"No evidence that depression is caused by low serotonin levels"

[stealersmealdeal]

DD almost 16 and been in the CAMHS system for 2.5 years for low mood, anxiety and self-harm, we're now v close to getting on the medication train as she has tried everything else and feels worse than ever. But now I've found this major study and almost can't believe it:

www.ucl.ac.uk/news/2022/jul/no-evidence-depression-caused-low-serotonin-levels-finds-comprehensive-review

And the Guardian's take on it:
www.theguardian.com/society/2022/jul/20/scientists-question-widespread-use-of-antidepressants-after-survey-on-serotonin

It's sertraline that DD is about to be prescribed, but looking at these studies it seems to be a total stab in the dark guess as to whether she – and thousands of others! – actually have low serotonin at all. In which case, what's the flipping point?! I've not told her I've found this as I worry it would just make her despair and give up hope. She's not thrilled about the prospect of going on meds, but just wants to feel better (obviously!) and the balance was tipping in favour of them... until now. What do people think?

This is one study. Take a good hard look at Joanna Moncrieff’s previous work. She has form for papers like this about various different drugs stretching back over 20 years - I.e. she is not independent. She has her own agenda - and that’s her right, but if you’re reviewing evidence, review a wider range of evidence. It is not good enough to base your decision making on one critical paper. ADs do help lots of people love normal or close to normal lives (and I’m sure lots of people will be along to tell you how they’ve helped) and if your doctor thinks they would help your daughter then why wouldn’t you want to at least give them a go, especially as nothing else is working?

But it's not just one study, though – it's based on dozens of other studies that involved tens of thousands of people – it's absolutely huge.

I will look into Joanne Moncrieff's previous work, though - thanks.

Re my DD, I just worry she'll be taking something useless or positively damaging, that could start her on a lifetime of chemical intervention and side effects etc – but I guess I lot of people do think this. It's supposed to be a temporary trial, but at the same time, the doctor hasn't looked at anything like diet as a possible cause. DD has been veggie since birth – perhaps protein deficiency could be a cause – but this isn't even being entertained.

Loads and loads of people are vegetarians who don’t have depression so unless she’s eating really badly why would that be likely to be a cause? If you want to cherry pick systematic reviews here’s one from The Lancet which makes a case for the benefits of anti depressants.

www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

All I’m saying is to read widely and read with an open mind. There are hundreds and thousands of studies on this and the broad consensus is that they benefit many people.

There are many people whose lives have been saved by antidepressants, my DH included. Why wouldn’t you try it ?

I don't know about studies, but my DD was completely out of education with anxiety & depression during 2020. It was only when she (aged 16) was prescribed Fluoxetine by our private Consultant Psychiatrist that she started to be able to function again. She's been on it for nearly 2 years now, but we reduced the dose over the summer, and may reduce again next summer all being well.

My view is if you needed meds for something else you'd take them, so why not for depression when it has such a debilitating impact on daily life.

Adding in a good quality vegetarian protein powder and getting her vitamin levels checked would be worth a shot. I've been 'depressed' before when really it was low iron and b12 and supplements did help a lot. Does she get enough Omega 3? That's really good for the brain, there are plant sources although best known source is fish, so something which could be missed in a vegetarian diet. There are vegetarian supplements if she won't eat the plant sources like seeds and nuts.
Before putting my teenager on medication I would want to know that they aren't neurodiverse, so screening tools for adhd, autism, sensory issues etc. and that any social causes are addressed eg. social issues at school, issues in the family and with other friends, and anything in the digital world like social media issues, learning issues are addressed, heath issues were screened for like thyroid problems, and any nutritional deficiencies addressed. The teenage brain is not the same as the adult brain, and so antidepressants can actually make things worse unless absolutely necessary. They can also trigger manic episodes in bipolar patients as well, so I would really want to know that any other causes had been investigated before giving antidepressant tablets. The doses are not always adjusted properly for children or women as based on a male adult model, so if you do proceed I would ask for the smallest dose possible to avoid risking possible issues like serotonin syndrome if serotonin is not the issue.

My view having worked in MH is that depression in most cases is not a physical or chemical illness but an issue of the mind. Environmental factors, emotions etc are the most beneficial treatments. Of course in some cases ADs are beneficial and should be used but talking therapy and building self soothing, help seeking and emotional coping skills are preferable.

Sometimes depression is related to hormones, so it would be worth considering whether there is a cyclical element to her moods, such as getting much more depressed one week a month, as this may need to be treated differently. Also, whether she experiences any highs of mood, which might be suggestive of bipolar disorder.
Is she anxious or just depressed?
Is she getting any counselling? Is she getting support in school or college?

I know antidepressants can be life saving and life changing for many people, but for some they make it worse and for many they don't work, so it's always a good idea to explore all avenues, whether you decide to medicate or not

Firstly I'm not sure I agree. She is only one Doctor. Secondly I honestly believe that many people have chemical imbalances, both in the brain or other parts of us. We need more, our natural levels are not enough. Thirdly, what are you suggesting as an alternative. She clearly has major depression, lack of self esteem, anxiety. What are you suggesting is done instead? Come on, you know this doesn't make sense.

As her mother you need to make sure she has the optimum diet, including supplements if necessary. I would definitely be giving her Omega 3 daily. Realistically the doctor isn't going to closely examine her diet, or her exercise, or the colour of her bedroom walls or how others are interacting with her to determine if any of those are affecting her mood. Realistically the doctor is going to prescribe medication that has helped millions world wide.

I know this sounds harsh, and I would have the same thought process as you in your situation.