This week’s Medication Monday talked about a medication that address cortisol levels. This is a different tactic, seeing as how selective serotonin reuptake inhibitors (SSRIs), one of the most popular types of anti-depressants, address serotonin levels. Yet despite the availability of anti-depressants, depression is not only still present, it is even on the rise. This makes me wonder, is serotonin a red-herring when it comes to depression?
For those not familiar with the term ‘red-herring’ it is when someone is portrayed as the villain or suspect in a criminal investigation, but is actually innocent. Basically they are there to mislead the audience and draw attention away from the actual suspect until the story reaches it’s climax. It is a tool often used in police-dramas and it is also possibly a perfect analogy for understanding serotonin v. cortisol in depressed patients. Research shows that depressed individuals not only show low levels of serotonin in the brain, but also increased levels of cortisol. Data are also demonstrating that serotonin transport may be limited during depressive episodes by increased cortisol levels in the blood, which may explain some of the limited success of SSRIs for individuals with treatment-resistant depression.
Understanding the ‘smoking gun’ of depression is important to understand the best way to treat it, both through a psychoanalytical approach and through a medication-based approach. Yet the uncertainty surrounding these issues, as well as the relatively recent research into the role of cortisol levels in depression, demonstrate just how much we don’t know and don’t understand about how the brain works and how mental illness operates. It is also important to understand that while there are data that supports the idea that cortisol is that smoking gun, it is far from conclusive.
Hopefully, as there is more understanding and acceptance of mental illness, more funding will be available for increased research, creating a positive cycle between increased openness and acceptance, increased funding, increased research opportunities, and increased understanding, which will all lead back to increased acceptance. And hopefully all of this will lead to increased healing, which is the ultimate goal.