The prevalence of mental health issues is on the rise, with depression affecting 1 in 6 adults in the UK, often accompanied by symptoms such as anxiety, stress, and loneliness. (Pindar, 2023) Approximately 1 in three adults are undergoing treatment for common mental health conditions, primarily through talking therapies and psychiatric medications including SSRIs. (mind,2024) Common causes of depression include homelessness, trauma, substance misuse, identity issues, and social inequality. (NHS, 2023) In the Western approach, mental health disorders are often attributed to a chemical imbalance in the brain, (NIH, 2007) with the use of medications to increase neurotransmitter levels. However, there is limited evidence to support the idea that depression is solely a result of a chemical deficiency.
Western understanding & approach to treatment
The Western approach to mental health treatment is based on the widely accepted theory that mental health disorders stem from a chemical imbalance in the brain. (Healthline, 2021) The focus was initially on the neurotransmitter norepinephrine by the 1960s the focus had shifted to the neurotransmitter Serotonin which led to the development of SSRIs (Selective Serotonin Reuptake Inhibitors) This theory was proposed by scientists in the late 1950s who observed the reversal of symptoms with the use of MAOIs, TCAs, and SSRIs (Leo, J, 2008), the alleviation of symptoms implies there could be additional internal or external factors at play that influence these symptoms.
The theory of chemical imbalance catalyzed additional research and significantly impacted both the field of psychiatry and the pharmaceutical industry.
Prescribing anti-depressants has become the primary method of treating patients with depression, overshadowing a psychiatrist's discussions with patients about everyday stress. (NHS, 2023).
The pharmaceutical industry has seen a substantial increase in profits, with the global market projected to reach 17.32 billion in 2024 at a compound annual growth rate of 4.3% (TBRC, 2024).
The concept that depression is caused by a range of chemical imbalances in the brain, particularly involving serotonin, has held significant sway for many years, providing a rationale for the use of anti-depressant drugs. Nevertheless, although these medications can enhance an individual's well-being, there is scant proof that the manifestations of depression stem from a lack of chemicals (Healthline,2021) for instance the delay between the initiation of SSRIs and the alleviation of symptoms implies that there could be additional internal or external factors at play that influence these symptoms.
The idea that depression is a result of various chemical imbalances in the brain, namely serotonin has been influential for decades justifying the prescribing of anti-depressant medications. (Leo, J., Lacasse, J.R.,2008).
However, while these medications may improve a person's health there is limited evidence that the symptoms of depression are a result of a chemical deficiency (Healthline, 30 November 2021) for example, there is a time lag between when a person starts taking SSRIs and the reversal of symptoms suggesting that there may be other internal or external changes occurring that impact symptoms. (PubMed, 2010).
The exact cause of mental health disorders remains unclear, biological psychological and environmental factors may all play a part in symptoms (WebMD, 2023).
A new analysis questions if we have been treating depression wrong.
An examination recently conducted raises doubts about the conventional approach to treating depression. The study which involved a systematic review of 17 research papers was published in Molecular Psychology on July 20th,2022 Titled “The serotonin theory of depression: A systematic umbrella review of the evidence, the review challenges the long-standing belief that depression stems from low serotonin levels. Moreover, it casts doubts on the efficacy of antidepressant medications in addressing the condition. (BMJ, 2023)
The findings of the review suggest that there is a lack of consistent evidence supporting the link between serotonin levels and depression. Contrary to popular belief, the analysis of placebo-controlled trials indicates that antidepressants only marginally outperform inert sugar pills in alleviating depressive symptoms. (Psychol, 2014) This revelation prompts a reevaluation of the underlying causes of depression, as the traditional notion of a chemical imbalance or serotonin deficiency may not fully capture the complexity of the condition.
Dr Joanna Moncrieff, a distinguished psychiatry professor at the University College London, has expressed skepticism towards the serotonin theory, which has gained significant popularity since the 1990s due to the promotion by pharmaceutical companies. Her research has shed light on the inconsistencies in the evidence supporting this theory, particularly since 2005. (Moncrieff,2021).
