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...

"Being depressed or feeling depressed may not even be a clinical condition"

@Ihavenocats yes, you're correct to an extent, which is why there is reactive depression (my loved one died/I lost my job/my marriage broke down etc and now I feel depressed) and clinical depression (everything should be great, I should be happy but I know the world would be better off without me, I'm worthless etc etc)

Unfortunately the NHS has ridiculously long waiting lists for psych support so most people get given anti-depressants as a fix, rather than a psychologist or psychiatrist having time to sit with them and delve into whether they are being sad cause of external factors, or whether it's something not working properly in the brain. Add to this the amount of people nowadays who "have anxiety" instead of just being anxious, and therefore want treatment and medication, and you have the mental health crisis.

For people who have "reactive" depression,the placebo effect is probably very true. I'm sad + meds to stop being sad = happy.

I think for those of us with clinical conditions, it will be more complex. I was always very sceptical about "happy pills" and have refused to even consider them for years. It wasn't until I had a few weeks of constant suicidal thoughts, plans etc,that I was taken to the GP and encouraged to just try them. They took a while to kick in, but they did. I still get bad days, but they aren't all consuming, I can still see glimpses of reality through the fog of my brain trying to trick me into thinking everything is over.

Reactive depression is about loss though. And it’s usually loss which drives depression. Some people cope with loss, some don’t.

If l hadn’t taken fluoxetine for 5 years when my ex Dh left l wouldn’t be here typing this. I don’t think you can differentiate between how the different types make people feel, or how they respond to medication.

@bigfootisreal yes I agree, this has been said for a long time.

The serotonin theory of depression is only that, a theory.

Doesn't mean the drugs don't work, especially for moderate to severe depression.

The placebo effect is a misleading term. Its not necessarily an actual effect. It could just be regression to mean, for example. That's the idea that chronic conditions fluctuate, and that people will seek help after a particularly bad batch, after which the symptoms are likely to recede anyway. It's a statistical artefact.

I think everyone agrees that antidepressants can help with severe depression, that there is a large placebo effect for all depression and anxiety disorders, and that the chemical imbalance theory is nonsense.

This thread is interesting.

There are examples of:

'This must be a lot of bollocks because i got better insert antidote.'

'This must be bollocks because I experienced x side effects (and not the intended benefit)'

'Well this study said...'

And 'I believe'

These are fundamentally flawed in terms of understanding how research works.

To clarify some of the misunderstandings about what it does and doesnt say:

The key point is that this was a review of 17 studies. So in theory is a greater level of reliability than an individual study.

It says that low serotonin does not cause depression.

It raises the question over whether anti-depressants rather than therapy should be first line of treatment especially since people DO suffer side effects including importantly withdrawal symptoms.

And crucially

SSRIs have no other proven way of working, Professor Moncrieff and colleagues said.

She added: 'We can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.

'We do not understand what antidepressants are doing to the brain exactly.

'Giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.'

Studies used in the review involved hundreds of thousands of people from various countries.

They found there was no difference in serotonin levels between people diagnosed with depression and healthy people, despite polls suggesting up to 95 per cent of the public believing this is the case.

It also says that it doesn't prove that SSRIs don't work. But does prove that they don't work in the way we have been lead to believe they do.

This is crucial to understand especially because there is a concern that used long term they might actually cause more problems.

This is a classic example of people not understanding studies. Usually I would blame poor reporting on studies, as I find it notoriously dreadful, however actually the articles are of a decent quality in terms of covering the most important points. Its just that readers are necessarily understanding what the findings actually are and are still in the land of anecdotes to 'prove' a review of numerous studies (which is a higher level of evidence than a single study).

R.e. the psilocybin, all I can say is after a shroom trip I felt like my mental health gloom cleared for a while, and I only took a lowish dose for a first-time trip. Even the trip itself was very healing.

I take ADs.

Being depressed or feeling depressed may not even be a clinical condition. What if some wealthy pharmaceutical moguls sat around a table and thought up a name for a state that we all get into,

We all get into sleeping for 16+ hours a day, not doing anything, not even showering or cleaning teeth or brushing hair, thinking about suicide every day and fantasising about how to do it, not leaving your house for weeks, not eating for days, cutting contact with all friends and family, self-harming, do we?

That's the idea that chronic conditions fluctuate, and that people will seek help after a particularly bad batch, after which the symptoms are likely to recede anyway. It's a statistical artefac

My chronic anxiety and depression don’t fluctuate though. They’re just there.

Being depressed or feeling depressed may not even be a clinical condition. What if some wealthy pharmaceutical moguls sat around a table and thought up a name for a state that we all get into

Not everyone gets into a state though. I think the black swirling malevolence in me shows to me that depression exists. Not an invention of Bigpharm

Good point.

"The placebo effect" combines two effects:
Sometimes people just get better on their own
People who think they're receiving effective treatment are more likely to get better on their own

If you have three groups of people
a) receive no treatment
b) receive a sugar pill and a pat on the head
c) receive a careful full consultation, and suite of blood tests after which they're given a saline injection
then some of group A will show an improvement, more of group B will show an improvement and even more of group C will show an improvement.

