Little evidence that chemical imbalance causes depression, UCL scientists find

[sl8]

https://www.theguardian.com/society/2022/jul/20/scientists-question-widespread-use-of-antidepressants-after-survey-on-serotonin

Little evidence that chemical imbalance causes depression, UCL scientists find

Researchers question use of antidepressants, prescribed to one in six UK adults

Andrew Gregory Health editor
Wed 20 Jul 2022 06.49 EDT

Scientists have called into question the widespread use of antidepressants after a major review found “no clear evidence” that low serotonin levels are responsible for depression.

Prescriptions for antidepressants have risen dramatically since the 1990s, with one in six adults and 2% of teenagers in England now being prescribed them. Millions more people around the world regularly use antidepressants.

“Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence,” said the study’s lead author, Joanna Moncrieff, a professor of psychiatry at University College London and consultant psychiatrist at North East London NHS foundation trust.

“It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.

[...]

[PortTack]

1. If that's the case, then why do sooo many ppl feel so much better taking them?

[Novara]

5. It's a good question; however ...

... if there is no biochemical cause, then I suspect the researchers would call it the placebo effect.

The mind is an incredibly powerful thing.

I'd like to see them explain this in terms of the clinical trials that are conducted in order to approve drugs, especially blind clinical trials with placebos. Especially double blind trials.

[Phoenix61]

6. The article doesn't say they don't work. Just that the

mechanism doesn’t have anything to do with low seratonin levels.

[PortTack]

7. There is a plethora of scientific peer reviewed information that disputes that.

[Phoenix61]

9. Which that? That they work or that they work through a

mechanism other than serotonin.

[PortTack]

10. The article says low seritonin is not the cause of depression. That is what I'm referring to

[Phoenix61]

12. This article says the same thing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4471964/
If depression were due to insufficient serotonin then all depression would be cured by raising the level of serotonin. However, many people aren’t helped by those medications. There’s also the issue them taking 4-6 weeks to work. No other medication takes that long to change chemical levels, not insulin, not thyroid medication. It makes sense that they are working through a currently not understood mechanism.

[PortTack]

21. Here's my issue.

As a retired medical professional I have seen this kind of report come out about a long standing drug with a proven track record of positive results, and all of a sudden physicians start telling patients they don’t want to prescribe it because of this new study…blah blah blah. Only to find a few weeks or months later the drug companies are pushing a new drug, a much more expensive drug. It never fails!

Thing is, even some here have talked about how SSRIs have helped, or have felt it was life changing. And now they want to pull the rug out from underneath them. Ppl suffering depression are vulnerable to self harm. Good caregivers understand this one simple rule, TREAT THE PATIENT, not the X-ray or the study. If it works quit trying to throw baby out with the bath water!

[Phoenix61]

22. The article doesn't say they don't work or not to use them.

It questions the mechanism of action. Think of all the people SSRI’s don’t work for. Wouldn’t it be great if there was something to help them too? I get your point about new drugs replacing older drugs that worked very well. Seems to happen about the time patents expire.

[PortTack]

25. I just want to shed light on what the real issue may be. Patients get caught in it and become

Desperate. Depression is that dark hole they fear.

[Silent3]

15. If the study is correct (and it's probably too soon to say that) it would be surprising...

...for many antidepressants to just happen to work anyway, by some other means, given that many of these drugs have been selected or designed primarily for how they effect seratonin levels.

As someone who takes a drug classified as a "serotonin-norepinephrine reuptake inhibitor" myself, I wouldn't be shocked at all to discover that it was nothing more than a placebo for me, and that improvements in my depression have been more matters of changes in life circumstances coincidentally happening along with taking the drug.

[Phoenix61]

16. I knew a psychologist who believed they were increasing

the number of neural connections and that’s why it took 4-6 weeks to see any effect and up to 6 months to see full effect. Interestingly, exercise is known to be helpful in treating depression and is the best way to increase neural connections. Throw in recent work with magic mushrooms and it’s all pretty fascinating.

[moonscape]

24. My father was addicted to physical activity his whole life and

in hindsight I realize it was mental therapy/relief. Winters were tough for him, getting less light and exercise, and this dread contributed to him taking his life one late Fall. This was around the time Prozac was new on the market and he had not gotten help with his secret depression,secret in the sense that he exhibited modest blues at times but kept the rest to himself.

[Elessar Zappa]

2. Anti-depressants have worked wonders for me.

I’m a completely different person, in a good way. I know they’re not for everyone.

[mopinko]

3. i think this is more that they dont work the way we think they do. not so much- do they work.

this has been out there for a long time.

[Elessar Zappa]

8. That makes sense, thanks.

[Ex Lurker]

13. Problem is, the anti psychiatry movement is already running with this.

As the spouse of someone who suffers with chronic depression, I know these meds do work, whether we understand exactly how they work or not.

[mopinko]

14. they've been on it for a long time.

but yeah, shiny new arrow for their quiver.

[BlueIdaho]

4. So what should the long term chronically depressed do?

What is the alternative?

[ProfessorGAC]

11. It Doesn't Say They Don't Work

The report just disputes the mechanism.
Perhaps other biochemical reactions take place that differ from serotonin balancing.
My wife is on a couple for BPD. I can attest they do help chronic depression. The positive effect for her is obvious.
Since it took quite some time to find the right blend of the right meds, I can't accept placebo effect as the cause.

[tulipsandroses]

17. Hey folks. This is not " new " News

I’m a psych nurse practitioner. I don’t know why psych continues to be the stepchild so many like to beat up. Lol. We are the red headed step child of medicine. 🤨
There is nothing earth shattering about this story.

