Is Depression Caused by a Chemical Imbalance?

Hey there, everybody, and welcome to today's video. Today we're going to be answering the question, does low serotonin cause depression? I'm your host, Dr. Donnellice Snipes. A recent study came out that seemed to indicate that serotonin was not involved in the development of depression at all. And I think it is very dangerous to sort of throw the baby out with the bathwater, so to speak. Yes, we're learning more about the serotonin system and we're learning more about what causes depression. And it's not all just serotonin. So I think it's important to look at what we might be talking about here, what actually might cause depression. We do know that only about 30% of people fully respond to the initial antidepressant, or SSRI. SSRI stands for selective serotonin reuptake inhibitor. We're going to talk about what that means in a minute. Ultimately, less than 55% of people ever respond fully to an SSRI. Okay, well, one of the caveats here is fully, in my clinical practice over 20 some odd years, I don't think I've ever encountered someone who was able to start taking an ssri. And boom, magically they felt better. Better. There are a lot of other things that contribute to it. So expecting someone to have full remission from taking an SSRI is probably pretty foolhardy to begin with, in my opinion. However, 30 to 55% of people do experience some benefit from taking an SSRI. So let's look at why this might be. Well, SSRIs, selective serotonin reuptake inhibitors typically only work on the 5ht1a receptor. But there are multiple 5ht or serotonin receptors that are involved in mood regulation, including 5 HT1, 5 HT2, 5 HT4, 6, and 7. So if the person has dysfunction in one of the other 5 HT receptors, an SSRI may not do any good. It's also important to recognize that SSRIs or serotonin is only one neurochemical that is involved in mood regulation. And there are a lot of other potential hormones or neurochemicals that could be out of balance that could be causing or contributing to a person's depressed mood state. SSRIs only impact one possible area of dysfunction in the system. What they do is basically make the serotonin stay in the synaptic cleft longer and make the receptors that would reuptake would take the serotonin up out of the synaptic cleft, makes them less active, so that serotonin can stay there longer. It also impacts the enzymes that break down the serotonin. But that means that the serotonin had to get into the cleft and that the receptors actually have to be responding correctly. Serotonin creation, secretion, absorption and distribution is impacted by multiple factors. And I'm going to try to show you in this graphic here. Now, I'm not the best artist, but hopefully this will make some sense. So what we have here is water. And we're going to use the plumbing analogy. Water to be created, if you will, is taken from wherever your city happens to get water from and put through a water treatment plant. Now, at the water treatment plant, the plant has to be functioning. So in our body, our body has to be functioning. If our body can't do what it needs to do to process the untreated water, then we're not going to have water. If our body cannot do what it needs to do to process the nutrients and hormones in order to produce the serotonin, then we're going to have a problem. So this, our body is sort of akin to the water treatment plant. If we don't have enough neurochemical being produced, then that can be due to poor nutrition. What we eat is broken down into its component parts and reassembled to make a variety of different neurotransmitters and hormones and other things. It's also important to recognize that our microbiome, our gut microbiome, those are the workers that break down what we eat and reassemble it. If our gut microbiome is in disarray because we're stressed or because we're eating crap, then it's not going to be able to do its job. Poor sleep can also contribute to activation of the stress response, or the HPA axis, which will impact the availability of different vitamins, minerals, and it will impact the composition of the gut microbiome. It impacts which microbes are actually recruited, which ones are called into work that day, and what they're going to work on. Illness can do the same thing, whether it is a temporary illness like the flu or an ongoing illness like autoimmune diseases or cancer, can also impact our body's ability to make and effectively process the hormones and neurotransmitters needed to keep us healthy. All right, so let's say, hypothetically, your body system is working fine. We which rarely happens in American society, But we'll get to that. Let's say your body factory is working fine, your treatment plant is a okay and you've got plenty of chemicals or whatever. You need nutrients in order to make the neurotransmitters. So then serotonin and other neurochemicals are made and secreted down the pipeline. It gets to your house. Now, most of us, if you live in a house, you've probably seen your water meter, and at your water meter, there's probably a water pressure gauge. I know we have one installed because we have to manage our water pressure because it comes in too high, I think. But whatever. There's a water pressure gauge at your water meter that can be thought of like your HPA axis. And it's going to govern theoretically the water pressure going into your house. So if you're taking a shower and you notice that you don't have very good water pressure, you might need to take a look at that meter and see if it got turned down. Is something going on? There is something going on at HPA axis. So it's either not pushing enough through or it's pushing too much through. Okay, so another problem could happen down the line before it gets to the house. Just because you're not getting enough water pressure doesn't mean that the water pressure gauge is dysfunctioning. It could mean that along the way