Psychiatry's ‘Chemical Imbalance’ Fraud: Who Killed Rebecca Riley?. 2008.

The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients. 2022.

Antidepressants and the serotonin hypothesis of depression. 2022.

The case against evidence-based principles in psychiatry. 2006.

The serotonin theory of depression: a systematic umbrella review of the evidence. 2022.

Serotonin and depression

02 November 2022
Volume 4 · Issue 11


George Winter discusses the role of serotonin when deciding how to treat depression and how new papers are now disputing the role in plays and whether antidepressants are even the correct treatment option

In a recent review, Moncrieff et al (2022) note that the decades-long idea of depression being the result of a chemical imbalance in the brain – especially serotonin (5-hydroxytryptamine or 5-HT) – has justified the use of selective serotonin reuptake inhibitor antidepressants. It is an idea that has helped cement the view that mental health problems are largely explainable in the language of wayward brain chemistry. Indeed, one might infer that over many years the mind has become academically suspect, with the psychiatrist's couch consigned to the attic to make room for the CT scanner since it is clear that mental health problems are caused by apparently verifiable brain pathologies.

Despite this, Moncrieff et al (2022) have set a scientific cat amongst certain evidential pigeons by concluding that ‘[t]here is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.’ Some sharp responses have ensued. For example, the strapline to an article by Kendrick and Collinson (2022) not only asserts that antidepressants ‘remain an effective treatment for depression, even without the “chemical imbalance” explanation’, but the authors claim that the conclusions of Moncrieff et al (2022) ‘could encourage sudden antidepressant cessation, causing withdrawal symptoms and risking relapse.’

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