A study that found that depression is not caused by low levels of serotonin, the “happiness hormone”, has become one of the most talked about and shared medical articles in recent months.
The conclusion sparked a wave of misinformation about antidepressant medications, many of which increase the amount of serotonin in the brain.
The research, however, does not point out that these drugs are not effective or fail to help patients.
On the other hand, it also provoked some genuine questions about how people treat mental illness.
After British woman Sarah had her first major psychiatric problem in her early 20s, doctors told her the medication prescribed was like “insulin for diabetics”.
For them, it was essential: they said the drug would correct a chemical problem in their brain and would need to be used for life.
Her mother had type 1 diabetes, so she took it very seriously.
Sarah continued to use the drugs, even though they made her feel worse. Eventually, she “heard threatening voices” urging her to kill herself. She also had electroconvulsive therapy (ECT).
However, the claim that Sarah needed the drug like a diabetic needs insulin was not based on any scientific evidence.
“I felt betrayed by the people I trusted,” she says.
His negative reaction to drugs was extreme, but the “chemical imbalance” argument as a cause of depression is not uncommon.
Many psychiatrists have said they have known for a long time that low serotonin levels are not the main cause of depression. Therefore, the recent article would not bring anything new.
However, the great repercussion of the research indicates that it was a novelty for many people.
The problem is that using the article to argue that antidepressants don’t work is an inaccurate leap.
And doctors fear that, in the confusion, people might stop taking their medication abruptly and risk serious withdrawal effects.
The UK’s National Institute for Health and Care Excellence (Nice) says that the use of these drugs should not be stopped abruptly, except in medical emergencies. Reducing the dose slowly can minimize withdrawal symptoms, it says.
What did the research show?
This latest research looked at 17 studies and found that patients with depression didn’t have different levels of serotonin in their brains compared to people who don’t.
The finding helps rule out a possible way the drugs might work — by correcting a deficiency.
London psychiatrist Michael Bloomfield makes a comparison:
“Many of us know that taking acetaminophen can be helpful for headaches, but I don’t think anyone believes that headaches are caused by not enough acetaminophen in the brain,” he points out.
So do antidepressants work?
Research shows that antidepressants work only slightly better than placebos. There are debates among researchers about how significant this difference is.
Within that average is a group of people who experience much better results with antidepressants. The problem is that doctors simply have no way of knowing if their patient is one of those people.
Some people who take antidepressants say the drugs help a lot with a mental health crisis or allow them to better manage their depression symptoms in everyday life.
Professor Linda Gask, from the Royal College of Psychiatrists (a professional body of psychiatrists in the UK), says that antidepressants are “something that helps a lot of people feel better quickly”, especially in a crisis.
However, one of the authors of the article on serotonin, Professor Joanna Moncrieff, points out that most research carried out by pharmaceutical companies is short-term. So, according to her, little is known about the performance of patients after the first months of using the drug.
“You have to analyze the results of the treatment and not keep the patient using the drug longer than he needs to, something that often doesn’t happen”, says Gask.
While there are risks to not treating depression, some people will experience serious side effects from antidepressants — the authors of the serotonin study say these harms need to be more clearly communicated by the industry.
Effects can include suicidal thoughts and attempts, sexual dysfunction, emotional numbness and insomnia, according to Nice.
A few months ago, UK doctors were told to prescribe therapy, exercise and meditation for patients with less severe depression.
What was said about the research?
Reactions to the study on the relationship between serotonin and depression said the research proved that prescribing antidepressants was “built on a myth.”
But that’s not true.
The problem with this argument is that the study did not look at antidepressant use.
Serotonin plays a role in mood, so adjusting it can make people feel happier, at least in the short term, even if they don’t have abnormally low levels of the hormone. It can also help the brain make new connections.
Others claimed that research shows that depression was never a disease in people’s brains, but a reaction to the environment.
“Of course it’s both,” says Mark Horowitz, one of the authors of the paper. “Your genetics affect your sensitivity and stress, for example.”
But some people may be better treated with “relationship counseling, financial advice or job change” than medication.
However, Zoe, who lives in southeastern Australia and suffers from severe depression and psychosis, says redefining depression as a “distress that would go away if we just fixed all the social problems” is also too simplistic.
For her, this concept neglects people with more serious problems of mental illness.
Psychosis runs in your family, but your episodes are often triggered by stressful events.
Zoe says she has found medications, including antidepressants, that have changed her life.
For her, “it is worth facing the side effects of the drugs”, as they prevent serious episodes.
And this is a consensus among experts who spoke to BBC News: patients need more information to be able to make the decision that best suits them.
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