
Serotonin may not be a major factor in depression, study suggests - mmastrac
http://www.medicalnewstoday.com/releases/281645.php
======
lutusp
Quote: "New evidence has put into doubt the long-standing belief that a
deficiency in serotonin - a chemical messenger in the brain - plays a central
role in depression."

Let's summarize this issue:

1\. Big Pharma has sold billions of dollars' worth of SSRI-based drugs, drugs
whose mode of action is to regulate serotonin to control depression. Tl;dr:
big influential companies, big sales, a gullible public who think psychiatry
is an evidence-based medical field.

2\. Studies show that the above drugs do not work for the majority of
patients. In a meta-analysis conducted by the FDA that combined the results of
published _and unpublished_ studies, "antidepressant medications have reported
only modest benefits over placebo treatment, and when unpublished trial data
are included, _the benefit falls below accepted criteria for clinical
significance_." Tl;dr: _these drugs do not work_.

[http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fj...](http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0050045)

3\. The linked study shows that serotonin has no clear correlation with
depression in an animal model. Tl;dr: because serotonin levels and depression
aren't correlated, _SSRI drugs could not possibly work_.

Guess what effect these studies, this science, is having on the sale of
antidepression drugs? None whatever. The reason? Psychiatry and psychology
aren't sciences, and (unlike in real medicine) ongoing drug therapies don't
hinge on evidence for effectiveness.

This is why the NIMH recently ruled that the DSM, psychiatry and psychology's
"bible", may no longer be used as the basis for scientific research proposals
-- not surprising, it has no scientific content.

[http://www.newyorker.com/tech/elements/the-rats-of-n-i-
m-h](http://www.newyorker.com/tech/elements/the-rats-of-n-i-m-h)

Let the downvotes begin.

~~~
twir
Ooh, here come the Scientologists!

I'm as skeptical of big Pharma as the next guy, but to say with such grandiose
broad-stroked generalizing that psychiatry (or, perhaps you mean instead/also
neurological pharmacology) is not science is simply untrue.

Anyone with Google at their fingertips can find a dozen peer-reviewed articles
about serotonin's _link_ to mood and behavior.

EDIT: accidentally a word or two.

~~~
coldtea
> _Anyone with Google at their fingertips can find a dozen peer-reviewed
> articles about serotonin 's link to mood and behavior._

And a ton of "peer reviewed" articles are crap too.

Peer review aint what it used to be.

~~~
lrem
Still, it's what demarcates the boundary between "blog about your idea, show
it to some smart folk" and "proper science". And we like clean demarcation
lines, they allow us to categorize without actually investigating (which is
infeasible if you want to get broad knowledge).

~~~
coldtea
I'd say avoid "peer reviewed" papers like the plague if you want to find out
what's actually "worth investigating" and " get a broad knowledge".

Instead, wait for 2-5 years to see what still floats from all the crap that
has been published.

Better to read slightly behind the times, but solid, university guidebooks and
published books that stood out, than to read the hot, but crappy, steam of
published research.

~~~
lrem
Is waiting 5 years always an option? Is 5 years always enough to distinguish
good from bad science? Then, you still use the "peer reviewed" filtering, just
add "test of time" to the pipeline. Which is fine, as long as the topic is of
level of importance to you at which being 5 years behind the trend is ok.

Unless you really mean that being peer reviewed is bad. I don't want to delve
into that option...

~~~
coldtea
> _Is waiting 5 years always an option?_

If your goal, as stated above, is to get a "broad knowledge", then yes.

If you want to know recent research trends, or are doing research yourself,
then no, go read current papers.

> _Is 5 years always enough to distinguish good from bad science?_

No, sometimes you have to wait even more. Just gave it as a delay period to
counter the "read the peer reviewed papers" notion.

> _Then, you still use the "peer reviewed" filtering, just add "test of time"
> to the pipeline._

No, I'm saying "forget the peer reviewed" in themselves, go for items that not
only have stood the "test of time", but have also become succesful and well
regarded books and/or university guides in their domain.

In essense, I'm saying that a journal's tiny "peer review" team is BS, the
majority of the scientific community agreeing on matured material is better.

> _Which is fine, as long as the topic is of level of importance to you at
> which being 5 years behind the trend is ok._

It's not a matter of "importance to you", it's what you want to use it for.

A subject could be extremely important to you as a study subject, and you
could still avoid losing time with the current, unfiltered, papers as they
come in.

