Research, Technology

Causes of Depression: Is the "Chemical Imbalance" Theory True?

Among the many dangerous diseases, depressionoccupies a special place. The devastating condition that sufferers face is a serious threat to life. And although depression is not a contagious disease, more and more people are getting a disappointing diagnosis. As the most popular “chemical imbalance” theory goes, depression disrupts the production of a number of neurotransmitters, including serotonin, which is responsible for our ability to “enjoy sunsets.” Surveys conducted by American researchers have shown that at least 90% of the population considers the cause of depression to be a violation of the production of serotonin in the brain. However, a new review of scientific research casts doubt on the popular "chemical imbalance" theory.

Is depression a disease of the twenty-first century? No matter how!

“Depression is the worst disease you can catch”, - with these words, Stanford University professor Robert Sapolsky begins one of his lectures on the biology of human behavior.

Content

  • 1 How depression manifests itself
  • 2 Chemical imbalance theory
  • 3 Serotonin Wars
  • 4 Treating depression
  • 5 Criticism of the meta-analysis
  • 6 Conclusions

How depression manifests itself

That a person is capable of losing joy andthe will to live, has been known for more than a century, but the term “depression” itself arose in the 19th century. Before him, the disease was called "melancholy", which in Greek means "black bile". Interestingly, the earliest references to the disease are found in the ancient texts of Egypt, Babylon, China and Mesopotamia.

Fight melancholy at that time with leeches,starvation, ice water and electric shock. Why, it often came to exorcism, so the treatment of depression for a long time remained extreme.

With the development of medical science, the reasonsthe onset of depression became clearer, however, as did the disease itself. But despite the advent of antidepressants and other treatments, many still see depression as a sign of laziness and weakness. Such an attitude, as you probably understand, aggravates the well-being of patients and leads to their stigmatization.

Depression is destructive and can lead to death

One of the symptoms of a depressive disorderis constant fatigue and bad mood. In severe cases, patients may not be able to simply get out of bed. Sleep disturbance, lack of appetite, and feelings of powerlessness and guilt can lead to suicidal thoughts, the most dangerous symptom of all.

As he writes in an article for Skeptic magazinepopularizer of science Michael Shermer, at some point the line between thoughts and actions is erased. Weeks and months of thinking about death as a salvation at some point become an action. Alas, depression is no less dangerous than cancer, diabetes and cardiovascular disease.

Depression symptoms
Loss of interest and joy in life, guilt,sadness and despair are considered major markers of depression. You can talk about the presence of the disease when the symptoms have been present for at least two weeks (or more). And since depression is the fourth leading cause of disability in the world, you should not delay a visit to the doctor, especially when thoughts of suicide appear.

If you have symptoms of depression, be sure to see your doctor

According to the World Health Organization(WHO), worldwide, more than 264 million people of all ages suffer from depression. The most popular treatment for depression is antidepressants, the effectiveness of which I talked about recently.

Chemical imbalance theory

There are several theories for the origindepression. So, in 2018, a team of scientists from the University of Toronto found that depression affects physical health and is associated with diseases such as arthritis and migraines. Moreover, over the years, patients have increased inflammation not only in the brain, but throughout the body. The full text of the scientific work can be found here.

The most common theory of depressionindicates a "chemical imbalance" in the brain, and antidepressants are mainly used in the treatment of SSRIs (selective serotonin reuptake inhibitors). Medication treatment for depression is accompanied by a variety of psychological approaches, including evidence-based cognitive behavioral therapy.

Scientists are increasingly questioning the chemical imbalance theory of depression

Recently published in the journal Molecular Psychiatrya systematic review of 17 large studies challenging the serotonin theory of depression. According to the authors of the work, there is still no clear evidence that the level of serotonin or its activity is responsible for the development of depression.

But what follows from this? Do millions of people really need to give up drug treatment? Even more questions are raised by the fact that depression can manifest itself in a variety of ways.

The authors of the review note that the popularity of the ideaThe chemical imbalance may be related to increased consumption of antidepressants. Thus, the number of prescriptions for drugs has increased dramatically worldwide since the 1990s. By 2005, advertisements for SSRI antidepressants flooded magazines, talk shows, and television, generating multibillion-dollar profits for the creators of the joy pills.

More about depression: Are antidepressants really bad for your health?

Serotonin Wars

After the release of the new review, the media literally exploded: a huge number of headlines says that serotonin theory of depression has no scientific basis. Which is actually somewhat odd (especially if you're in treatment for depression like me).

The new work, the first of its kind, presentsis a comprehensive overview of the evidence for depression and its treatment. The results showed that "there is no evidence of an association between decreased serotonin levels and depression." Strong statement, right?

Are antidepressants really a panacea?

