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With the “chemical imbalance” theory in doubt, what’s next for treating depression?

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For Maria Christ the idea that depression is a chemical imbalance in the brain has always felt true to her personal experience.

The 57-year-old former Christo teacher was on antidepressants for most of her adult life. She experienced anxiety attacks and panic attacks from her youth, and these feelings intensified in adulthood and eventually led her to a deep state of depression.

When she began taking anti-depressants in her 30s, Christ slowly regained her functioning and felt her true self return. She said the medication helped keep her “on the level.”

Christ is not alone in her opinion: according to polls, more than 4 out of 5 people depression is believed to be caused by imbalanced brain chemistry and specifically low levels of the neurotransmitter serotonin. This explanation of depression has an appropriate treatment – antidepressants, known as SSRIs, designed to increase serotonin levels and correct the so-called imbalance.

Psychiatrists, however, say that this understanding of depression has long been disproved. There was a theory first proposed in the 1960s and received a significant promotion in the 1990s when pharmaceutical companies began developing and marketing this new class of antidepressants adapted to this theory.

While SSRIs have been moderately effective in clinical trials, the serotonin theory has never been proven. And recent research shows that there is no single cause for depression.

The dissonance between the public’s understanding of depression and the psychiatric literature recently came to a head when British psychiatrist Dr. Joanna Moncrief, co-author Mark Horowitz, and colleagues published a broad overview of existing research in July and drove the last nail in the coffin of the serotonin theory. The review was packaged as a revelation that debunks the conventional understanding of depression and related treatment.

“The vast majority of the general public thought it was an established fact that there was evidence to support the idea that depression was caused by low serotonin levels, and indeed, many people take antidepressants because of that belief,” said Moncrieff, the professor. of critical and social psychiatry at University College London, said during a HealthDay Now interview. “That’s why I thought it was very important to do this study and be able to make a definitive statement about the state of the evidence for this theory.”

The study generated widespread media coverage and controversy, with Moncrief and her co-authors showering widespread criticism on the treatment of depression. Other psychiatrists emphasize the difference between how a drug works and whether it works.

“We don’t fully understand how statins work to lower cholesterol—we’re learning more. But the reason we use them is because clinical trials” said Dr. Srijan Sen, director of the University of Michigan Depression Center.

SSRIs have been shown to provide modest, often short-term benefits for some people, especially those with severe depression. “They are not blockbuster drugs that help everyone,” Sen said Health Day is now. “But it’s clear that there’s a subset of people for whom these drugs work and a subset for whom they don’t.”

However, at the heart of the research, almost everyone agrees that depression is a complex and changing condition, and there is no definitive explanation for why or how antidepressants may be helpful.

For Mary Christ, only she is important personal experience with anti-depressants, which she says helped her live again. She may not understand the exact effects of the medication on her brain, but she believes it is causing something positive.

“I can’t help but think and feel that it definitely has a chemical effect on me,” Christ said during a Health Day is now an interview. “What exactly happens to serotonin? I don’t know. But clearly, if the study didn’t confirm that, then there must be other things going on that they haven’t figured out.” She said she hopes this new study will inspire a new push for answers.

But patients should not expect simple explanations like the serotonin theory to be discovered in the future.

“I think it’s important to expect that there will be outbursts, theories that work and theories that don’t,” Sen said. “We shouldn’t let these studies and clashes affect our understanding of whether different treatments work.”

Encouragingly, the pipeline of new treatments has never been more crowded. In 2019 esketaminea drug derived from ketamine, became the first new depression drug to receive FDA approval in decades, and is now an increasingly popular option for patients who have not benefited from antidepressants. Although psychedelic therapy for depression is not yet approved, it is also the subject of a huge amount research efforts and financing.

However, Sen cautions against repeating old mistakes.

“I remember commercials from pharmaceutical companies showing us neurons and serotonin the levels are changing, and that’s oversimplifying and suggesting that we understood what was going on,” he said. “I think we should be modest now that we don’t, but it’s also clear that understanding is not that guides our treatment recommendations.”


The Chemical Imbalance Theory of Depression Is Dead, But That Doesn’t Mean Antidepressants Don’t Work


Additional information:
There is more about treating depression in US National Institute of Mental Health.

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Citation: With the “chemical imbalance” theory in doubt, what’s next for treating depression? (2022, September 6) Retrieved September 6, 2022, from https://medicalxpress.com/news/2022-09-chemical-imbalance-theory-depression.html

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