A controversy in the scientific community over a recent claim that antidepressants may be ineffective in treating depression has highlighted the difficulties in understanding mental health conditions.
One of the prevailing theories currently focuses on serotonin. Depression has been linked to a deficiency in the molecule involved in transmitting emotions to the brain.
Claims that depression is unrelated to a chemical imbalance in the brain related to serotonin, casting doubt on the need for antidepressants, have drawn strong backlash.
A July study by psychiatrists Joanna Moncrieff and Mark Horowitz in the journal Molecular Psychiatry concluded that there was no proven link between a lack of serotonin and depression.
The authors said it challenged the underlying assumption behind the use of antidepressants, which were primarily designed to alter serotonin levels, and shattered a theory that served as the framework for research for decades.
The study is based on several previous publications, but quickly drew criticism – particularly the presentation by Moncrieff, who is known for her skepticism about biological explanations for depression and her radical stance on the pharmaceutical industry.
“I broadly agree with the authors’ conclusions about our current efforts, although I lack their rock-solid certainty,” psychiatrist Phil Cowen told the Science Media Center website.
“No psychiatrist” would share the view that a complex condition like depression “results from a deficiency in a single neurotransmitter,” Cowen added.
– “Mainstream” Psychiatry –
Some colleagues have questioned the methodology, which measured an indirect trace of serotonin rather than taking direct measurements of the molecule.
Moncrieff, who wants to break with what she calls “mainstream” psychiatry, believes the serotonin theory still holds an important, if less prominent, place in the industry.
“Even though leading psychiatrists began to question the evidence that depression was linked to low serotonin levels, no one has shared this with the public,” the British psychiatrist wrote on her blog.
The link between depression and serotonin is firmly entrenched in popular imagination. French author Michel Houellebecq titled his 2019 novel, in which the main character is depressed, ‘Serotonin’.
Moncrieff’s subversion of the serotonin theory to argue against current antidepressants, going beyond the conclusions of her own study, has drawn the most vehement criticism.
Swiss psychiatrist Michel Hofmann told AFP their study is “serious” and contributes to expert debates about depression.
“But I don’t think it’s an article that should have any impact on antidepressant prescribing in the short term,” he said.
Moncrieff has warned that antidepressant treatment should not be stopped suddenly. But for them, the benefit of an antidepressant regimen is dubious if it’s based on a discredited theory.
However, many emphasize that the effectiveness of treatments has been scientifically studied regardless of the primary cause of depression.
The drugs used to treat depression “are typically numerous and ultimately, in most cases, we don’t know exactly what makes a treatment effective,” Hofmann added.
Debates about the role of serotonin only illustrate how difficult it is to understand the biological and social workings of an illness as complex as depression.
The challenges are forcing researchers to move away from models that are inherently incomplete.
“We are still at theories and continue to search and test models against each other,” said Hofmann.
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