Is the Science Behind Some Antidepressants Backward?

Antidepressants rank third among the most common prescriptions, with 23% of middle-aged women and 14% of non-Hispanic white people taking the drugs. For many people who have struggled with depression, antidepressants are life-savers. For others, antidepressants don’t offer much relief, leading to a seemingly endless search for the right drug.

According to the authors of a paper published in Neuroscience & Biobehavioral Reviews, the science behind many popular antidepressants could actually be backward.

Understanding the Low-Serotonin Theory of Depression

A number of factors, ranging from brain chemistry to environment, can contribute to the development of depression, but many popular antidepressants work on the theory that insufficient brain serotonin causes depression. This neurotransmitter—a chemical messenger that helps carry signals across a nerve synapse—is thought to play an important role in regulating mood. Many antidepressants, most notably selective serotonin reuptake inhibitors (SSRIs) such as Paxil and Zoloft, work to increase the amount of serotonin in the brain.

Do Antidepressants Get It Wrong?

If serotonin helps to regulate mood, it makes sense to conclude that insufficient serotonin levels could cause mood problems. The paper’s authors think this theory gets it wrong, though. They reviewed data over the past 50 years suggesting that low serotonin levels can lead to depression, and they argue that there’s insufficient research supporting this claim. Instead, they argue that research points to evidence that the brain actually produces more serotonin during episodes of depression. If this is the case, then people who recover from depression while taking SSRIs apparently aren’t getting better because of the drugs; they’re getting better in spite of the medication.

Paul Andrews, the study’s lead author and an assistant psychology, neuroscience, and behavior professor at McMaster University, has previously argued that many people get worse after taking antidepressants. He believes that depression is a painful but adaptive component of human experience.

Andrea Schneider, LCSW, a GoodTherapy.org Topic Expert contributor, said there’s strong evidence for the efficacy of antidepressants, particularly among women struggling with postpartum depression.

“Brain neurochemistry is truly on the cutting edge of current scientific research, and discoveries are being made every day about the delicate interplay between reproductive hormones and neurotransmitters,” Schneider said. “What we do know is that there is scientific evidence to support the fact that antidepressants have been shown to help resolve depression and anxiety during the perinatal period. I have seen this to be true in my own practice, in combination with psychotherapy, good self-care, and social supports.

“For some women, antidepressants have been life-saving during the pregnancy and postpartum period. To make a blanket statement that antidepressants are good or bad is not helpful. We do know that antidepressants can have great therapeutic benefit for some women with a biochemical basis to their depression/anxiety during the perinatal period, and we see excellent results with continuity of treatment over the period of recovery.”

References:

1. Science behind commonly used anti-depressants appears to be backwards, researchers say. (2015, February 17). Retrieved from http://www.sciencedaily.com/releases/2015/02/150217114119.htm
2. Wehrwein, P. (2011, October 20). Astounding increase in antidepressant use by Americans. Retrieved from http://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624
3. What is serotonin? What does serotonin do? (2015, February 12). Retrieved from http://www.medicalnewstoday.com/articles/232248.php

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