Well, here is the study of the year for me.  link

This study is a game changer.  A recent study is turning upside down the theory of how SSRIs treat depression, with startling implications.  It turns out that serotonin (which is increased by SSRIs, of course) interacts with the Serotonin Receptor across the lifespan to modulate how the brain responds to the environment.  Enhanced serotonin activity permits MORE neuroplasticity in response to environmental inputs.  So, supports and care on SSRIs can make a larger positive impact in helping a person recover from depression.  Positive experiences are more able to lift the mood of depressed persons.  It is as if the serotonin activation gets the brain out of its negative “rut”–it no longer loops around and around in depression, unable to respond to the good things that happen.

People describe this experience:  Depression makes everything so black that nothing matters.  Then, with meds, they start to feel better.  The new idea?  It’s not the meds making them better; it’s the positive experiences that lift a depressed mood thanks to the SSRI.

This is the twist.  The brain on SSRIs is more neuroplastic, period.  So, if the environment is BAD, the SSRI make you MORE susceptible to bad experiences and could actually worsen your depression!  It is a double-edged sword.  It throws in a twist that needs accounting as doctors prescribe SSRIs.  (or SNRIs, atypicals, anything that involves the serotonin system).

This is preliminary data, but the psychiatric community is abuzz with what to do with the results.

Do we not give SSRIs to people in bad environments?

Do we insist on CBT/Behavioral Activation or Social worker supports before we start SSRIs to ensure they have enough positive experiences for the SSRi to work?

Hmmm.

Much to ponder.  It sure seems more complex than anyone else thought.

Joris