It's only when you want to take advantage of recent research (e.g because you
are a researcher yourself, or an implementor and needs a new solution etc)
that you have to have the latest research -- which I think is different than
"importance". Let's call it "business importance" if you wish...

------
Xcelerate
Does anyone have experience with atypical depression? That's what I have, and
SSRIs seem to do almost nothing for it. Prozac made me feel spacey, and it
didn't fix any of my problems (except OCD), so I quit it. I've since read a
lot of articles in psychology/psychiatry journals and it appears that MAOIs
(nardil, parnate), are much more effective for this condition, although they
have strong side effects and dietary restrictions. MAOIs were the original
antidepressants used in the 1950s and 1960s. A lot of articles indicate nardil
is particularly effective for social anxiety, over SSRIs.

Atypical depression is characterized by excessive sleeping, extreme rejection
sensitivity, leaden paralysis (heavy limbs/fatigue), and the ability to feel
happy in response to a positive event. This last characteristic is a
distinguishing factor from regular (endogenous) depression, where even
positive events won't make someone feel happier.

~~~
lutusp
You know what? I'm not either a doctor nor a psychiatrist, but what you've
described sounds like chronic fatigue syndrome, not depression. Or (second
vote) hypothyroidism, which also can create some of the symptom set you
describe.

Both depression and CFS have no known causes, which makes their diagnosis
problematic and their treatment even more problematic. But overall I would
suggest that you look at CFS -- IMHO it seems to be a better fit to your
symptoms.

Again, I am not a doctor and this is just an off-the-cuff opinion.

~~~
_bdog
CFS and depression can complement each other. Also the one can lead to the
other.

But I second this: get a check of your thyroid gland, if you thyroid doesn't
work properly, medication won't work properly!

------
coldcode
Even with all our advanced modern knowledge we still barely understand how the
brain works much less what happens when it doesn't "work" and even that
depends on how you define "doesn't work". I suffered from a major depressive
time about 12 years ago and taking a drug helped me get out of it and it
hasn't returned. But there is no way to know what went wrong much less prove
that the drug had any actual clinical effect; at least it appeared to make
life possible again. Some day we might actually understand enough brain
chemistry to know the exact mechanisms. Today it is still a lot of guesswork.

~~~
meowface
It makes me wonder if we'll even have much more understanding of the brain in
100 years than we do now. At least, understanding at a level that lets us
effectively stop the root cause of many complex mental disorders without
deleterious side effects.

~~~
devnonymous
<disclaimer > This is a general statement, I do not intend it to be 'in
response' to your comment in particular, your comment just provides a logical
space to precede mine.< /disclaimer > . I don't understand this negative,
defeatist attitude of people with regards to our 'current' understanding of
anything. We certainly know a lot more about everything in this world,
including the brain than what we did in the year 1914. Why then is there a
doubt that 100 years hence we'd understand lesser ? Is there really a proven
'law of diminishing returns' in the field of scientific research. Also, in
reference to the parent comment, sure there isn't possibly a way to be 100%
certain that the drugs did indeed help but the reasoning behind manufacturing
them were presumably sound scientifically speaking based on the knowledge
known at the time of their creation and the experiments conducted then.
Development occurs not by discarding prior knowledge but by refining it or in
the worst case scenario, eliminating the factors that make it obsolete. So, in
summary, I think we are in the 'discovery phase' of medicine these days,
similar to what the 1600-1900s were for physics.

------
ianstallings
It's important to note that they are using the word _major_ to substantiate.
It might not be major, but I think the word _important_ would be justified.
Saying there might be other chemicals or components involved in depression
seems to be obvious given our limited understanding of the topic. We just have
a currently useful tool to help, SSRIs. Maybe with these type of studies we'll
see more accurate medicines.

~~~
lutusp
> We just have a currently useful tool to help, SSRIs.

Yes, but the quoted study shows that serotonin and depression aren't
correlated. If that is so, if the study bears up under scrutiny, then SSRIs
cannot possibly work. The prior FDA meta-analysis shows that SSRIs don't work
for the majority of patients, this new study explains why.

> Maybe with these type of studies we'll see more accurate medicines.

Let me suggest an alternative -- instead of searching for a better
_description_ of depression, we should seek an _explanation_ , like in
science. Armed with an explanation, we could treat depression's causes, rather
than its symptoms.

But we can't do this with psychiatry -- psychiatrists aren't scientists and
have no respect for evidence.

