Low Serotonin Causes Depression? Right?

Welcome to the official Newsletter of Advanced Medical Care.

We Have All Been Told That Depression

is Caused by a Chemical Imbalance.

Specifically, when the serotonin level is low, it causes depression. It is not a personal weakness. It is not the fault of the depressed person, it's just a chemical imbalance. And as the theory goes, the solution is to take a pill that will cause an increase in serotonin. These pills are known as SSRIs. When the serotonin level goes up, the problem is solved.

Or so the theory goes.

Would it Surprise You to Find Out,

The Serotonin Theory of Depression is

Not Universally Accepted?

Some doctors and researchers dispute that serotonin deficiency is the primary cause of depression, or even a contributing cause.

In July of 2022, the journal Molecular Psychiatry published, what the authors called an "exhaustive" review of the research basis of the serotonin theory and the clinical outcomes of serotonin based treatment of depression.

Exhaustive Review: Depression & Serotonin

Not Related

Mark Horowitz, GDPsych, MBBS (Hons), PhD, of the Division of Psychiatry, University College London, UK, the lead researcher said:

"We found no consistent evidence in the main avenues of serotonin research that there is an association between serotonin and depression, and we found no support for the hypothesis that lower serotonin activity or concentrations are responsible for depression."

And Of Course, Others Disagree With This Report.

In June of this year, a group of more than 30 academics and researchers in psychiatry and psychopharmacology published their disagreement in the same journal. They claim the exhaustive review was full of flaws, and incorrect conclusions. One noted researcher is calling for the article to be retracted.

But the authors of the study that is critical of the serotonin theory are standing their ground. They insist there is no convincing evidence that low serotonin levels are the primary cause of depression:

"It's not an evidence-based statement to say that depression is caused by low serotonin; if we were more honest and transparent with patients, we should tell them that an antidepressant might have some use in numbing their symptoms, but it's extremely unlikely that it will be the solution or cure for their problem."

These researchers state that it is time for the medical community to acknowledge that the serotonin theory of depression has been disproven.

What is The Truth?

I suspect that depression is multifactorial. I do not believe there is any one single cause of depression. And that is too bad, because the medical industry, and people in general, do best when things are simple. We all like it when each problem has one cause. We attack the cause and the problem is fixed.

But life is rarely like that. The equation is never that simple. There are always multiple causes, and some causes are more important than other causes. Solving problems that have multifactorial causes requires some detective work, and treatment might be hit and miss. Based on your best educated guess, your proposed treatment might work, and might not.

For depression, I suspect that some, but not all, cases are due to serotonin deficiency. Some people receive an antidepressant and they do great. And they should keep taking their antidepressant as long as they need it.

Unfortunately, based on numerous studies, we know that half the people that get an antidepressant report no benefit. The other half do benefit to some degree or another. Some get full remission of their depression, some only get partial benefit. For the patients that get some, but not complete relief, serotonin deficiency is probably a contributing cause, but not the sole cause.

Why Is This Important For Doctors to Know?

Many doctors are overly committed to the serotonin theory. When they have a patient that doesn't respond to an SSRI, they just try 1 or 2 different SSRIs. When that doesn't work, they throw their hands up and label the patient as "treatment resistant". Because they are overly committed to the serotonin theory they don't consider any other options, and the patient suffers.

Why Is This Important to You?

If you or a loved one are fighting depression, and your prescribed antidepressant is not helping, there is still hope. Serotonin deficiency may not be the primary cause, or even a contributing cause for your depression. But there are other known causes, and other known treatments, and if you persevere, you can find help.

If My SSRI Isn't Helping,

What Are Some Other Options?

• Inflammation is known to cause, or contribute to depression. Eating an anti-inflammatory diet has been shown to reduce inflammation and depression. Supplementing omega 3s also reduces inflammation and helps depression. According to a recent study, omega 3s are quite a bit more effective than SSRIs.

• Good quality sleep is essential for health in general and reduces depression.

• Light impacts your mood and you can sit in front of special lamps for 30 minutes a day at your desk or work station to treat winter depression. For year round depression sunlight is also therapeutic and is free.

• Exercise has been shown to be more effective than SSRIs and is now recommended by some doctors as a first line treatment for depression. Exercise can be as simple as a daily walking program and has a very rapid onset of action. We now know how much exercise is needed to treat depression.

• Relationships are important, including family and friends. The time and energy we put into our relationships are a good investment. Loneliness contributes to depression and some researchers and doctors consider lost relationships as a primary cause of depression.

• Counseling: Sometimes being able to talk to somebody can be a real game changer. This could be in the form of a trusted confidante, or a health care professional. This can benefit your physical and mental health.

I prescribe SSRIs for those that find them beneficial. The options described above are some of the other tools I also utilize in my practice at Advanced Medical Care.

988 is the Suicide and Crisis Lifeline. In any crisis you can call 988 for yourself or on behalf of a friend or family member.

Take care and BE HEALTHY!

CW Jasper

September 2023

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