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Have we been treating depression the wrong way for decades? – CBC News



This is an excerpt from Second Opinion, a weekly analysis of health and medical science news. If you haven’t subscribed yet, you can do that by clicking here.

A new analysis of the cause of depression has seemingly upended what we know about this common condition and challenged the use of antidepressants. But it may also leave patients with more questions than answers as the science evolves.

A systematic umbrella review of 17 studies published in Molecular Psychology on July 20 looked at the decades-old theory that depression is caused by low serotonin, and found there was “no consistent evidence” of “an association between serotonin and depression.”


The theory that depression is caused by a chemical imbalance in the brain has been around since the 1960s. But for years, many experts have doubted this, feeling it oversimplified a complex condition.

“The serotonin theory is very old and has been very popular since the ’90s, when the pharmaceutical industry started promoting it,” said Dr. Joanna Moncrieff, a psychiatry professor at University College London and lead author of the study.

“But since about 2005, probably a bit before then, there’s been sort of rumours that actually the evidence isn’t very strong, or it’s inconsistent. Some studies are positive, some studies are negative, but no one’s really got that evidence together anywhere.”

Moncrieff and her team set out to challenge the serotonin theory in a systematic review of available research. They also went a step further in their conclusion by suggesting that antidepressants are ineffective at treating depression — and have largely worked as a placebo.

“Evidence from placebo-controlled trials show that antidepressants are a little bit better than a sugar tablet,” she said. “And if that little difference is not to do with rectifying a chemical imbalance, improving low serotonin levels, what is it to do with?”

The research paints a compelling picture that depression isn’t caused by low serotonin alone. Many experts say this is already widely accepted and that it’s also true that antidepressants can be extremely beneficial to some patients — even if we don’t know exactly why.

So where does this leave patients and physicians, and could the analysis impact the way we treat depression in the future?

Are antidepressants effective against depression?

Antidepressants are widely believed to affect the behaviour of neurotransmitters, chemical messengers in the brain like serotonin and dopamine, in a way that can alter emotions and mood to help improve the symptoms of depression in some patients.

WATCH | Living alone during pandemic can worsen anxiety, depression:

Living alone during pandemic can exacerbate anxiety, depression

2 years ago

Duration 2:02

The ongoing physical distancing precautions because of the COVID-19 pandemic can exacerbate anxiety and depression, especially for people living alone.

People with depression can face a wide range of symptoms, including persistent feelings of sadness and desperation, changes in appetite, sleep deprivation, fatigue, irritability and loss of interest in hobbies and social connections that can impact everyday life.

While it’s unclear exactly how antidepressants work at a biological level to alleviate those symptoms, it’s clear that they can still be hugely helpful to some patients.

“It’s a typical discovery in medicine — you find a drug that works, but you don’t quite know why,” said Dr. Phil Cowen, a professor of psychopharmacology at the University of Oxford.

“[The review] is a debunking exercise and in a way, they’re criticizing older studies that were hard to do,” he said. “These [older] studies, clearly, were very indirect and they’re messy, and I don’t think anyone thought that they were that great.”

Moncrieff’s team found that some depressed patients actually had higher serotonin levels in certain areas of the brain, and in some cases the long-term use of antidepressants could actually lower the amount of serotonin — though the findings were “inconsistent.”

“I think it makes a huge difference, because how [antidepressants] work actually influences whether they work,” she said. “It influences how helpful we think they are.”

The findings have caused a major stir in the media and scientific community, with hundreds of news outlets covering the study — quickly landing it in the top five per cent of all research scored by Altmetric, a company that analyzes where published research is shared.

Findings of this perceived magnitude can have a seismic impact on the way we understand and treat a widespread condition like depression, which affects an estimated one in eight Canadians at some point in their lives.

While the research questions the very nature of what we know about depression, many doctors are hesitant to change the way we treat it.

Antidepressants can be ‘lifesaver’ for some

Dr. David Juurlink, head of clinical pharmacology at Sunnybrook Health Sciences Centre in Toronto, said he’s not surprised by the findings, because the chemical imbalance theory for depression is now widely seen as an “obvious oversimplification” for a complex condition.

