depression-part-2

Depression: Part 2 - Medications

Humans have always found substances to improve health and heal illness. Modern medications are an extension of that. Unfortunately, massive corporations with limited regulation are now in charge of the complex research and chemical design of these products. We don't have trusted traditional remedies, we have brand new substances and a medical-psychiatric profession who follow the leaflets that promote the drugs.

Prior to the 1960s, depression was dealt with informally through rest, activity and social changes—and formally by psychiatrists in sessions involving analysis and counseling. Severe cases were referred to institutions where powerful drugs and dubious procedures (electroshock and lobotomy) were imposed. In the late 60s, some researchers claimed that people with depression showed lower levels of the neurotransmitter serotonin.

Neurotransmitters are just that—substances that transmit electrochemical signals from one neuron (brain cell) to another through the tiny gap (synapse) between them. After a neurological transmission happens, neurons regularly re-absorb excess serotonin. Pharmaceutical industry researchers hypothesized that if the serotonin was prevented from being re-absorbed, more of it would remain and might alleviate depression. These “anti-depressant” medications were classified as Selective Serotonin Re-uptake Inhibitors (SSRIs).

Before this time, emotional problems were dealt with—person-to-person—with family members, friends, doctors, and in the last 100 years, specialists called psychiatrists. These problems were generally assumed to come from the stresses of adult life or a dysfunctional childhood. In the 60s a new paradigm began to emerge—our troubles are mostly biochemical, and that our problem biology is a result of our given genetic structure. This theory implied that we are “born deficient,” that is, have a life-long “genetic” illness. It concluded that the chemical “imbalance” can only be improved with a permanent subscription of drugs.

In the decades after that new theory emerged, psychiatrists spent less and less time with patients as they shifted to quick drug prescription visits. The “bible” of psychiatry and psychoactive drug prescription, the Diagnostic and Statistical Manual of Mental Disorders (DSM), was introduced in 1952. This small 32-page pamphlet has now grown to a massive 1377 pages, with list-based diagnoses that psychiatrists can easily link to the recommended pharmacological medications. In seven decades, pharmacy companies have grown like the DSM into massive, billion-dollar entities.

During this time, however, therapists like myself witnessed clients come out of depression through their own efforts—something that would be impossible if it were a genetic condition. We also witnessed how some clients, overwhelmed with depressive feelings did seem to get relief from taking SSRIs. We also saw many, many of them struggle with horrid withdrawal symptoms when they wanted to stop taking them.

In the last few years, however, something changed. We began to see headlines like this:

Antidepressants don't make people any happier, major study claims

Have we been treating depression the wrong way for decades?

Depression is probably not caused by a chemical imbalance in the brain—new study

Chemical Imbalance Theory of Depression Hugely Profitable—and It's Not Even True

Then, in 2022, a major study appeared in Molecular Psychiatry, a highly respected peer-reviewed scientific journal published by Nature. This deeply thorough study, The serotonin theory of depression: a systematic umbrella review of the evidence, by Joanna Moncrieff, et al, from University College London (UCL) found no

basis for the chemical imbalance theory of depression.

Here are three sections that explain the results. I have included them in full (italics mine) because they provide such a profound summary.

Our comprehensive review of the major strands of research on serotonin shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity. Most studies found no evidence of reduced serotonin activity in people with depression compared to people without.

The chemical imbalance theory of depression is still put forward by professionals, and the serotonin theory, in particular, has formed the basis of a considerable research effort over the last few decades. The general public widely believes that depression has been convincingly demonstrated to be the result of serotonin or other chemical abnormalities, and this belief shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood. The idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue antidepressant medication and may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.

This review suggests that the huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression. This is consistent with research on many other biological markers. We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.

There you have it. Depression is not genetic. Depression is not a life sentence. There is no permanent imbalance that compels you to a lifetime of medication.

Are Anti-depressants Ever Necessary?

I have known people who appear to benefit from SSRIs and others who have had terrible reactions, including suicide. There are many different SSRIs, and the biochemistry, trauma load, and life situations of everyone are different. No medication is a one-size-fits-all remedy.

If, as the research concludes, there is no convincing evidence that serotonin elevation chemically improves depression, why does it sometimes appear to work? The childhood origin theory of emotional dysfunction proposes that emotional pain (trauma) is held beyond consciousness to allow our systems to function—and if that mechanism falters, the pain leaks out in all the symptoms of emotional illness. When this happens the only options are to, 1) block the pain, or 2) process, release and resolve it. In other words, you either use some kind of “painkiller” or you let the pain through and transform it.

When SSRIs appear to work—bring the pain down—they are acting as a form of painkiller. If SSRI manipulation of serotonin does what is claimed—altering the transmission of neuronal information—then it is reasonable to assume that it may dull the emotional pain signal and thereby give some people relief. And that's exactly what appears to happen to every person I've known who experienced some benefit. However, since some SSRIs make the symptoms worse it's impossible to know what is happening in the brain. It is also possible that any number of other substances would provide similar symptom-blocking results.

Psychotherapy and other life-supporting activities are not quick fixes. Changing deep patterns is like turning a large boat—it takes time and the ability to hang on to the helm and not let go. These efforts, when successful, however, are more likely to be long lasting. Symptom-adjusting medications are not.

I don't prescribe medications, but for the above reasons, SSRIs may be worth considering when, in spite of other efforts, symptoms have made it impossible to function in everyday life. If that path is taken however, I strongly advise users—and their friends and family—to carefully monitor the effects for at least three weeks before assuming it is safe. The first few days are especially important because it is often early that destructive reactions appear. Some effects are so bad that people become delusional and fall into extreme negativity and self-harm with no self- awareness. Monitoring by friends and family is essential.

If SSRI use seems to help, then therapeutic approaches can be applied as well. Since no one really knows what SSRIs do to brain chemistry I believe it is reasonable to discontinue use when a person is feeling more balanced and well supported in life. Withdrawal, however, must be very carefully managed.

If SSRI's, when they work, are acting as pain blockers, then some of the emotional pain may return when the block is removed. So when a person—with the guidance of their doctor or psychiatrist—lowers their dose, a whole host of uncomfortable symptoms can appear. From the accounts I have heard, many of those symptoms are not like the original depression but more biochemical—tingling, buzzing, zapping, aching, nausea, dizziness, insomnia, etc. It is important to lower the dose very gradually, with lots of personal and health-related support. Sometimes it becomes too difficult and dose increases are necessary before another attempt. Clearly, these pharmaceutical medications are powerful.

(continued in "Depression: Part 3 - Solutions")