For decades, a simple explanation for depression dominated popular imagination and even many clinics: that it would be caused by a “chemical imbalance” in the brain, specifically, by low levels of serotonin. This idea, known as the serotonergic hypothesis of depression, became so widespread that it shaped the way millions of people understand their own pain and seek treatment.

This narrative, although comforting in its simplicity, has always been more of a hypothesis than a proven fact. Recently, a robust review of studies, with significant impact on the scientific community, has challenged this theory emphatically. The research analyzed decades of investigations and found no clear and consistent evidence supporting the idea that depression is directly caused by a lack of serotonin.

This revelation may generate confusion and even distress. If depression and the serotonin theory no longer hold, what does this mean for current treatments? Are antidepressants ineffective? The answer is much more nuanced and opens doors to a deeper and integrated understanding of emotional health, a view that we, at the Brazilian Society of Hypnosis, advocate and practice.

The truth is that depression is a complex multifactorial condition. It cannot be reduced to a single neurotransmitter. Genetic, environmental, psychological, and social factors intertwine to create the depressive picture. Understanding this does not invalidate existing treatments but invites us to expand our therapeutic arsenal, valuing approaches that act on how we interpret our experiences and react to them.

In this article, we will demystify the serotonin theory, explore what the latest scientific evidence tells us about the causes of depression, and, more importantly, show how an integrated view of mental health paves the way for effective and evidence-based practices, such as scientific hypnosis, which can enhance the results of any health treatment by addressing the psychological and stress factors that exacerbate the condition.

The Origin of the Serotonin Hypothesis in Depression

The serotonin hypothesis in depression emerged in the 1960s and 1970s, primarily based on indirect observations of how certain medications affected people’s emotional states. Initially, science focused on the relationship between serotonin, a neurotransmitter, and the treatment of mood disorders. It was not a direct discovery that people with depression had low levels of serotonin, but rather the positive response that some antidepressants caused that led to this inference.

The first antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs), demonstrated effectiveness in improving depression symptoms. Research on their mechanisms of action revealed that these medications affected serotonin in the brain. This connection established the idea that a lack of serotonin could be the primary cause of depression, a view that quickly gained popularity.

Moreover, the concept of a “chemical imbalance” was simple and easy to communicate both to the public and in the marketing of medications. This biological explanation helped destigmatize depression, presenting it as a medical condition rather than a sign of personal weakness. Selective Serotonin Reuptake Inhibitors (SSRIs) further solidified this idea as they became widely prescribed. They work by preventing excessive ‘cleaning’ of serotonin in the synapses, increasing its availability and potentially improving mood.

This simplified narrative brought comfort to many struggling with depression, even though the reality behind the disorder is much more complex and involves a combination of biological, psychological, and social factors.

The Study that Questioned the Theory: An Analysis of the Evidence

A significant study published in 2022 in the journal Molecular Psychiatry shed new light on the theory of serotonin as the primary cause of depression. This work, known as a “umbrella review,” analyzed various existing reviews and meta-analyses, giving it a high degree of scientific robustness. The evidence raised challenges the idea that depression is caused solely by serotonin imbalance.

The researchers sought to understand whether there were effective differences in serotonin levels or their metabolites between individuals with and without depression, but found no consistent results. Furthermore, studies that attempted to induce depressive states in volunteers through artificial reduction of serotonin were unsuccessful. These findings are crucial as they indicate that the relationship between serotonin and depression may not be as direct as previously thought.

• Inconsistency in Serotonin Levels: No clear differences in serotonin levels were observed between depressed and non-depressed individuals.
• Induction of Depression: Experiments that attempted to cause depression through serotonin reduction failed.
• Comprehensive Review: The research analyzed several meta-analyses and previous studies, offering a detailed and robust overview.
• Complexity of Depression: The analysis suggests that depression is a more complex phenomenon, involving multifactorial elements beyond brain chemistry.

These results do not imply that antidepressants are ineffective; in fact, they may act in more complex and varied ways than previously thought. The mechanisms of action may involve modulation of emotional reactivity or promotion of neuroplasticity, thus distinguishing them from simply increasing serotonin. This reevaluation of the serotonin theory opens space for a deeper and integrated understanding of depression and its possible interventions.

If It’s Not Serotonin, What Causes Depression?

Depression is a complex and multifactorial condition, and the theory of falling serotonin, which many believed to be the main explanation, no longer holds. Today, we recognize that depression results from a complex interaction of various factors that go beyond brain chemistry. This understanding aligns with the biopsychosocial model, which considers the impact of biological, psychological, and social aspects on mental health.

Let’s explore these factors:

• Genetic predisposition: Some people have a greater propensity for depression due to family history and genetic factors affecting neurotransmission.
• Stressful life events: Traumatic experiences, grief, and adversity can trigger or worsen depressive symptoms.
• Psychological factors: Negative thought patterns, rumination, and low self-esteem play a significant role in the development of depression.
• Social factors: Social isolation and lack of emotional support can intensify feelings of loneliness and helplessness.
• Biological aspects beyond serotonin: Inflammation, dysregulation of the HPA axis (hypothalamic-pituitary-adrenal axis), and changes in neuroplasticity are also fundamental.

