One is 6 adults are on some form on anti-depressants and the number of people of SSRI’s (serotonin reuptake inhibitors) is on the rise with each passing year. The theory for decades has been that low serotonin levels lead to depression; therefore increasing serotonin levels often helps people with depression.
This latest review paper published in the journal Molecular Psychiatry concludes that after decades of research, involving over 100,000 patients, that there is no substantial evidence that low serotonin levels are responsible for depression.
“The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.“ – Moncrieff J et al 2022
Other studies have found that stressful life events or trauma are sometimes associated with depression and suggest that talk therapy should be the first line of treatment for some individuals with depression before jumping into fixing chemical imbalances such as serotonin levels.
Despite this study, it is not recommended that people discontinue their use of anti-depressants as SSRIs have been shown to be life changing in many people.
An analogy is that acetaminophen (Tylenol) can be effective for treating headaches, yet we don’t think that headaches are caused by low acetaminophen levels. The cause of headaches may be stress yet it is often relieved by acetaminophen.
Ibuprofen (Advil) can reduce inflammation, but we don’t think that inflammation is caused by low levels of Ibuprofen in the body. The cause of inflammation is complex but one reason is trauma to a tissue.
Let’s just say, medicine still has a long way to go in understanding and effectively managing depression, pain and inflammation.
So what’s wrong with taking SSRIs, acetaminophen and ibuprofen on a regular basis?
Well, everything has the potential for side-effects. Could the medicine actually worsen the malady?
“Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.” – Moncrieff J et al 2022
“…the use of anti-inflammatory drugs was associated with increased risk of persistent pain, suggesting that anti-inflammatory treatments might have negative effects on pain duration.” – Parisien M et al 2022
“Opioid-induced hyperalgesia (OIH) occurs when opioids paradoxically enhance the pain they are prescribed to ameliorate.” – Wilson S et al 2021
Let’s just all agree that depression, inflammation and chronic pain are all complex and attempts at “fixing” those conditions simply by correcting chemicals in the body is probably short-sighted. I certainly do not propose to have the magic answer either!