3 Recent Articles on the Serotonin Theory of Depression 

I read a LOT of literature on neuroscience, brain research, and psychotropic medications. In the past six weeks, three important articles were released related to the serotonin theory of depression.

Article 1 

The first came out on July 20, 2022:

Moncreiff, Joanna, Ruth Cooper, Tom Stockmann, Simone Amendola, Michael Hengartner, and Mark Horowitz. “The Serotonin Theory of Depression: A Systemic Umbrella Review of the Evidence.” Molecular Psychiatry. Published online July 20, 2022.

It created quite a “buzz.” As the title suggests, it calls into question the serotonin theory of depression.

When it was released, I read several biblical counselors touting this article. One stated that biblical counselors were owed an apology from the psychiatric world for having said biblical counselors were wrong to question the serotonin theory. Some biblical counselors used the article to call into question the efficacy of all SSRIs (Selective Serotonin Reuptake Inhibiters) for treating any depression.

More momentarily on how we biblical counselors might use such research…

Article 2 

The second article released September 6, 2022.

Pies, Ronald and George Dawson. “Serotonin or Not, Antidepressants Work.” Psychiatric Times, Vol. 39, Issue 9, September 6, 2022.

In their article, Pies and Dawson summarize seven ways they seek to refute the conclusion of the Moncreiff article.

Table 1: 7 Ways the Review and Its Conclusions Are Amiss

1. “There has never been a casually based ‘chemical imbalance theory’ or a ‘serotonin theory’ of depression espoused by academic psychiatrists, psychopharmacologists, standard psychiatric textbooks, or professional psychiatric organizations, at least in the United States.

2. Psychiatrists have known for decades that the etiology of depression and other mood disorders is extremely complicated and cannot be explained solely in terms of 1 or 2 neurotransmitters.

3. The review sampled a very small portion of a much larger universe of serotonin-related hypothesis and their applicability to psychiatric disorders and their treatment.

4. The report findings were not news, in that at least 4 previous reviews of the serotonin (5-HT) hypothesis (1954-2017) found that the total evidence was inconclusive or inconsistent.

5. The brain contains dozens of neurotransmitters, and hypotheses regarding the etiology of depression have extended far beyond serotonin—indeed, far beyond biogenic amines—to many other potential biological causes and risk factors. In some cases, layered models integrating several hypotheses have been developed.

6. Many effective drugs used in general medicine, neurology, and oncology act through unknown or multiple mechanisms; this fact is not an indictment of the drugs or those who prescribe them.

7. The precise mechanism of action of SSRIs is irrelevant to the safety and efficacy of these agents in the treatment of major depressive disorder. Although there is legitimate debate over the efficacy of long-term antidepressant use, the review contributes no new information in that regard.”

So far, I’ve not seen other biblical counselors quoting, citing, posting, linking to, or discussing this article. I could have missed such posts. And perhaps some are still forthcoming…

More momentarily on how we biblical counselors might use such research…

Article 3 

The third article was just released yesterday via The Gospel Coalition (TGC), and written by three CCEF authors: Ed Welch, Mike Emlet, and Alasdair Groves.

Welch, Ed, Mike Emlet, and Alasdair Groves. “Serotonin and Depression: 4 Questions and Answers About a New Study.” The Gospel Coalition. Released online on September 8, 2022.

I found this article an excellent example of how biblical counselors can wisely, with balance, respond to current research. The authors clearly carefully read what Moncreiff and her co-authors said and did not say, claimed and did not claim.

Here are their four questions.

1.     Does this new research mean depression is only a spiritual matter?

2.     Will the serotonin study affect the amount and type of medication prescribed for depression?

3.     If it’s not serotonin, what causes depression?

4.     What should we do about it?

Their answer to question 1 was particularly important.

“The discrediting of the serotonin hypothesis doesn’t mean the body and brain are now marginalized players in depression. Years ago, Charles Spurgeon described his depression as a physical event largely beyond his control. He wrote, ‘A sluggish liver will produce most of those fearsome forebodings, which we are so ready to regard as spiritual emotions.’ Our brains and bodily fallenness are complex. The present research study only suggests that clinicians would be inaccurate to say that medication treats an underlying serotonin deficit, not that there’s no physical culprit contributing to depression” (emphasis added).

How Biblical Counselors Respond to Research

You will often read in biblical counseling circles a phrase something like this:

“Biblical counselors are not against science. We’re just against bad science.”

You will often read a response by non-biblical counselors, saying something like this:

“That’s great. We’re all against bad science. So, show me where you ever quote and use good science?”

I think that’s a fair pushback that all of us as biblical counselors could respond to humbly. If asked, could we point to a positive answer to this question?

What are specific examples where you and I as biblical counselors have positively quoted good scientific research that we can apply to our biblical counseling ministry?

