Review Beyond the serotonin deficit hypothesis: communicating a neuroplasticity framework of major depressive disorder, 2024, Page et al

Beyond the serotonin deficit hypothesis: communicating a neuroplasticity framework of major depressive disorder
Chloe E. Page, C. Neill Epperson, Andrew M. Novick, Korrina A. Duffy, Scott M. Thompson

Abstract
The serotonin deficit hypothesis explanation for major depressive disorder (MDD) has persisted among clinicians and the general public alike despite insufficient supporting evidence. To combat rising mental health crises and eroding public trust in science and medicine, researchers and clinicians must be able to communicate to patients and the public an updated framework of MDD: one that is (1) accessible to a general audience, (2) accurately integrates current evidence about the efficacy of conventional serotonergic antidepressants with broader and deeper understandings of pathophysiology and treatment, and (3) capable of accommodating new evidence. In this article, we summarize a framework for the pathophysiology and treatment of MDD that is informed by clinical and preclinical research in psychiatry and neuroscience. First, we discuss how MDD can be understood as inflexibility in cognitive and emotional brain circuits that involves a persistent negativity bias. Second, we discuss how effective treatments for MDD enhance mechanisms of neuroplasticity—including via serotonergic interventions—to restore synaptic, network, and behavioral function in ways that facilitate adaptive cognitive and emotional processing. These treatments include typical monoaminergic antidepressants, novel antidepressants like ketamine and psychedelics, and psychotherapy and neuromodulation techniques. At the end of the article, we discuss this framework from the perspective of effective science communication and provide useful language and metaphors for researchers, clinicians, and other professionals discussing MDD with a general or patient audience.

Link (Molecular Psychiatry)

(I don't know if this is the right forum for this.)

 

Mostly looks like a marketing rebranding to me, latching on to some of the latest buzzwords and concepts, trying to jam in antidepressant drugs into the mix for no good reason.

It's not about making sense of the data, it's about making narratives out of what's been fashionable recently while not letting go of old things.

From "your chemicals are imbalanced" to "your brain circuit is imbalanced" isn't much of a leap. Impossible to say without being able to read it, but it would have to make sense of how it happens in the first place, a lot of which is really mostly about ghosts in the machine.

Then you have the broader issue of the range that spans from major depression to everything that's been labeled as depression-like, especially the absurd insistance that unexplained fatigue is basically depression. The whole thing is such a giant mess.