there's a clog like a tree root. And that tree root can be likened to either systemic inflammation, which promotes neuroinflammation, which alters the way your neurons communicate, or it can be similar to the serotonin coming out of that synaptic space too quickly. It gets sucked up before it actually gets down the line. So this little tree here is drinking your water, and it's not getting down to the shower where you need it to wash your hair. So it's important to recognize that there could be a variety of things going wrong in the neurotransmitter system. And we have the glutaminergic symptom system, the dopaminergic system. We have a lot of different systems, but ultimately they all work together. And when one goes offline, it impacts the ability for the others to function effectively as well. So, to summarize, to make serotonin, people need a healthy diet. We need to give our body the neurochemical or give our body the nutrients that it needs in order to create serotonin and norepinephrine and estrogen and those sorts of things. We need a well functioning microbiome. So once the nutrients or the chemicals get to the factory, then we have to have a workforce that can actually effectively assemble them. And they have to have orders to assemble the right neurochemicals. If you're stressed, they have orders to assemble stress chemicals. If you are not stressed, then they have orders to assemble relaxation chemicals. And I know that is grossly oversimplified, but I'm trying to keep this into a 30 minute presentation. So you have a healthy diet and a well functioning microbiome which allows your body to convert food to 5ht and then to serotonin and then release that down downstream. Now, just like the water we drink, at least in my town, is not pure water, unfortunately, it is a cocktail of a variety of different chemicals like fluoride and chlorine and all those other things. Well, I want you to think of your body the same way, because serotonin isn't just out there on its own. Serotonin levels are affected by and affect the levels of norepinephrine, acetylcholine, gaba, glutamate, endocannabinoids, dopamine, progesterone, oxytocin, testosterone, thyroxine, estrogen, dhea, adrenaline, cortisol and endorphins, just to name a few. So the mnemonic I use to remember each one of these is Snagged potted ace. And I know that doesn't make a lot of sense, but mnemonics can help you remember what needs to be there or what things you need to remember. And so three words I can remember that a whole lot easier to prompt me to remember all of those chemicals. But all of the chemicals that make up snagged, potted, ACE affect one another. When one goes up, it affects the availability or the demand for the others. When glutamate goes up, GABA goes down, for example. So it's important to recognize that. It's important to recognize that serotonin for some is involved in depression. It's involved in, we know it's involved in mood regulation. Norepinephrine is another neurochemical as well as dopamine that may be targeted in antidepressant medications. So we know that you know the trio serotonin, norepinephrine and dopamine. Any of those three, or all three of those may be dysfunctional in your particular system. We still don't know exactly where. So it's important to remember that. It's also important to remember that, for example, estrogen and testosterone. Now those are sex hormones. You wouldn't be thinking about them impacting serotonin, but they do. Estrogen and testosterone levels impact the availability of stress Serotonin and the reactivity of the serotonin receptors. So as we age, for example, our natural levels of our gonadal hormones, testosterone or estrogen, drop. Because of that drop, we see less availability in some people, some people more than others of things like serotonin. So it is important to recognize the interactivity within the body. And we can't just take something as complex as a human and say, oh, this one little thing over here, if we tweak that, everything will be fine. That's just not how it works. The HPA axis also needs to be functioning healthfully, functioning well. And we know that when people are exposed to chronic stress, when people are exposed to trauma, it may contribute to HPA axis dysregulation. So if that water pressure gauge ain't working, then we've got a problem. Sometimes it's just way, way on. So it's just gushing water through all the time. And the person starts to feel overwhelmed by the flow of water, if you will, or it's turned down. We've talked about how over time the HPA axis turns down its sensitivity. But during that process, there may be ebbs and flows where all of a sudden it just lets us spurt of neurochemicals through a spurt of adrenaline through, and then eventually it's calms down, if you will. So it's just, it's not letting near as much through. The water pressure has been turned down. Neurotransmission is altered when systemic inflammation increases the permeability of the blood brain barrier. So it's important to recognize this, that the neurons have difficulty communicating when there's systemic inflammation. Again, let's think about our culture. How many people have autoimmune issues? How many people have chronic inflammation from eating inflammatory foods? How many people have chronic inflammation from other things? Inflammation is a huge issue in our society. So and inflammation levels impact the functioning of the neurotransmission throughout the brain. Inflammation impacts the composition of the gut microbiome. So does serotonin directly cause depression? Well, in some people, again, maybe, and in some people, maybe not. But we know that inflammation alters the levels of neurochemicals that we know are responsible for, for mood regulation. So what I think we've been doing all along is we haven't been looking back far enough. It's like the plumber that comes out and there's not enough water pressure. So instead of looking at