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No evidence depression caused by chemical imbalance

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Depression isn’t caused by a chemical imbalance—and any benefits from taking a SSRI (selective serotonin reuptake inhibitor) antidepressant are a placebo effect, a major review has concluded.

Researchers from University College London (UCL) say they couldn’t find any evidence to support the theory.  “There is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity,” the researchers concluded.

They reviewed 17 studies that had involved hundreds of thousands of depressed patients, and discovered, at best, ‘weak’ evidence of an association.  

Depression is more likely to be the result of ‘negative life events’, the researchers suggest.  In particular, people who suffer from continual and chronic stress are at the highest risk of developing depression.

The insight gives people hope that depression may be reversed whereas they may feel they may never alter a chemical imbalance, the researchers say. One survey discovered that up to 90 percent of people believe that depression is the result of low serotonin or a chemical imbalance—and it’s a theory that most psychiatrists also believe.

Co-author Mark Horovitz commented: “I had been taught that depression was caused by low serotonin in my psychiatry training and even taught this to students in my own lectures.  Being involved in this research was eye-opening and feels like everything I thought I knew has been flipped upside down.”

The chemical imbalance theory of depression was first mooted in the 1960s, and it gained traction in the 1990s when drug companies started to produce SSRI antidepressants, which would become one of the most prescribed drugs, with Prozac leading the way.   

(Molecular Psychiatry, 2022; doi: 10.1038/s41380-022-01661-0)

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