First let’s address this fact before we talk about psych.

The rest of this article is behind a paywall.
Researchers have come a long way in understanding how many pharmaceuticals work at the molecular level, but there are still many drugs whose mechanisms remain murky at best. While a detailed understanding of their molecular pharmacology isn’t necessary for clinical use, it could help scientists understand the basic science involved and, therefore, develop new and improved drugs with fewer side effects.

“If we threw out all the drugs for which we do not know the molecular mechanisms, we wouldn’t be left with a lot,” Peter Imming, a pharmaceutical chemist at the Martin Luther University of Halle-Wittenberg in Germany, told The Scientist.

https://www.the-scientist.com/news-analysis/mystery-mechanisms-33119

From one of my professional journals. Long, but worth the read in it’s entirety at the link if you are interested in this topic.

Serotonin: How Psychiatry Got Over Its “High School Crush”
SNIP——-
I invite you to consider 2 claims relating to mental illness:
• Psychiatrists think that most mental illnesses are caused by a “chemical imbalance”
• Psychiatrists think that some mood disorders are associated with abnormal serotonergic neurotransmission, among other functional or structural brain abnormalities, which may or may not be the “cause” of the disorder

Since there are light years of conceptual space between these 2 claims, you might imagine, or naively hope, that psychiatry’s most strident critics would be able to distinguish claim 1 from claim 2. Alas, antipsychiatry bloggers continue to bang away at the notion that “Psychiatry” (that sinister, monolithic corporate entity) deliberately duped the public by promoting a bogus “chemical imbalance theory,” in cahoots with “Big Pharma.” Suffice it to say that this line of argumentation is itself bogus, for reasons I have reiterated at length in several venues.2,3 For example, in 2005, on a publicly available website, the APA clearly stated, “The exact causes of mental disorders are unknown . . . [but] we can say that certain inherited dispositions interact with triggering environmental factors.”4 At that time, the same APA website also indicated that “several factors can play a role in the onset of depression,” including “biochemistry” (abnormalities in brain chemicals or brain networks), genetics, personality, and environmental factors. To my knowledge, no professional psychiatric organization has ever publicly promoted a “chemical imbalance theory” of mental illness in general. (And, no, the original biogenic amine hypothesis was not a “theory”-the scientific distinction is important.5) That antipsychiatry bloggers assiduously comb the Internet and find a handful of “celebrity psychiatrist” quotes to the contrary neither surprises nor impresses me.

But there is a sense in which some of psychiatry’s critics have a point, and this brings us back to Dr McIntyre and our old friend (or “frenemy”?),serotonin and weave an entire tapestry with it, ultimately producing the threadbare “chemical imbalance theory.” No doubt, this was abetted by drug company “illustrations” of serotonergic synapses, complete with little packets of neurotransmitters whose reuptake is inhibited by the company’s ace antidepressant. Even today, some non-pharma websites continue to post misleading diagrams that attribute depression to a “chemical imbalance,” as Dr John Grohol recently discovered.7

https://www.psychiatrictimes.com/view/serotonin-how-psychiatry-got-over-its-high-school-crush

[blogslug]

19. Thank you

I've always looked sideways at the term "chemical imbalance". The explanations of how SSRIs work, that I was told, sounded more like an electrical problem than a chemical one. My synapses don't fire right.

[Pompoy]

18. Bullshit

"Scientists have called into question the widespread use of antidepressants after a major review found “no clear evidence” that low serotonin levels are responsible for depression."

They work, there are side effects like lower libido, but they work. It takes time to build up the serotonin levels because they aren't building up serotonin, but inhibit their metabolism so they stay longer in the brain, thus slowly building up the levels.

Their agenda is to besmirch SSRI's. Same as with scientists denying climate change or vaccines. There are all kinds out there.

[tulipsandroses]

20. Expert reaction to a review paper on the 'serotonin theory of depression'

Dr Livia de Picker, Postdoctoral researcher, Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, said:

“While umbrella reviews can provide an interesting wide-angle overview of a research field, they are ultimately bound by the design and quality of the summarized studies and the original studies they rely on, and therefore do not allow us to draw new conclusions. Studying changes in brain functioning is very complicated, and this review paper mostly shows that depending on the methods used, it is not always possible to easily detect such changes just by drawing a blood sample for example. Nevertheless, it is important to point out that this study did not in fact look into the effectiveness of antidepressants directly. Antidepressants with serotonergic activity were already being used effectively for patients with depression prior to the theory of serotonin changes of depression. Since this original theory, newer research has also indicated that antidepressants affect several pathways and receptors in the brain, not just limited to serotonin. There is really no reason to question the effectiveness of current antidepressants even if our understanding of the biological causes of depression moves away from theories focused solely on serotonin.”

https://www.sciencemediacentre.org/expert-reaction-to-a-review-paper-on-the-serotonin-theory-of-depression/

And yes this was meant to be a hit piece on psychiatry.


The additional important context of understanding the reactions to these claims about antidepressants is that the authors are part of a community that are vocally skeptical of psychiatric medication in general, sometimes called “critical psychiatry” or “anti-psychiatry.” These groups can raise important issues around the limitations of individualized interventions, ethics in psychiatry, and conceptual questions around diagnoses, while some more extreme proponents challenge the existence of what we call “mental illness” at all.
https://www.vice.com/en/article/88qge4/the-new-study-on-serotonin-and-depression-isnt-about-antidepressants-chemical-imbalance

[Buckeye_Democrat]

23. All I know is that if I keep living in the USA...

... long enough, I'll be happily smiling like this WW1 soldier eventually:




We're all expected to be POSITIVE and HAPPY regardless of our circumstances anyway, don't you know.