Category: Neuroscience

The Serotonin Theory.

I have been a sufferer of mental health for the best part of 30 years diagnosed to include depression and OCD. During this time I have tried CBT Therapy, seen a therapist, and have been given medication that has altered over the years from Prozac, Sertraline, and Mirtazapine. These drugs have literally done nothing for me other than make me feel zombified. I am now researching neuroplasticity and how hypnosis and meditation can help me heal through my own self-help therapy. So learning that some mental health disorders have nothing to do with a chemical imbalance does not surprise me. If anything dopamine the happy feeling we have when we are engaged in something we like may help us overcome disorders. “Although I joke around, if I was happy living on cloud nine, I reckon I would not have as many issues as I have now (the reason I say this is I have hit highs and lows and when I am happy without a care in the world my symptoms start to subside“).

Dopamine is a medication form of a substance that occurs naturally in the body. It works by improving the pumping strength of the heart and improving blood flow to the kidneys. Dopamine injection (Intropin) is used to treat certain conditions that occur when you are in shock, which may be caused by a heart attack, trauma, surgery, heart failure, kidney failure, and other serious medical conditions. Dopamine is a type of neurotransmitter. Your body makes it, and your nervous system uses it to send messages between nerve cells. That’s why it’s sometimes called a chemical messenger. Dopamine plays a role in how we feel pleasure. It’s a big part of our uniquely human ability to think and plan. It helps us strive, focus, and find things interesting.

Doctors are starting to rethink that ‘chemical imbalance’ does not cause depression. Psychiatry has known for some time that the “serotonin theory” of depression, the notion that too little of the brain chemical can be a cause of depression, is a decades-old hypothesis and deeply entrenched trope in society that helped promote a class of antidepressants taken by millions is wrong, says Montreal psychiatrist Dr. Joel Paris.

Montreal psychiatrist Dr. Joel Paris: “I am afraid this has something to do with the toxic relationship between industry and academia.”© Christinne Muschi for Postmedia/File “You want to know why it took so long for the truth to come out,” Paris, a professor of psychiatry at McGill University, wrote in an email. “I am afraid this has something to do with the toxic relationship between industry and academia.” Drug companies encourage doctors to prescribe often, and heavily, he said, and have “paid many academic psychiatrists to promote their products.”

Two months after a major review found no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations, and no convincing evidence of a “chemical imbalance,” the paper is still stirring controversy. Its authors say they have been ridiculed and attacked and accused of dog whistling far-right commentators who have groundlessly linked antidepressants to mass shootings. Responses from psychiatrists have been oddly contradictory, ranging from “nothing new here, of course, we knew it was never serotonin, it was never that simple” to criticisms that it’s premature to toss out the serotonin theory outright and that the authors missed some studies and interpreted others incorrectly.

Dr. Joanna Moncrieff, a consultant psychiatrist, and professor of critical and social psychiatry at University College London told the National Post. Specifically, drugs known as SSRIs, or selective serotonin reuptake inhibitors have been said to work by correcting abnormally low serotonin, a neurotransmitter that helps move messages between brain cells and that’s thought to play a role in how our brains process emotions. Moncrieff’s study didn’t look at the efficacy of SSRIs, just how likely they are to do what people have been told they do, and she’s been accused of seriously over-stepping the data. “It seems the main criticism is that antidepressants work,” Moncrieff said. “It doesn’t matter how they work. It doesn’t matter that the original idea, the original theory for how they work is unproven. They work, and that’s all that matters.”

“Contrary to any arguments or beliefs and being a sufferer for more than 30 years I know that anti-depressants make you feel zonked out, they do not allow you to function properly and make you tired and lethargic. So although I take Mirtazapine and although it is meant to be for depression, and OCD, all it does is send me to sleep, and when I wake I have to drink energy drinks to help me function during the day”.

• Canadians report struggling with anxiety, but are we really coming undone?
• Fewer than half of Canadians support assisted death for mental disorders: poll

To Moncrieff, it matters. “Because whether they work or not depends on how we understand what they are doing.” And if they are not correcting a serotonin imbalance, or reversing some underlying mechanism of depression, what are they doing? “We have to consider other possible ways that they may be ‘working,’ inverted commas, which include the fact they are drugs that change normal brain chemistry.”

The serotonin “bombshell” caused an international media frenzy, though was largely ignored in Canada, with many headlines along the lines of, “How were so many duped?” Some psychiatric opinion leaders dismissed the study as “old wine in new bottles,” arguing that no serious psychiatrist today believes depressions are due to a tidy, simple imbalance in brain chemicals or “serotonergic deficit.” Apparently, no one told the public. One survey of Australian adults found that 88 percent believe in the “chemical imbalance” hypothesis of depression. A British Columbia government website says the SSRI escitalopram “works by helping to restore the balance of a certain natural substance (serotonin) in the brain.” Forbes Health quoted a Vanderbilt University psychiatrist explaining that SSRIs like Prozac, Paxil, Zoloft, and their generic equivalents work by boosting serotonin activity in the brain. “The idea is that if you have more serotonin in your synapses (regions in the brain where nerve impulses are sent and received) the better your mood will be.”