Moncrieff and her team have conducted studies that suggest the long-term use of antidepressants may lead to a decrease in serotonin levels. Interestingly some depressed individuals were found to have higher levels of serotonin in specific brain regions, although these findings were not consistently replicated. This challenges the traditional understanding of how antidepressants affect serotonin in the brain.
Furthermore, Moncrieff's research indicates that antidepressants may work by desensitizing the brain to negative emotions, but this process may also inadvertently desensitize positive emotions such as joy and happiness. This numbing effect, rather than being a desired outcome raises concerns about the long-term implications of using antidepressants for managing mental health conditions.
Correspondence from Chris Davey, the head of the psychiatry department at Melbourne, highlighted the significance of maintaining confidence in treatment options, particularly for depression. Davey expressed his apprehension about the detrimental effects of undermining individuals' trust in their treatments. He underscored the importance of ensuring access to psychotherapy for all individuals and suggested that medication should be considered only when psychotherapy proves ineffective for certain mental health conditions. (Moncrieff,2023).
Additional investigation is required to ascertain the correlation between serotonin levels in the brain and the efficiency of antidepressants. The aetiology of depression and anxiety is intricate, with significant variations in cause and effect among individuals. Factors such as societal shifts, lifestyle choices, occupational stress, family dynamics as well as the experience of grief and loss impact individuals in diverse ways. It is crucial to focus on identifying and addressing the underlying causes of mental health issues.
Anti-depressants undoubtedly play a valuable role in managing severe depression and anxiety. However, it is essential to recognize that talking therapies can also be highly effective in diagnosing and treating these conditions. Talking therapy provides individuals the opportunity to explore and understand the root cause of their mental health struggles. Combining pharmacological interventions with psychotherapy can lead to more comprehensive and sustainable outcomes for individuals dealing with depression and anxiety. (PubMed, 2010).
In conclusion, the relationship between serotonin levels and antidepressant effectiveness and mental health outcomes is multifaceted and warrants further exploration, addressing the complexities of depression and anxiety requires a holistic approach that considers individual differences and diverse contributing factors by prioritizing the identification and treatment of underlying causes, utilizing a combination of medication and therapy, individuals can work towards achieving long term mental wellbeing and improved quality of life.
The potential adverse effects and health hazards associated with the consumption of prescribed SSRIs and SNRIs (selective serotonin reuptake inhibitors) encompass a range of symptoms. These may include difficulties such as insomnia, headaches, dizziness, joint and muscle pain, gastrointestinal disturbances, alterations in blood clotting capacity, as well as sexual dysfunction (Publishing, August 2021).
Patients should be advised about the possible risks associated with SSRIs and SNRIs, as well as the importance of reporting any unusual symptoms or changes in health status during treatment. By fostering open communication and proactive monitoring both patients and healthcare professionals can work together to mitigate the risks and optimize the benefits of pharmacological interventions for mental health disorders.
SSRIs undergo metabolism in the liver through cytochrome enzymes, which are also responsible for the metabolizing of various other drugs. This shared metabolic pathway can result in drug interactions potentially leading to either increased or decreased blood levels of the drugs, consequently causing additional health complications.
Serotonin Syndrome, a rare yet severe health condition may manifest with symptoms such as rapid heart rate, profuse sweating, confusion, and elevated blood pressure. This condition can arise because of interactions between SSRIs and other medications posing a significant risk to the individual's health (NHS, 2021).
In addition to serotonin syndrome, individuals taking certain medications may also be at risk of developing diabetes, hyponatremia, psychosis, suicidal thoughts, and even death.
SSRIs should never be taken alongside the herbal remedy St John’s wort, Monoamine oxidase inhibitors, or lithium which is used to treat bipolar disorder (NHS, Side effects- Antidepressants, 2021).
These risks highlight the importance of closely monitoring individuals who are prescribed such medications to ensure their safety and wellbeing.