“Although I think doctors prescribe serotonin-enhancing antidepressants far too often, in part because of this oversimplification, it’s important to acknowledge that they really do improve the well-being of some patients,” he said in an email.

“How exactly they do that isn’t as clear-cut as we’ve been led to believe.”

A bottle of antidepressants is shown in Miami, Fla. A new analysis suggests depression isn’t caused by low serotonin, and that antidepressants are ineffective at treating it. (Joe Raedle/Getty Images)

Dr. David Gratzer, a psychiatrist and attending physician at the Centre for Addiction and Mental Health (CAMH) in Toronto, said he wasn’t surprised by the findings — just that they got as much attention as they did.

“This suggestion that depression is all about serotonin all the time hasn’t been accepted by psychiatrists for many years, probably many decades,” he said, adding that the researchers are “terribly biased” in their assessment of antidepressants.

“Their paper shows things are much more complicated than serotonin — no surprise — and then they turn around and say, ‘You see, that’s another example of the fact that antidepressants don’t really work.’ One doesn’t necessarily give rise to the other.”

Gratzer said he still prescribes antidepressants regularly as a treatment option for depression, and has no plans to stop doing so based on the research.

“That’s not going to change. These medications work,” he said.

“An antidepressant is not necessarily [recommended] in everyone who has depression — some people might in fact do better with talking therapy — but it is certainly a tool in our tool kit and, to be blunt, it’s a lifesaver for some of our patients.”

Research calls antidepressants into question

Moncrieff said the research found that another way in which antidepressants may function is by desensitizing the brain to negative emotions associated with depression. In theory, that could also impact other feelings.

She said one of the effects previous studies have reported in patients is “emotional numbing,” where they not only don’t have unwanted emotions like depression and anxiety, but positive emotions like joy and happiness.

“There may be some people that feel that that’s an effect they want. But I think generally, people aren’t going to want to be emotionally numbed, not for long periods, anyway, and so I think it totally changes the sorts of decisions people might make about antidepressants,” said Moncrieff.

Chris Davey, the head of the department of psychiatry at the University of Melbourne, said in an email that undermining the confidence that people with depression have in their treatments can be “very damaging.”

“People will stop their medications suddenly, without supervision,” he said, “which can cause dramatic deteriorations in their mental health.”

Davey said he is concerned that the paper diminished a treatment option that can be incredibly beneficial to some patients, especially when alternatives may not always be available to those at risk of severe depression.

WATCH | Research shows exercise can help alleviate pandemic depression:

Research shows how exercise helped fight pandemic depression

7 months ago

Duration 2:04

A study conducted by B.C. researchers during the COVID-19 pandemic showed how exercise, especially a combination of yoga and high-intensity exercise, helped fight depression – backing up decades of research on how exercise improves mental health.

“This [research] shouldn’t make any difference to the treatment of depression. I hope it makes people realize that depression is a very complex condition, and that there are no simple explanations for it,” Davey said.

“Everyone should know that improving their diet, exercising more and paying attention to their sleep can be helpful. Everyone should have access to psychotherapy. And for those people for whom those things don’t help, that’s when we think about medications.”

Gratzer said there are many new areas of research into treatment options for depression that can be beneficial, including novel ways of delivering psychotherapy, emerging medications and discoveries like the use of ketamine

Ketamine is a general anesthetic first approved in Canada in the 1960s for medical or veterinary surgery, as well as a psychedelic party drug sold on the illicit market. It’s also increasingly being used as a fast-acting and effective treatment for depression in low doses, by working to restore synapses in the brain that are destroyed by stress.

There’s “an understanding that certain life experiences might be more connected, and so research is very active. Maybe at the end of the day, we’ll understand depression isn’t one illness,” Gratzer said.

“As is often the case with mental health care, these are early days.”