Antidepressants, although they may not act solely by increasing serotonin levels, show effectiveness through other mechanisms. They may help reduce emotional reactivity and stimulate neuroplasticity, enabling the brain to form new connections. This is why these medications often take weeks to show results. This approach, although more complex than the view of a mere chemical imbalance, reflects the reality of depression more accurately.

Understanding this complexity is a fundamental step towards developing more personalized and integrated treatments that consider the diverse facets of human experience. Thus, we can offer more effective and empathetic interventions for those suffering from this disorder.

Scientific Hypnosis in the Integrated Treatment of Depression

If depression is not just a chemical issue but is intensely influenced by stress, anxiety, and thought patterns, then interventions focusing on these aspects become essential. One approach that has shown promising results is scientific hypnosis, defined by the Brazilian Society of Hypnosis (SBH) as a state of focused attention and reduced peripheral awareness that enhances the capacity for response to suggestion.

In this state, a qualified health professional can help the patient alter negative automatic thoughts that often perpetuate depression. By accessing this state of focus, the therapist can guide the patient to reinterpret memories and experiences, helping to create new associations and perspectives that favor well-being.

Hypnosis stands out especially when used in conjunction with evidence-based practices, such as Cognitive Behavioral Therapy (CBT). This integration enhances treatment, as it allows patients to develop healthier coping strategies and build emotional resilience. Through hypnosis, it is possible to work on mental processes that are often rooted in stress and anxiety, helping to alleviate symptoms associated with depression.

The pillar of the SBH is clear: Everything that stress and anxiety can worsen, scientific hypnosis can help. This tool, when used by qualified health professionals, opens new possibilities for the treatment of depression. By focusing on methods that address the complexity of the condition, hypnosis positions itself as a powerful component, enhancing other interventions and promoting a path to recovery and overall well-being.

Conclusion

We have reached the end of our journey unraveling the complex relationship between depression and the serotonin theory. The main message to take away is that science advances, and with it, our understanding of emotional health becomes richer and more accurate. The idea of a simple ‘chemical imbalance’ as the sole cause of depression, although useful in the past to reduce stigmas, today proves to be an excessive simplification of a much more complex reality.

Depression is a multifaceted condition, influenced by a web of biological, psychological, and social factors. Recognizing this is not a step back, but a giant leap forward. This new perspective frees us from reductionist models and encourages us to seek truly integrated treatment approaches that care for the person in their entirety, not just a supposed imbalance in their neurotransmitters.

It is in this scenario that scientific hypnosis, practiced ethically and based on evidence, reveals its immense potential. By focusing on the modulation of automatic thoughts, the management of stress and anxiety, and the alteration of how we interpret our experiences, hypnosis acts directly on the psychological components that we know are central to the maintenance of depressive states. It becomes a valuable tool to enhance the results of treatments conducted by qualified health professionals.

The downfall of an old theory is not the end of the road, but the beginning of a new, more promising path that aligns more closely with the complexity of the human being. It is an invitation for health professionals to update themselves and incorporate new tools into their therapeutic repertoire to provide the best possible care.

Are you interested in learning scientific hypnosis to apply professionally? To enhance your results in your current profession or even to have a new profession? Discover the evidence-based hypnosis training and postgraduate courses from the Brazilian Society of Hypnosis through the link: https://www.hipnose.com.br/cursos/

Frequently Asked Questions

What is the serotonergic hypothesis of depression?

The serotonergic hypothesis suggests that depression is caused by an imbalance in serotonin levels in the brain. This idea has been widely accepted for decades, but recent studies question its veracity, indicating that depression is a multifactorial condition involving biological, psychological, and social factors.

What factors influence depression beyond serotonin?

Depression results from a complex interaction of factors, including genetic predisposition, stressful life events, negative thought patterns, social isolation, and biological aspects such as inflammation. These elements combine to create a more complete depressive picture.

Are antidepressants still effective if serotonin is not the only cause of depression?

Yes, antidepressants can still be effective, as they act in complex ways, not just by increasing serotonin. They may modulate emotional reactivity and promote neuroplasticity, significantly improving emotional state and contributing to the treatment of depression.

How can hypnosis help in the treatment of depression?

Scientific hypnosis helps in altering negative automatic thoughts and reinterpreting experiences. Used alongside evidence-based therapies like Cognitive Behavioral Therapy, it enhances treatment, helping patients tackle depression more effectively and integratively.

What is the importance of an integrated approach in treating depression?

An integrated approach considers all aspects of mental health, including biological, psychological, and social factors. This holistic view allows for personalized treatment, increasing the effectiveness of interventions by addressing the diverse facets of human experience and promoting recovery and well-being.