Anti-depressants are the most commonly-prescribed medication in the U.S., with one in 10 Americans currently taking pills like Zoloft and Lexapro to treat depression. But these pharmaceuticals are only effective less than 30 percent of the time, and often come with troublesome side effects.
In a controversial new paper published in the journal Neuroscience & Biobehavioral Reviews, psychologist Paul Andrews of McMaster University in Ontario argues that this failure of medication may be based in a misunderstanding of the underlying chemistry related to depression.
Andrews surveyed 50 years’ worth of research supporting the serotonin theory of depression, which suggests that the disease is caused by low levels of the “happiness” neurotransmitter, serotonin.
But Andrews argues that depression may actually be caused by elevated levels of serotonin. And this fundamental misunderstanding may be responsible for inappropriate treatment: The most common form of antidepressants are selective serotonin re-uptake inhibitors (SSRIs), which operate by targeting serotonin receptors in the brain in an effort to amplify serotonin production.
What do you think is the future of depression treatment?
As people and physicians become more aware that antidepressants only work for a limited period of time, and are less safe than they have been supposed, the use of antidepressant medications will decline and the use of psychotherapies will increase.
I would suggest that the attempt to pharmacologically reduce depressive symptoms is not likely to produce lasting effects. You can get these temporary effects, but they’re not likely to be lasting effects, and they can cause a whole lot of problems.
Psychotherapy is more likely to produce lasting effects, and can help people cope with the things that actually triggered their depressive episodes, and that’s why these therapies are more productive in the long run.
This interview has been edited for clarity and length.