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Funding runs out for COVID Assessment and Testing Centres – The Bay Observer – Providing a Fresh Perspective for Hamilton and Burlington



The COVID-19 Testing and Assessment Centre and the Flu, COVID and Cold Clinic at the West 5th Campus will be closed at the end of this month. The move is in response to a sustained drop in the prevalence of COVID-19 and a decline in appointment bookings for testing, attributed to uptake in vaccinations, higher levels of immunity, and declining circulation of the virus in the community. It also reflects the fact that provincial funding for these sites ends on March 31st. The Hamilton site was operated in conjunction with HHSC.

Says Dr. Greg Rutledge, Deputy Chief of Staff, St. Joseph’s Healthcare Hamilton. “It’s been a long time getting to this point where we see a significant drop in COVID-19 transmission.”

The hospital says Ready access to COVID-19 testing in the community through most pharmacies will meet the needs of the public and health care workers.


The move comes as the Globe and Mail published a story noting that these sites served the additional purpose of diverting many patients from Emergency Rooms. In the case of similar centres operating in the Toronto area, and estimated 14,500 potential ER visits were diverted.

According to the Globe and Mail, “Ontario Health described these clinics as a model for providing the right care to patients in the right place at the right time. They demonstrated an ability to optimize resources and reduce the burden on emergency departments. Most clinics have been set up in what are considered high-priority areas, located near public transit. All are accessible by wheelchair and able to provide translation in multiple different languages.” The article quotes Dr Sajjad Dr. Tavassoly, who works at a Brampton centre slated for closure as saying said what frustrates him most is the unmet needs of the community continue to grow, regardless of the government’s March 31 funding expiry.

More than 390,000 tests have been done at the West 5th Testing and Assessment Centre through the past three years.

The last day of operation for both the Testing and Assessment Centre and the Flu, COVID and Cold Clinic will be Friday, March 31, 2023.

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Those With Rare Diseases Need to Wait, as Usual



Science has developed the ability to research, develop and create functional cures for many of our so-called “incurable diseases”, but having the ability to do something and actually doing it are two different things. Medicine has always suffered from a problem with “knowing-doing”. It is the difference between what a doctor actually does for a patient and what can be done with all that we know. Developmental breakthroughs in medicine are allowing doctors to do things they never could imagine before. Sometimes these break-thoughts don’t fit into businesses/governmental financial or regulatory systems, meaning that it can take a long time for patients to actually benefit, a time many patients may not have.

The National Institutes of Health in America invest more than $40 Billion in biomedical research each year, and the private sector twice as much. The discoveries are valued by all, but why is it so hard to use these discoveries?

Science’s ability to engineer medicines has far outpaced how these medicines are actually built, tested, and put into human beings. Artificial Intelligence has assisted the community by mapping the human genome in efforts to cure various diseases. The US Government defines rare diseases as those that affect fewer than 200,000 people in America. Some affect only a handful of people. There are over 7000 different rare diseases, with more than 30 million people in America diagnosed with one of them. That is 10% of the US population. So improving how society can find and care for these patients could have a great impact. Problem is that the health system is not flagging enough people with these diseases, while many individuals don’t even know what disease they may have, or that they indeed have a disease. A.I. steps up front to assist in the recognition, tracking, analyzing, and identifying of these patients through computer-programmed systems. Put one’s symptoms into the machine, and often voila, a point from which a doctor can begin his medical investigation and treatment. A diagnostic odyssey in each individual case.

Artificial Intelligence has a prominent place within our health system, including helping design new treatments, helping predict which treatment is better for which patient, and screening for rare diseases with suggested diagnoses to boot. Why are many with rare diseases often left out in the cold, to search on their own for a cure? Money! Simple.


Who makes medicines, and invests millions in treatments and research for diseases? Pharmaceutical Firms.
What are they but profit centers for investment bankers, massive corporations, and a financial structure centered upon the shareholder, and not the average joe? Solutions can be found, but the willingness to spend way beyond what a firm can make in profits needs to be there. Sure our DNA is constantly changing, and evolving biologically. Making a drug that cures cancer, may cure some, but certainly not all forms since each person is unique, their biology specific to that person. Many doctors realize that their methods are much like witch Doctors, forever experimenting with the specific individual’s condition.