In order to get approval a drug needs to show it performs better than group B and ideally better than group C.

If I take paracetamol for pain relief and it works, does that mean I had low paracetamol levels in my body?

Surely it's just far far more complicated than "this doesn't actually work"?

There may be different types of depression that we can't differentiate yet which are helped in different ways.

It's highly likely that it's not just Serotonin which is implicated. There might be other neurotransmitters or other body chemistry things or environmental things going on as well.

I don't know a huge amount about depression but I know about ADHD, for which a similar thing applies - the assumption for a long time was dopamine deficiency, therefore stimulants, which make you produce more dopamine. Then they realised noradrenaline was in the game, so I forget the name but the reuptake inhibitor of that. Now they're talking about low dose combining both for a different effect. And there are people who medication just didn't work on at all.

I listened to a really interesting podcast a while ago where they basically said we are stumbling in the dark with psychiatric medications, and essentially these medications are like knowing your car engine needs oil and just pouring oil all over the engine. It might do the job, but it's nowhere near as efficient as if you were able to actually use an oil tank and apply it directly. But we're not at that level in psychiatry yet, and this is currently the only way to get "oil into our cars".

If it helps people then it should be available.

Isn’t this study saying that it isn’t lack of serotonin that causes depression and we don’t yet fully understand how ADs work? People tend to read these click bait headlines and jump to the conclusion that they are bad, a placebo or don’t work which just adds more stigma. ADs work really well for some people, me included and don’t work for others. I’ve done plenty of therapy and for me it’s the ADs that keep me level and stop my anxiety spiralling. Starting taking medication was such a breakthrough for me it makes such a positive difference. I’m also neurodivergent so perhaps they impact me differently.

You don't have good days and bad days? It doesn't change over time at all? So how do you know you have it at all if it's the background normal of your life?

It doesn't matter for a statistical effect, though. It only needs to affect a substantial minority. For example, we can say covid is getting milder but individuals are still dying from it. It's not milder for them. Especially if they only got it the one time.

I have good days and bad days, but they’re held in place by the medication. If something bad were to happen I’d struggle.

And as for how do l know? The last time l swapped over l had to spend a certain amount of time medication free. It was terrible.

I totally agree with this.

Take this with a pinch of salt...they'll probably change their opinion next year. Irresponsible of them to take away hope for people. Thousands of people have been cured by these. It's just the latest medical bollocks.

I'm on an unusual atypical antidepressant. I was first prescribed it in another country and I had to really fight for years before they would put back on it. It does have side effects though.

For me, alternative therapies work better to be honest. Acupuncture, sunlight, exercise, massage, running, boxing and a routine.
To be honest though, I think I do need the antidepressants in the background as I suffer from insomnia without them.

This is the one I'm on. en.wikipedia.org/wiki/Agomelatine It works in a different way and is not authorised in the US. I had to fight and fight and fight for it here as mainly they had never heard of it.

*put ME back on it

Lack of sleep is a massive problem for me. Ideally, I should be on melatonin but they don't prescribe that here.

My depression is situational in cause.

You can get it off label, or on label if you are over 55. It doesn’t last though.

Get what?

My depression began in the O level season of 1984. By 87 I found the energy to recognise that maybe it was more than a normal response to a huge life change. Couldn’t get anything from the doctor. I recall him saying something about dependance and I do remember a lot of headlines about women being prescribed drugs for mental health issues in the 60s & 70s and just being left on a repeat prescription for decades. No follow up, just addiction and awful consequences when they just stopped taking them, or couldn’t get them anymore.

It all sounded awful. So I never took anything.

And then in 2020, my long standing pit of despair + covid + post viral falling over got me a new GP who was very kind and persuaded me to try them. He gave me them in drop form, so I could start on a minuscule dose (I suffer from the nocebo effect and was scared senseless even at that tiny dose). It took months to get me up to a dose that could have any impact, it was so slow, and I was convinced they’d be useless at anything other than making me feel nauseous and zombie-like. I felt vindicated in that regard when I started having a very strange sensation. But then I realised it was mild optimism. Been so many decades since I’d felt it that I needed a while to connect the feeling and the word.

From there I went onto tablet form (counting drops is hard in high numbers). Now on 2 tablets a day and it’s like being let out of prison after a life sentence. One one hand I’m kicking myself for letting media hysteria in the 80s rob me of the chance of far, far less time down the bottom of the well. On the other, grateful I got this doctor who was prepared to work around my resistance, because I could still be down the bottom of the well.

Nothing works for all of the people all of the time. And I don’t think people they don’t work for should be forced onto them, nor left to rot when other solutions could and should be sought for them. But anti depressants work for me and they’ll be prised from my cold dead hand.

If this is round 3.0 (or 4.0?) of ADs don’t work then I’ll start a stock pile. I don’t think my GP would deliberately make me wean off them, but things are in flux, media band wagons have impact more quickly than they used to and I have no idea who will be minister for health by next month. So taking no chances. Buggered if I’ll let myself be collateral damage this time around.

@Dalint I also am on an atypical AD (not same as yours). And like you when I come off it the issue is lack of sleep. I am in the UK and now have melantonin on prescription.