NPR: Depression is More Than a Serotonin Imbalance

I was very pleased to see this article from NPR over the past week, because it highlights something I’ve been saying for about 20 years regarding depression and mood disorders.

Here’s a quote from Alan Fraser at the UT-San Antonio School of Pharmacology:

I don’t think there’s any convincing body of data that anybody has ever found that depression is associated to a significant extent with a loss of serotonin.

The thing about SSRIs (Selective Serotonin Reuptake Inhibitors) like Prozac and Zoloft is that they do seem to have some positive impact when it comes to treating depressed mood. I explain to my clients that these SSRIs are a bit like a lifejacket. On the one hand, these medications help to buoy up your mood and allow you to float on top of the turbulent seas of depression. On the other hand, the medications can often feel like a hindrance or impediment when it comes to moving forward in the ways you might need to get out of the situation. It’s hard to swim while you’re wearing a lifejacket. But you’re a lot less likely to drown if you have one.

As the NPR story explains, one reason why drugs like Prozac have such a pull on our imagination is that we want to help people understand that depression is a type of sickness, and that medication can help treat the symptoms of that sickness. Because serotonin is your body’s “Mission Accomplished” neurochemical, having more serotonin in your system gives you a greater sense of peace and calm. But there is more to depression than simply feeling uneasy. Lack of pleasure (anhedonia) is another hallmark symptom of depression and makes it more difficult for those in its grip to shake themselves free. “Nothing tastes good” is a common complaint from people who are in the midst of a depressed episode. There are also existential issues for many people with depressed mood. Why should I bother trying? What’s the point of my life? Where am I going? Will this ever get better?

The answers to these existential questions are extremely important. Dispensers of conventional wisdom and friendly advice might try to offer helpful solutions, but those suggestions often ring hollow when you’re in the throes of depression. To find your way out of the depression, you have to find solutions that work for you. And because of the lack of desire, pleasure, and energy, it’s difficult to believe that anything will really help.

It’s one reason why the professional help of a trained outside observer can be so valuable. While medication can be very beneficial, so can talk therapy. A therapist can help you to use your support system in appropriate ways, tackle the “stinking thinking” that keeps you stuck, and take action in ways that move you out of the maze of negativity and frustration.

For more on depression and treatment, I recommend these blogs:

Beyond Blue

The Happiness Project

Mindfulness and Psychotherapy

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