Is depression caused by a serotonin deficiency in the brain?
After 25 years researching health and happiness, the idea that a disease state is caused by lack of a single neurotransmitter in the brain seems ludicrous. Human biochemistry is incredibly complex with countless interacting processes mediated by genetics and lifestyle factors. The serotonin hypothesis of depression is really a house of cards with no foundations.
Recent in-depth reviews of scientific research found no link between depression and serotonin in the brain, but did find antidepressants to be no better than placebos.1-3 Hope and expectation are responsible for any positive effect of antidepressants, and there are much better ways to have hope without the serious side-effects of these drugs like sexual dysfunction, akathisia (inner restlessness), increased suicide risk and even homicide.4
“Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the actual evidence contradicts these claims.”— Elliot S. Valenstein, professor emeritus of psychology and neuroscience, University of Michigan
And yet if you go to your doctor with depression, all you’re likely to come away with is a prescription. The reason the serotonin (monoamine) myth started and perpetuated is complex, but the simple answer is “follow the money.” Drugs are incredibly good business. Direct to Consumer advertising has us all believing that serotonin is the answer to happiness.5 It isn’t. The drug industry has effectively turned a flaky hypothesis into a lot of cash as $12 billion is spent and 230 million prescriptions are written for depression every year in the US alone. There’s just no money to be made from the truth about depression, or from a natural cure.
“And where there is a scientific vacuum, drug companies are happy to insert a marketing message and call it science. As a result, psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.”— Dr. Daniel Carlat, psychiatrist
In a 10-year follow-up study in the Netherlands, 76% with unmedicated depression recovered without relapse compared to 50% of those treated.6 There are no studies that show a better outcome in people prescribed antidepressants long term.
And even if depression were associated with serotonin deficiency in the brain, the solution wouldn’t be to add drugs, it would be to correct the underlying cause of why the deficiency happened.
“We have hunted for big, simple, neurochemical explanations for psychiatric disorders and have not found them.”— Kenneth Kendler, psychiatrist & co-editor of Psychological Medicine
Is depression psychological or physical?
Mind and body aren’t separate. It only takes poor sleep to see that mental health depends on physical health. And it only takes one stressful thought to see that our bodies are reacting powerfully to our thoughts. Each affects the other and the two are intimately intertwined.
While stressful life events are often thought of as a trigger for depression, in most cases it’s really the straw that breaks the camel’s back — emotional stress overloading a body already under physical stress. Emotional stress is just one more factor that plays into the big picture.
To understand what depression is, it’s helpful to think of what happens when there is a simpler cause and effect relationship like the hangover we get from drinking alcohol. If we have too much to drink and suffer the next day, the cause and effect is very clear. All those symptoms like sensitivity to bright light and loud noises, headache, irritability and nausea — we understand the cause. And we know that we must allow our body to recover.
But what would happen in our body if before we recover, we add more alcohol? We’d have a physiological crisis where homeostasis is never achieved. The causes of depression are more complex and happen over a longer time frame but the process is essentially the same in that it does have identifiable causes, and just as we know to stop adding alcohol in order to heal, we must correct the causes of depression in order to heal.
If you have a hangover, and your thinking becomes negative, muddy and disturbed, again you know the cause, you know it’s just temporary so you don’t identify with that state as yourself, as your personality. Depression is just the same, but it persists because we don’t correct it, and this leads to so many psychological issues because we lose ourselves in the symptoms. Who we feel we are becomes blurred as the condition goes on and on. But you are not your depressed self any more than you are the temporary effect of alcohol.
Is psychotherapy the answer?
Good psychotherapy will align your beliefs with the truth — change your view of things to the way things really work. One problem is that finding a good therapist is hit and miss, and there aren’t so many with clarity about the big picture of what really works for happiness. It’s not possible to give what you don’t have.
But in a sense psychotherapy is the only place we can start with change — in the sense that until you change a belief, you can’t change your action. For example if you believe that depression is caused by lack of serotonin, you will act on that and take the drugs. In this article, I’m attempting to realign your beliefs with the truth as I understand it after 25 years of research. And if I do a good job, your new belief will create new effective action.
The new belief I would like you to have is that depression is the result of multiple lifestyle factors happening over a long time-frame. And so the cure for depression is to correct all factors, the way we think, and the way we live, our lifestyle habits. This is really the fundamental belief you need. It’s the seed idea, the one idea that can sprout and grow into happiness. I love the saying…
“It takes a lot of aspirin to feel good if you’re sitting on a tack.”
Sub-optimal lifestyle is like sitting on a lot of tacks. It’s no use just taking aspirin if you want to get to the root causes, you have to remove all the tacks.
Happiness is the cure for depression
Happiness is a state of being, with causes. And as I mentioned, the cause for either happiness or depression are lifestyle factors happening over a long time frame. So the cure for depression is to change our lifestyle factors into ones that produce a happy biochemistry, and change our thoughts into happy ones, all together.