Biblical Counseling and the Positive Use of Science, Neuroscience, and Descriptive Research

Steve Viars says it well in his chapter in the book Counseling the Hard Cases:

“…those ministering the Word through counseling should be friends of good science and desire to promote the research and development of hard data in every area of human existence.”

And in that chapter, Pastor Viars provides four positive examples where descriptive research can aid the biblical counselor in thinking through possible contributing factors in the lives of people struggling with OCD.

Another biblical counselor who does an excellent job quoting good scientific research and applying it to biblical counseling is Dr. Charles Hodges. Here are four examples:

1. Hodges, Charles. Biblical Counseling and Science: In Gratitude for Science Daily 

2. Hodges, Charles. Germs and Worry: New Research

3. Hodges, Charles. The Importance of Science in Biblical Counseling

4. Hodges, Charles. Schizophrenia: Reviewing an Overview

I especially appreciate Dr. Hodges balanced approach, and his ability to articulate positive examples of scientific research useful for the biblical counseling world. And I liked his concluding questions in the first article above. These are questions we could all ask ourselves as biblical counselors:

• Do you have a healthy appreciation for scientific research in the field of social science?

• What have you learned from scientific literature that has made an impact on your counseling?

Biblical Counselors and the “Co-Belligerent” Use of Research 

Now for a more subtle point. It’s nuanced, but important, so please track with me.

Biblical counselors will sometimes say, “I quote from research. Here’s an example!”

But read the examples closely and you’ll note that often they are quoting a researcher debunking another researcher.

There’s even a label for doing this: the co-belligerent use of research.

• You wage war against a common enemy by quoting those who you might otherwise disagree with. It follows the adage: “the enemy of my enemy is my friend.” For example, a biblical counselor who is anti-DSM would only quote secular psychiatrists who were also anti-DSM.

• Put another way, we can be prone toward only quoting research that is negative about research!

• Or, put yet another way, we can have a tendency only to quote research that seems to agree with our preconceptions.

The rush to quote Moncreiff’s article that dismisses the serotonin theory of depression is one recent example. Do we quote that article without also quoting Pies and Dawson’s article about antidepressants working? (This is not to say that we can’t raise questions about Pies and Dawson. For example, is there perhaps some revisionist history in their article when they seem to imply that no academic psychiatrist ever believed exclusively in the serotonin model of depression…?)

As biblical counselors, we’ll talk about the noetic effect of sin on the mind of an unsaved researcher—because they are not regenerate, their conclusions are negatively impacted. Okay. But shouldn’t this negative impact also impact unsaved researchers who appear to agree with us…? 

We’ll also talk about the biases of unsaved researchers. I found it interesting that none of the people I read who quoted from Moncreiff’s article quoted the final section where the co-authors acknowledged their potential biases. Notice the following disclosures of potential conflicts of interest:

“MAH reports being co-founder of a company in April 2022, aiming to help people safely stop antidepressants in Canada. MPH reports royalties from Palgrave Macmillan, London, UK for his book published in December, 2021, called “Evidence-biased Antidepressant Prescription.” JM receives royalties for books about psychiatric drugs, reports grants from the National Institute of Health Research outside the submitted work, that she is co-chairperson of the Critical Psychiatry Network (an informal group of psychiatrists) and a board member of the unfunded organisation, the Council for Evidence-based Psychiatry. Both are unpaid positions. TS is co-chairperson of the Critical Psychiatry Network. RC is an unpaid board member of the International Institute for Psychiatric Drug Withdrawal.”

So, if we are going to consider the biases of researchers, should we not consider the biases of researchers even when they agree with us?

The tendency in the co-belligerent model is to ignore biases and ignore the noetic effect of sin when the findings seem to support our conclusions. This is less than a stellar model of the fair, wise, balanced, and accurate use of descriptive research, neuroscience research, and research into psychotropic medications.

The Point: A Fair and Balanced Use of Research 

The Moncreiff article against the serotonin theory of depression and the Pies article in favor of the efficacy of antidepressants are two good current test cases in how we as biblical counselors can use descriptive research into psychotropic medications. We can ask ourselves:

• Do we fairly analyze articles that agree with our presuppositions and ones that disagree with our presuppositions?

• Do we assess the noetic effect of sin and the potential biases related to research articles that agree with our presuppositions and the ones that disagree with our presuppositions?

• Do we fairly engage with and accurately quote research articles—even ones that raise points of contention with views we currently hold?

• What have we learned from scientific literature that is positive and not co-belligerent that has made an impact on our counseling?

• Are we friends of good science and do we desire to promote the research and development of hard data in every area of human existence?

• Do we have a healthy appreciation for scientific research in the field of social science?[1]

[1]For quotes from the Reformed tradition about common grace and the use of findings from the arts and sciences see: 1. 7 Reformed Theologians on “Common Grace”. 2. John Calvin on Common Grace. 3. Herman Bavinck on “Common Grace,” Part 1. 4. Herman Bavinck on “Common Grace,” Part 2.