Jacob Freedman
Jacob Freedman Courtesy

Is depression due to a chemical imbalance? Many people are quoting this recent study in Nature and saying “no!”

That being said, I’m not sure I’ve ever met a psychiatrist I respected who told their patients, “your depression is due to low serotonin.” Yes, this was often repeated in the media, but I think we can all agree that it’s a lot more complicated than that.

Most of my colleagues would honestly say that depression (and other psychiatric illnesses) are the result of many factors including biological/genetic predispositions and environmental/psychological stressors.

The chemicals involved in depression are infinitely more complex than just serotonin and its fellow neurotransmitters like norepinephrine and glutamate. Hormonal changes, inflammation, and neuronal connectivity are most certainly involved as well.

Developmental struggles (like those described so many years ago by Erik Erikson) are critical, as are psychological traumas like abuse, and inevitable life challenges like grief and loss.

Societal issues are equally important as people from different cultures experience depression differently.

In short, I am not surprised that an article such as this has recently been published in a prestigious journal such as Nature. I am not surprised by any means because I was never taught that the story of depression was as simple as serotonin. In all of my years as a psychiatrist who trained under the famous professors of Harvard Medical School, not a single one of my mentors ever suggested as much.

The more we learn as a field, the more we be able to help our patients. New research allows us to recommend targeted medication interventions with better efficacy and decreased risks of side-effects. The past decade has taught us so much more about non-pharmacological medical interventions such as therapy, exercise, and mindfulness.

And while many people feel misled, I have no concerns relating the following truth: that many patients have benefited from psychopharmacological treatments which have been reliably shown to be helpful.

For example, lithium is known to prevent death by suicide and antipsychotic medications are proven to prevent institutionalization in patients with schizophrenia. Drugs that target the serotonin system are absolutely beneficial in depression, anxiety, PTSD, and OCD. Psychiatric medications allow members of our community to stay where they belong: at home and with their loved ones.

Here is another important truth: a good psychiatrist (and a good doctor in general) will never take it personally if you ask them to explain the recent research in the field. Even when it’s an article that seems quite concerning, such as the one published in Nature. A doctor who is unwilling to have such a discussion isn’t worthy of their degree.

With that in mind, I would recommend that a patient should never stop their medication before having a thorough discussion with their doctor about the benefits and risks. Again, this is relevant in psychiatry as well as any other branch of medicine.

Wishing everyone a safe, a healthy, and—ultimately—a blessed day.

Jacob L. Freedman MD is a Board-Certified Psychiatrist in America and Israel whose website is Drjacoblfreedman.com

Dr. Freedman’s new book is now available from Menucha Publishers: