We lack a good theory for depression

(written by lawrence krubner, however indented passages are often quotes). You can contact lawrence at: lawrence@krubner.com, or follow me on Twitter.


The problem is that we’ve never had an adequate theory of what depression is, and the evidence seems to be that it is far more complex and situational than any one-pill-fixes-all approach could ever attack. The author is correct, but hardly novel or prescient, in noting that there are serious issues with the long-term efficacy of SSRIs and SNRIs (and most other classes of psychoactive drugs). The problems of discontinuation of drug therapy, especially for long-term users, and that the drugs often appear to exacerbate the condition when withdrawn, were noted decades ago.

So, this “study” appears to rehash some old (and valid) critiques of the therapy. All it adds is the interesting hypothesis that depression is “natural” (so is senescence and death) and “beneficial”. Which I guess is the novel part.

We may not know what causes depression, but we do know that the constellation of symptoms that we call clinical depression are uniformly unpleasant and all-too-often fatal. So I’m really not convinced that labelling it natural and beneficial absent some pretty strong evidence is all that helpful.

From the article:

When depressed patients on SSRI medication do show improvement, it appears that their brains are actually overcoming the effects of anti-depressant medications, rather than being assisted directly by them. Instead of helping, the medications appear to be interfering with the brain’s own mechanisms of recovery.

“We’ve seen that people report feeling worse, not better, for their first two weeks on anti-depressants,” Andrews says. “This could explain why.”

It is currently impossible to measure exactly how the brain is releasing and using serotonin, the researchers write, because there is no safe way to measure it in a living human brain. Instead, scientists must rely on measuring evidence about levels of serotonin that the brain has already metabolized, and by extrapolating from studies using animals.

The best available evidence appears to show that there is more serotonin being released and used during depressive episodes, not less, the authors say. The paper suggests that serotonin helps the brain adapt to depression by re-allocating its resources, giving more to conscious thought and less to areas such as growth, development, reproduction, immune function, and the stress response.

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