Study Depression not caused by low serotonin after all

[Rose White]

The serotonin theory of depression: a systematic umbrella review of the evidence

From the article: “Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.”

If so then why might this theory have been pushed so hard?

Also from the article: “The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue antidepressant medication and may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.”

Sigh. From the article the only thing that was weakly associated with lowered serotonin was not depression or genetics but rather long-term antidepressant use.

 

[Sideways]

If so then why might this theory have been pushed so hard?

I'm cynical, but it was a great way for drug companies to sell drugs. People could understand "low serotonin, so jack it up with pills".

 

[joeylittle]

The whole "chemical imbalance" thing is just an extreme oversimplification of what's going on, neurologically. Oversimplified to the point where it's really easy to misinterpret it completely...pet peeve of mine. And this:

From the article: “Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.”

Early hypotheses that appear to be playing out consistently over time are often adopted by the scientific community...it's always just a matter of time until some other researcher asks, "but what if that's not it, after all?" And I suspect that some of that questioning ended up being driven by failures in drug trials.

So without the initial hypothesis about serotonin, there wouldn't have been such an explosion of new psych meds being brought to market. Without the drive to make newer and better drugs, there wouldn't have been so many failed trials...and therefore, not enough data generated to call the initial hypothesis into question.

I try and see it all as progress - since scientific progress doesn't always look like success. But yeah, I also agree w/you @Sideways, that there's some straight up greed maybe we all could have done without.

 

[Rose White]

So without the initial hypothesis about serotonin, there wouldn't have been such an explosion of new psych meds being brought to market.

I wonder what the implications of this study might be for other psych meds, but at the same time I suspect this study will be swept under the rug. The chemical imbalance theory seems rather entrenched—people like it—the idea of taking pills is already dominant, antidepressants merely ride that wave, they didn’t create it

 

[Tinyflame]

This was revealed several years ago, the Journal of the American Medical Association (who apparently wrote an entire edition on how they had been misled by the data the pharmaceutical companies supplied)., along with also the Canadian Medical Association and the New England Journal of Medicine to name a few, all stated apologies of sorts, that they had been provided erroneous data by the pharmaceutical companies (including but not limited to) selective provision of trial data (the companies left out the trials that showed little or no correlation to serotonin levels and a role in depression), and that they had not sufficiently fact-checked before publishing the findings. According to Psychologist Dr. Michael Yapko the Pharmaceutical companies had also hired well-known, well-respected ghost writers to endorse the 'findings, even the prestigious journals were fooled, and it became accepted for decades that depression was a disease requiring medication. There have been several scientific papers published since that can find no evidence of it being effective after decades of research.

Notwithstanding however that some people seem to benefit, and it's not necessarily a placebo effect, there is much to discover.

I remember saying to my mom I don't feel in my case it's physiological as it would not change with what I heard (which it often did).

Even David Burns said with his 1st book about 2/3 of people given it to read awaiting therapy did not feel they needed therapy for depression and anxiety after reading it.

Some, like Marsha Linehan (creator of DBT) required the in hospital patients to walk every day before they began (I think it was 5 miles), proposing in a sense a different approach again.

I was thinking about this earlier (sort of, though more so re: suicidal ideation, though I also thought how it includes depression or other situations/ conditions), and I believe it's something quite different than even Michael Yapko believes (though he even says every person experiences it differently). But my opinion or conclusions are not relevant here. But I think I have learned something about myself, and I don't think it's just about coping mechanisms, social or problem solving skills, or social support.

Oddly enough also however, lack of sleep causes an initial spike in serotonin levels followed by a gradual decrease (in extracellular serotonin). And lack of sleep is sometimes a terrible contributor I believe. I think there can be an interplay with serotonin, but not necessarily in a simple manner.

 

[Sideways]

The chemical imbalance theory seems rather entrenched

The different parts of our brain communicate with each other using neurotransmitters. Neurotransmitters are "chemicals" in the literal sense. So, using those vague definitions, it's true that with depression neurotransmitters (brain chemicals) are "out of balance", because mental illness necessarily involves neurotransmitters. It's a bit like saying "your brain is out of balance".

So, I can see how the 'unbalanced chemicals' line came about, and to an extent, it probably still serves a purpose. A lot of folks around the world don't understand mental illness even remotely and would happily recommend "get over it" as a legitimate treatment strategy. By assigning the "unbalanced chemicals" phrase, it does at least help move mental illness into the realm of science in Joe Average's head. But yeah, huuuuge oversimplification.

 

[BigLittle]

I read a book about the early testing of SSRI s on humans. They took the suicides out of the data to get approved and to manipulate the research data and studies to push the drugs on the market.

Funny enough I am taking 20 mg of Escitolopram for about a year now and I can say it helps, placebo or not. So for now its fine for me.

Then again I am clean and sober and take it everyday at 9 pm.

My mother also took SSRIs while not being clean and sober plus not as prescribed, meaning of and on in combination with other medication drugs. She is highly suicidal and major depressed.

So it comes back for me at least that there are so many factors that come into the data for each individual that for me there is no such thing as a general approach to a unique human being.

My 2 cents

 

[Rose White]

But my opinion or conclusions are not relevant here. But I think I have learned something about myself, and I don't think it's just about coping mechanisms, social or problem solving skills, or social support.

