"No clear evidence" that chemical imbalance causes depression

[flashbac]

From the Guardian:

"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."

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

I've seen Dr Jessica Taylor talking about this (I know she has flaws) and her argument is partly that if you can't measure it and can't say what the ideal chemical balance would be, you can't put something down to a chemical imbalance.

On the whole with other medical conditions like liver function, blood sugar, pregnancy etc there are tests that give you a conclusive outcome. But not something like depression. I have paraphrased and over simplified but that's the general gist and I see her point.

That said, I have used antidepressants and they did improve things for me. It is a worry that we seemingly don't know properly why / how they work and I don't know what the alternative is. I don't think talking therapies would have done the job, although it would be preferable to drugs.

Part of the problem is that 'depression' is a heterogenous disorder. So two people can have a diagnosis of depression, yet their symptoms are opposite - e.g. insomnia vs sleeping too much, not eating vs overeating. The biology underlying these different sub-types may well be different, and is not often taken into account. If one type was related to serotonin and another not, just for example, then a large scale analysis would show no overall effect, even if it were true for some types.

If you haven’t already seen this guy -he is amazing and explains it so well.

Mind blowing and made me angry after years of being told it’s a chemical imbalance.

.Johann Hari
www.ted.com/talks/johann_hari_this_could_be_why_you_re_depressed_or_anxious

Here is a link to the scientific study that was just published about it

www.nature.com/articles/s41380-022-01661-0

Its very interesting reading (if you stick to the intro and discussion…the method and results are a bit too in depth for light reading imho!)

Placemarking

A few years ago I listened to a radio programme which from searching I think was called The Inflammed Mind.
The suggestion was that immune system problems and residual effects of physical illness could cause mental health difficulties.

It struck a cord with me because my first severe bout came very soon after an operation for a condition which also caused an infection and I was really ill for several days. Life was far from ideal but I'd been doing fine, then wham. I also know a couple of people who were fairly happy go lucky until getting terrible cases of illnesses such as glandular fever, then never the same again. Anecdotal I know but made me wonder.
An ongoing dehabilitating illness I could see you might say you have reason to feel depressed, but these were supposedly short term, cure you and then all back to normal illnesses.

www.bbc.co.uk/news/health-37166293.amp

Thanks. I'll take a look.

Interesting. Will reserve judgement till I've read up on it (although generally speaking I think Johann Hari tends to make a lot of sense) but my initial reaction to this is that I hope it doesn't lead to the NHS deciding the answer is to herd even more of us into cognitive therapy. It isn't suitable for everyone, definitely set me back in my own battle against depression, and it really bothers me that it's prescribed so widely.

Also, the evidence for antidepressants being very helpful isn't particularly strong except for the treatment of moderate to severe depression in the short term. Yet we have so many people taking them for years on end.

Haven’t read all yet, but worries me a little that it will cause the “pull yourself together” argument to re-emerge.

Me too. 😨

I think there needs to be a multi faceted approach and more tailored support. Depression is so common now. Our capitalist and selfish society almost encourages it.

I wouldn’t trust anything Johann Hari wrote. He’s a liar and plagiarist.