“Here is my take on this, if someone was to give me £1m and said it was mine to do what I want and never have to pay it back, my mood would change. Serotonin also found in chocolate has done nothing for my health other than make me gain weight” If you could erase all my bad memories and heal by starting a new life so would my mental health become better. I have known for years the medication I take does nothing for me other than send me to sleep or make me really drowsy and I have been on a fair few in my time. I know if I was happy, I would see an improvement in my mental well-being without a shadow of a doubt, because I have seen for myself how my moods change.

“It may well be the case that psychiatrists have a more ‘sophisticated’ understanding of the role of serotonin than the lay public,” Moncrieff and one of her co-authors, Dr. Mark Horowitz later wrote for Mad in America, “but psychiatrists have failed to correct this misunderstanding.”

“I, therefore, challenge anyone and want to prove my theory. I know when I was happy my OCD was less noticeable (if anything it was 95 % eradicated, I still had the odd intrusive thought here and there, and tried to fight the uncomfortable feeling with CBT). Through traumatic events over the last two decades, I am back to feeling unhappy and have had to start healing. Only a drastic intervention can cure me now”.

“I did not have depression, because I was happy”.

The serotonin theory seemed promising when first introduced 60 years ago, “but was soon discarded,” said Dr. Allen Frances, a professor emeritus of psychiatry at Duke University who led the task force that created the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994.

The association was weak and often didn’t replicate. “Depressions are so remarkably heterogenous, there can’t possibly be any unitary cause,” Frances said. “Further study revealed just how ridiculously complicated in brain structure and function.”

SSRIs like Prozac, Paxil, Zoloft account for 44 percent of the leading prescribed drug class in Canada — psychotherapeutics.© Joe Raedle/Getty Images

But the “chemical imbalance” theory was a marketing godsend for drug companies, following the benzodiazepine crisis in the 60s and 70s when the highly addictive tranquilizers were “doled out by the bucketload” to people, particularly women, who were unhappy “just to numb their unhappiness,” Moncrieff said.

In the 1980s, when the first SSRI, Prozac, was launched, “the pharmaceutical industry knew it couldn’t market them in the same way (as benzos) because numbing someone’s unhappiness had got a bad rep with the benzodiazepines, Moncrieff said. “So, it had to convince people that they had an underlying disease and needed to take the drugs for an underlying disease.”

“If you think something is wrong with your brain and a drug is going to put it right, of course, you’re going to take it.”

For their “umbrella” review published in Nature’s Molecular Psychiatry, Moncrieff and her co-authors reviewed high-level studies in six major areas of research spanning 56 years that together involved tens of thousands of people. While there’s no such thing as a “normal level” of serotonin, Moncrieff said, the studies involved indirect measures of serotonin activity, looking at, for example, serotonin and its breakdown products in people’s blood or cerebral spinal fluid, and comparing those levels between people diagnosed with depression, and people not diagnosed with depression, the healthy “controls.”

The researchers found no overall difference in levels of serotonin between the two groups. Serotonin is made from tryptophan, an essential amino acid that comes from the diet. When healthy people were put on diets lacking tryptophan, it didn’t make them depressed. When the researchers looked at studies of genes involved in the brain’s serotonin system, again there was no consistent difference between depressed and healthy volunteers.

“I think people need to think carefully about why they are taking (SSRIs) and what they think the drug is doing for them,” Moncrieff said. “If they are taking the drug because they think it’s correcting an imbalance in their brain, I would suggest that they could re-evaluate whether they need to take it,” she said. “They should, of course, not stop it suddenly,” she said. “They should do that slowly and gradually,” under a prescriber’s care.

What’s often lost in the loaded and polarized controversy over chemical imbalance and depression, Frances said, is that mild depressions are usually triggered by stresses in our lives and don’t require medications. “Instead, they improve with time, support, reduced stress and/or psychotherapy,” he said. Severe depressions do require meds and rarely respond to anything else, he said. “No one size fits all.”

However, “Continued attacks on the ‘chemical imbalance theory’ by anti-psychiatrists are beating a long dead horse and have the harmful unintended consequence of discouraging people with severe depression from taking the meds they desperately need and won’t get well without,” Frances said.

But if psychiatry knew the chemical imbalance theory isn’t real, they had a professional duty to tell people, said Marnie Wedlake, a psychotherapist and assistant professor in the School of Health Studies at Western University.

“If they knew this was a false narrative, as the self-proclaimed and publicly recognized primary experts, they should have been out there saying, ‘No, no, no. Correction.’ But they did not. They just let it go.’”