I am curious about your opinion and conclusions—what do you think you have learned?

 

[enough]

i will always remember and never forget the wise words of a geology professor that I befriended: "If i hadn't believed it I never would have seen it"'

There is big money in curing depression. (or selling textbooks about geology)
The manufacturers needed a believable premise for the efficacy of the drugs.
They found one
they sold the theory and the drugs.

End of story? Doubt it, it will be clung to until a real understanding comes around. It took our ability to understand bacterial infections and transmissions for the bad smell theories to fall away, but you can still buy spray dienfectants and lots of people buy into "that clean, fresh smell". And will.

Another angle? If we can't understand it on our own we search for meaning in the things we think we see and buy into explanations easily. I saw a cartoon of serotonin blobs being taken up by their sources, missing the little receptor nodes they were intended to placate. What? You didn't see that with your own eyes too?

Lots of people think that rabbits talk to young deer and slide around on the ice with them too. Thanks Walt. Talking animals are a fact of life but not fact. Same same.

 

[Tinyflame]

I'm sorry @OliveJewel it's too personal for me even to share anonymously. Besides which, it would require so much back info I've never shared here, plus I could be wrong, plus everyone is unique, like @BIgLittle said. I hope that's ok. (My 'normal' thought for myself would be it's probably silly, but I actually think I found one puzzle piece for myself. As we know our own selves best. )

The different parts of our brain communicate with each other using neurotransmitters. Neurotransmitters are "chemicals" in the literal sense.

^^ I always come back to learning in Genetics about 'jumping genes'- genes that responded differently in the presence of others, read as it were a different code and therefore had a different action. (I am sure they are now leaps and bounds ahead of what I learned then). But I've often wondered about a similar mechanism with neurotransmitters?

Another angle? If we can't understand it on our own we search for meaning in the things we think we see and buy into explanations easily

I can't say I've fallen in to explanations easily, unless I trust the source and cross-reference. But I love to learn. I know though desperation can be a big factor- I remember at one point with insomnia thinking this must be how people fall in to quack cures because I was ready to try just about anything. Same with depression and many other things.

 

[joeylittle]

End of story? Doubt it, it will be clung to until a real understanding comes around. It took our ability to understand bacterial infections and transmissions for the bad smell theories to fall away, but you can still buy spray dienfectants and lots of people buy into "that clean, fresh smell". And will.

SO very true.

And to the point about understanding...it always blows my mind a little that Lithium - something that wasn't created, but instead discovered - there are theories about the mechanism of action, but it's really still (largely) unknown. It really helps certain people with certain disorders...no one knows why...but that doesn't invalidate the alleviation of symptoms. Been in use medically long enough to have real longevity studies, and generally, no damage from long-term use, providing its dosed correctly and monitored well.

I wonder what the implications of this study might be for other psych meds, but at the same time I suspect this study will be swept under the rug.

Well, it's not a clinical study proving anything - it's a review of the existing body of studies, which points at an interesting conclusion. Nothing to sweep under a rug - just a question of how many doctors read it and decide to re-think their prescribing practices.

I suspect the generation of psychiatrists who are just now beginning their medical degree will have a very different outlook on the serotonin question (by the time they enter practice), compared to docs who trained 10, 20 years ago. Same with psychedelics and their utility for depression, that'll continue to have traction in research for the foreseeable future.

So, I can see how the 'unbalanced chemicals' line came about, and to an extent, it probably still serves a purpose.

Exactly - that's what's so maddening about it. It's not totally wrong...it's just not saying much of anything, and extremely open to misinterpretation.

I have zero doubts that there's something going on in my brain function that is off. Something missing or disabled, the same way people with color deficient vision (color blindness) are missing certain elements in the cones inside their eyes. That thing is just not there. It's sometimes correctable through the introduction of external aids, but not yet correctible with surgery or medication (when it's a genetic deficiency).

That's my depression. It's been with me for far too long, and there's so much mental illness in my immediate family (referred to as 'genetic load') - it'd be unrealistic for me to think it could be entirely addressed by cognitive work, IMO.

Doesn't mean that cognitive work isn't going to be....who knows? Half the solution? 90% the solution? 5%? I. Just. Don't. Know.

All I know is, it's really f*cking hard. Especially because what I really believe I know, from being inside my depression - can't yet be medically 'proven' with any scientific measure. It's really terrible to live with this, do so much learning and research, try so many pills, so many therapeutic modalities....and keep coming back to just waiting for more research. Hoping for a scientific diagnostic process. I'm not sure I even understand why that remains so important to me, when I'm sure enough about it myself. Validation, I guess. Legitimacy.

Anyway. This topic hit a nerve for me, I guess. Not in a bad way.

 

[enough]

I remember at one point with insomnia thinking this must be how people fall in to quack cures because I was ready to try just about anything. Same with depression and many other things.

That’s been my experience with the reputable inhibitors, tried them all based on the anecdotal info from other sufferers and then the anecdotal info my prescriber was hearing and finally got sucked into the “great Pfizer neurontin debacle”. And now I get a sigh of frustration from my providers when I tell them about the laundry list of drugs I have wasted efforts on.
I have had that same thought” this is how people fall into the quack cures” but I have learned not to voice it to the true believer prescribers, they don’t like to hear it.