OPINION: Dr. Mimi Winsberg, a Stanford-trained psychiatrist and chief medical officer of withbrightside, writes about 'the misconception of depression as a single disease, along with the prevalence of one-size-fits-all prescribing practices.'
Last week, in a groundbreaking paper in the journal Molecular Psychiatry, authors Joanna Moncrieff and colleagues debunked the theory of depression as a chemical imbalance of serotonin, concluding in their meta analysis of related scientific literature: “There is no evidence of a connection between reduced serotonin levels or activity and depression.”
The link between brain chemicals and depression originated in the 1950s when doctors treating tuberculosis patients with Iproniazid observed that patients receiving the drug underwent a sudden and dramatic improvement in their mood symptoms. Separately, in 1954, another group of patients were prescribed the drug Raudixin to treat high blood pressure and they, in turn, experienced a sudden onset of depression; many also became suicidal.
What has been certain for well over a decade is that the monoamine theory of depression is oversimplified at best. If researchers had to sum up the relationship of serotonin to depressive symptoms, the answer would be “it’s complicated.” And the question of how serotonin levels relate to depressive symptoms is a separate question from whether SSRIs actually help alleviate symptoms of depression.
To qualify for the diagnosis, people must have one of two primary symptoms and at least five out of nine total symptoms. Many of these symptoms are bivalent — meaning they can present as one of two extremes. So a symptom of disrupted sleep might mean trouble falling asleep, or sleeping too much. Same is true for appetite.
The widespread misconception of depression as a chemical imbalance may be less of a problem than the misconception of depression as a single disease, along with the prevalence of one-size-fits-all prescribing practices in which millions of patients are prescribed an SSRI that may be suboptimal for their symptom presentation. For some patients with some symptoms, serotonin activity may play an important role.
France Dernières Nouvelles, France Actualités
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