The Eastern Perception and approach to treating Mental Health Disorders
The Eastern perspective on addressing mental health conditions differs significantly from Western approaches.
Chinese Medicine offers a holistic view that recognizes the interconnection of the mind, body, and spirit. The primary goal of treatment in traditional Chinese Medicine (TCM) is to eliminate any energy blockages within the body to restore balance, thereby facilitating homeostasis, and allowing the body and mind to naturally heal (K.H.Aung, 2013).
In TCM the treatment of mental health disorders involves a thorough assessment of the individual condition considering their unique constitution and circumstances. Considering the interconnectedness of the mind, body, and spirit aims to restore harmony and balance within the individual, promoting overall well-being and mental health. This approach reflects a fundamental difference in the understanding and management of mental health disorders compared to Western medical practices.
Traditional Chinese Medicine (TCM) and Western medicine share several similarities and differences in their approach to healthcare. (PubMed, 2019) TCM which has a history of over 3000 years encompasses various therapeutic modalities including acupuncture, herbal medicine, cupping, moxibustion, and Qigong, in contrast, Western medicine is rooted in the scientific method and evidence-based practice, utilizing pharmaceutical, surgery, and other modern technologies for diagnosis and treatment.
One of the fundamental principles of TCM is the concept of balance, where any sustained imbalance in the body can lead to disharmony and disease. This is akin to the Western medicine concept of homeostasis, which emphasizes the body's ability to maintain internal stability and equilibrium for optimal health. Both systems recognize the importance of achieving and maintaining a state of balance for overall well-being (M, 1995).
In TCM the flow of “Qi” or energy throughout the body is considered crucial for health. This concept is not directly analogous to specific principles in Western Medicine, and some researchers have criticized TCM as pseudoscience due to its pre-scientific origins. However, both TCM and Western medicine ultimately aim to alleviate suffering and promote health albeit through different philosophical and methodical approaches.
When viewed through the lens of Western medicine, the concept of “Qi” can be equated to ATP (adenosine triphosphate) a nucleotide essential for providing energy and storage within living cells (Dunn J, Grinder MH,2023). This transition highlights the fundamental role of ATP in cellular functions and the overall maintenance of bodily processes.
Despite the differences in terminology between Eastern and Western medical paradigms, both emphasize the importance of maintaining homeostasis for optimal health. The disruption of this delicate balance can result in the onset of diseases and severe cases even death.
This shared understanding underscores the importance of equilibrium within the body.
Traditional Chinese medicine (TCM) approaches focus on restoring the flow of “Qi” and blood to promote balance and homeostasis within the body, by addressing the underlying imbalances that disrupt the natural flow of energy, TCM therapies aim to support overall well-being and prevent the development of illnesses. This holistic perspective aligns with the core principles of maintaining health in both Eastern and Western traditions.
Traditional Chinese Medicine (TCM) therapies encompass a variety of modalities aimed at promoting health and well-being.
Acupuncture involves the insertion of fine needles into specific acupoints along meridian pathways to stimulate the central nervous system, leading to a series of physiological responses. Research has shown that acupuncture can effectively regulate the nervous system and neurotransmitter activity influencing the release of serotonin and helping to alleviate symptoms of anxiety and mood disorders as well as relieving pain and reducing inflammation.
Cupping therapy, a well-known TCM practice, is believed to eliminate harmful substances from the bloodstream while enhancing the body’s immune response. By creating suction on the skin surface, cupping helps draw out toxins and promote detoxification. This modality is often used to address various health concerns and is valued for its ability to boost the immune system and promote overall well-being.
Chinese herbal medicine plays a vital role in restoring balance within the body by tonifying deficiencies and clearing excess pathogens, ultimately aiding in the restoration of the body's natural equilibrium.
Qigong is a comprehensive meditative discipline that emphasizes the importance of regulating the breath and performing gentle fluid movements with the body. The primary goal of this practice is to achieve mental tranquility by synchronizing the breath with deliberate movements, which in turn helps to alleviate stress and alleviate physical discomfort promoting overall well-being.
