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“No convincing evidence” that depression is caused by low serotonin levels

bmj.com

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Re: “No convincing evidence” that depression is caused by low serotonin levels

#11

Post by patmorgan23 »

nvrspyx wrote: post #6
Arubis wrote: post #2

So...why do SSRI users self-report efficacy?

My guess, without digging into the study itself since I'm on mobile, is that there is no singular cause for depression. Rather, depression is simply a symptom of a wide range of causes, with one possible cause being low serotonin (or a reduced sensitivity to it). Or even, low serotonin is a symptom of the depression. Not all patients with depression find relief from SSRIs, or medications in general, but some certainl…

It could even be that increasing serotonin is helps improve the patients mood and break thought patterns/cycles than kept them in their depression.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#14

Post by copperx »

carabiner wrote: post #4
Arubis wrote: post #2

So...why do SSRI users self-report efficacy?

https://en.wikipedia.org/wiki/Placebo

In my case, at this very moment, I'm going through antidepressant withdrawal and have random crying spells. Sure, depression might not be mediated by serotonin, but these drugs have an effect on mood. It might be that there's a different mechanism of action.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#15

Post by [deleted] »

hackerlight wrote: post #10
kennywinker wrote: post #9

Earlier quoted context omitted.

When they test drugs, they test them against a placebo.

Yes, but according to Irving Kirsch, the benefit of anti-depressants above placebo is very small for anyone who isn't severely depressed, and the observed small effects can plausibly be explained by patients unblinding themselves (due to the presence of other side effects in the treatment group), or by things like publication bias. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

[deleted]

Re: “No convincing evidence” that depression is caused by low serotonin levels

#16

Post by dotcoma »

I thought it was widely accepted by now that the serotonin thesis was a bullshit story spread, among others, by Al Gore’s wife, maybe in good faith, maybe not.

Edit: Tipper Gore; I did not remember her name (I’m not from the US).

I read she was a big fan of the serotonin theory in a book (whose title I don’t remember at the moment).

Re: “No convincing evidence” that depression is caused by low serotonin levels

#17

Post by lumost »

patmorgan23 wrote: post #11
nvrspyx wrote: post #6

Earlier quoted context omitted.

My guess, without digging into the study itself since I'm on mobile, is that there is no singular cause for depression. Rather, depression is simply a symptom of a wide range of causes, with one possible cause being low serotonin (or a reduced sensitivity to it). Or even, low serotonin is a symptom of the depression. Not all patients with depression find relief from SSRIs, or medications in general, but some certainl…

It could even be that increasing serotonin is helps improve the patients mood and break thought patterns/cycles than kept them in their depression.

It could be that any forced cognitive pattern change would have the same effect.

Double blind trials are hard, double blind comparative trials are more or less impossible.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#18

Post by PragmaticPulp »

SSRIs raise extra-synaptic serotonin levels within the first hour of taking them. However, their efficacy against depression takes weeks or even months to manifest. We've known this for decades, and as a result the "chemical imbalance" theory of depression hasn't been a real contender in depression research for a long, long time.

The key thing to understand is that serotonin levels don't have to be low for SSRIs to induce positive changes. SSRIs don't just "raise serotonin levels" as many have come to believe, but rather change the dynamics of serotonin in the brain. This produces downstream changes that, over time, can contribute to lessening depressive symptoms in some patients.

This makes more sense if you think about other conditions like chronic pain. Someone suffering from chronic pain doesn't have an "endogenous opioid deficiency". They're just in pain. Opioids are one medication we can use to modulate their pain.

Unfortunately, the pop-culture misunderstandings about "low serotonin" can mislead a lot of people into thinking that research like this debunks SSRIs. It doesn't. As I said above, we've known for decades that something else is going on. This isn't actually a surprise to anyone in the field.

Re: “No convincing evidence” that depression is caused by low serotonin levels

#19

Post by walrus01 »

I have a completely unscientific, subjective theory that some significant portion of depression in the population as a whole is caused by the economic circumstances that some people live in.

Things like being trapped in a dead end job to keep healthcare benefits in the USA, living in a never ending treadmill of debt.

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