The Wellness Theory of Depression
Influencers and far-right activists join arms in a pseudobattle against psychiatry
On July 20, a systematic review, published in the Nature journal, Molecular Psychiatry, caused an immediate uproar. Nothing in the text was groundbreaking. It merely rekindled a half-century debate in psychiatry. Still, only a handful of scientific studies create this sort of fury and defensive posturing each year. This one targeted one of the sacred cows of modern psychopharmacology: the serotonin theory of depression.
First hypothesized in the 1960s, neurobiologist Christopher Kerr explains the theory succinctly in a 1994 paper:
In its simplest form, the serotonin deficiency theory of depression postulates that there is a net reduction in serotonin transmission in depressive illness. The pathophysiological change may result from two different mechanisms. The first involves a decrease in serotonin availability which has the consequential effect of compensatory receptor up-regulation or supersensitivity. The second mechanism implies a primary defect in receptor activity and/or signal transduction.
Put simply, the theory states that depression is caused by a chemical imbalance in the brain. And the recent paper, based on 17 reviews and studies on the topic, found that
the main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.
The initial theory rests on the depletion of the brain’s serotonergic system. Researchers tore this notion apart back in the seventies. Studies showed similar changes in serotonin levels of depressed patients and the control group. Bangor University psychiatry professor David Healy, an expert in pharmacological history, put it best when writing,
The serotonin theory of depression is comparable to the masturbatory theory of insanity.
Still, this new review didn’t sit well with some psychiatrists and pharmacologists. And there’s good reason to debate the many nuanced aspects of mental health therapeutics. But an even more frustrating trend has been rekindled in recent months by non-experts: wellness influencers and far-right agitators shoehorning mental health into a binary narrative that suits their own agendas.
While I covered this topic in more depth on today’s Conspirituality bonus episode, including a brief history of 20th-century pharmacology and a synopsis of modern suspicions of current mental health protocols, this article will focus on the insidious ways that influencers and far-right activists distort credible debates in order to operate in and, often, attempt to monetize fears in a world where binaries are currency.
To briefly touch upon frustration and confusion in regard to the pharmaceutical industry, Research Professor of Sociology, Joseph Davis, writes in his book, Chemically Imbalanced, that four trends shifted the way we treat mental health between the late sixties and today:
We’re taking antidepressants far longer than our parents and grandparents took tranquilizers. Some argue that we’ve gotten better at naming the etiologies of diseases, while others counter that naming a disease allows you to prescribe for it.
The infamous cocktail: a lot of people ingest multiple drugs simultaneously, often to counteract the side effects of the original drug. Sometimes this is necessary, yet it can also get out of control. I also interviewed a woman for my last book who was prescribed 18 drugs for her PTSD. It took her years to taper off that protocol.
Children are prescribed a range of pharmaceuticals in an attempt to regulate their emotions and ability to focus, which was practically unheard of two generations ago.
Drugs are no longer widely associated with psychotherapy. Whereas the popular sedative, Valium, was prescribed in conjunction with insight psychotherapies in the seventies, some psychiatrists today rarely play the role of an analyst. Their main job is in pharmacotherapy, which works for people who can’t afford both, bringing into play the questionable incentives of the health care industry.
In 2021, 17% of American college students took antidepressants. This tracks just above the national average of adults; roughly one in six Americans regularly take an antidepressant. Add to this the supposed moral shame associated with mental health: in 2021, 47% of Americans believed seeking therapy is a sign of weakness. Under such conditions, it’s easy to understand why people would choose taking a pill, which they can do in secret, over the more laborious and “seemingly weak” project of seeing a therapist.
While we can (and should) debate the efficacy of pharmacology, it’s undeniable that many have found antidepressants effective for helping them manage life—a fact you won’t hear in the blanket criticisms by conspiritualists. As experts say, pills should be treated as a tool, not the tool, in a psychiatrist’s apothecary—ideally (though not always possible) for short-term usage. Those are a lot of caveats, but like science, mental health isn’t a binary. There’s a lot of work left to do, and our understanding of this science is not fixed.
Conspiritualists would have you believe otherwise.
Expertise not required
To start this section on a good note, the following clip is from recent Conspirituality guest, Danielle Belardo’s podcast, Wellness: Fact vs Fiction. She’s talking to clinical psychologist, Jonathan Stea, who accurately expresses the care that clinicians put into their thinking around mental health.
