🔮 Sunday Commentary: Critical Psychiatry’s Serotonin Problem

A rich discussion emerged on the Exponential Do community Slack earlier this week inspired by a new paper published in Molecular Psychiatry. I asked one of the members involved in the discussion, Josh Hardman, founder and editor of Psychedelic Alpha, to share his views with us. Here’s Josh:

A new paper published in Molecular Psychiatry has caused quite a stir among researchers, practitioners, and reporters alike: according to Altmetric, it’s been cited in nearly 170 news articles and over 4,000 tweets since its publication on Wednesday.

The systematic review claims to debunk the serotonin theory of depression which holds that depression is caused by low levels of serotonin; a ‘chemical imbalance’. Instead, the authors argue that depression is caused by difficult life events.

Space does not allow us to delve into some of the methodological issues and more substantive debates around this paper (readers should see Science Media Centre for expert reactions in this vein) but it does afford us the chance to briefly explore the implications of its ‘findings’ and their largely uncritical depiction by media outlets.

The authors’ ‘finding’ that low serotonin does not cause depression is, prima facie, a pretty uncontroversial argument. While the first sentence of the publication claims that such a theory of depression “is still influential,” it’s not clear that this is the case among experts: you would be hard pressed to find a psychiatrist, for example, that subscribed to the notion. While it may remain undeniably salient among the public and perhaps even general practitioners, it is certainly not accepted among experts - most of whom subscribe to the biopsychosocial model knowing that depression is a heterogeneous disorder with several potential underlying causes.

It appears the authors are hoping that by debunking the chemical imbalance theory of depression they might restore agency to individuals who may otherwise be pessimistic about their ability to self-regulate their mood, perhaps believing that their mental health is biologically predestined.