There are a lot of articles going around trying to discredit the use of antidepressants, specifically SSRIs, on the basis of the fact that low serotonin levels or a “chemical imbalance” do not cause depression.
They don’t cause depression.
There are, of course, countless factors that contribute to a person experiencing depression, clinical or otherwise.
But I fail to understand how this equates itself to the fact that serotonin has nothing to do with depression. I keep scrolling through my newsfeed and seeing things like this, which honestly feels like a huge slap in the face:
The stigma is real, but it does not come from a place of logic. Images like this are usually made by people who have never experienced mental illness, people who think depression is just sadness, and for whom taking walks in nature has been enough. But let’s remember that everyone’s illness is unique to them, and the same thing doesn’t work for everyone.Depression isn't a joke. It can be lethal, if left untreated. Click To Tweet
Depression isn’t a joke. As the number one cause of suicide, it can be lethal if left untreated. We need to think about how we speak about depression; we need to think about the impact of what we’re saying or posting. By shaming someone for choosing a different option than the one you chose, you are often leaving them with no remaining options but to suffer.
Why are we so intent on suffering? Why are we so intent on doing things “without help” even if that means we never get better, even if that means we might not survive? Why do we tell people that their life is not worth living if they can’t do it “on their own”?Why do we tell people that their life is not worth living if they can't do it on their own? Click To Tweet
As someone for whom SSRIs have significantly helped, and as someone who tried everything humanly possible (yes, including walks in nature!) and was still not able to even begin the process of healing, I am going to take the time to explain what exactly SSRIs do.
For starters, SSRI stands for Selective Serotonin Re-Uptake Inhibitor. Serotonin is a neurotransmitter, meaning it is a chemical substance (naturally produced by the human brain) that carries a specific message and travels from a neuron (nerve cell) to a neuron within the brain, like so:
Among other things, serotonin is a natural mood stabilizer. A healthy human being has a ‘normal’ level of serotonin. In other words, there is a range of all emotions (happy, calm, focused, anxious, stable, etc.) that is normal, and serotonin is a big part of what keeps us at that level.
According to the National Institutes of Health, a normal serotonin range is 101 to 283 ng/mL (a pretty wide range, if you think about it). It definitely isn’t always the case that one’s serotonin levels are linked to depression, and we cannot say that serotonin levels cause depression, but it’s absolutely another factor to potentially take into account.Serotonin is naturally produced by the human brain and regulates our emotional stability. Click To Tweet
Usually, serotonin is released, circulates in the brain, and then absorbs into the bloodstream. SSRIs serve to block the “re-uptake” or re-absorption of serotonin by blocking some of the receptors in our blood that usually absorb serotonin after it is released; they prevent blood from absorbing serotonin in the brain.
This allows more serotonin to be available to our brain for a longer duration of time. Ultimately, SSRIs don’t increase the production of serotonin, they allow our body to use the serotonin we already produce in a more efficient and effective way.
In 2015, World Psychology (The Official Journal of the World Psychiatric Association) published an article that highlights the ways SSRIs help to ease depression, regardless of the fact that low levels of serotonin do not necessarily “cause” depression in the first place.
The primary reason depression is mitigated by consistent, long-term use of SRRIs is that SSRIs promote “synaptic plasticity,” or the ability of synapses (gaps between neurons) to strengthen or weaken over time. Synaptic plasticity is important because it is part of what allows humans to be able to learn, unlearn, and re-learn emotional responses. This is why therapy often works exponentially better in combination with medication like SSRIs.Synaptic plasticity, promoted by SSRIs, helps humans be able to learn, unlearn, and re-learn. Click To Tweet
Emotions are not the same as moods; emotions are temporary, automatic responses to internal or external stimuli. Most people with depression (known as a mood disorder) have “negatively biased” emotions, which lead to a permanent negative mood. Increasing serotonin activity in the brain gives individuals with depression the opportunity to shift their thinking, to re-learn negative emotional responses as positive ones.
Without SSRIs, some people are unable to break their pattern of depressed or anxious thoughts. Not because they are not trying hard enough, but because their brain does not provide them with the right chemicals at the right time. People with depression are not weak; they genuinely have a harder time feeling good – the same way someone with a broken leg might genuinely find it harder to walk.
For example, perhaps when an event occurs that triggers depression or anxiety, serotonin levels are not where they should be in order for the person to feel good, even if they are trying to think positively. It’s like your brain is reaching for its naturally produced “feel good” chemicals, but those chemicals have come and gone too quickly, and your brain is stuck with the negative.
If you choose to take SSRIs, you are simply allowing your body to do what other peoples’ bodies are already doing. It really is similar to taking insulin for diabetes, something your body naturally makes but doesn’t make enough of in some cases.Serotonin activity helps the brain re-learn negative emotional responses as positive ones. Click To Tweet
Depression is not just sadness. It is sadness at a level which prevents one from functioning in the most basic of ways. After taking SSRIs for a while, I’ve definitely experienced a change. I don’t feel like this “happy pill” has cured me or saved me from having to put forth any effort. I do, however, feel more capable of putting in the effort to exercise and go to therapy. I feel this way about a number of activities that benefit my overall physical, mental and emotional health. I am functioning.
I finally feel like the amount of effort I put in is actually leading to more appropriate results, emotionally-speaking, as opposed to putting in 200% and gaining little to nothing, or somehow feeling worse. I know this is something that is difficult to understand or relate to if you’ve never experienced it, but so are a lot of illnesses that we still manage to accept as valid health issues.The brain is part of the human body. Click To Tweet
The brain is part of the human body. Mental health is a kind of health – it is no less important than physical health. They are both subsets of our overall health. When we start to see it that way, maybe we’ll finally start to take better care of our brains, ourselves, and each other.
When we start to see it that way, maybe we’ll finally start to take better care of our brains, ourselves, and each other.