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Key points
- Negative publicity about psychiatric medication is misleading.
- Not fully understanding how antidepressants work is not a reason to reject a treatment if it's effective.
- Major depression is best treated with an integrative approach.
There has been a rash of negative media coverage about antidepressants as the result of an umbrella review of research studies that found no consistent link between depression and serotonin. It’s left many people questioning the legitimacy of psychiatric medication that targets serotonin levels. And that is unfortunate and potentially tragic. While SSRIs, selective serotonin reuptake inhibitors, are not a cure-all for everyone who is depressed, they can be extremely effective.
Research Findings Do Not Tell The Whole Story
At this stage of psychopharmacological advances, there is broad recognition that serotonin is not the only neurotransmitter that is affected by depression. There are many psycho-neuro chemical processes that can contribute to depression. Neuroadrenaline, dopamine, glutamate, and other chemicals are involved, which is why when SSRIs are not sufficiently effective at reducing symptoms of depression, SSNRIs (serotonin-norepinephrine reuptake inhibitors), NRIs (norepinephrine reuptake inhibitors), NDRIs (norepinephrine-dopamine reuptake inhibitors, and or SNDRIs (serotonin-nNorepinephrine-dopamine reuptake inhibitors) may be prescribed.
It's important to keep in mind that the umbrella review that sparked so much attention did not look at the effectiveness of antidepressants but rather at the depression-serotonin connection, which it challenges. There is no question that there needs to be more research to better understand the mechanism of how antidepressants work. Research findings about serotonin do not tell the whole story and have, unfortunately, misguided people by portraying a partial view of a complex condition. Focusing solely on serotonin is picking one aspect of major depression, a condition that can also be affected by not only other neurotransmitters but also hormone and nutritional deficiencies, metabolic problems, and other medical conditions (like Parkinson’s disease). Not fully understanding the complex brain chemistry is hardly a reason to decry treatment and instill mistrust of medical treatment in people who are already feeling vulnerable because of suffering from depression.
Symptom-Specific Medications Can Lead to Positive Outcomes
In medicine, we don’t always understand how everything works but when a treatment does work, we make sure to use it. As doctors, we take the Hippocratic Oath, the ethical commitment to “Do No Harm.” We are extraordinarily fortunate to live at a time when there is a robust array of psychiatric medications, with each able to target specific symptoms of depression, including problems related to mood, sleep, appetite, and focus. To not prescribe antidepressants in the appropriate circumstance would be negligent and malpractice. Yes, it may take some trial and error but, as shown by the Star-D study (sequenced treatment alternatives to relieve depression), the largest and most comprehensive research conducted about antidepressant use to date, positive outcomes can result even if an antidepressant isn’t, at first, fully effective by augmenting it through increasing the dose, supplementing it with an antidepressant from another class, or switching antidepressants.
The bottom line: no one should stop taking antidepressants that are effectively treating their depression because of research that fails to show a consistent link between serotonin and depression. Both the neurochemicals in our brain and the psychiatric medications available are much more complex than such a simplistic view of the condition.
Integrative Treatment Is Optimal
Yet, just as serotonin is not the full answer to treating depression, neither is medication as a sole approach. Depression can be caused by biological, psychological, and social determinant factors as well as traumatic experiences. It is optimally treated with an integrative approach that includes medication (when needed), psychotherapy, and mind-body practices, such as mindfulness and exercise, that help regulate mood and promote well-being. The treatment for depression can be highly effective. No one who is depressed or has a depressed loved one should lose hope. Everyone is treatable. It's natural to have questions about medication so don't hesitate to express your concerns to your doctor. Successful treatment depends on a collaborative approach between patient and doctor, as you navigate your way to recovery. Most important: if you suffer from Major Depression, do not be misguided by anyone or anything who casts remarkable developments in psychopharmacology in a negative light.
