Has psychiatry finally reached its Apocalypse Now moment?
A new review has comprehensively debunked the serotonin theory of depression.
Whilst I was in the midst of writing last week’s post, The ADHD scam, a systematic umbrella review was published in the journal Molecular Psychiatry, on the so-called serotonin theory of depression. This theory posits that low levels of, and/or low activity of, the neurotransmitter (brain communication chemical) serotonin is causally associated with depression. The review concluded that
“The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”
My first reaction to the review was “No sh*t, Sherlock”.
I’ve been writing about the complete lack of evidence for the “serotonin deficiency” and “biochemical imbalance” theories of depression for most of the last decade.
In my article 5 reasons to think twice before taking an antidepressant, originally written in 2013 and updated several times since then (the last time in October 2020), I quoted David Healy, professor of psychiatry at Cardiff University. After devoting ten years to studying serotonin levels and activity in depressed people, Healy shared his findings in Let Them Eat Prozac, published in 2004. In this book, Healy stated categorically “No abnormality of serotonin in depression has ever been demonstrated.” He also pointed out that George Ashcroft, the psychiatrist who first advanced the serotonin theory of depression in the late 1950s, had abandoned it due to lack of evidence by 1970 – a full eighteen years before the first drug that supposedly treated depression by raising serotonin levels within the brain, fluoxetine (Prozac) was launched onto the market and became a near-instant blockbuster.
In my article ‘Depressed’ or just going through a rough patch – have you been misdiagnosed?, written in 2014, I referred to research performed by Irving Kirsch, and presented in a highly accessible form in his book The Emperor’s New Drugs (published in 2009) which clearly demonstrated that antidepressant drugs are no more effective than placebos at relieving the symptoms of depression. Clearly, this would not be the case if the drugs were correcting a “deficiency” or “imbalance” of neurotransmitters which had caused the depression in the first place.
In my article Who says you’re depressed or anxious? Pfizer does, written in April 2018, I shared my reading list of books which blow the “biochemical imbalance” theory of depression (and other so-called mental disorders) to smithereens: Peter Breggin’s many titles including Toxic Psychiatry, Talking Back to Prozac and The Antidepressant Fact Book; Robert Whitaker’s Anatomy of an Epidemic and Psychiatry Under the Influence; Gary Greenberg’s Manufacturing Depression; Irving Kirsch’s The Emperor’s New Drugs; Peter Gøtzsche’s Deadly Psychiatry and Organised Denial; and James Davies’ Cracked. (The title of the article refers to the fact that Pfizer owns the intellectual property for the screening questionnaires that doctors use to identify people who may ‘qualify’ for diagnoses of “depressive disorder” and “generalised anxiety disorder”, for which Pfizer conveniently makes several of the most widely-prescribed drugs, including venlafaxine [Efexor], sertraline [Zoloft], escitalopram [Lexapro] and alprazolam [Xanax]. These screening questionnaires, the PHQ-9 and GAD-7, have an abysmal positive predictive value, meaning that their ability to detect actual depression and clinically meaningful anxiety is low. They’re great for drumming up new customers for the pharmaceutical-medical-industrial complex, though.)
In my article The biochemical imbalance theory is dead; someone should tell your doctor, written in June 2021, I wrote about a study on the effects of cognitive-behavioural therapy on serotonin receptors in depressed people. In a nutshell, researchers found the exact opposite of what the serotonin hypothesis of depression predicted: the serotonin transporter protein, 5-HTT, which reduces the amount of active serotonin in the brain, is found in lower levels in depressed people, and after their depression remits, 5-HTT levels rise (i.e. serotonin activity decreases). The researchers speculated that “One possible interpretation is that the serotonin system doesn’t cause depression but is part of the brain’s defence mechanism for protecting itself against depression. One might hypothesize, for example, that the level of 5-HTT drops when an individual is subjected to stress, such as during a depressive state, and that the level rises or normalises when this stress goes away.”
I could go on, but I think I’ve made my point. The umbrella review is a fine piece of work – as I would expect given the excellent form of the lead author, Professor Joanna Moncrieff, who has been a leading voice in the psychiatric reform movement for decades. But I wasn’t remotely surprised by any of its findings, because none of them are “news”.
I’ll tell you what I was surprised by in a minute, after I’ve précised the paper.
Here are the key findings:
There is no relationship between plasma serotonin levels and depression, but antidepressant use is associated with lowered serotonin concentration.
There is no association between the serotonin metabolite, 5-HIAA, and depression.
Studies examining the binding of serotonin to its 5-HT1A receptor, and serotonin transporter (SERT) binding “showed weak and inconsistent evidence of reduced binding in some areas, which would be consistent with increased synaptic availability of serotonin in people with depression, if this was the original, causal abnormaly [sic]. However, effects of prior antidepressant use were not reliably excluded.” Or, in plain English, they found more serotonin in the synapses of depressed than non-depressed people (the opposite of what would be predicted by the serotonin theory of depression), but this may have been due to the effects of antidepressant drugs they’d used in the past.
