This is the first of three posts based on the work of writer Johann Hari, whose search for answers about his own depression led to his book Lost Causes: Uncovering the Real Causes of Depression–and the Unexpected Solution. Most of us are familiar with the standard explanation for depression: depression is the result of a chemical imbalance in the brain, specifically a deficiency of the neurotransmitter serotonin, the “feel good” chemical. This has been the dominant explanation for about the past 30 years, since SSRI antidepressants first came on the market. The idea is that some brains have too little serotonin and this makes you feel sad, lethargic, pessimistic, and generally hopeless. You interpret everything in a negative way. Even minor obstacles seem insurmountable. However, according to the serotonin model, this gloominess is only a matter of perspective. Once you balance your brain chemistry by taking a drug that boosts serotonin back to it’s normal levels, your world looks brighter. However, we’ve long known there have been some problems with this model. First, it takes about six weeks for an SSRI to start working. If it were simply a matter of boosting serotonin levels and an SSRI boosts serotonin levels quickly, shouldn’t people start feeling better right away? There have been a number of attempts to explain this, some of which are rather convincing. For example, SSRIs might actually cause a downregulation in specific serotonin receptors that limit serotonin production. Fewer of these receptors means the brain can maintain more serotonin in the synapses, which makes you feel better. And this may take six weeks to happen. Another explanation is that the real action takes place in the hippocampus. Higher serotonin levels are also associated with more neurogenesis in the hippocampus, an area of the brain involved in creating long-term memories. So serotonin might be driving a secondary effect that has a more direct impact on depression. There is a more troubling explanation though: maybe SSRIs never worked that well to begin with. Harvard professor Irving Kirsch looked into the original research on SSRIs and found that much research showing SSRIs were hardly effective at all was discarded. Many of these studies were funded by pharmaceutical companies looking for their next wonder drug, and they wanted research showing these drugs worked. Indeed, more recent research has shown the effectiveness of SSRIs sliding ever downward and now they appear to be only slightly better than placebos. Furthermore, we’ve known for a long time that psychotherapy can improve depression symptoms, often more effectively than SSRIs. Clearly, your perception and interpretation of events in your life makes a difference if interventions like cognitive behavioral therapy can reduce depressive symptoms. And sometimes, we have good reason to be depressed. The loss of a loved one, a job, or a marriage often cause depression, yet we don’t assume a depressed person whose spouse has just died is suffering from a serotonin deficiency. What if most cases of depression have similar explanations that we aren’t recognizing? More on that in the next part.
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