The context of this moment is experiencing depression after a life-changing event, such as the death of a loved one or loss of a job—some stressor that throws your emotions into disarray. Jonathan discusses how he would go about the situation, which is, of course, ultimately decided on a case-by-case basis.
The takeaway: not every intervention is going to work for everyone, and different people are going to react to different interventions, or sometimes, a variety of them, before (hopefully) finding relief.
It’s not clear-cut because there are too many variables to consider. Experts understand this.
Now let’s listen to this clip from a conversation between Kelly Brogan and Aubrey Marcus. My Conspirituality co-host, Matthew Remski, has extensively covered Brogan’s unscientific tapering protocol and questionable sales techniques. Notice how mental health is treated in this conversation as compared to the last clip. To frame this, the title of the podcast is—seriously—“If you want to STAY SICK, Don’t Watch This.”
Please excuse the weird behavioral divergence that’s borrowed from economic theory (though I don’t think they realize that). Hearing the clip in full is relevant to point out a) the lack of focus when discussing a topic that demands laser-focused attention, b) the paradox of claiming not to be able to help anyone but then also charging people to supposedly help them, and c) the pivot points to other branches of pseudoscience.
This clip began with Brogan, a trained psychiatrist whose bona fides include “escaping” that industry, stating that victim consciousness is the only human pathology. To return to Davis, there certainly might there be too many mental health classifications in the DSM. But that’s not what’s really happening in this clip.
The two binaries at the bookends are relevant:
Brogan states that only one pathology exists, and every disorder is effectively a form of it, or at least rooted in it.
Marcus states that science never evolves and is only designed to treat humans as computers.
To address the second: no actual scientist speaks like this. Only people completely ignorant of the scientific process make such claims, which Aubrey further shows in his anti-vax sentiments around childhood vaccinations. The “I’m just asking questions” attitude is not fitting for someone who almost certainly cannot list those 72 vaccines or identify what doctors or medical institutions require that number, especially considering the CDC lists 32 vaccines on their list of recommendations for children 0-18 years old, with some being geographically-dependent or contingent upon other factors.
As for Brogan, a reminder: Watch what they say, then watch what they sell.
She clearly states that she’s not qualified to say what’s right for anyone while also claiming that all pathologies are really just variations of one phenomenon. So how, then, is a self-proclaimed unqualified therapist comfortable having you join her Vital Life Project or Vital Mind Reset communities to help you navigate your variation of this one pathology for $40 a month or a thousand-dollar initiation fee? (These numbers are based on Matthew’s 2020 article and may have increased by now.)
Brogan is opposed to pharmacological intervention for any mental health treatments. She also markets plenty of ways to keep you off drugs, including books, programs, webinars, and online communities. It’s obviously in her best interest to define all pathologies as one pathology that she just happens to address, even as she admits she’s not qualified to care for anyone.
These aren’t the only two conspiritualists weighing in on a topic they’re unqualified to discuss.
Bernhard Guenther, a trained percussionist and self-styled philosopher with no listed psychiatric training, wrote this exceptionally long Telegram post which offers about as much nuance as the Brogan-Marcus conversation. Like Brogan, he has his own “theory of everything” when it comes to mental illness, adding in a little past-life regression because things that can’t be proven are a badge of honor in the wellness set. His wife, Laura Matsue, also lists no actual psychiatric credentials on her website, only that she “studied a wide range of modalities ranging between modern Western psychology and Eastern spirituality,” which could mean “I watched YouTube for dozens of hours.” She also boasts services in “intuitive life coaching,” because see directly above about meaningless terms.
Christiane Northrup isn’t wrong when she claims a good therapist can do wonders, but notice the not-so-subtle recommendation of St John’s wort. This is only the latest in an array of posts by doctors speaking on topics they’re not trained to understand.
(The NIH has stated that St John’s wort is not a replacement for conventional interventions and little is known about its long-term efficacy. Alarmingly, it can also contraindicate to antidepressants, making advice like the below dangerous to people currently on medications.)
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Over on the right…
Conspirituality is the study of the intersection of wellness and the far right. latter’s provocateurs have not been silent, nor attempted to avoid pseudoscience and false claims, when weighing on mental health. Let’s start with Fox News.