Depleting levels of tryptophan (the amino acid from which serotonin is made) in non-depressed people had no effect on the mood of most of them; a study of just 75 people with a family history of depression found weak evidence of an effect but two larger studies with 342 and 407 participants respectively, found no effect.
Studies involving a total of nearly 160 000 people found no evidence of an association between variants of the SERT gene and depression, or of an interaction between genotype, stress and depression.
“The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration.”
Or, as Joanna Moncrieff expressed it in layman’s terms, in the press release for the publication,
“I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin…
Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence.”
Let that sink in for a moment. “No convincing evidence” doesn’t mean “nobody has designed proper experiments to investigate these theories, so they might still be true”. It means everyone and their dog has been trying nine ways to Sunday to show that there’s some kind of connection between serotonin and depression, for decades, and despite blowing uncounted sums of taxpayers’ money in research grants on it, they’ve come up with nada, big fat nothing, diddly squat.
Are you surprised by these findings? If not, congratulations – my guess is that you’ve (gasp) done your own research and discovered that psychiatry/psychopharmacology is a monumental fraud.
If you are surprised, I don’t blame you, and you’re not alone. According to the authors of the review article,
“Surveys suggest that 80% or more of the general public now believe it is established that depression is caused by a ‘chemical imbalance’ [15, 16]. Many general practitioners also subscribe to this view  and popular websites commonly cite the theory .”
Big Pharma, its pimps (doctors) and its poodles (the media and entertainment industry) have done a stellar job of persuading the public that the tissue of lies known as the “serotonin theory” of depression, and the “biochemical imbalance theory of mental illness” more broadly, are solidly grounded in science.
Now, do you want to know what did take me by surprise, when this paper was published? It was this comment by co-author of the paper, Dr Mark Horowitz, who is described as “a training psychiatrist and Clinical Research Fellow in Psychiatry at UCL [University College London] and NELFT [North East London NHS Foundation Trust]”:
“I had been taught that depression was caused by low serotonin in my psychiatry training and had 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.”
Say what? How is it even possible that a person can undergo psychiatric training and not be aware that there is not, and has never been, any persuasive evidence for the serotonin hypothesis of depression? Remember, the person who first proposed this hypothesis, George Ashcroft, had already abandoned it due to lack of evidence in 1970. You know, 1970, as in over fifty freakin’ years ago.
How exactly does a person get through medical school, internship and residency, and then a psychiatric fellowship, without ever stumbling across the vast professional and popular literature critiquing the foundational dogmas of psychopharmacology?
And what does this tell you about medical education more generally? Might the fact that a person who lectured medical students on psychiatry was unable to uncover the complete lack of evidence for one of his core beliefs, until well into his career, shed some light on doctors’ behaviour during the manufactured COVID crisis? Ya think?????
Although in popular parlance, the term apocalypse has come to connote universal or widespread destruction or disaster, it derives from the Greek word ἀποκάλυψις (apokálupsis) which translates to “revelation” or “disclosure”.
I’ve often wondered (usually after having to explain to yet another client that their depression was not caused by serotonin deficiency or biochemical imbalance), ‘Just how many “revelations” and “disclosures” do there have to be before people stop believing this giant pile of crap?’
Observing the massive traction that this review article has gained, I’m cautiously optimistic that the colossal swindle known as psychiatry has finally reached its Apocalypse Now moment. The message that there is no scientific basis to the serotonin theory of depression (and therefore to the hundreds of millions of prescriptions written every year for drugs that aim to manipulate serotonin levels) has been relentlessly plastered across both legacy and new media since the article was published.
With trust in the pharmaceutical-medical-industrial complex plummeting due to the disastrous performance of COVID injections and approved treatments, and the unfathomable cowardice of the medical profession which has stood by as the multi-layered tragedy unfolded, I expect a lot of patients who have been prescribed these drugs are going to be asking their doctors some very awkward questions.
Let me make myself very clear: Human suffering in the face of life’s vicissitudes is real. But the notion that this suffering is due to “biochemical imbalance” is, quite frankly, held only by complete morons.
As Mark Horowitz put it,
“One interesting aspect in the studies we examined was how strong an effect adverse life events played in depression, suggesting low mood is a response to people’s lives and cannot be boiled down to a simple chemical equation.”
You don’t say.
Professor Moncrieff’s critique of her own profession’s mendacity and careless disregard for the effects of serotonin-manipulating drugs on patients’ brains is trenchant and well-aimed:
“Our view is that patients should not be told that depression is caused by low serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.”
I love the smell of honesty in the morning.
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For information on my private practice, please visit Empower Total Health. I am a Certified Lifestyle Medicine Practitioner, with an ND, GDCouns, BHSc(Hons) and Fellowship of the Australasian Society of Lifestyle Medicine.
Important note. Antidepressant discontinuation syndrome (“withdrawal syndrome”) is common, often mistaken for relapse of the condition for which the drug was prescribed, and can be extremely distressing and frightening. Antidepressants should not be abruptly discontinued, especially if you’ve been taking them for an extended period. Please see my suggestions for conducting a medication taper and ensure that you have adequate, qualified supervision before you commence.