Depression is not just a chemical imbalance

If low serotonin levels explained everything, then we would all be happy by now.

I’m not a psychiatrist. But every day I work with people who are being treated for depression. And I’m the one treating them. Like with so many problems, primary care doctors end up being the first line of help. Available psychiatrists and counselors can be hard to find, expensive, and require a greater level of commitment from people than just seeing their family doctor. We follow guidelines for diagnosis and treatment, and most people seem to improve. But by necessity, convention, and patient preference, we rely heavily on medications like Lexapro and Zoloft. These SSRI’s increase serotonin levels in the brain. Yet even though I’m not a psychiatrist, I have watched the paradigms shifting during my two decades of practice. Depression is a big tent diagnosis. We are learning that it has many causes, and that for each individual there are multiple factors in play besides low serotonin.

One in five people in the United States is diagnosed with major depression during their lifetime, and one in 10 copes with depression in any given year. Women have twice the risk of depression as men.

In this double length post I’m going to highlight a recent study that piqued my interest in which depression was explained to patients as a natural adaptation to their troubled surroundings instead of a disease. I’ll touch upon a meta-analysis from last year that some consider the nail in the coffin for the serotonin hypothesis of depression. We will then review some of the newer causes of depression that are being discovered, acknowledged, and researched. And finally we will conclude with the evidence based treatments that have been shown to help people with depression.

If you are one of the 80% of people who believe that depression is simply a chemical imbalance in the brain, you are obviously not alone in this oversimplification. And by oversimplifying the cause, many are missing opportunities to better understand what they are feeling, why they are feeling it, and what should be done… besides just taking a pill.