I’ve been really struck in the last few days at the number of blog posts I have read from people struggling with guilt and shame at having to take, or being recommended to take, antidepressants / medication for anxiety.

I work as a General/ Family practitioner and I see this so often. People struggling with crippling anxiety and debilitating anhedonia, who somehow believe this is a sign of ‘weakness’ or  a character flaw. That if they could just “pull themselves together’ it would all go away.

This is just NOT the case. Low mood / anxiety are two sides of the same coin and they are both due, in part at least, to low levels of the neurotransmitter serotonin. This is FACT. An individual can no more control their levels of serotonin than their levels of insulin. Ergo, will power alone will NOT , CANNOT manage anxiety and depression.

Anxiety / Low mood is very,very, very common. Probably about one in three people will visit their doctor at some time with this complaint. Sometimes its presented as fatigue, sometimes as somatic symptoms. But the underlying low serotonin, if treated, will improve all these symptoms

(and before any one jumps on me, not everyone with fatigue is depressed, obviously, but its very common)

This is a somewhat simplified version of the role of neurotransmitters, as my aim with this blog post is not to discuss the finer points of neurophysiology, but offer evidence that might make someone who is low, feel less stigmatised about being offerred / taking antidepressants.

NEUROTRANSMITTERS are the brain chemicals that communicate information throughout our brain and body.  They relay signals between nerve cells, called “neurons”  The brain uses neurotransmitters to tell your heart to beat, your lungs to breathe, and your stomach to digest.  Serotonin is a neurotransmitter which affects mood, sleep, concentration, weight, anxiety, appetite, memory and learning, temperature, and behaviour. Norepinephrine, dopamine, endorphines and oxytocin are also involved in various aspects of mood.

Lots of things, obviously affect mood. Social circumstances, relationships and thousands of other things. But low serotonin levels- are definitely one of the factors that affect mood and one of the factors that we can modify. The diagram below shows the overlapping relationships between some of the neuro chemicals involved


We can ‘help ourselves’ with exercise and a variety of other techniques, we can try to manage stress levels, and we can avoid substances that deplete serotonin – eg alcohol… BUT, for many people, medication is a very useful tool to improve mood and reduce anxiety. I will often explain to my patients that lifting your mood allows one to create a ‘virtuous circle’ – when you feel a but more motivated, you are likely to exercise more, get more done – this makes you feel better – and so on…

so please, if you are low, depressed, anxious, unmotivated, exhausted, struggling with mood disorder, please recognise that this is an illness; Its not under your ‘control’ and there is treatment that can help.

DOI. I take a serotonin reuptake inhibitor, and I believe it has, if not saved my life, helped me beyond measure.