but the “chemical imbalance” message she was given was not uncommon.
Many psychiatrists say they have long known that low levels of serotonin are not the main cause of depression, and this paper says nothing new.
However, the large and unusual public reaction suggests that this was news for many.
But some have gone from just saying that antidepressants don’t work by fixing chemical imbalances, to saying they don’t work at all.
Doctors fear that people will stop taking their medications suddenly and risk dangerous withdrawal effects.
The National Institute for Health and Care Excellence says these medications should only be stopped suddenly in a medical emergency, noting that slowly reducing the dose can reduce withdrawal symptoms.
What did the search show?
This latest research looked at 17 studies and found that people with depression do not seem to have different levels of serotonin in their brains compared to people who are not depressed.
The results help rule out one possible way the drugs might work – by correcting deficiency levels.
Dr. Michael Bloomfield notes, “Many of us know that taking paracetamol can be good for headaches, but I don’t think anyone thinks headaches are caused by not enough paracetamol in the brain.”
Do antidepressants work?
Research suggests that antidepressants work slightly better than placebos during research. There is debate among researchers about how important this difference is.
And there’s a group of people who do much better after taking antidepressants – doctors don’t have a good way of knowing who those people are when prescribing the drugs.
Linda Gaske, from the Royal College of Psychiatrists, says antidepressants are “something that helps a lot of people feel better quickly”, especially during times of crisis.
But Joanna Moncrieff, one of the authors of the Serotonin research paper, points out that most research by drug companies is short-term, so little is known about people’s condition after the first few months.
And while there are risks of leaving depression untreated, some people will experience serious side effects from taking antidepressants — something the serotonin study authors say needs further clarification.
This can include suicidal thoughts and attempts, impotence, emotional sedation and insomnia, according to the National Institute for Health and Care Excellence.
Since last fall, UK doctors have been asked to prescribe psychotherapy, exercise, exercise or meditation for people with less severe depression first, before trying the drugs.
How was the research talked about?
A misleading comment claimed that the study showed that prescribing antidepressants was “based on a myth.”
But the study did not address the use of antidepressants at all.
Serotonin plays a role in mood, so changing its levels can make people feel happier, at least in the short term, even if they don’t have abnormally low levels to begin with. It may also help the brain make new connections.
Others claimed that this study shows that depression was never a disease in people’s brains, but rather a reaction to the environment in which they live.
“Of course, both are correct,” says Dr. Mark Horowitz, one of the paper’s authors. “A person’s genetics influence their sensitivity to stress,” he adds, for example.
But people who have an understandable response to difficult circumstances may be better helped with “relationship counseling, financial advice, or job changes” rather than medication.
However, Zoe, who lives in southeastern Australia and suffers from both major depression and psychosis, says that re-characterizing depression as an “affliction” that would go away if “we just fixed all the social problems” is too simplistic and condoning people with ailments. More severe psyche.
Psychosis runs in Zoe’s family, but his attacks are often triggered by stressful events, such as exam deadlines.
Zoe was able to “calculate” the side effects of the drugs to avoid severe attacks.
And that’s something all the experts who spoke to the BBC agree – patients need more information, and better explained to them so they can make these difficult calculations themselves.
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