PARIS — A controversy in the scientific
community over recent claims
anti-depressants can be ineffective at treating
depression has highlighted the difficulties in understanding mental health
conditions.
اضافة اعلان
One of the prevailing theories currently focuses on
serotonin. Depression has been linked to a lack of the molecule, which is
involved in transmitting emotions to the brain.
Claims that depression has no link to a chemical
imbalance in the brain related to serotonin, casting doubt on the need for
anti-depressants, have sparked fierce reaction.
A study by psychiatrists Joanna Moncrieff and Mark
Horowitz in the journal Molecular Psychiatry in July concluded that there was
no proven link between a lack of serotonin and depression.
The authors said it queried the underlying
assumption behind the use of anti-depressants, which are mostly developed to
alter serotonin levels, undoing a theory that for decades acted as a framework
for research.
The study is based on several previous publications,
but it quickly attracted criticism — particularly its presentation by
Moncrieff, known for her skepticism towards biological explanations of
depression and her radical stance against the pharmaceutical industry.
“I’m broadly in agreement with the authors’
conclusions about our current efforts, though I lack their adamantine
certainty,” psychiatrist Phil Cowen said on the Science Media Centre website.
“No mental health professional” would endorse the
view that a complex condition like depression “stems from a deficiency in a
single neurotransmitter”, Cowen added.
‘Mainstream’ psychiatry
Some peers have questioned
the methodology, which measured an indirect trace of serotonin rather than
taking direct measurements of the molecule.
Moncrieff, who wants to break with what she calls
“mainstream” psychiatry, believes the serotonin theory still occupies an
important, albeit less prominent, place in the profession.
“Even if leading
psychiatrists were beginning to
doubt the evidence for depression being related to low serotonin, no one told
the public,” the British psychiatrist wrote on her blog.
The connection between depression and serotonin is
firmly rooted in the popular imagination. French author Michel Houellebecq gave
the title “Serotonin” to his 2019 novel in which the main character is
depressed.
Moncrieff’s undermining of the serotonin theory to
argue against current anti-depressants, going beyond the conclusions of her own
study, has sparked the most vehement criticism.
Swiss psychiatrist Michel Hofmann told AFP her study
was “serious” and contributed to expert debates about depression.
“But I don’t think it is an article that should have
any impact in the short term on the prescription of anti-depressants,” he said.
Moncrieff has warned that anti-depressant treatment
should not be suddenly interrupted. But for her, the benefits of a course of
anti-depressants are doubtful if it is based on a discredited theory.
But many stress
that the effectiveness of the treatments has been scientifically assessed,
irrespective of the primary cause of depression.
The medicines used to treat depression “are usually
many and ultimately, in most cases, we don’t know what exactly makes a
treatment effective”, Hofmann added.
Debates on the role of serotonin only illustrate how
difficult it is to understand the biological and social workings of an illness
as complex as depression.
The challenges are forcing researchers to move away
from models that are incomplete by their very nature.
“We are still at theories and we continue to search
and test models against each other,” Hofmann said.
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