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Cause of depression remains a mystery

Section: Health
January 24th, 2005

So why do some people react so badly to anti-depressants that they kill themselves or someone else?

A genetic glitch in liver enzymes might make them poor metabolizers, so the drugs build up to toxic levels and derange their minds.

But if that’s true, it isn’t the whole picture. Sometimes anti-depressant-triggered suicides have normal blood levels.

In fact, despite all the talk of “chemical imbalances,” no one really knows how the drugs work.

That the brain can break down like a car and be fixed as easily is an idea so seductive in its simplicity that it’s hard to resist.

With something as fraught with uncertainty as mental health – or health in general – reassuring notions give a much-needed sense of control. At least you know what’s going on, if nothing else.

A good story helps sell drugs, too, by giving them scientific legitimacy.

So it’s no surprise drug companies have been the biggest pushers of the idea that depression is caused by a dip in the brain chemical serotonin and that “selective serotonin reuptake inhibitors” make everything OK by restoring normal levels.

But the history of medicine is full of convincing ideas that were just plain wrong. Centuries ago, medical authorities assured sick people that their humours were out of whack, and then accidently bled some to death. More recently, postmenopausal women were told they had to take hormones to stay healthy. But then it was realized doing so caused heart attacks and cancer.

The serotonin theory might head to the dust bin of medical history, too.

One of the major supports of the idea is that when the brains of rats given anti-depressants are ground up in a blender, nerve cell serotonin channels act a little different than when normal rat brains are ground up.

“What that has to do with people I don’t know,” said Harvard University psychiatrist Dr. Joseph Glenmullen, an expert on the drugs.

Though serotonin levels might or might not have something to do with depression, the drugs alter levels of all kinds of nerve chemicals.

That’s why they can trigger body-wide side effects like impotence, constipation, yawning and additional psychiatric difficulties.

Scientists think there’s actually many biological mechanisms behind depression, said University of Washington pharmacy professor Dr. Stanley Weber.

At this point, the chemical imbalance/serotonin theory of depression is so suspect that Ireland forbids drug companies from promoting the idea.

Until more is known, there is no way to tell who will have a violent reaction to an anti-depressant. The best way to prevent tragedy is to recognize the warning sings.

M. Alexander Otto 253-597-8616

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