Low Serotonin Does Not Cause Depression– So What Does?
Earlier this year various iterations of the headline “Chemical Imbalance Does Not Cause Depression” surged through media and news outlets. These articles were all in response to the research review, The serotonin theory of depression: a systematic umbrella review of the evidence. Essentially, the researchers collected overviews of the existing research done on the “chemical imbalance theory” and the idea that serotonin plays a major role in depression. They discovered that there is actually no evidence linking serotonin to depression and that the idea that a chemical imbalance in the brain is the cause of depression is grossly oversimplified, if it is even true at all.
This rocked me to my core. Why all those years had I been taking medication that basically increases the amount of serotonin in my brain when serotonin has nothing to do with depression? And if that doesn’t cause depression, what does?
Turns out, nobody knows, but that doesn’t mean people don’t have their theories. After reading Johann Hari’s Lost Connections: Why You’re Depressed and How to Find Hope, I now have my own theories, too. While Hari is a journalist (and one with a slightly tainted past) and not a scientist, he is a person who has suffered from depression for decades. After discovering that antidepressants are not what the pharmaceutical companies have marketed them to be, he set out on a journey around the globe to see if he could understand what really causes depression and thus, try to find a cure.
He concludes that depression and anxiety (which he declares go hand in hand and should not be considered two separate illnesses) have three types of causes, a mixture of biological, psychological, and social. He then identifies the major issue with the way western medicine has approached depression. The emphasis has always been on the biological (meaning, there is a problem with the chemistry in your brain) because we are submerged in a capitalist culture that encourages us to buy our way out of our problems so that a few people at the top can make a bunch of money. If nobody knows what is specifically going on in the brain to cause depression how can they so easily say a pill will be the most effective treatment? Spoiler: for most people, it’s not. “You aren’t a machine with broken parts. You are an animal whose needs are not being met,” Hari emphasizes.
Hari claims that the solutions to our depression may lie not in the biological, but rather, the psychological and social, and defines the main causes of depression as a disconnect from seven essential needs to human existence: meaningful work, other people, meaningful values, childhood trauma, status and respect, the natural world, and a hopeful or secure future. The American ideal of individualism, everyone’s problems are their own and you’re an admirable person for pulling yourself out all by yourself, is keeping us all depressed and the solution to our collective depression lies in a shift to that of a community based culture.
Why as a culture have we gotten so far off course that we readily, and easily, dismiss the social causes of our depression? So many of us are overworked, overtired, overstressed, and lacking in connection from the things that actually matter. Of course we’re depressed! We don’t even have enough time in a day or a week or a month to making a living, spend quality time with our loved ones, connect with nature, exercise, or even just sleep.
In a world that addresses depression as having social causes with community oriented solutions, a person would walk into a psychiatrist office and say doctor, my loved one died a month ago and I can’t get out of bed, and the doctor would acknowledge that grief and depression are normal responses to loss and ask them various questions like, are you still able to afford your rent, are you eating, do you have a support system? And if the person answered no to any of those questions, those needs would be addressed first.
Now don’t misunderstand me, I’m not saying antidepressants don’t work for some people. If they work for you then that’s great. However, no scientist has proven why antidepressants work. For all they know it could be mostly placebo effect (which is not to be minimized because mindset is powerful). But if antidepressants don’t work for you, it’s not your fault. There’s nothing wrong with you. You are not alone in that experience. And you most certainly are not a lost cause.
For years I was told that I have “treatment resistant depression.” This was in response to the fact that despite having tried several different meds and combinations of meds spanning over more than 15 years, I still continued to have major depressive episodes. This made me believe that there was a problem with my brain that was completely out of my control. I spent years feeling helpless and that the only solution to depression (medication) did not work for me and therefore and I would be depressed for the rest of my life.
After reading Hari’s book, I have begun to approach my depression much differently. I have started thinking about what in my life is not serving me, what in my life is missing, if I am living in a way that is aligned with my values. I am digging into every corner of myself and the ways I think to find where I am most disconnected. Am I holding onto mindsets or values that I actually no longer agree with? It has been a tough road to travel and has me reevaluating everything I thought I knew to be true and confronting things about myself that are not easy to grapple with and sometimes deeply buried in shame. But in the end, if I want to get to the root causes of my depression, I’ve got to get truly vulnerable and do the hard work.
If you are depressed, don’t so quickly fall into the belief that there is something wrong with your brain. Not only might that be inaccurate, but it also takes away the perceived control and power you have over your mental health. If you are chronically depressed, and especially if medication has not worked for you, it’s time to take a step back and take stock of your current situation and your life. Chances are, something is not right. Whether it’s housing or financial insecurity, lack of community or a support system, missing meaning or purpose in your work life, not healing from trauma or grief, or a disconnect from your true values. Whatever the reason, I guarantee you there’s something because, come on, none of us are perfect and none of us have it all.
If you break your ankle, you will feel pain. That pain is trying to alert you to the fact that there is something wrong with your ankle. If you are depressed, that pain is trying to tell you something, too. Listen to it.
Further Reading
The serotonin theory of depression: a systematic umbrella review of the evidence — Molecular Psychiatry: the scientific paper that sparked the recent surge of media coverage on the chemical imbalance and serotonin myth
Depression is probably not caused by a chemical imbalance in the brain – a new study — The Conversation: a slightly simplified summary of the findings from the above mentioned paper, written by the paper’s authors
Does a ‘Chemical Imbalance’ in the Brain Cause Depression? Maybe Not — US News: one of the many news articles that came out after the publishing of the above mentioned paper that also details the implications of their findings in regards to antidepressants
What causes depression? — Harvard Health Publishing: brief descriptions of what they do know is going on in the brain of a depressed person
Is Depression Just Bad Chemistry? — Scientific American: published in 2014, academics and scientists have been questioning the chemical imbalance theory for years
*Main photo is of so called Intersection Rock, taken from Hidden Valley Campground in Joshua Tree National Park