Our umbrella review that revealed no links between serotonin and depression has caused shock waves among the general public, but has been dismissed as old news by psychiatric opinion leaders. This disjunction begs the questions of why the public has been fed this narrative for so long, and what antidepressants are actually doing if they are not reversing a chemical imbalance.
Before I go on, I should stress that I am not against the use of drugs for mental health problems per se. I believe some psychiatric drugs can be useful in some situations, but the way these drugs are presented both to the public and among the psychiatric community is, in my view, fundamentally misleading. This means we have not been using them carefully enough, and crucially, that people have not been able to make properly informed decisions about them.
Much public information still claims that depression, or mental disorders in general, are caused by a chemical imbalance and that drugs work by putting this right. The American Psychiatric Association currently tells people that: “differences in certain chemicals in the brain may contribute to symptoms of depression.” The Royal Australian & New Zealand College of Psychiatrists tells people: “Medications work by rebalancing the chemicals in the brain. Different types of medication act on different chemical pathways.”