The demonization of antidepressant drugs can lead to a worsening in mental health care, warns psychiatrist Jose Gallucci Neto, director of the Electroconvulsive Therapy (ECT) service at the USP School of Medicine’s Institute of Psychiatry. A recent British study published in the scientific journal Molecular Psychiatry pointed out that there is no “convincing” evidence that depression is associated with low concentrations or activity of serotonin, the axis on which some of the drugs try to act. He points out that the study only points out limitations of the chemical imbalance theory – something already widespread in the area -, in addition to opening doors for research on the relationship of other neurotransmitters and also for the long-term investigation of the effectiveness of antidepressant drugs. “Never stop taking your antidepressant without guidance from your psychiatrist.”
What is the relevance of the British study?
It is an important study, but it is not groundbreaking. It corroborates something we already knew: there is no correlation between serotonin levels and being depressed or not. How did we already know that? Because when we prescribe antidepressants, we don’t dose serotonin beforehand. The sieve to indicate or not is based on the clinical diagnosis. We also know that when you treat patients with depression, 30% do not respond to antidepressants. Although the biological marker for depression is sought in scientific research, this marker does not yet exist. This means that mental illness probably has a multifactorial and complex origin. Seeing the lack of serotonin as a cause of depression is a reductionism.
Why did serotonin end up in the spotlight when talking about depression?
The first medications that were observed, through observation, to have an antidepressant effect were medications that bound to serotonin, norepinephrine and dopamine receptors. And many patients improved (with these first medications). So, it is also useless to demonize the biochemical imbalance theory simply because serotonin did not establish a cause and effect correlation.
One of the study’s suggestions is that professionals no longer inform patients that depression is related to low concentrations of serotonin. How do you analyze the issue?
This information should never have been given because it is a misguided simplification. I have never informed a patient of mine that his depression was caused by low serotonin levels. Even though I know a lot of people do that. The correct information is that we do not know the origin of depression and we have some theories, among them this one, but that probably do not explain everything or all cases.
Should we stop prescribing antidepressants?
No way. We need to know better the mechanism of action of antidepressants, this depends on investment in research. We need long-term studies to primarily assess the effectiveness of antidepressants, because in medicine we usually only have short-term studies. The introduction of antidepressants and psychotropic drugs in the treatment of mental illnesses is a watershed in the mental health of the population. We were only able to deinstitutionalize serious cases and close the asylums in the psychiatric reform because of antidepressants and electroconvulsive therapy. If we start demonizing antidepressants, we’re going to have a worsening of mental health care.
The information is from the newspaper. The State of São Paulo.
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