A blueprint for happiness
Here are the six lifestyle elements that when you work them into your life consistently, will create a happy biochemistry and a happy mind…
1. Eat and drink the right stuff
The foods we evolved eating are the foods we are biologically adapted to — fruits, vegetables, nuts/seeds, fish, eggs, meat, seafood. For hundreds of thousands of years people hunted and gathered from nature. But in only the last few thousand years, industrialized food and farming have radically shifted our diet to one that has a drip, drip negative effect over time, and is a primary cause of disease.7
One of the most damaging aspects of modern diets is grains. This one thing alone can be like the snowball that creates an avalanche by causing intestinal permeability leading to autoimmune diseases, allergies and food intolerances. Grains can also damage villi (nutrient absorption sites) causing vitamin and mineral deficiencies and malnutrition. Food intolerances can be a primary cause of depression and other mental illnesses.
Even just balancing omega-6 and omega-3 in your diet has a strong positive effect on depression.8 Lack of DHA, a long-chain omega-3 fatty acid increases corticotropin-releasing hormone, a hormone that moderates emotionality. This in turn, may contribute to hyperactivity within the hypothalamic pituitary adrenal (HPA) axis, an important neuroendocrine system that regulates mood.
Magnesium deficiency is very common and is highly associated with depression. Magnesium is rapidly lost in times of stress — a clear reason why emotional stress can lead to depression. Magnesium depletion leads to NMDA overactivity (the N-methyl-D-aspartate receptor controls synaptic plasticity and memory function) and, as a result, to depression, anxiety, increased cortisol levels, sleep disturbances — including a reduction of slow-wave sleep — and increased inflammatory markers.9
Grains, essential fatty acids and magnesium are just three examples of many of how nutrition powerfully affects depression.
By correcting deficiencies and getting back to human foods, we correct these insidious problems that hurt us physically and avoid those problems for the future. A return to human foods is like a reset that automatically means we avoid all potential problems. When the dots become impossible to connect, a simple reset is the most effective approach. If we combine knowledge of our natural diet with the wisdom of tradition and the best of modern science, we have the perfect recipe for the healthiest diet.
Several studies have shown that exercise is effective in treating depression. For example, a study published in the American Journal of Preventative Medicine found that the “public health dose” of exercise 5x/week led to a 42% remission rate.10 Really, the idea that exercise is good for you and makes you feel good is a no-brainer. But forget no pain, no gain — make it fun, you could just start with walking. Make it enjoyable so you keep doing it. A simple step or dance mat are easy ways to get moving at home. Walk, move, play.
Sleep deprivation is epidemic, and yet it’s common sense that we need consistent and plentiful sleep for health. I have no doubt at all that lack of quality sleep and resulting circadian rhythm disruption are major factors in depression.
4. Be free from drugs
Our biochemistry is complex beyond imagination and no one mind can hold how it all works. We could spend our whole lives studying a tiny piece of the miracle that is your body. Yet the inputs our bodies need are very simple… the right food, sunshine, exercise, sleep. And when the inputs are there, we have a state of homeostasis when the body has what it needs for health. So drugs are like a crude sledge-hammer approach — the wrong approach for health. The correct way is to get the inputs right, simple things that allow our bodies to do the rest. If you’re taking antidepressants though, don’t just stop. They need to be tapered off gradually because our bodies create a “new normal state” when drugs are consistently present, and it takes time for biochemistry to adjust. Stopping psychotropic drugs like antidepressants can cause very severe withdrawal symptoms if not tapered properly.
We also need to be careful about the commonly used drugs like alcohol, caffeine and nicotine. These are very often playing into the big picture of depression — for example, the vicious cycle of too many stimulants leading to poor sleep leading to more stimulants.
5. Get organized
As our moods darken, we stop functioning as well and our lives can start spiraling downhill. Things we used to take care of easily stop getting done. But having a simple list of “regular actions” can turn this problem around. Woody Allen famously said “99% of success is showing up.” The regular actions list means we start showing up again, and lots of good things spin off from doing that. Even with our minds not functioning well and with low energy, we can hold onto the idea of just going through our list — it’s a very powerful tool because good things start happening consistently and so we start to feel better about ourselves.
As well as regular actions, if you keep a prioritized list of “one off” actions, you’ll be able to relax because it’s all out of your head and onto paper, and you’ll have all your things-to-do taken care of and optimized. It frees you to take one thing at a time and really enjoy it.
6. Live in the moment
Living in the moment means we start to take back control of our mind. If we can make our mind quiet, it means we can choose our thoughts, rather than be at the mercy of dark thoughts. The simple act of listening to our thoughts pop up, rather than being swept away by a stream of mind-chatter has incredible effects when we practice it consistently. It means we stop believing conditioned thoughts that are really lies about ourselves and our life. This awareness separates our identity from thoughts, a sense of identity based on ideas, and we become naturally happy again like we were when we were children. This simple awareness, this simple state of being is our naturally happy state.