Still, while it would be easy to pile all blame on psychiatry and the drug industry, “that’s too tidy,” Wedlake said.

We’ve allowed a “pathologizing” of our human condition, she said. “If I’m feeling happy and peaceful, that’s great, but anything else has become a symptom.” When high school kids talk about their emotions today, “they use language that medicalizes their thoughts and feelings,” she said. “It’s just my OCD,” obsessive-compulsive disorder. “I was a shy kid. Kids in my class now in university, they’ve got social anxiety disorder.”

It’s hard to sit with despair she said, even though our human condition includes a heavy dose of it.

“As a species, we don’t know what to do with despair anymore. Ideally, we would say, ‘Okay, I’m feeling somewhat despairing, it’s just part of my life, the full colour spectrum of who I am. Sometimes I’m angry, sometimes I’m sad…. But it has been pathologized, and we don’t know what to do with it.’”

And SSRIs are being prescribed not just for depression, but for social anxiety disorder, panic disorder, OCD, phobias, and the list ever expands.

Meanwhile, the mental health system is failing, “miserably,” Wedlake said. “We’ve got Apps and 10 sessions of group CBT (cognitive behavioural therapy) you might have to wait for a year-and-a-half for. If you’ve got someone living with extraordinary internal distress, 10 sessions of group CBT are like a band-aid on someone who has been in a car wreck.

“We don’t have the psychotherapeutic resources we need to meet the needs of those who need to deal with their distress.”

If people can’t afford private psychotherapy, if they can’t function or work, “the only option that’s available to them is the Paxil, Prozac, Zoloft, or Celexa that their GP is handing out,” she said. “People are stuck.”

Moncrieff, the co-founder of the Critical Psychiatry Network and author of The Myth of the Chemical Cure and other books, said she is “definitely not anti-drug. I see myself as being a very cautious person in relation to drugs.” She uses them in her own practice for people with severe illnesses like schizophrenia. Sedatives like benzodiazepines can be helpful in a crisis, short term, she said. “But I think that drugs that affect the brain, we should be cautious about.”

There’s no evidence they’re reversing an underlying brain abnormality, she said, but “they are doing something to the brain. And by doing that they change our normal mental states.”

SSRIs have been widely reported to cause an emotional blunting effect, a blunting of both positive and negative emotions. “Maybe there are some people who feel that is a useful effect for them. Some people will just decide they want to carry on taking antidepressants. That’s fine. I just think people need to have this information.”

Montreal psychiatrist Dr. Joel Paris: “I am afraid this has something to do with the toxic relationship between industry and academia.”© Christinne Muschi for Postmedia/File Is she anti-psychiatry? “I question the idea that mental disorders are usefully thought of as brain disease,” Moncrieff said.  I don’t think they’re the same sort of thing as having a brain tumor or multiple sclerosis.”

That doesn’t mean there’s not something going on in the brain, she said. “Of course, there is.” Serotonin is just one chemical that’s been implicated. “But that doesn’t help explain the situation. And we probably never will be able to quite pin down what it is, anyway.”

Paris, of McGill, agrees that SSRIs are overused. “The old adage is that if you have a hammer, everything looks like a nail. Clinicians want to do something for their patient, and these days that will usually be a prescription, given that psychotherapy is so poorly insured in Canada.”

The result is over-prescribing, and “polypharmacy,” giving people multiple medications, “but you can’t blame that on an incorrect theory.” Even though we don’t know how antidepressants work — some have suggested neurogenesis, the formation of new neurons, might be at play — “they do work for a lot of people,” Paris said. “Like so many treatments in psychiatry, and in medicine as a whole, to be fair, the effects are entirely empirical,” said Paris, who offers antidepressants if there are good reasons to suspect they will help.

Note From The Editor.

I am starting one course at a time and have already completed my diploma in OCD & Hoarding Hypnosis and I am starting to research and study neuroplasticity.

From what I have learned so far, always think in the present tense, when you are thinking about your dream job, dream, home, or dream vacation. Always be grateful for what you have and always say thank you to your God or the Universe. Believe you already have this and meditate just as you are falling asleep or when you have just woken. Visualize you already have what you desire. Never say (if (if I had it) when (when I get it), or any negative thoughts out loud). Our mind has five states beta, alpha, theta, delta, and gamma. They are distinguished by brain activity and predominant brain wave signals. This speed and frequency are measured in ‘Hertz’ and the figures are obtained using an Electrocardiogram (EEG) machine. Your 5 Brainwaves: Delta, Theta, Alpha, Beta and Gamma | Lucid We have the ability to rewire our minds, through hypnotherapy, meditation, and positive thinking.

Further Reading:

#serotonin #dopamine #neurotransmitter #neurons #neuroplasticity #neuroscience