A UK-based research team debunked the low-serotonin theory as the primary cause of depression last month. It also challenged the use of antidepressants even though patients suffering from depression have said that pills are ‘lifesavers’.
While psychiatric science is evolving fast, it is also increasingly leaving patients with more questions than answers. On one hand, the recent study found ‘no evidence’ of chemical imbalance leading to depression, and on the other, a vast research study – published only this year – found that antidepressants are indeed effective in relieving acute depression in adults.
At a time when stigma continues to shroud the topics of ‘depression pills’ or clinical antidepressants, conflicting research studies have its own consequences on those who have either been diagnosed of chemical imbalance or taken these medicinal drugs.
Stress of a diagnosis
“Any health diagnosis comes at a cost, and that cost is mental stress. Now when that diagnosis is about having a mental illness, instead of physical, the stress doubles because it is battling a war on several fronts. When I was told that I have a lack of a good dose of serotonin, I didn’t understand anything at first,” said 26-year-old Ranjini Gautam, an engineer working at an MNC in Bengaluru.
After her initial skirmish of acceptance, began the battle to convince her kin about her diagnosis. “Psychiatric science is ridiculed everywhere. You take years to accept yourself and your mental diagnosis. Then a study hits you that may be your diagnosis was wrong all this while,” she said, adding that she is well aware that such research findings surface from time to time.
Gautam was first prescribed antidepressants when she was 22 years old and has been taking them almost regularly for the past four years. “Magical” is how she described its effect.
She said she considered herself lucky that she comes from a background where she understands science, and what the terminologies would mean to a layman.
“You know, I am still someone who is from a science background, so I cannot even begin to imagine what one, who is absolutely layman in terms of all this, may go through. It’s a dilemma to constantly read and move on, but still rely on what your own set of doctors say,” she rued.
For 30-year-old Prableen (name changed to protect identity), antidepressant pills have been a saviour too.
When therapy hit a wall
A junior school teacher based in Delhi, Prableen has been taking therapy sessions for over three years. But it was only after she started taking SSRIs (selective serotonin reuptake inhibitor) that she felt a significant change in her life.
SSRIs are a class of drugs that are typically used as antidepressants as part of the treatment of major depressive disorder, anxiety disorders, and other psychological conditions.
“Something was missing in my therapy session – That feeling of “better” was always fleeting. A session usually lasts for 45 minutes to an hour and a day or two following that session, you feel more or less fine, but you are still in the constant loop of gloom. It’s like a cloud!,” she described.
It was a year ago that she finally decided to take the plunge of visiting a psychiatrist and who eventually prescribed her medication for depression.
“These pills were life-saving. I was on the verge of giving up on myself and considered suicide at one point. I really had no idea of how to emerge from this gloom of sorrow, which more often than not had no reason at all. It was always just there. Once I started taking these serotonin pills, I found life in me. I started feeling like a happy child again,” she stated.
“So now that I read that low serotonin theory has no evidence, I am confused, even though I may not question my treatment, but I am in two minds about myself,” she added.
Like Prableen, 32- year-old Pawan has a similar story to share. “I have been going to therapy for almost two years and even though it went well, I was not getting the desired result. At Vimhans Delhi, I was prescribed very basic SSRIs and also mild medicines that helped me to put myself to sleep. Within a month or two, I got better. But my question to my therapist and psychiatrist was if it was because of medicines or the fact that I was, in general, doing better in life,” he said.
“But I decided to continue my medicines because I felt better and the introduction to medicines kind of coincided. I still routinely take these pills and I can say that I do feel better and I don’t have any physical activity to claim benefits from other routes,” said Pawan.
Stigma against ‘saviour’ drugs
While society has slowly begun discussing depression and the necessity of its treatment, what usually is recommended by people is therapy and not medicines for the fear of “addiction”, despite psychiatric science proving the belief to be a stigma.
“As a victim of that stigma, I was gaslighting myself against using medicines for depression for a good amount of time. I was super cautious. I was fearful of the same so-called addiction. I stopped myself from medication for almost two years,” Pawan said.
Though initially, he had reservations about the prescribed medication, he started understanding its benefits soon.“But it was only after going into proper dosage, I started sleeping well. Since I have taken medication, my sleep has become better. I used to sleep for a few hours and that wasn’t sound. But that has changed. However, I am constantly haunted by the thought that I should not get used to those tablets. It’s always there,” he said.
His doctor also vouched for the fact that the only thing that had changed was his medication.
The psychiatric research led by Dr. Joanna Moncrieff at the University College London is a systematic umbrella review of 17 studies published in Molecular Psychology on July 20. It looked at the decades-old theory that depression is caused by low serotonin, and found there was “no consistent evidence” of “an association between serotonin and depression.”
In the study, Dr Moncrieff led research has suggested that antidepressants are ineffective at treating depression — and have largely worked as a placebo. The research paints a compelling picture that depression isn’t caused by low serotonin alone.
The “serotonin hypothesis” of clinical depression is almost 50 years old.
Meanwhile, in February 2022, another international study — a meta-analysis pooling results of 522 trials covering 21 commonly-used antidepressants and almost 120,000 patients — uncovered a range of outcomes, with some drugs proving more effective than others and some having fewer side effects.
An international study, by a team of researchers of Britain’s Oxford University, did a meta-analysis pooling results of 522 trials covering 21 commonly-used antidepressants and almost 120,000 patients — uncovered a range of outcomes, with some drugs proving more effective than others and some having fewer side effects.
The study, published in The Lancet medical journal, found some differences in the effectiveness of the 21 drugs.
In general, newer antidepressants tended to be better tolerated due to fewer side effects, while the most effective drug in terms of reducing depressive symptoms was amitriptyline, discovered in the 1960s.
Some well-known medicines — such as the selective serotonin reuptake inhibitor (SSRI) fluoxetine, sold under the Prozac brand — were slightly less effective but better tolerated.