Serotonin's Depressing Story.

Unless your newsfeed features obscure psychiatry and psychology news, UK news, or the very limited U.S. news coverage of the July publication of "The serotonin theory of depression: A systemic umbrella review of the evidence," in the Journal of Molecular Psychiatry, you might not have heard this news: In a sweeping metaanalysis addressing six serotonin-based hypotheses and multiple studies, one of more than 150,000 people, the conclusion has been drawn that, verifying what the senior author of the article, Dr. Mark Horowitz, noted is "known in academic circles, that no good evidence has ever been found of low serotonin in depression." The evidence does indicate, in some studies, that long-term use of some antidepressants can lead to lower serotonin levels, just as long-term use of drugs that boost dopamine (amphetamines, for example) ultimately can lead to depletion and insufficiency of that neurotransmitter.

To repeat, in the academic world, it long has been known that there really is no substantive evidence linking low serotonin levels to depression. This is similar to the academic knowledge that marijuana, especially in its modern, heightened THC formulas, is a dangerous road to sometimes unrelenting anxiety or even psychosis. However, since science is hard and so often inconvenient, these particular unpopular truths usually have been ignored. About one in six Americans, and about one in six English adults, are on antidepressants. Yet, the science says the rationale for these drugs--that they will fix a chemical imbalance in the brain--does not stand. The science does seem to indicate a placebo effect, as well as some people experiencing a numbing of emotional pain, which might be sufficient to begin the work of the changes necessary to heal from depression. The researchers are quick to note that no one should stop these medications quickly; cessation ought to be done slowly, with medical supervision, because of the risk of physical and psychological ill effects during withdrawal.

Depression, as Horowitz's team and countless other researchers and clinicians long have asserted, is a complex experience of physical, emotional, cognitive, and social aspects. It also is a rather fluid diagnosis, encompassing, as it does now in the current diagnostic manual, almost any two-week period in which sufficient symptoms are met, even when life's events make it a completely normal response. As I have noted in other articles, the grief exclusion for...