Research on serotonin receptors and itstransporter (the protein most antidepressants target), found weak and inconclusive evidence suggesting higher levels of serotonin activity in people with depression. Widespread use of antidepressants is considered as a likely cause, the authors of the meta-analysis write.

The next step for scientists was to studystudies with a large sample of patients (about tens of thousands of people). It turned out that the consequences of stressful life events have a strong influence on the risk of developing depression - the more such events a person experiences, the higher the likelihood that he will fall into depression.

Do you want to be the first to know about the results of scientific research? Subscribe to our channel in Telegram - so you definitely won't miss anything interesting!

It follows from this that the risk ofdepression is associated mainly with the environment. Which, by the way, is quite controversial, since depression can be a hereditary disease. The truth is most likely somewhere in the middle. And, as neuroscientist Robert Sapolsky has repeatedly said, Human health is influenced by both genes and the environment.

Treatment for depression

Three consecutive decades of mainstream treatmentdepression are antidepressants, the use of which has increased dramatically throughout the world and is unlikely to change in the foreseeable future. So, in England they are prescribed to every sixth adult, and previous studies confirm the serotonin theory of depression.

Most depression is treated with antidepressants.

The fact is that antidepressants from the SSRI grouptemporarily increase the availability of serotonin in the brain, but this does not necessarily mean that the cause of the disease is a chemical imbalance, the researchers explain.

In the new meta-analysis, the authors also point toplacebo effect: drug trials have shown that antidepressants are hardly any different from pacifiers when it comes to treating depression. Moreover, studies of serotonin production show that there is either no difference between people with depression and people without depression, or serotonin activity is actually increased. This means that SSRIs can be contraindicated people with depression.

You can read more about when to see a doctor and how to cure depression here, don't miss it!

Sounds convincing, but the results of a majora 2018 study showed that antidepressants are more effective than placebo and have been successfully used to treat depression in adults. At the same time, the effectiveness of various drugs varies from small to moderate.

Criticism of meta-analysis

Most likely, after the publication of the meta-analysis, manywant to stop taking medication. According to the authors of the review, "People should be aware that the theory of chemical imbalance may be wrong." But what about those who are already taking antidepressants?

Drug treatment is strictly under the supervision of a psychiatrist

According to psychiatrist and science journalist Viktor Lebedev, the news that serotonin has nothing to do with depression greatly exaggerated. This is especially noticeable in works thatmeta-analysis was not included (and there are actually a lot of them). In his Twitter, Lebedev notes that the review does not indicate the severity of depression, and the conclusions are drawn on the basis of 17 studies (which is clearly not enough for a sensation).

The study analyzed the metabolism of serotonin inbrain by the content of its metabolite in plasma and cerebrospinal fluid. No relationship was found between metabolite concentration and depression. And it seems to sound good, but in reality it may not mean anything at all, writes a practicing psychiatrist.

Moreover, the authors of the review ignoredthe clinical efficacy of drugs acting on the basis of serotonin and "thrown a lot of rather controversial conclusions about the work of the serotonin system of the brain without taking into account the real picture of the disease and its course."

More on the topic: New blood test can diagnose depression and bipolar disorder

Depression takes away the will to live

On the whole, Lebedev sees no clear arguments against the serotonin theory. In addition, depression itself manifests itself in different ways, which means that it is necessary to study each of its forms. As you can see Not all research is useful.

findings

And here is perhaps the most interesting:there are many studies confirming the effectiveness of antidepressants from the SSRI group. However, there is no consensus on depression and its treatment among doctors and scientists today. Let's hope that further research into depression, its origin and treatment will dot the i's.

As for the new meta-analysis, its authorsRemind them not to stop taking antidepressants abruptly. Otherwise, the patient's condition may worsen due to the "withdrawal syndrome". Recall that mild forms of depression respond well to treatment without drugs, but more severe cases without antidepressants, alas, cannot be cured.

You may be interested: Scientists have found a way to block depression and stress in the brain

Depression can be dealt with. The main thing is to ask for help in time

Many people think that antidepressants are like drugs that you can't get off of. But in fact, the beginning of taking drugs (as well as the end) passes strictly under the supervision of a psychiatrist. For example, in my case, antidepressants werescheduled three months after the first visit. Thanks to qualified help, I was able to get out of a difficult condition and now, as Sapolsky says, I enjoy sunsets.

It is important to understand that medication will notlast forever, and the attending physician will provide the patient with the necessary support and prescribe the timing of drug withdrawal. As a rule, the completion of treatment lasts several months (at this time it is advisable to attend psychotherapy sessions).

And the last:a study published in JAMA Network Open showed that public stigmatization of depression has dropped significantly. And this is good news, because without the support of loved ones, defeating the disease is much more difficult. Stay healthy and don't forget depression is treatable!