In case you haven’t heard, there’s a new systematic review, published in Nature Molecular Psychiatry, that’s causing a splash in the mental health world.
The gist: After examining scores of studies, the authors conclude that serotonin levels don’t affect depression.
The authors’ conclusion: The prevalent “chemical imbalance” theory of depression is destroyed.
The further conclusion: There’s no theoretical reason for using SSRI antidepressants.
The authors then point out that no one should stop taking SSRI’s without talking to their doctor first.
A few points.
First, studies like this are important because they advance our understanding of the disease, but the “chemical imbalance” theory hasn’t prevailed for some time.
In fact, I’ve seen scant research or discussion on the idea over the past decade.
Why, because researchers are finding a lot of different, more compelling, complex, data-supported explanations for why depression might develop (more on that later).
Crucially, none of these more compelling theories suggest anything other than the idea that depression is still a medical condition.
In fact, if anything, we’re realizing that it’s a far more complex medical condition than just an imbalance of serotonin levels.
This is no different from any medical condition.
Explanations, theories, treatments for any condition are constantly being refined and altered, according to the science and things usually get increasingly more complex.
Alzheimer’s, for example.
No one would deny it’s a medical condition, but researchers are continually trying to identify risk factors for its development, treatments that supposedly work but then are dashed by subsequent studies.
Throughout all these changes in the study of Alzheimer’s, no one has doubted that it’s a medical condition.
We’ve just been trying to understand it better, medically. And hopefully will get there one day.
The reason I stress this is simple.
There are still loads of Christians who deny depression is a medical condition.
These Christians typically populate both Pentecostal and uber-traditional churches that rely solely on verses and prayers for treatment.
I can never say “never” about someone’s spiritual or mental health journey, but the idea that verses can treat mental health has literally killed many and wounded beyond belief scores of other Christians who are wracked with guilt and shame for thinking they have faulty spirituality at the root of their mood disorder.
As this blog has constantly stressed, there’s simply no theological case for clinical mood disorders having any relationship to our level of spirituality.
Sadly, I’m afraid that important studies like this will be abused.
Christians will likely pounce on this, and use it to further shame and throw scorching cold water on the idea that mood disorders are medical conditions.
In fact, I’ve already started hearing it.
Now let’s say you’ve embraced the idea that depression is simply caused by a “chemical imbalance” and are doubting now the medical basis.
Don’t doubt.
I’d urge you to read (and bookmark for your skeptical Christian friends) this quick article by Dr. Austin Perlmutter‘, who helpfully responds to the study in question by showing all the more compelling medical connections that researchers have been making for why depression might develop.
These range from chronic inflammation, the brain-gut axis, neuroplasticity, to endocrine changes and more.
Each is far more complex than the “chemical imbalance theory,” and yet much more compelling, from a clinical study perspective.
These are the mechanisms that researchers have been studying and finding solid support for.
Sadly, the “chemical imbalance” article is the one making the waves in the media, and I’m certain around churches.
Very few researchers have subscribed to this theory in recent years.
So why are SSRI’s still prescribed?
I’m not a medical doctor, but the odd thing about this study is that it draws such a sweeping conclusion on SSRI’s by merely looking at their effects on serotonin.
It is a very narrow way to dismiss something.
Many SSRI’s have, for example, anti-inflammatory effects that decrease the neuroinflammation that’s prominent in those with mood disorders.
Psychology Today also points out that data suggests that SSRI’s can positively affect neuroplasticity.
In other words: if you’ve been helped by SSRI’s, it might be via an entirely different mechanism from its affect on serotonin levels.
We see this with other medications frequently.
A personal example.
I took a tricyclic antidepressant (not an SSRI) for ten years.
Sadly, some of the side-effects started to become so bothersome that I went off it.
What happened shortly thereafter?
All of my inflammatory markers increased, and I developed adult-onset Crohn’s Disease.
Can I prove it was related to quitting the tricyclic? No.
But the fact is: something verifiably substantial changed in my body as I weaned off the medicine. That doesn’t prove causation, but the correlation is interesting.
And a potential explanation is fairly simple.
Tricyclics help reduce levels of the inflammatory marker TNF-alpha, a key contributor to the development of Crohn’s Disease and autoimmune conditions.
It’s easy to see why my inflammation might have soared, why my depression might have worsened, and why all the other medical conditions may have developed.
All this to say:
This study making a splash certain does throw cold water on the “chemical imbalance theory,” but that water was thrown years ago.
Second, it’s irresponsible of the authors to so casually dismiss SSRI’s when there are clearly other ways they affect the body that could help with depression.
Third, the study does nothing to change the fact that clinical mood disorders are medical conditions.
We find out new things about cancer all the time that are dismissive of old ways of thinking, but never doubt that cancer is a medical condition.
In fact, we are finding more and more support for the notion mood disorders are medical conditions.
And fourth, it’s terribly sad that Christian skeptics will now share this study around churches and social media and, rather irresponsibly and dangerously, urge their fellow believers that they’ve been scammed and victims of secular science.
The irony is that they would never share all the studies from “secular science” that still support the medical basis for mood disorders.
They would call those studies “scams” from “sources you can’t trust.”
And yet… they will use this study from “secular science” for their own ends.
It’s an inconsistency that’s lost on so many, and will contribute to losing so many lives.
Mood disorders are still medical conditions. This study does nothing to suggest otherwise.
Find a psychiatrist here.
Find a therapist here.
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