The debate over how antidepressants work is putting millions of people at risk

almost 10 percent of all Americans Will experience symptoms of depression every year. One of the common forms of treatment involves a combination of therapy and antidepressants. According to the CDC, approximately 13 percent of Americans over the age of 18 Was taking antidepressants between 2015 and 2018. The most commonly prescribed form of these is called selective serotonin reuptake inhibitors (SSRIs), which have been developed to alter serotonin flow in the brain.

I am one of the millions of people who take a medication called the SSRI—sertraline—to manage symptoms of anxiety, depression, and obsessive compulsive disorder. Before I spoke to a psychiatrist about taking this drug, I dealt with feelings of impending doom and dread, as well as dozens of intrusive thoughts and feelings every minute. Basically, it’s like having your own heckler yelling at you all day long. Taking medication has been extremely helpful to me, as has been to many others.

And that makes it even more strange to recognize that, as with many other complex diseases, researchers are still not sure what exactly causes depression, and whether serotonin is one of the main culprits. In the 1960s, scientists critically discovered that certain drugs used as sedatives helped ease depression. Gerard Suncora, a Yale University psychiatrist and director of the Yale Depression Research Program, told The Daily Beast, since these drugs act on the serotonin system, it is “a very simplistic idea that low levels of serotonin lead to depression. “.

Most scientists now adhere to the idea that there are many Genetic, social and biological contributors to depression, And yet the idea of ​​a chemical or serotonin imbalance has stuck in the popular zeitgeist. It remains largely due to its prominent place in drug advertisements. prozac In the late 1980s—even when psychiatric research was already changing its approach.

This brings us to the current debate around SSRIs. Most neuroscientists, psychiatrists, and physicians who study and treat depression agree: How do antidepressants like SSRIs work? as well as cognitive therapy. With the right treatment, remission rates for depression can range between 5 and 50 percent, There is no question that people like me are getting real relief thanks to these medicines.

But if depression isn’t linked to serotonin levels as much as we previously thought, it raises the issue that we don’t really know how SSRIs work and why they might help some depressed people. There are several promising theories that suggest they play a role in mediating gut bacteria, helping the brain to grow new cells and require itself, beyond simply raising serotonin levels to larger and more complex physiologic functions. to alter. But none of these theories have been proven yet.

The ensuing discussion boils down to an all-out debate, pitting mainstream psychiatry against a minority of researchers who don’t think antidepressants actually work.

every few years, a new field of studies falls out of the shadows, supposedly “debunking” the notion of the serotonin hypothesis. These studies suggest that depression is either the result of social factors or caused by traumatic experiences, and that antidepressants either do not work, numb feelings, or actively harm. Rather than medication, he believes depression is better treated only through therapy.

,The ensuing discussion boils down to an all-out debate, pitting mainstream psychiatry against a minority of researchers who don’t think antidepressants actually work.,

Disputes between competing academics and researchers are just as intense and vicious as any other battle on the Internet. Twitter controversy, Op-Aids for Think-TanksAnd the news outlet itself, The shady history of the pharmaceutical industry continues to raise doubts about the efficacy of antidepressants. When Antidepressant clinical trials did not bear the results that were expected, Drug companies essentially buried the evidence and biased the record in favor of antidepressants – which has increased mistrust of these drugs and their manufacturers.

fuel a fire, a Recent Review Study published in the journal molecular psychiatry re-evaluated data from past decades on serotonin levels in depression, finding no evidence of a link between the two and treating it as evidence that SSRIs do not work or work by simply blunting emotions. this finding Criticized by many psychiatrists and physicians-The study also didn’t analyze whether antidepressants work—but with Support from the study authors, right wing media Pushed this message out anyway.

University College London psychiatrist Joanna Moncrieff led, “If there are benefits, I would say they are due to this feeling numbing effect, and otherwise, the evidence that shows there are very small differences between drugs and a placebo.” ” study, told The Daily Beast. “Antidepressants are drugs that alter the normal state of your brain that, generally, are not a good thing to do. [that] on a long-term basis.”

