[adrice727]

Johann Hari covers a lot of the history of antidepressants in "Lost Connections." Per the studies he covers in the book, most of the benefits are placebo effect. The remainder is somewhat of a mystery. Whether you give someone a medication that increases the level of serotonin in their system (i.e. an SSRI), or that decreases the level of serotonin, the effect will the be same. Replace the drugs targeting serotonin with drugs that target dopamine and you can expect the same effect.

https://www.theguardian.com/books/2018/jan/17/lost-connectio...

[Alex3917]

> Replace the drugs targeting serotonin with drugs that target dopamine and you can expect the same effect.

Anything, drug or non-drug, that has any effect on the senses will have roughly the same effect. E.g. hot therapy, cold therapy, meditation, float therapy, aromatherapy, massage, acupuncture, etc. There's nothing at all special about serotonin, it just happens to sit at the intersection of several different areas of pseudoscience and a lot of marketing dollars. The research that lead to the monoamine hypothesis in the first place was faked.

[subcosmos]

There is something special about serotonin - throughout evolution, it has been an important part of regulating social emotional processing in animals and humans. It strongly regulates the function of the salience network in the brain, alterations of which are associated with anxiety disorders.

Like other neurotransmitters, serotonin is specifically synthesized in a specific brain region, the raphe nuclei. (Dopamine is from the substantia nigra)

Brain circuits have lots of overlap but they definitely have specialization. Case in point, genes associated with serotonin processing have SNPs for depression-like illnesses.

Sapolsky gives one of the better lectures on the specific features associated with abnormal serotonin, dopamine, or neuropinephrine signaling, and their associated symptomology. Ultimately it's the job of the psychiatrist to figure out what's out of balance based on behavior.

https://www.youtube.com/watch?v=NOAgplgTxfc

[smolder]

MDMA easily proves on it's own that there is "something special" about serotonin.

[frereubu]

Although this is largely correct, there was pushback when that book was published, mostly to do with Hari setting up straw men: https://www.theguardian.com/science/brain-flapping/2018/jan/...

"Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away."

While this is meant as an attack on the modern absence of the “grief exception”, where grief reactions are used to rule out depressive symptoms, it’s at best a staggering exaggeration, at worst an active fabrication to support a narrative. Grief is complex and the medical community is still not agreed on how to deal with it, but the idea that you can be diagnosed with a mental health issue after showing symptoms for one minute is ludicrous. People typically require weeks of symptoms to be officially diagnosed, to suggest otherwise can only damage the perception of medical professionals.

It's a nuanced critique that's worth reading - it's in agreement with a good deal of what Hari writes rather than just being a hatchet job. My take from it (as someone with an MA Honours in experimental psychology and a neuroscience MSc) is that in those parts of the book Hari is criticising outdated practices and opinions in the field that hardly exist any more, if at all.

Having said that, the pharmaceutical industry does have a lot to answer for...

[sibeliuss]

Highly recommend this book. The way it opens, describing the discovery of placebo, was quite eye opening.