Serotonin

If you go into your PCP’s office and mention that you’ve been feeling down there’s a good chance you’re going to get a prescription for a SSRI.

SSRI stands for Selective Serotonin Re-uptake Inhibitor.  This is a class of drugs that slows the brain cell’s ability to pick up the hormone serotonin that your brain cell just used to send a message to the neighboring brain cell.  To put it in simpler terms, SSRIs keep serotonin in play longer, increasing the likelihood that a message is going to be relayed.

The typical concept that is used in explaining the use of SSRIs is that you have a chemical imbalance in your brain (serotonin) and this drug will fix it.

Sounds pretty straightforward and seems to make sense.  It also gives many people hope that there is a drug to fix how he or she is feeling.  There is something WRONG and it can be FIXED.

But what if this entire concept was MADE UP?

Couldn’t be possible, right?

There’s no way a concept like a drug that can fix a chemical imbalance in the brain and help with depression could become as well-founded in medicine and society as drinking water to cure thirsty.

You know where I’m going with this although this point you’re probably about as skeptical as you’ve ever been.  This information was all brought up in an editorial in the BMJ by Dr. David Healy, a professor of psychiatry in Wales.  The full text of this editorial can be found on his website by clicking here.

Let’s review some things that we already know first:

1. SSRIs have been shown to be pretty much worthless in the medical research beyond placebo (especially when ALL the studies are taken in account—not just the positive ones).
2. The placebo effect is very, very powerful and deals with the brain. Which is ironic since depression and anxiety are “brain” problems.
3. While a small few do benefit, the vast majority of patients in my office who are on this class of drugs don’t notice all that much of an improvement in mood with use beyond 3 months. Most give me a sheepish shrug and a grunt of “maybe” when I ask if they seem to help.

With these three things in mind, it’s time to clarify a few more myths and identify the timeline of SSRI development, marketing and use.

Serotonin levels and depression

Early clinical studies attempted to demonstrate that people with depression had lower levels of serotonin.  This was never able to be proved.  To make this a little bit more confusing, the SSRIs have never been shown to actually increase serotonin levels (except theoretically in the synaptic cleft between brain cells).  Contrast this with compounds like tryptophan and 5-HTP, which give the body the building blocks to make more serotonin if needed.

There has been no evidence that the strength of the SSRI’s effect on blocking serotonin reuptake was related to the better outcomes (in other words, stronger SSRIs did not have a greater effect on depression).

Just to make matters worse, the original clinical trials pitting SSRIs up against the tricylic antidepressants like Elavil and Amitriptyline had them failing miserably.

Finding a use for the SSRIs

The SSRIs were developed in the late 1980s, but originally had no indication.  In other words, the drug companies had a neat new drug but no idea what to do with it.  The original thoughts were to use it for controlling blood pressure of maybe weight loss, but these ideas were quickly scrapped.

But concern was rising with the risk of dependence from the use of tranquilizers, creating a potential market for the SSRIs.  However, the general public had been trained to expect an immediate response from their anxiety and diabetes drugs and the SSRIs didn’t fit this expectation.

So the drug companies needed to retrain the public and doctors by reframing how we thought about depression.

It’s amazing what gobs of money can accomplish.

So the drug companies created the idea of a chemical imbalance linked to serotonin levels.  Luckily, the white horse was already on its way in.

So where does that leave us?

All of this does not mean that serotonin was a worthless concept.  But it does likely mean that the use of drugs that affect serotonin reuptake are not the answer.  Don’t expect this message to be adopted anytime quick, though.  This is still one of the most successful classes of drugs on the market and there are enough prescriptions written in the Westernized world to treat every adult.  Many of these prescriptions are being used because patients could not get off of them.

The long list of side effects that are experienced with withdrawal are sometimes used to convince patients that they NEED to be on the drugs.  What a way for the drug companies to create their own market.

The real long-term answer to psychological disorders lies with brain health.  Making sure that the cells of your brain have the energy they need to function at their best.  Making sure that the cells are healthy enough so that they can communicate with each other when needed as well as NOT communicate with each other when needed.

Tools for this should include:

• Exercise
• Stress management techniques (yoga, biofeedback, meditation)
• Counseling—you NEED a good therapist on your team to help you learn long-term coping strategies
• A brain-healthy lifestyle (you can check out my Depression eBook by clicking here)
• Positive outlook—waking up each day at looking for the positives, always focusing on these rather than the negatives
• Brain-healthy supplements like vitamin D, magnesium and fish oils

I’m not saying that there is no need for drugs that affect the psychological aspects, but these drugs should be used short-term while you get the motivation and education to rise above your current mental state.

Some may still need drugs long-term, but these drugs, like any other drugs, should not be the ONLY tool in your toolbox.  Rather, they should be just one of many (like those on the list above) of the tools you use to help your brain.