@dr.matthew.parker: I prescribe antidepressants. I also know the serotonin hypothesis is wrong. The 2022 Moncrieff umbrella review in Molecular Psychiatry confirmed what many of us have suspected for years: there’s no convincing evidence that depression is caused by reduced serotonin activity or concentrations. But here’s the thing — that doesn’t mean SSRIs are useless. It means we’ve been using a marketing framework to explain a real treatment effect. The current model is more nuanced: • Monoamine-glutamate continuum • Reduced BDNF and hippocampal volume • Impaired neuroplasticity • Ketamine’s rapid antidepressant effect is proof-of-concept for the neuroplasticity model A treatment can work without its proposed mechanism being correct. Aspirin. Lithium. ECT. Ketamine. What I tell patients now: ‘We don’t fully know how these work, but the evidence is that they do. Let’s make the decision together.’ If you’re in psych, mental health, or just curious — I’d love your take in the comments. #MentalHealth #psychiatry #depression #MentalHealthAwareness #antidepressants

Dr Matthew Parker, DO

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Thursday 03 September 2026 13:38:19 GMT