How to take the news that depression has not been shown to be caused by a chemical imbalance

This article is from psychiatrist Dr. Joanna Moncrieff. It begins:

“For decades people have been told that depression is caused by a serotonin deficiency. This was the rationale behind the introduction of the SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants in the 1990s, which were thought to work by boosting low levels of serotonin. Our research shows no evidence of low serotonin in depression, which suggests that antidepressants do not work in the way they were originally thought to work.

There are other explanations for how antidepressants affect people, and why they can be helpful that are not to do with reversing underlying brain abnormalities and have different implications. Drugs like antidepressants change normal brain chemistry and this affects people’s moods and behaviour. SSRI’s blunt both negative and positive emotions, for example, and this may provide relief for people who are acutely distressed or unhappy. Antidepressants also act through inducing hope and optimism (the placebo effect). In the long-term these effects may not be so helpful, however, and there are also harmful effects of long-term use such as dependence and withdrawal. People need this information in order to make properly informed decisions about whether to take antidepressants. If people do decide they would like to stop them, they should discuss this with their doctor and do it slowly and gradually following recent guidelines.

The serotonin research paper

Last week we published a systematic review in a journal called Molecular Psychiatry which brought together the evidence from all the main areas of research into connections between serotonin and depression (you can find the paper here). We found that none of these areas of research showed convincing evidence that depression is caused by low serotonin. In fact, there was little evidence of any abnormality of serotonin in people with depression.

The fact that this research has had such wide coverage shows just how shocking this finding is to many, many people. One TV presenter said it ‘blows your mind’. This is because the message that depression is caused by a chemical imbalance, and more specifically a lack of serotonin, has been widely publicised for many years …”

You can read more from here.

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