the pipes leading up to the pressure gauge and then maybe beyond and doing testing, he just replaces the, replaces the faucet and says you should be fine. Well, not if that's not where the problem was. The ability of serotonin to activate the receptors is kind of like getting enough water through the shower head in order to get the soap out of your hair. That depends on how long it remains in this synaptic space and if it's activating the right receptors. Again, if the medication somebody is taking is activating the wrong 5ht receptor, you know, they're kind of like knocking on the wrong door to deliver a package. It ain't gonna do any good. And if it doesn't stay in the synaptic space for long enough before being reabsorbed, then it can't do its job. If so, the medications that people take theoretically keep the serotonin in that synaptic space longer. But no matter how long it stays in the synaptic space, if it's poor quality or not enough has been secreted, then you're going to have a problem. Or if the receptors that are being addressed by the medication are the wrong receptors, then it's still going to get taken up too quickly anyway. So we need to recognize all of the crazy nuances that we need to that are responsible for, for mood regulation in people. We are not that simple that we can just tweak a nutrient and all of a sudden, lo and behold, bada bing, you're healthy and happy and live forever. Contributing factors as I've mentioned, factors that contribute to imbalances in our hormones and neurotransmitter levels include sleep problems, nutrition problems, medications that especially those that act on the cytochrome P450. But there are a lot of medications that are known to produce depression as a side effect. Be aware of what medications you're taking and how they're impacting your body. Hydration, inflammation, aging, childbirth, and just your plain old neurological wiring. Some people are much more hypersensitive to stimuli in the environment, so they experience a lot more stress than people who are less sensitive to stimuli in the environment. Cognitive and emotional factors. Well, HPA axis dysregulation, or a stress response system that just isn't working effectively or efficiently as a result of trauma or trauma related changes in the way you perceive the world or ongoing distress. If you've been experiencing chronic stress for weeks, months or even years, yeah, that's going to negatively impact your HPA axis, which is going to increase your cortisol, increase your adrenaline, increase all those stress hormones and reduce the relaxation hormones and contribute to feelings of distress and Acute stressors or trauma. Let's face it, if you get into a car accident or you break your arm or you have to have surgery or you experience a loss, there is going to be a change in your neurotransmitter levels. Now that's probably expected and very healthy. My point is there are things that happen that prompt changes in our neurotransmitters that prompt us to experience sensations that we've labeled with emotional labels like anxiety or depression or anger. Environmental stressors that impact the levels of our neurotransmitters. There have been a lot of studies that have shown people who live in noisy environments have higher rates of depression. Toxins that impair your ability to make serotonin or increase estrogen levels or do a variety of things, put stress on the body can contribute to inflammation, can contribute to systemic dysfunction and depression. Temperature and light are also factors. If you are especially heat can contribute to emotional distress. And light in and of itself may not be bad, but it helps you set your circadian rhythms. And if people are exposed to what they now call light pollution, it adds stress on the body and it can impair their sleep, which causes stress. And that stress ramps up that HPA axis. You see how all of this is involved. And and then as soon as that HPA axis is altered in some way, whether it is turned on or turned off, that's going to impact the balance of the neurotransmitters and hormones in the system. And finally, stressors that come from relationships, including low self esteem, your relationship with yourself, a lack of secure attachment, or poor interpersonal and communication skills. If you have difficulty asserting your needs, setting your boundaries, then you may feel hopeless, helpless and depressed. Because when you're in that situation, you feel vulnerable, you feel threatened, you feel, guess what, stressed. And again, that will alter the balance of neurochemicals. Conclusion Depression can be caused by altered levels of a variety of neurotransmitters and hormones as a result of physical, environmental or emotional stress. And generally when you have one, you start having them all. Effective treatment of any mental health issue, whether we're talking depression, anxiety, anger, addiction, schizophrenia, must examine stressors in all pacer aspects of the individual. What that means is all physical, affective or emotional, cognitive, environmental and relational aspects of the individual. Because as long as stress stays high, then it's going to alter the balance of the neurochemicals and it's going to affect the responsiveness of the HPA axis. And if you've watched my video on the HPA axis you know, that when people stay stressed for too long, it starts causing neurodegeneration. We actually see the loss of, of neurons in the brain. We start to see a shrinking of the hypothalamus as a result of neurotoxicity. So we do know some things happen. Now, whether we know exactly how it happens or exactly what causes it, maybe not. SSRIs, antidepressants, psychotropic medications, those are an excellent tool to have in your toolbox. It doesn't mean it's going to do anything for everybody, and it certainly doesn't mean it's going to do everything for anybody. But it is a tool that can be used to help people in their recovery process.