Have we been treating depression the wrong way for decades?

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A new analysis of the causes of depression has overturned what we know about this common condition and has challenged the use of antidepressants. You may have many questions.

A systematic comprehensive review of 17 studies published in molecular psychology .

The theory that depression is caused by chemical imbalances in the brain has existed since the 1960s. For years, however, many experts doubted this, feeling that it was an oversimplification of a complex situation.

“The serotonin theory is very old and has been very popular since the 90s when the pharmaceutical industry started pushing it,” says Joanna Moncrief, Ph.D., professor of psychiatry at University College London and lead author of the study. said.

“But since about 2005, maybe a little while before, there have been rumors that the evidence is actually not very strong or inconsistent. Some studies are positive, some studies are negative. , no one has really put together that evidence.”

Moncrief and her team set out to challenge the serotonin theory in a systematic review of the available research. We took our conclusion a step further by suggesting that

“Evidence from placebo-controlled trials shows that antidepressants are slightly better than sugar tablets.” If so, what does it have to do with it?”

This study paints a compelling picture that depression is not solely caused by low serotonin levels. It is also true that it is very beneficial.

So where does this leave patients and doctors behind, and could this analysis influence how depression is treated in the future?

Are antidepressants effective for depression?

Antidepressants affect the behavior of neurotransmitters, chemical messengers in the brain such as serotonin and dopamine, which can alter emotions and moods and help improve symptoms of depression in some patients. It is widely believed that

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People with depression have a wide range of symptoms that can affect their daily lives, including persistent sadness and hopelessness, changes in appetite, sleep deprivation, fatigue, irritability, and loss of interest in hobbies and social connections. may face.

It is unclear exactly how antidepressants work on a biological level to alleviate these symptoms, but it is clear that they can be very helpful for some patients.

Dr Phil Cowen, professor of psychopharmacology at the University of Oxford, said:

“[The review] This is an act of ranting, and in a sense they are criticizing old research that was difficult to do. [older] Obviously the research was very indirect, messy, and I don’t think anyone thought it was that great. ”

Moncrief’s team found that some depressed patients actually have higher serotonin levels in certain areas of the brain, and in some cases, long-term use of antidepressants actually reduces serotonin levels. have been found to be able to reduce the

“I think it makes a big difference. [antidepressants] Work really affects whether they work or not,” she said.

The findings caused a stir in the media and scientific community, with hundreds of news outlets covering the study. alto metrica company that analyzes where published research is shared.

Findings of this perceived magnitude could have a dramatic impact on how we understand and treat a wide range of conditions like depression. 1 in 8 Canadians at some point in their life.

The study questions the very nature of what we know about depression, yet many doctors are hesitant to change how they treat depression.

Antidepressants could be a ‘lifesaver’ for some

Dr. David Juurlink, director of clinical pharmacology at Sunnybrook Health Sciences Center in Toronto, said the chemical imbalance theory of depression is now widely viewed as a “clear oversimplification” of a complex condition. said he was not surprised by the discovery.

“I think doctors prescribe serotonin-boosting antidepressants too often, but I admit that they actually improve the health of some patients, in part because of this simplification. It’s important,” he said in an email.

“How they do it is not as clear as we are led to believe.”

Dr. David Gratzer, a psychiatrist and attending physician at the Center for Addiction and Mental Health (CAMH) in Toronto, said he was not surprised by the findings.

“This suggestion that depression is always related to serotonin has not been accepted by psychiatrists for years, perhaps decades,” he said, noting that researchers have been using antidepressants He added that it was “severely biased” in its evaluation of

“Their paper shows that things are much more complicated than serotonin – no surprise – and they turn around and say, ‘Look, it’s the fact that antidepressants don’t really work. Another example.” One does not necessarily produce the other. ”

Gratzer said he regularly prescribes antidepressants as a treatment option for depression and has no plans to stop prescribing based on research.

“It doesn’t change. These drugs work,” he said.

“Antidepressants are not necessarily [recommended] For everyone with depression, some may actually do better with talk therapy, but it’s certainly a tool in our toolkit and, frankly, some It is a lifesaver for patients.

Studies cast doubt on antidepressants

Studies have shown that another way antidepressants work is by desensitizing the brain to the negative emotions associated with depression, Moncrief said. In theory, it could also affect other emotions.

One of the effects that patients have reported in previous studies is “emotional numbness,” the absence of not only unwanted emotions such as depression and anxiety, but also positive emotions such as joy and happiness. she said.

“Some people may feel that’s the effect they want. But in general, people don’t want to be emotionally numb. Anyway, not for a long period of time. People. might think about antidepressants,” Moncrief said.

Chris Davey, head of psychiatry at the University of Melbourne, said in an email that undermining confidence in treatment for people with depression can be “extremely harmful.”

“People quit drugs suddenly without supervision,” he said.

Davey said he is concerned that the paper has reduced treatment options that are incredibly beneficial for some patients.

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“this [research] There is no difference in treating depression. I want people to realize that depression is a very complex condition and there are no simple explanations,” Davey said.

“Everyone should know that improving their diet, exercising more, and paying attention to sleep can help. Everyone should have access to psychotherapy. For people, we think about medicine.”

Gratzer has developed new methods of delivering psychotherapy, new drugs, and Ketamine.

Ketamine, the first general anesthetic drug approved in Canada in the 1960s, is for medical or veterinary surgery and is also a psychedelic party drug sold on the illegal market. It is also increasingly being used as a low-dose, effective, fast-acting treatment for depression. Repair brain synapses destroyed by stress.

“There is an understanding that certain life experiences may be more relevant, and that’s why research is so active. Perhaps we’ll find out that depression isn’t one disease after all,” says Gratzer. said Mr.

“As is often the case with mental health care, these are early stages.”