Our Health system is tied to our financial system. That is the root of it. So long as the doctors, hospitals, and researchers are tied to profit (our financial system) the necessary technology, research, and investment will not be found for those with rare diseases. I have a disease that has no cure. My immune system is attacking the tissue in my mouth. It is sorely painful, personally transformative, and damn if you could find a doctor who is a real expert in the field. Since it is rare, the institutions of the industry will not find proper medicine for its management, let alone its cure. I live with it, and the disease manages the way I eat, what I eat, how I clean my teeth, how I sleep, and interact with my partner too. This disease can transfer to another. Great eh!

For those of you who have or know of someone who has a rare disease, all I can say is to be patient. The present-day financial and healthcare systems need to change drastically, with governmental intervention in all aspects of research, planning, and manufacturing of medicines. Out of the hands who care for themselves, and hopefully into the hands of those who care about you and those you love.

Steven Kaszab
Bradford, Ontario

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The Healthcare Systems Failing Continually



North Americans are aging, while the number of births within the tri-nation continent is continually falling. Birth Rates in the Caribbean have been stagnating since 2023 now showing a 7.5% decline. If national governments could dream this would be a nightmare. National union’s pension plans are at risk, as the number of workers declines but the number of pensioners continues to grow. No corporation can run properly in this fashion, much like the California Banks which recently were shut down because they spent more money than they made.

By 2046, 4.6 million Ontarians will be aged 85 and older. The province has fewer than 500 hospice beds and 4,000 hospital palliative care beds available. Ontario’s Healthcare Ministry and the many hospitals its controls are not prepared for the massive growth rate and demands of the aged. Like a car used a great deal, it breaks down. So to our aged population who do experience illness and disease. Ontario does not have enough nonprofit hospices, old age homes, long term care facilities now, and with the upswing of conservatism within Canada, the USA, and the Caribbean there will be a movement towards restraint at a time when necessary investments in these aged services and institutions present themselves. This seems to be typical for our present-day governmental administrations who lack an interest in long-term planning, with the needed revenue investments to be made for near future population demands. Migrants’ can be brought into our lands, but their training in the many fields required will certainly take a lot of time. The time our population does not have.

What is needed? With the present-day migration of nurses, medical professionals, and doctors moving from the Caribbean to the USA and Britain, the demand for trained professionals specializing in aged medicine, bereavement and grief training, hospice palliative care, Navcare to help clients find the services they need has increased at an urgent pace. Volunteers are being trained and relied upon to carry out the needed services that missing professionals should be doing. The management within many facilities has allowed friends and family to fill these positions. While community involvement is commendable, what are our taxes paying for here? Medical, hospital, and hospice centers are under the management and direction of the healthcare ministry, and these ministries are simply not doing the job they were assigned. Lack of funds, certainly lack of personnel, and lack of future financial gain have drained our healthcare ministries of their potential. Lives are at stake, and our politicians seem to be willing to fight the nurses, and healthcare professional union rather than carry out the needed governmental process. Stingy governments invest in the police, military, and economic growth of the state while their fellow citizens suffer and sometimes perish.

The healthcare systems respond by training people and sending them into areas within the system that will reduce emergency room visits, hoping to reduce hospital stays and make it possible for aging clients to stay in their homes. Such protocols are being carried out in Oxford(UK), British Columbia, and Scandinavia. Hospice technicians have been successful within their practicing regions, utilizing various professions in a team atmosphere. Many Traditional Medical Professionals within the hospital setting view these hospice professionals with prejudice and suspicion, creating further tensions within the healthcare system.


The Pandemic has shown us that our healthcare system was not prepared in any way to respond effectively, and the systems managers concentrated on revenue expenditures instead of being prepared for any eventuality. No plans on how to respond, no excess staff to rely upon. This health event has happened before, yet those we rely upon claimed innocence in their often failed reactions.

The aged within our area will also suffer a similar fate when our healthcare system and its managers fail to prepare, plan for, train, and hire needed staff. It is all about the money after all. Problem is that it is our taxes paying for these services, the managers and politicians to prepare and function for us, with us effectively. What do you do when you do not get the customer service you expect and are paying for? Is it time that our multi-system healthcare systems to be transformed?

Steven Kaszab
Bradford, Ontario

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