The serotonin theory of depression and why we use antidepressants

Nada Khan asks what GPs should tell patients when they ask how antidepressants ‘work’.¹

Surely prescribers need to talk honestly with patients, explaining that it is unclear how antidepressants ‘work’, even for ‘depression’, and that serotonin has multiple effects — on all physiological systems as well as on feelings of overwhelm, hopelessness, and ‘depression’. These effects can include paradoxical suicidality, sexual dysfunction, blunted emotions, digestive problems, fatigue, weird dreams, and compulsions — and other apparently bizarre effects that also affect mood.

Many people are suffering exacerbated physical and mental illness as a consequence of taking antidepressants ‘as prescribed’, often for many years. I and others have been trying to raise our concerns with GP prescribers through the BJGP — such as:

• Stevie Lewis’s ‘Four research papers I wish my GP had read before prescribing antidepressants’:² ‘As a busy GP, should you wish to learn more through reading current research, which papers give you the best insight into this subject? I would suggest the following four …’

• Ed White’s ‘Tapering antidepressants: why do tens of thousands turn to Facebook groups for support?’:³ ‘… there is a huge amount of evidence that patients’ withdrawal symptoms are often misdiagnosed when trying to stop taking ADs’

• My own ‘New NICE guideline: antidepressants and chronic pain — chicken or egg?’:⁴ sounding the alarm that antidepressant problems are actually a definite contributor to ‘where we are’ and that initial decisions to prescribe them warrant urgent attention — as well as how to address the longer-term dependence issues that are clearly now evident.

• David Misselbrook’s BJGP article ‘Don’t get fooled again’⁵ picked up on our concerns and asked fellow GPs, ‘… were we all too easily bewitched by our need to have the answers? And, fair enough, our desire to help patients, even when the evidence was doubtful or conflicted?’

Please may I also recommend the 2022 book Antidepressed by Beverley Thomson,⁶ written in plain language specifically to enable prescribers and patients to engage in the important discussions that need to take place with anyone prescribing or taking, considering prescribing or taking … or indeed trying to ‘come off’ antidepressants.

• © British Journal of General Practice 2022