Traditional Chinese Medicine (TCM) is recognized as a complementary and alternative medicine (CAM) approach that is commonly utilized independently or in combination with Western practices for the treatment of mental health conditions such as depression and Anxiety. TCM philosophy emphasizes the impact of excessive emotions on the development of diseases, highlighting the importance of emotional regulation in the healing process (Li et al) further support this notion by suggesting that the management of emotions can lead to the resolution of various health issues.
In TCM the interconnectedness of physical, mental-emotional, and spiritual health is acknowledged underscoring the holistic nature of this ancient healing system. Emotions are believed to reflect the 5 spirits, each of which is associated with one of the 5 yin organs in the body - Heart, Liver, Spleen, Lung, and Kidneys. These organs are believed to store specific emotions, and references to this concept can be traced back to ancient texts such as the Su Wen of the Huangdi Nei Jing (fundamental questions of the Yellow Emperor's Inner Classic). (Neijing, 1995).
The Shen
The Heart is the dwelling place of the Shen, which is the essence of the mind and serves as the illuminating force behind our eyes. It is how we engage with the world. The Shen encompasses our consciousness, ego self-awareness, and identity influencing our interactions with others and the formation of relationships. A grounded Shen results in clear thinking, keen insight, a strong sense of self, alert eyes capable of maintaining eye contact, restful sleep, coherent speech, and empathy for others. Conversely, when the Shen is disturbed, an individual may experience a lack of insight, feelings of despondency, and challenges with forming connections with others. This may manifest as a lack of confidence in social situations, potential signs of paranoia, agitation, restlessness, insomnia, and a diminished capacity for empathy towards others.
The Po (Corporal Soul)
The Po is linked to the Lungs and is closely tied to the act of breathing. It is connected to the physical body, entering at birth and departing upon death. The Po influences both emotional and physical reactions to external stimuli. Any imbalance in the Po can lead to feelings of grief or sadness, as well as unjust or exaggerated responses to situations.
The Hun
The ethereal concept known as the Hun is intricately linked to the Livers Qi, with its presence established from the moment of birth and not contingent on the physical body's existence after death. It is the Hun that governs the capacity for compassion and empathy that an individual displays towards others and the world during their lifetime. At night, when we sleep the Hun detaches from the physical body to connect with universal energy, rejuvenating and replenishing itself, however disruptions or imbalances affecting the Hun can manifest in negative emotions such as anger, frustration, or a feeling of disconnection from the essence of life. ( K.H.Aung,2013)
The Yi
The Yi is linked to the spleen and cognitive functions. It empowers individuals to exhibit creativity and possess a clear vision through rational thinking, Imbalance in the spleen can lead to excessive rumination, heightened anxiety, and a decrease in innovative thinking.
The Zhi
The Zhi linked to the Kidneys, plays a crucial role in an individual's willpower and drive to accomplish personal objectives and reach milestones. Imbalances with the Zhi can result in a noticeable decrease in motivation and determination, often accompanied by feelings of fear in various areas of life (K.H.Aung, 2013).
Supporting evidence that Traditional Chinese Medicine (TCM) is effective in treating Mental Health Issues
Current research including meta-analysis and systematic reviews offers promising results that TCM is effective in treating mental health issues. (PubMed, 2023)
The World Health Organization recognizes and recommends Acupuncture in the treatment of mental health issues. (WHO, 2021)
Supporting evidence from Dr. Mayer at the National University of Health Sciences (Mayer, 2023) The Chief Clinician of the Acupuncture and Herbal Medicine Department promotes the benefits of acupuncture in regulating internal imbalances that contribute to mental health issues.
Dr. Mayer outlines four reasons why psychiatrists are increasingly recommending acupuncture for mental health. Unlike opioids, acupuncture is a popular pain relief tool without addiction or side effects. Recent studies have shown that acupuncture not only treats pain symptoms but also provides significant benefits for mental health.
