What You Need to Know If You See This Study About Antidepressants and Serotonin Levels

I recently came across a new study conducted by University College London, via reporting published by The Guardian, which stated that “there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.” At face value, I worry that this report may do more harm than good.

We often talk about depression (and other mental illnesses) as being caused by a “chemical imbalance” such as by the neurotransmitter serotonin, which this report calls into question. And, sure, perhaps that’s right; it could be that our established understanding of depression is incorrect and that with better understanding will come better treatment options, such as new treatments like ketamine infusions and psilocybin.

But the problem lies in the conversation surrounding these findings. As we work to reduce the stigma surrounding depression and mental illnesses as a whole, there is a chance it could be undone by misreported findings and assumptions made without the full picture, delegitimizing depression as nonexistent since it seemingly isn’t caused by a chemical imbalance after all.

The study found that: “Research comparing levels of serotonin and its breakdown products in the blood or brain fluids did not discover any difference between people diagnosed with depression and healthy people … [Researchers] also looked at studies where serotonin levels were artificially lowered in hundreds of people and concluded that lowering serotonin in this way did not produce depression in hundreds of healthy volunteers.”

But worse still than delegitimizing depression is the suggestion that this has, as reported by The Guardian, “called into question the widespread use of antidepressants,” particularly since (at least in the United Kingdom) “prescriptions for antidepressants have risen dramatically since the 1990s, with one in six adults … being prescribed them.”

“Many people take antidepressants because they have been led to believe their depression has a biochemical cause,” said the study’s lead author, Joanna Moncrieff, a professor of psychiatry at UCL. She is also a consultant psychiatrist at North East London’s NHS foundation trust. They also found “evidence from other studies that antidepressants may actually induce low serotonin in the long term.”

This is the real danger in this reporting. Delegitimize antidepressants, and you risk placing millions of people in danger of withdrawal or worsening symptoms due to refusing or stopping medication without the aid of a medical professional. I personally take antidepressants to great effect, and I don’t know where I’d be without them. The same goes for many people I love; they help me to live when therapy alone hasn’t.

I’m not the only person calling this into question. Other experts, including from the Royal College of Psychiatrists, urged people not to stop taking their antidepressants since antidepressants remained effective. A spokesperson for the Royal College of Psychiatrists said: 

“Antidepressants are an effective, Nice-recommended treatment for depression that can also be prescribed for a range of physical and mental health conditions. We would not recommend for anyone to stop taking their antidepressants based on this review, and encourage anyone with concerns about their medication to contact their GP.”

Meanwhile, speaking to the Guardian, Dr. Michael Bloomfield, a consultant psychiatrist at UCL who was not involved in the study, said: “Many of us know that taking paracetamol can be helpful for headaches, and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression.”

There is evidence, he said, that antidepressants can be helpful and even life-saving.

So, it’s important we don’t simply assume that our misunderstanding of depression’s cause automatically renders it void, nor should we simply stop taking antidepressants because of these findings. Perhaps antidepressants are being “overprescribed” as the Guardian reported in this article, but we are also living through a global pandemic that has, at the time of writing, claimed the lives of 6.38 million people. We are living with the effects of climate change on mental health and on the environment, an ongoing war in Ukraine, skyrocketing cost of living, and political turmoil in the United States. If antidepressants are being prescribed now more than ever, it is because we live through a terrifying time in human history.

The Guardian reported the researchers also looked at studies that said “the more stressful life events a person had experienced, the more likely they were to be depressed, showing the importance of external events.” Considering what we are living through, then even if a chemical imbalance isn’t the cause of depression but external events are, then we need antidepressants now more than ever.

I’m not going to stop taking my antidepressants based on this study, and if you’re prescribed psychiatric medication, I would strongly urge you to at least talk to your psychiatrist or other prescribing medical professionals before you stop taking your medication. Even with the side effects, my antidepressants help me more than hinder me. I wouldn’t give that up for anything.