May 29, 2023

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Foreign caused by a chemical imbalance there’s an article that was published in july of 2022 that has been getting lots of press for deconstructing what is known as the serotonin hypothesis of depression for several decades now people have referred to depression as a chemical imbalance with the implication here being not only that depression is a fundamentally

Biological illness but also that it would require biological treatments like medications to fix in this article the authors review all the studies that have been done on the relationship of serotonin to depression including measuring levels of serotonin and serotonin metabolites and body fluids as well as the activity of serotonin receptors serotonin transporters

And serotonin-related genes what the authors found was both clear and consistent none of the studies showed any clear association between depression and low serotonin levels serotonin metabolites or serotonin-related genes the only findings that possibly showed a correlation came from studies looking at serotonin receptor in transporter binding which showed weak

Evidence of reduced binding in some areas although it’s possible that these results could have been caused by prior antidepressant use by some of the patients in these studies rather than being a feature of depression itself the authors also looked at studies on tryptophan depletion which is a method of inducing a state of low serotonin as tryptophan is required

By the body to produce serotonin these studies also found no evidence that acutely lowering serotonin induces a state of depression with the possible exception of people with a family history of this mood disorder taken as a whole the authors concluded that decades of research have shown no convincing evidence that depression is caused by low serotonin levels so

What does this mean for psychiatry psychopharmacology and most importantly for patients have millions of patients been misled into thinking that depression is a chemical imbalance should we abandon the use of serotonergic medications when treating this condition the answer here is nuanced it has been known in the field of psychiatry for years now that the evidence

For low serotonin being the cause of depression was weak if not non-existent with the phrase chemical imbalance largely persisting as a marketing term not a scientific one if this study helps to publicize that fact and lead more people to an understanding that depression is not an exclusively biological phenomenon but has important psychological social and cultural

Roots as well then that can only be a good thing however there is a temptation when looking at the study to jump to a conclusion that while seemingly logical on the surface is actually incorrect just because there’s little evidence for serotonin imbalance being the cause of depression doesn’t inherently mean that there’s no evidence for serotonergic medications

Being an effective treatment for depression to use a very concrete if somewhat silly example no one is saying that a broken bone is caused by a lack of crutches but that doesn’t mean that crutches aren’t still helpful when recovering from one in fact many of the most commonly prescribed medications across all fields of medicine have mechanisms that do not directly

Relate to the underlying pathophysiology of the disease that they’re trying to treat to use another example proton pump inhibitors like omeprazole are highly effective for reducing symptoms of acid reflux however that doesn’t mean that the cause of gastroesophageal reflux disease is too much proton pump activity instead a wide range of factors are involved including

Motor abnormalities in the stomach and esophagus high intra-abdominal pressure in associations with obesity tobacco and alcohol from these examples we can learn two things first that the treatment for a disease does not need to be directly related to its underlying cause in order to be helpful and second that most things in medicine are complex and cannot be boiled

Down to any single explanation ultimately the chemical imbalance theory of depression is wrong and it deserves to be killed off in the public consciousness what doesn’t deserve to be lost in the process however is the fact that for some people serotonergic medications can be an effective tool in the fight against depression the more we understand that any disease

As complex and multifaceted as depression is more than just a chemical imbalance the more able we will be to truly help people struggling with this condition thanks for watching i hope you’ll all take some time to look at this important article and consider what it does and does not say about the nature of depression if you’re curious to learn more about depression

Or antidepressants consider picking up my book’s memorable psychiatry and memorable psychopharmacology available on amazon please also consider liking this video and subscribing to the channel until next time bye for now foreign

Transcribed from video
Is depression caused by a chemical imbalance? By Memorable Psychiatry and Neurology