A 2021 study published in the Annals of General Psychiatry found that acupuncture therapy aimed at reducing anxiety in patients had beneficial effects compared to controls. (Yang, 2021) Similarly, a 2020 study found that acupuncture had better clinical efficacy compared to medicine therapy in the treatment of chronic pain with depression especially in patients who had poor responses to conventional medication and serious side effects. (PubMed, 2020)
Studies have also shown that acupuncture can be useful alongside medication. A 2019 study published in the Journal of Clinical Medicine found that acupuncture showed clinically relevant benefits in reducing the severity of depression compared to sham acupuncture, usual care, and as an adjunct treatment to antidepressant medication. (Medicine J. o., 2019)
One of the major advantages of acupuncture is that it has few negative side effects or contraindications. This can be particularly beneficial for pregnant women and those who use prescription medication. Acupuncturists can also treat side effects experienced from medication alongside their primary treatment. (Mayer, 2023)
Conclusion
Treating mental health issues is a multifaceted challenge. While both Western and Eastern approaches show potential, research in this area is constrained. It is crucial to delve into the root causes and comprehend the potential adverse effects of conventional medication. Each individual is unique; therefore, treatment should be tailored to the specific needs of a patient.
References
Bai, l. (2013). Acupuncture effect and central autonomic regulation. PubMed.
BMJ. (2023). Review that questioned serotonin theory of depression was flawed, say researchers.
Centre, T. B. (2024). Antidepressants Global Market Report 2024. TBRC.
Dunn J, Grider MH. (23 February 2023). Psychology Adenosine Triphosphate. Start pearls.
Healthline. (30 November 2021). Chemical imbalances in the brain.
K.H.Aung, S. (2013). Traditional Chinese Medicine as a Basis for treating psychiatric disorders: A review of theory with illustrative cases.
Leo, J., Lacasse, J.R. Media and the Chemical imbalance theory of Depression. (November 2008). The Media and the Chemical Imbalance Theory of Depression. USA: https://doi.org/10.1007/s12115-007-9047-3 Lincoln Memorial University.
M, N. (1995). The Yellow Emperor's Classic of Medicine, a new translation of the Neijing Suwen with Commentary. 114.
Mayer, D. D. (2023). National University of Health Sciences.
Medicine, D. O. (2020). Effect of Acupuncture on Chronic Pain with Depression: A Systematic Review. PubMed.
Medicine, J. o. (2019). Acupuncture for Depression: A Systematic Review and Meta-Analysis. PubMed.
mind.org.uk. (2024). Depression.
Moncrieff, J., Cooper, R.E., Stockman, T., et al. (2021, June 21). The serotonin theory of depression: a systematic umbrella review of the evidence.
NHS. (2021). Side effects- Antidepressants.
NHS. (2023, July 5). Causes-Depression in Adults.
NIH. (2007). Information about Mental Illness and the Brain. National Institutes of Health.
Nurse, j. R. (2023). Traditional Chinese medicine -based integrated health interventions for depression: A systematic review and meta-analysis. PubMed.
Organization, W. h. (2021). WHO benchmarks for the practice of acupuncture.
Pindar, J. (2023). Depression statistics UK. Championhealth.co.uk.
Psychology, Z. (2014). Antidepressants and the Placebo Effect. PMC.
Publishing, H. H. (August 2021). What are the real risks of antidepressants?
PubMed. (2010, January 6th). The timing of Antidepressant Effects: A comparison of Diverse Pharmacological and Somatic Treatments.
PubMed. (2019). An East Meets West Approach to the Understanding of Emotion Dysregulation in Depression: From Perspective to Scientific Evidence.
Singla S, Jhamb S, Singh KD, Kumar A. (2020). Depression affects the autonomic nervous system of the body. PMCID: PMC7530411.
WebMD. (2023). causes of mental illness.
Yang, X. Y. (2021). Effectiveness of acupuncture on anxiety disorder: a systematic review and meta-analysis of randomized controlled trials. Ann Gen Psychiatry, Biomedical Central.
Comments