Over the past two days, a class of antidepressant drugs, called SSRIs, have been the subject of much discussion in the media.
But what are SSRIs? How do they work and are they really effective in treating depression?
What are SSRIs?
Selective serotonin reuptake inhibitors are a class of drugs used to treat certain mental health conditions such as depression, PTSD, OCD, and anxiety disorders.
SSRIs were first used as an anti-depression treatment in the 1980s and are now widely used, usually in combination with talking therapies such as cognitive behavioral therapy.
How do SSRIs work?
SSRIs alter the way serotonin works in the brain. Serotonin is a neurotransmitter that also acts as a hormone and carries messages between nerve cells in our brain and throughout the nervous system of our body.
Normally, once serotonin has carried these “messages” between nerve cells, it is reabsorbed. This is called “reuptake”, and this is what SSRIs prevent from happening.
Because SSTIs prevent serotonin from reabsorbing, there is more serotonin available to carry even more messages through the brain and body. It is assumed that this is how SSRIs relieve depression, at least in part.
Why are people talking about SSRIs now?
SSRIs have been the subject of recent discussion in the media following the publication of an article that reviewed 17 studies on serotonin. The authors wanted to see if there was any evidence that depression is associated with lower serotonin levels. They found no such evidence.
This article has questioned the role that serotonin plays in depression and, by implication, the effectiveness of SSRIs in this condition – but it is important to note that this was not the purpose of the article.
To say that low serotonin levels are the cause of depression is way too simplistic. While many experts agree that serotonin often plays a role in major depressive disorders, the causes of depression are much more complex and involve environmental factors, socioeconomic influences, other physical conditions and medical conditions and even our personal experiences such as violent events or childhood trauma. .
Professor David Curtis, Honorary Professor, UCL Genetics Institute, said:
“This article does not present any new findings but simply reports findings that have been published elsewhere, and it is certainly not news that depression is not caused by ‘low levels of serotonin’. The notion of depression due to a “chemical imbalance” is outdated, and the Royal College of Psychiatrists wrote that this was an oversimplification in a position statement published in 2019. Nor is it true that SSRI antidepressants increase serotonin levels Their immediate action is to alter the balance between serotonin concentrations inside and outside neurons, but their antidepressant effect is likely due to more complex changes in neuronal functioning, which occur It is very clear that people with depressive illness have abnormal brain function, although we don’t yet know what it is. works, and that antidepressants are effective treatments for severe depression, while interventions such as exercise and mindfulness are not. It is important that people with severe depression are not discouraged from receiving appropriate treatment, which can make a huge difference for them and those around them.
So, are SSRIs effective?
As with all treatments for physical and mental health conditions, the answer is: it depends.
For some people, SSRIs are very effective. For others, they seem to make little or no difference.
In many cases, SSRIs can help improve symptoms, but only when used in conjunction with other forms of treatment such as cognitive behavioral therapy.
More research is needed to better understand why SSRIs work for some people and not others.
Dr Michael Bloomfield, Consultant Psychiatrist and Principal Investigator at UKRI, Head of the Translational Research Group in Psychiatry, UCL, said:
“Many of us know that taking paracetamol can be helpful for headaches, and I don’t think anyone believes that headaches are caused by too little paracetamol in the brain. The same logic s applies to depression and the drugs used to treat depression. There is consistent evidence that antidepressant drugs can be helpful in the treatment of depression and can save lives. Antidepressant drugs are one type of treatment alongside other types of treatment such as psychotherapy (talking therapy) Patients should have access to evidence-based treatments for depression, and anyone taking treatment for depression and considering stopping treatment should Discuss it with your doctor first.
Should I stop taking my antidepressants?
It is very important that if your doctor has prescribed antidepressants for you, that you do not suddenly stop taking them. This can cause symptoms such as dizziness, nausea, mood swings, brain fog, and in some cases even thoughts of suicide.
Instead, you should talk to your doctor about your treatment options and follow their recommendations.
For more information, you can find useful resources here:
SSRIs – NHS information
Stop antidepressants – advice from the Royal College of Physicians