This research article by Peter Sterling (Professor of Neuroscience) has been published by Mad in America. It begins:
“Abstract
Neuroscientists widely hypothesize that ‘depression’ arises from a brain disorder caused by some defect in a specific neural pathway. If so, we might identify and localize the defect, and then develop a rational therapy. However, recent evidence from multiple sources fails to support this hypothesis: (1) Neuroimaging does not identify brain abnormalities in depressed individuals; neuroimaging does not even distinguish between large populations of depressed vs healthy. (2) Genome-wide association studies identify hundreds of variants of small effect, but these do not identify a depressed individual, nor even a depressed population. (3) The ‘chemical imbalance’ theory of depression has failed for want of evidence, thus depriving ‘antidepressant’ drugs of a neuroscientific rationale. Perhaps unsurprisingly then, new analyses of clinical trials indicate rough parity for most participants between drug and placebo. (4) Depression, while weakly predicted by any ‘biomarker,’ is strongly predicted by childhood trauma and chronic social stress. Furthermore, depression is significantly reduced by physical repairs to the community (housing facades and vacant lots) and by psychological repairs through sharing experience of trauma and abuse. Thus, depression—given its lack of any reliable biomarker, its diverse and shape-shifting symptoms, its transience on the scale of human lifetime, and its positive response to renewed hope—would be most fairly characterized as a distressing psychological disturbance rather than as a brain disease or disorder.
Various of my friends and family take drugs for depression and anxiety. Some have confided that they are unhappy with the effects but find it difficult to quit. Wondering if my experience as a neuroscientist1,2 might help, I investigated. I found new insights across many levels: large-scale neuroimaging and genomic studies, longitudinal studies of prevalence, and reviews of clinical trials. Here is my current understanding.
Neuroimaging
Depression is widely claimed to be a distinct disorder at the level of neural circuits—that is, a disruption of neurons, connections, or signals in a specific neural pathway. Were that so, neuroscience might trouble-shoot the circuit and try to repair it. But no example has been found of mental disturbance attributable a disordered neural circuit. Consequently, mental ‘disorders,’ such as depression, are said to be ‘just like‘ a neurological disorder—usually ‘just like‘ Parkinson’s disease whose cause is certain, a progressive loss of dopaminergic neurons, and whose therapy follows from that understanding. ‘Just like‘ is a simile, a figure of speech, and what it really expresses is a hypothesis that neuroscience and psychiatry often forget is unproven …”
You can read more from here.
