A recent study found that low serotonin levels do not cause depression. But has the research been misinterpreted?
A study that found depression isn’t caused by low levels of serotonin, the “happy hormone,” has become one of the most talked about and shared medical articles in recent months.
The conclusion sparked a wave of misinformation about antidepressants, much of which increases the amount of serotonin in the brain. However, the research doesn’t indicate that these drugs aren’t effective or don’t help patients. On the other hand, it also provoked some serious questions about how people deal with mental illness.
After British Sarah had her first major psychiatric problem in her early 20s, doctors told her the drug she was prescribed was like “insulin for diabetics”.
For them it was crucial: They said the drug would fix a chemical problem in their brain and would need to be used for life.
Her mother had type 1 diabetes, so she took it very seriously. Sarah continued to take the drugs, even though it made her feel worse. Eventually, she “heard threatening voices” telling her to kill herself. She also had electroconvulsive therapy (ECT).
However, the claim that Sarah needed the drug like a diabetic needs insulin was not based on any scientific evidence.
“I felt betrayed by the people I trusted,” she says.
His negative response to drugs was extreme, but the argument of “chemical imbalance” as a cause of depression is not uncommon.
Many psychiatrists have said they have long known that low serotonin levels are not the main cause of depression. Therefore, the current article would not bring anything new.
However, the great resonance of the research shows that it was a novelty for many people.
The problem is that using the article to argue that antidepressants don’t work is an inaccurate leap.
And doctors worry that in the confusion, people may abruptly stop their medication and risk severe withdrawal symptoms.
The UK’s National Institute for Health and Care Excellence (Nice) says use of these drugs should not be stopped abruptly, except in the case of medical emergencies. Slowly reducing the dose can minimize withdrawal symptoms, they say.
What did the research reveal?
This latest study looked at 17 studies and found that patients with depression did not have different levels of serotonin in their brains compared to people who didn’t.
The finding helps to rule out a possible mode of action of the medication and to remedy a deficiency.
London psychiatrist Michael Bloomfield draws a comparison:
“Many of us know that taking acetaminophen can help with headaches, but I don’t think anyone believes that headaches are caused by not having enough acetaminophen in the brain,” he points out.
So do antidepressants work?
Research shows that antidepressants work only slightly better than placebos. There is debate among researchers as to how significant this difference is.
Within that average, there is a group of people who get much better results with antidepressants. The problem is that doctors simply have no way of knowing if their patient is one of these people.
Some people who take antidepressants say that the drugs help a lot with a mental crisis or allow them to better manage their depression symptoms in everyday life.
Professor Linda Gask of the Royal College of Psychiatrists (a professional body of psychiatrists in the UK) says that antidepressants “is something that helps a lot of people feel better quickly,” especially in a crisis.
However, one of the authors of the article on serotonin, Professor Joanna Moncrieff, points out that most of the research done by drug companies is shortterm. So, in their opinion, little is known about patient performance after the first few months of using the drug.
“You have to analyze the treatment results and not let the patient take the drug longer than necessary, which often doesn’t happen,” says Gask.
While there are risks of not treating depression, some people will experience serious side effects from antidepressants — the authors of the serotonin study say these harms need to be communicated more clearly by the industry.
Effects can include suicidal thoughts and attempts, sexual dysfunction, emotional numbness and insomnia, according to Nice.
A few months ago, British doctors were told to prescribe therapy, exercise and meditation for patients with less severe depression.
What was said about the research?
Responses to the study on the relationship between serotonin and depression said that research had proven that antidepressant prescriptions were “built on a myth.”
But that’s not true.
The problem with this argument is that the study did not look at antidepressant use.
Serotonin plays a role in mood, so adjusting it can make people feel happier, at least in the short term, even if they don’t have unusually low levels of the hormone. It can also help the brain make new connections.
Others claimed the research shows that depression is never a disease of people’s brains, but rather a reaction to the environment.
“Of course it’s both,” says Mark Horowitz, one of the paper’s authors. “Your genetics affect your sensitivity and stress levels, for example.”
But some people are better treated with “relationship counseling, financial advice, or job changes” than medication.
But Zoe, who lives in southeast Australia and suffers from major depression and psychosis, says redefining depression as “distress that would go away if we just solved all social problems” is also too simplistic.
For them, this concept neglects people with more serious mental health problems.
Psychosis runs in her family, but her episodes are often triggered by stressful events.
Zoe says she found medication, including antidepressants, that changed her life.
For her, “it’s worth looking into the side effects of the drugs” because they prevent severe flareups.
And that’s a consensus among experts who spoke to BBC News: Patients need more information to make the best decision for them.
This text was originally published at https://www.bbc.com/portuguese/geral62584210
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