Depression, Serotonin, and the Black Dog

Depression, Serotonin, and the Black Dog

Mental health is an inner war. Many have heard the bleak bark of the black dog.

The crushing weight of depression makes it so that just getting out of bed becomes an insurmountable task. The black dog is always there, trailing your every step. He only sleeps when you sleep.

It’s no secret that the mental illness is becoming more and more prevalent. Depression and anxiety disorders have skyrocketed in the West the past decade. Especially in 2020, for obvious reasons.

The common knowledge thus far has been that depression is a result of low serotonin levels or “chemical imbalances in the brain”. Thus, the only way to treat it is by taking antidepressants—which can induce a wild range of adverse effects, ranging from nausea to suicidal thoughts.

Except, a new systematic review of the evidence suggests this may not be the case.

Researchers conducted an umbrella review on existing systematic reviews, meta-analyses and “large studies that combined data from individual studies” relevant to the effects of serotonin with respect to depression.

Their aim was to “establish whether the current evidence supports a role for serotonin in the aetiology of depression, and specifically whether depression is associated with indications of lowered serotonin concentrations or activity.”

The research examined included 17 systematic reviews, meta-analyses and umbrella reviews in areas related to: serotonin and serotonin metabolite concentrations in body fluids; serotonin receptor binding; serotonin transporter (SERT) levels; tryptophan depletion studies; SERT gene associations; and SERT gene-environment interactions.

The systematic review of the research concludes (emphasis added):

“The huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression […] We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”

This is huge and essentially lays to rest the theory that low serotonin is the primary cause of depression.

Consequently, the paper also calls into question the efficacy of selective serotonin reuptake inhibitors (SSRIs), or antidepressants. Since SSRIs are designed to regulate serotonin levels, but it turns out that low serotonin may not even be the cause of depression—so why take antidepressants?

The researchers stop short of evaluating the efficacy of antidepressants, but they interestingly drop this comment while citing two related studies:

“Other explanations for the effects of antidepressants have been put forward, however, including the idea that they work via an amplified placebo effect or through their ability to restrict or blunt emotions in general.”

Read the study if you want to look into this further.

Individuals suffering from depression have long believed that their condition is a result of their biology. Depression has long been claimed to be a biochemical problem which can only solved by medical intervention in the form of drugs. It’s easy to see how these conclusions can lead to a sense of helplessness in depressed individuals. When depression is a medical condition, it requires specialised treatment which most people can't figure out for themselves. So, control or influence over their own mental health is limited.

As a result, this can inevitably lead to long-term dependence on antidepressants, which as we have discussed, may not even work and can have an array of nasty side effects—including making symptoms worse.

This review, however, suggests that this may not need be the case.

The prevalence of depression and anxiety disorders over the past decades comes as no surprise to anyone actually paying attention. Most people live junk lives pervaded by meaninglessness, hopelessness, and weakness. People are increasingly disconnected from one another and from themselves. Their entire sense of identity has been called into question by a vocal minority of victims who would rather drag everyone else down to their level instead of working towards pulling themselves up.

On top of that, it just seems like the world is constantly going through crisis after crisis after crisis. The news and media propagate a never-ending cycle of fear porn, fomenting negativity and pointing the finger at some new scapegoat for the world’s ills every other week.

It’s absolutely maddening and when you start to look at these things as a whole, it’s no wonder mental illness is on the rise.

So what can we do to insulate ourselves from all this and proactively combat the malaise of the modern world? Instead of taking mind-altering medications, how about:

  • Improving your nutrition for optimal health,
  • Regular exercise and the challenge of physical training,
  • Avoiding news media and vaccuous TV shows,
  • Going outside, experiencing nature and getting some sunlight,
  • Intellectual pursuits such as reading and problem-solving,
  • Improving life satisfaction by setting and achieving goals,
  • Cultivating meaningful, positive relationships,
  • Confronting and resolving past trauma,
  • Pursuing meaningful activities instead of self-indulgence.

Investing in yourself and building positive habits is the best antidepressant. It just requires a little more effort than taking a pill.

Moncrieff, J., Cooper, R.E., Stockmann, T. et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022).

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