Happiness is the result of the synergistic effect of these 6 lifestyle elements — caring for body, mind and soul every day consistently. It’s the result of the best nutrition, sleep and exercise and a clear mind free from worry. Very simple things — not easy at first, but easy in the end.
How to change: crystal clear vision + steps
Just knowing what to do isn’t enough. There are many pitfalls to actually bringing about change that can all be solved by some simple methods. Basically, have a clear vision of your own lifestyle blueprint based on these six elements and then take small, doable weekly steps.
Most of the pitfalls to effective change come from trying to go too fast and hitting backlash — either biochemical backlash because your body can’t adjust so fast, or psychological backlash from changing habits too fast. We like our comfort zones. Small steps make it easy to stick to changes and self-belief begins to skyrocket as we start getting wins and see we’re going to make it. And as we move into our new lifestyle, our new habits start to become comfortable and easy, and so they effortlessly create happiness every day.
1000 problems, 1 solution
The wonderful thing about healing depression naturally is that many other problems you might be having in your life will also heal. The lifestyle needed to heal depression is the same lifestyle needed to reverse heart disease. Even acne is caused by not living the lifestyle our genes expect. What truly heals one thing will heal everything because our bodies work as a synergistic whole where everything affects everything else. Every chronic disease state has the same root causes. By lining up our actions with this truth, we can really become happy, and being happy is what we really want more than anything else.
Have faith in the finish line
Trusting that happiness is normal and natural, and believing in the idea that realignment with the lifestyle your genes expect will bring you back to a natural state of happiness, means you stay solid in your action, even though it can take time.
For example it can take up to 6 months for the body to completely get rid of gluten, it takes time to correct vitamin and mineral deficiencies, it takes time for your gut flora to shift into a healthy state, it takes time to overcome addictions, it takes time to catch up on lost sleep and when we start to balance the essential fatty acids in our diets, it can take time for tissue levels to become optimal and so reduce chronic inflammation — a major factor in depression. How could a pill possibly resolve these things?
Health and happiness creation is really about pursuing the 6 lifestyle elements. And that means that although the results take time to come, we don’t lose faith but continue with our solid steps until we have the optimal healthy life in place. Your body has a remarkable ability to heal when the conditions for healing are in place. Those conditions are not the ones that caused the problem to show up. Create the conditions, starting with a crystal clear vision and then taking steps to your happy finish line.
“A few months ago it felt as though I was losing control of my thoughts and was slowly slipping into the beginning of a deep depression. But having put your advice into practice, I can honestly say I’m happy now. Thanks and hope you guys are doing great! Happy Matt =) P.S. I can’t believe how much this worked.”— Matt, USA
1. Risch N, Herrell R, Lehner T, et al. Interaction Between the Serotonin Transporter Gene (5-HTTLPR), Stressful Life Events, and Risk of Depression: A Meta-analysis. JAMA. 2009;301(23):2462-2471. doi:10.1001/jama.2009.878
2. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, et al. (2008) Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Med 5(2): e45. doi:10.1371/journal.pmed.0050045
3. Moncrieff J, Cohen D (2006) Do Antidepressants Cure or Create Abnormal Brain States? PLoS Med 3(7): e240. doi:10.1371/journal.pmed.0030240
4. Lucire Y, Crotty C. (2011) Antidepressant-induced akathisia-related homicides associated with diminishing mutations in metabolizing genes of the CYP450 family. Pharmacogenomics and Personalized Medicine 2011:4:65-81. doi:10.2147/PGPM.S17445
5. Lacasse JR, Leo J (2005) Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Med 2(12): e392. doi:10.1371/journal.pmed.0020392
6. Van Weel-Baumgarten, E. M., Van Den Bosch, W. J., Hekster, Y. A., Van Den Hoogen, H. J. and Zitman, F. G. (2000), Treatment of depression related to recurrence: 10-year follow-up in general practice. Journal of Clinical Pharmacy and Therapeutics, 25: 61–66. doi: 10.1046/j.1365-2710.2000.00264.x
7. Cordain L, Boyd Eaton S, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. The American Journal of Clinical Nutrition 2005;81:341-54. Free full text.
8. Peet M, Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry. 2002 Oct;59(10):913-9. doi:10.1001/archpsyc.59.10.913.
9. Zarate, C., Duman, R. S., Liu, G., Sartori, S., Quiroz, J., & Murck, H. (2013). New paradigms for treatment-resistant depression. Annals of the New York Academy of Sciences, 1292, 21–31. doi:10.1111/nyas.12223. Free full text.
10. Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO. Exercise treatment for depression: efficacy and dose response. Am J Prev Med. 2005 Jan;28(1):1-8. doi: 10.1016/j.amepre.2004.09.003