Depression NOT linked to low serotonin.

[Eyesopenwideawake]

www.dailymail.co.uk/health/article-11027847/Depression-NOT-caused-low-serotonin-levels-study.html

Yeah, I know it's the Fail but also in the Times (behind a paywall)

www.thetimes.co.uk/article/antidepressants-study-casts-doubt-on-drugs-taken-by-8m-people-db2dsb9zf

Sorry drug companies, the party is almost over...

I agree that GPs are much quicker to prescribe ADs than pretty much any other medication, and this isn't always a good thing. However, they do help a lot of people. A s I understand it, all these studies show is that the mechanism by which they help people isn't quite as straightforward as previously thought.

Kimberley Wilson has a book called the heathy brain and she talks about this. Also on instagram and posted about this story on her page today.

The long running thread on here about psilocybin is very interesting, and there are a few good documentaries on Netflix about this. In short, a single high dose of psilocybin can 'cure' depression and/or OCD for months at a time, and maybe even permanently. Clearly a one-off dose won't have a lasting impact on your serotonin levels (or levels of anything else) so there's obviously something different going on there.

Not caused by lack of serotonin is not the same as no link. While I'm no fan of drug companies and instant prescribing, there is significant evidence that ssri's can help esp in moderate to severe depression.

For a few people ECT does exactly the same thing. It's also the likely cause of catastrophic brain injury in some others though, so the fact SSRI's appear to bring benefits for some and do nothing for others is just in keeping with pretty much every other psychiatric medicine and form of therapy, so really shouldn't come as any surprise.

I've always thought that if they did exactly what it says on the tin then they'd be a lot more effective in many more cases than they are in reality, so if the truth is that they are not quite doing exactly what it says on the tin then that marries with what we see in practice.

@colouringindoors

"However, analyses of the published and the unpublished clinical trial data are consistent in showing that most (if not all) of the benefits of antidepressants in the treatment of depression and anxiety are due to the placebo response, and the difference in improvement between drug and placebo is not clinically meaningful and may be due to breaking blind by both patients and clinicians."

www.ncbi.nlm.nih.gov/pmc/articles/PMC6584108/

I’ve suffered depression most of my life. I don’t really care about serotonin. I only know anti depressants make me function and probably saved my life

Placebo effect for me is a load of tosh. They just WORK

I've just come off my sertraline and started lifting heavy weights in the gym. I have never ever felt better.

I don't believe it can be a placebo effect. I've seen many people with dementia who do not know they are being prescribed antidepressants and the improvement on mood is noticeable.

My DD has severe depression which has been linked to cerebral hypothyroidism.

But if that were the case, wouldn't people start feeling better as soon as they started taking them? The fact that so many people say they only started to feel better after 4 to 12 weeks suggests it's not just the placebo effect.

Similarly, the fact that people often 'fail' several ADs before finding the one that works doesn't support the placebo theory.

I've no skin in this game btw. I tried two ADs, one of which worked extremely well but had other side effects, and the other (sertraline) nearly killed me.

Not buying placebo at all . Think it lot more complex than that . Thousands of studies have proven they help some folk and loads of people would not be here today without them . Worrying what this might do to some folk now or people like me that is already very anxious to start taking . I think as with every drug they work for some and others not and science still not know exactly why or how

i tried a complementary medicine for anxiety and had no effect so why did that not have a placebo effect then ?

This. I don't want to sit an talk to someone. I have no interest in therapy. For me, the drugs do work, safely and predictably.

Placebo has to have end-user buy in, and I'd expect that if someone is expressly told 'these take a month to six weeks to begin to work', then a month to six weeks is when they'd start experiencing placebo.

I'm sceptical of the claim that there is no discernible benefit above and beyond placebo, but I do think there is a definite placebo effect with SSRI's in some cases, but that will require the recipient to be open to the possibility that SSRI's might have some beneficial effect.

@SabiRiver

If you don't mind me asking, it's not my field, so I'm curious. How do you go about determining a depressed state in an individual with dementia? Are we talking people who still experience periods of lucidity and can describe their own mental state? If not, how do you then ascertain that there has been an improvement in mood if the person themselves can not express this directly? I'd be concerned that if it's simply someone 'looking' cheerier, or responding more positively to certain stimuli, that in itself is no indicator at all that a depressed state existed and has been relieved by an SSRI. Again, I'm asking out of genuine curiosity and not trying to poo-poo the idea.

I was on SSRIs and my mental health issues got better. I thought I was fixed so I came off them. And all my mental health symptoms came back. So I went back on them and it got better again. So I'm fairly certain it's not a placebo. I was so happy to come off them and gutted that it didn’t work out for me.

If it's a placebo effect, why did I feel amazing on Mirtazipine but horrific on Sertraline? Rather than amazing on both?

No need to be sniffy about placebo. It's your own body's healing mechanism triggered by an external stimulus. I'm only surprised that anyone is surprised by this new study. There has long been knowledge of a significant placebo effect with ADs.

There has long been knowledge of a significant placebo effect with ADs

But this study from Oxford says the opposite

www.psych.ox.ac.uk/news/all-antidepressants-are-more-effective-than-placebo-at-treating-acute-depression-in-adults-concludes-study

I have yet to meet one person who suffers debilitating mood disorders who thinks that anti depressants are placebos. It seems to me that people who don’t need them say they are placebos.

The placebo effect is very strong for mild to moderate depression. A lot of people will report real benefit from going to their Doctor, asking for help and receiving confidently prescribed Smarties: there are a gazillion studies showing this including ones which scanned the patients' brains and saw the changes.

Doesn't necessarily mean that medication never works.

I just wish some of the 14 or so that I’ve tried exerted their placebo effects on me.

3 made me suicidal
3 caused horrific anxiwty
1 caused akisithia

We’re these placebo effects?🤔I guess they must have been😂

The thing about the Lancet study is that it was big news because it was the first study to really show solidly that drugs were better than placebo. Until then a lot of doctors would have said that the jury was still out. And it took until 2018, and an absolute shitload of analysis to get there, precisely because the placebo effect can be very powerful.

But these are the side effects, not the therapeutic effects. Noone is saying they are placebos, they are saying that the effect on depression is the placebo response. They are drugs& all drugs have side effects.

My SSRI saved me. Couldn't function without it. It makes me feel like I can live without crumbling inside of myself.

There are various tools used to assess depression in someone who has dementia. They would rule out any underlying medical cause with bloods, urine screen etc and referral is made to psychiatrist who specialises in older adults. Someone with depression and dementia may present with various signs, loss in appetite, sleep disturbance, changes in behaviour all the way to a catatonic state. I've seen someone with a catatonic depression and advanced dementia be prescribed antidepressants which have saved their life as their appetite, acceptance of fluids and engagement all return.