Summary: Researchers are critical of the latest findings about serotonin’s role in depression and acknowledge that people should keep their current treatments to help control their depressive symptoms.
source: University of Michigan
Currently, more than 1 in 10 Americans are taking medication to treat depression — a number that has risen during the pandemic.
But how do these drugs work — and why don’t they work for everyone? And why do people get depressed anyway?
Experts still do not know all the answers to these questions. After all, the brain is a complex place. But they do know that depression has its roots in everything from the genes we were born with, to the experiences we had in our early years, to what is happening in our lives now.
At the same time, they know that many people with depression get help from antidepressant medications — and from talk therapy, better sleep, exercise, more social interaction, and, in severe cases, treatments like ketamine and electroconvulsives.
The important thing is for people with symptoms of depression to reach out for help and keep trying until they find something that works for them.
That’s why the director of the country’s first depression center, Srijan Sen, MD, is concerned about the impact of a new study on the role of serotonin in depression that has received so much attention.
He worries that simplistic news stories and social media posts may make some people question whether they should continue to take depression medications that target the brain’s serotonin system.
He says such drugs, called SSRIs, are far from perfect. But there is plenty of evidence that it works for many people.
The main takeaway for people with depression
Sen directs the Eisenberg Center for Family Depression, which has brought together researchers from the University of Michigan for more than 20 years. His research has explored the roots of depression for more than two decades. He is a depression scientist and a psychiatrist at the same time, and he has treated many people for depression.
“Do we need to understand exactly how pharmacological or non-pharmacological therapy works in order to use it? No — if that were true, we wouldn’t have treatments for depression, whether it was drugs, like SSRIs, psychological treatments like cognitive therapy, or changes Lifestyle like more consistent sleep patterns,” he says.
“The biology of the brain, and how the brain differs when we are in an episode of depression, is incredibly complex and our current understanding is limited.”
There is no doubt that basic science, including research on serotonin and genetic variation among depressed individuals, is critical to our search for the future, better treatments, and more personalized treatment. EFDC members – who come from many areas of UM – are helping to lead this research.
But, Senn says, “For people who are currently depressed, the information we get from clinical trials should guide care. Clinical trials suggest that SSRIs are moderately effective and play an important role in treating depression, along with Medications and other psychotherapy.
In other words, “If a treatment or combination of treatments prescribed or recommended by your healthcare provider works for you, great – stay with it. Your personal experience with the treatment is more relevant than this study. And if you are using medication for depression or another treatment and do not If you feel relief from depression symptoms, talk to your healthcare provider.”
The state of serotonin science
Senn notes that mental health experts certainly don’t think a simple “chemical imbalance” is the root cause of depression.
Serotonin is one of the primary brain chemicals, called neurotransmitters, that help brain cells “talk” to each other by contacting receptors on the cells’ outer surfaces.
The new study that has received much interest looks at a lot of older studies on serotonin, and is trying to draw conclusions by combining information from them.
The study did not conduct new trials or even combine previous studies in a meta-analysis. But instead, the researchers performed a “comprehensive review” of some, but not all, meta-analyses related to serotonin.
By chance, another “study of studies” on serotonin and depression was published just a week earlier than those in the news. It concluded that genetic variations of the serotonin transporter play a major role in the risk of depression, along with stressful experiences across a person’s life. But this study has not received the same amount of attention.
In other words, Senn says, the science of serotonin’s exact role is far from stable.
I look ahead
Sen and his colleagues hope that newer studies, using modern tools that allow scientists to see much more information from a much larger number of patients than those older studies, will speed up progress in treating depression.
“Within the brain, we now have much better tools to look directly at how neurotransmitters work and neural circuits change than we did 20 to 30 years ago when many of the initial studies were done that are covered in the comprehensive review,” he points out. “Furthermore, we can now computationally integrate information across many study levels and many patients in ways that were not possible before.”
For example, Sen and colleagues are working to determine how different combinations of genetic differences, along with current life and lifestyle events including sleep patterns, affect depression risk or response to treatment.
By studying people with severe stress and different schedules — like the thousands of new doctors in the Intern Health Study that Sen leads — they are learning more about how these factors interact.
Meanwhile, researchers at UM and beyond are studying ketamine, esketamine, ECT, talk therapy, and even psychedelic drugs like psilocybin, derived from fungi, to see what effect they have and who responds most. They are looking for people with depression, anxiety, and other conditions to participate in carefully controlled research studies.
Sen says. “But we don’t need to know the exact molecular mechanisms to act on clinical trial data that show positive effects of interventions such as better sleep, cognitive behavioral therapy, or SSRIs.”
The future of depression treatment may be more personalized to each patient, just as cancer treatment has become.
Sen says. “We all have different weaknesses and sensitivities.”
About this research on depression news
author: Kara Gavin
source: University of Michigan
Contact: Kara Gavin – University of Michigan
picture: The image is in the public domain
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