What Comes After the “Chemical Imbalance” Theory in Depression Treatment?

Christ, a 57-year-old retired teacher, had been taking antidepressants for much of her adult life. She began having anxiety and panic attacks at an early age, and as she got older, the symptoms got worse and eventually led to severe depression.

Christ eventually regained her functioning and experienced the return of her genuine self when she began taking antidepressants in her 30s. She claimed that the drug had kept her “at a level point.”

According to studies, more than 4 in 5 people concur with Christ that depression is caused by an imbalance of brain chemistry, notably low levels of the neurotransmitter serotonin.

This theory of depression has an associated treatment: SSRI antidepressants, which work by increasing serotonin levels and redressing the alleged imbalance.

However, according to psychiatric professionals, this theory of depression was long since debunked.

The idea was first put forth in the 1960s, and it received a significant promotion when pharmaceutical companies began creating and selling a new class of antidepressants that were specifically based on it in the 1990s.

The serotonin theory was never confirmed, despite the fact that SSRIs were only modestly successful in clinical trials. Furthermore, according to recent research, depression might have many different causes.

The gap between the general public’s perception of depression and the psychiatric literature recently reached a breaking point when British psychiatrist Dr. Joanna Moncrieff, co-author Mark Horowitz, and colleagues published a thorough analysis of prior research in July, effectively killing the serotonin theory.

The review was pitched as a surprise that refutes conventional wisdom regarding depression and the accompanying therapies.

According to Moncrieff, a professor of critical and social psychiatry at University College London, “the vast majority of the general public believed that this is an established fact, that there is evidence to support this idea that depression is caused by low serotonin, and in fact, many people are taking antidepressants because of that belief.”

depression serotonin debunked

For this reason, the author felt that it was imperative to do this research and to be able to clearly state the current state of the evidence for this theory.

As a result of the study’s substantial media coverage and the ensuing debate, Moncrieff and her co-authors criticized the state of depression treatment in general.

Other psychiatrists have emphasized the distinction between a drug’s mechanism of action and its efficacy.

“Although we are learning more, we still don’t fully get how statins cut cholesterol. However, it is because of clinical studies that we employ them “added Dr. Srijan Sen, the University of Michigan’s depression center’s director.

It has been demonstrated that SSRIs can help certain patients, particularly those with severe depression, in a moderate, frequent short-term manner.

According to Sen, they are not “blockbuster medications that help everyone.” But it’s obvious that there are subsets of persons for whom these medications are effective and those for whom they are not.

The key finding of the studies, however, is that depression is a complicated and varied disorder, and there is no clear reason why or how antidepressants can be beneficial.

chemical imbalance theory debunked

All that matters to Mary Christ is her own personal experience on antidepressants, which she claims gave her the ability to live once more.

She may not be aware of the specific impact the drug is having on her brain, but she feels as though something good is being stimulated.

In an interview with HealthDay Now, Christ stated, “I can’t help but think and feel that it clearly has a chemical effect on me.”

“What precisely happens to the serotonin? I’m not sure. However, it is obvious that there must be other things going on that they haven’t been able to explain if the data hasn’t consistently supported that.” She expressed the hope that the new findings will spur fresh efforts to find solutions.

However, sufferers shouldn’t hope that straightforward explanations like the serotonin theory will be found in the near future.

According to Sen., there will be theories that work and ones that don’t, fits and starts, and successful and unsuccessful theories. “We shouldn’t let those studies and fits and starts get in the way of our capacity to evaluate the efficacy of various therapies.”

Positively, there are more innovative treatments in the pipeline now than ever before. The U.S. Food and Drug Administration approved the ketamine-derived pharmaceutical esketamine in 2019, making it the first brand-new antidepressant to do so in decades.

Patients who haven’t responded well to antidepressants are now increasingly choosing this treatment option. Psychedelic therapy for depression is the focus of extensive research efforts and funding, although not yet receiving approval.

Sen does, however, advise against making the same errors again.

He stated, “I recall drug company advertising showing us neurons and changing serotonin levels, and that’s oversimplifying and pretending that we knew what was going on.”

Now that we don’t, I believe we should be modest, but we should also be clear that our recommendations for treatment are not based on our lack of understanding.