Some brief notes on the new Moncrieff paper
https://www.nature.com/articles/s41380-022-01661-0
Some of you may have seen coverage of this research. I thought I'd throw up some comments on it as it's one of the things I'm digging into for my PhD (and I'm a huge fan of the lead author, Prof Moncrieff). Just some bullet points:
- the paper demonstrates no known link between serotonin and depression; this is significant because the 'chemical imbalance hypothesis' has been dominant for decades and is still culturally influential, even if it is now officially abandoned as an explanation;
- by itself this does not mean that anti-depressants 'don't work' - sometimes they do, we just don't know how; however
- whether they work or not is therefore something of a lottery for any one individual;
- in the aggregate (ie for a population) they are not as effective as a placebo;
- anti-depressants are powerful brain-altering chemicals with major side-effects (suicidal ideation, loss of libido etc);
- anti-depressants are addictive and extremely difficult to come away from;
- major corporations make a lot of money from the sale of anti-depressants, and it has been a lucrative and rapidly expanding market;
- there is interesting research around infections as a cause/ factor in depression, ie the body isn't able to 'get back to normal' after an illness;
- there is also a clear link with adverse life-events triggering the depression (to which the only response is 'duh!');
- the suffering is real.
In my view we're in the very early moments of a classic 'paradigm shift' when dealing with questions of mental health, shifting away from a strictly biological/medical understanding (= there is something wrong with your body) towards a much more holistic understanding which takes all the social and individual factors into account. The new paradigm isn't in place yet, although what is called the 'Power Threat Meaning Framework' I think holds a lot of promise.
Of course, what I really think is that we can't talk about psychiatric problems without talking about the psyche, the soul.... in other words, the ultimate cure for depression is faith, but that is a very complicated (and very dangerous) idea to handle carelessly. Which is why it's going to take me the next five or six years to tease out what I mean!
(Personal note: apologies for mostly radio silence - am dealing with very knotty domestic legal problems which are taking up a lot of my attention. Things will change, hopefully this side of the eschaton.)