Shout out to EJ Dickson for her excellent Rolling Stone article on this topic. She writes,
Carlson blamed the Highland Park shooting on everything but actual guns, including social media, porn, video games” and antidepressants. In an extensive rant, he claimed that “crackpots posing as ‘counselors’” are forcing American children to take ‘psychotropic drugs,'” claiming “a lot of young men in America are going nuts” and that “a shockingly large number” of them have been prescribed SSRIs. Georgia congresswoman Marjorie Taylor Greene also took to Twitter last week to make similar claims, writing, “When are we going to have an honest conversation about drug abuse, mental illness, and SSRI’s … and deadly side effects. Are we really going to keep pretending? Or covering for Big Pharma? Because I’m absolutely done with the political plays on this.”
Dickson interviews actual doctors for the article, who point out that there are side effects to SSRIs—violence is not one of them. At worst, irritability ensues as the medication begins working, according to her reporting. Furthermore, in this particular case, there’s no evidence that the Highland Park shooter was on an SSRI, or any drugs at all.
But this isn’t about making credible criticisms against pharmacology. The GOP is exploiting a topic truly is ripe for criticism, but instead of thoughtfully researching the topic and creating an argument, they treat it like a battering ram to shove into whatever argument they want—in this case, keeping as many guns as possible in circulation.
Guns aren’t the only subject Carlson is trying to distract from. His outrage farm has many stables. He went so far as to side with Scientology, an organization that has been leaning into mental health in an attempt to indoctrinate new members for decades. Like Guenther, he adds a bit of metaphysics to the equation.
In another example of peak conspirituality, crypto enthusiast ElonTrades, who offers a $100/month Patreon marketed to help grow your portfolios that’s also somehow “entertaining and educational only” (likely so that he can skirt the whole “don’t offer investment advice” thing), throws Eckhart Tolle and Sadhguru into the mix in a reply to the criticism of Carlson boosting Scientology.
To parallel Aubrey Marcus, Greene couldn’t resist falsely inserting anti-vax sentiments in the context of mental health.
Far-right conspiracy theorist Jack Posobiec couldn’t keep quiet on the topic either, assuming protestors were on antidepressants (which conveniently makes his fanbase not question the thing people were protesting, in this case a GOP conference).
All of these figures meet in their inability to distinguish between viable criticisms of mental health interventions and pharmacology while employing manufactured talking points that push forward an agenda. The social media and podcasting platforms they dominate allow these non-experts to exploit their agendas without the need for actual training in mental health or any form of journalistic factchecking.
This is why charismatics flourish even when they have no idea what they’re talking about. When someone who is truly suffering from depression comes across their hot takes, they’re likely to be drawn into all the surrounding accouterments that shield the influencer or far-right activist from needing actual credibility.
Shayla Love’s recent VICE article on the serotonin-depression paper shows just how nuanced the etiology of depression is. After noting that the study’s authors were not focused on the efficacy of SSRIs but rather the notion that low serotonin does not necessarily cause depression, she writes,
There are many other hypotheses about how antidepressants may help with the symptoms of depression, like the idea that they enhance neuroplasticity, or interact with serotonergic activity in brain circuits that are involved in reward seeking and mood. In people who experience depression, there may not be something “wrong” or “imbalanced” in their brains, but an SSRI could still interact with these circuits, and in some people, improve mood in that way. There are many reviews that suggest that antidepressants are helpful in the treatment of depression for some people—beyond placebo effect.
Influencers and activists spouting uneducated, biased nonsense is unfair to people suffering from depression and other mental health disorders. Reducing the complex world of emotions and biology to a single theory of everything (that also happens to be addressed in their online communities, books, or coaching sessions), and minimizing the incredible work scientists do to score cheap points on social media, is not helping either people suffering from depression or the people who have spent their lives trying to minimize their patients’ suffering.
From my experiences—a sentiment that Jonathan Stea expressed beautifully above—both of these groups show high levels of humility in the face of such overwhelming odds. It’s those monetizing the wellness theory of depression that we need to be wary of.
Hey there Derek, Just trying to get in touch to make a topic suggestion for your Conspirituality podcast - you might want to consider covering Christopher Duncan and the Magnetic Mind Rapid Reset / Superconscious movement. I've experienced great grief and sadness witnessing an old colleague join the movement, she's very intelligent but seems to have lost her critical thinking abilities. I'm not sure if it quite meets the criteria to be classed as a cult, but it certainly comes close, I think.