In what is being said, Moncrieff himself is an influential figure.severe psychosis“The Critical Psychiatry Network, which Moncrieff co-chairs, describes the movement on its website: “This presents a scientific challenge to claims about the nature and causes of mental disorder and the effects of psychiatric interventions.” Researchers associated with this movement advocate against using drugs for mental health conditions, and even COVID-19 conspiracies fueled,

If depression is caused by the interaction of stressful events and biology, as some argue within the Critical Psychiatry Network, Sancora does not follow, it simply means that antidepressants do not work. “I just don’t follow logic,” he said.

Four other experts who spoke to The Daily Beast specifically pushed back on Moncrieff’s findings, specifically emphasizing that his and his team’s paper critically conflicts with the two hypotheses under the serotonin theory. . There is the chemical imbalance hypothesis that is very well known, which suggests a decrease in the serotonin neurotransmitter in the body leads to depression. But according to Roger McIntyre, professor of psychiatry and pharmacology at the University of Toronto, “the notion of a chemical imbalance in your brain has never been put forward as a coherent, comprehensive, evidence-based proposition.”

Instead, the more prevalent serotonin hypothesis that psychotherapy takes seriously and which McEntry and others argue is supported by evidence, is that a dysregulation of the body’s entire serotonin system contributes to clinical depression. These include problems with the amount of receptors available to bind to serotonin, how cells fire, and many other disruptions at the biomolecular level. He argues that when it comes to making the grand claim that there is no evidence for the involvement of serotonin in depression, Moncrieff gets it wrong.

,The notion of a chemical imbalance in your brain has never been put forward as a coherent, comprehensive, evidence-based proposition.,

, Roger McIntyre, University of Toronto

Also, not knowing the mechanism of a drug is not a good enough reason to stop its use if it is helping people. “We are very convinced that SSRIs work for depression,” Tyler Randall Black, a child and adolescent psychiatrist at the University of British Columbia, told The Daily Beast. “There is evidence that shows us they work, but not why they work.” McEntry pointed to the fact that We Don’t Even Fully Know How Tylenol WorksDespite the fact that it is one of the most widely used pain relievers around the world. Tylenol also affects the brain in unexpected ways—though it numbs social or psychological painThere is no ground to remove it from the market.

Condemning these drugs can have unintended consequences because therapy is often unavailable, making SSRIs the only accessible option. “The demand for mental health care far exceeds the access available,” Sunakora said, noting that many Americans wait months to see a good cognitive behavioral therapist. Additionally, making a sudden decision to stop taking SSRIs can be dangerous: one in five patients Those who do will experience flu-like symptoms, insomnia, incontinence and other symptoms that can last up to a year.

While psychiatrists who spoke with The Daily Beast emphasized that the serotonin hypothesis was only one way to explain a complex disorder like depression, they highlighted that it has fueled downsides over time. “The story of ‘chemical imbalance’ negatively affected patient decision-making and patient self-understanding,” Awas Aftab, a psychiatrist at Case Western Reserve University in Cleveland, Ohio, told the Daily Beast.

,The demand for mental health care far exceeds the available access.,

, Gerard Sancora, Yale University

Phil Cowen, a psychiatrist at the University of Oxford in the UK, told The Daily Beast that socioeconomic status is a contributing factor to depression, leading people in the critical psychiatry field to believe that it affects patients “by doctors and industry.” gives power to”. Ironically, this ignores the millions of “experienced people” who were helped through antidepressants.

Still, the million dollar question remains: How do SSRIs work? Aftab explained that a new major hypothesis is that they encourage formation of new neurons and new connections between neurons inside the brain. The hippocampus, a seahorse-shaped region of the brain that is important for memory and learning, shrinks and loses neurons when depression hits. SSRI thinks Stimulate the production of neuronal stem cells, which integrates into the hippocampus to restore its function and structure. Other studies suggest SSRIs help the brain reconnect connections that cause the clinical symptoms associated with depression.

He also noted that SSRIs may work through different mechanisms in different individuals, so treatment may have to be more customized on a case-by-case basis.

And more specific, personalized treatments may require psychiatrists to be more honest with their patients about what we know and don’t know about these drugs, versus groping a simplistic (and downright wrong) explanation.

Black already tries to do this with his patients: “I say we know for sure that it affects serotonin, but we don’t know how it changes your brain and we don’t know. That you are initially deficient in serotonin.” He found that this open discussion on what we know so far about therapy and drugs pays off in the long run, and that many of his patients still choose to take antidepressants as part of their quest to help prevent depression. To find out what works best for them.

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