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Nearly 10 percent of all Americans will experience symptoms of depression every year. One of the common forms of treatment includes a combination of therapy and antidepressants. According to the CDC, around 13 percent of Americans over the age of 18 were taking antidepressants between 2015 and 2018. The most commonly prescribed form of these are called selective serotonin reuptake inhibitors (SSRIs), developed to alter serotonin flux in the brain.

I’m one of the millions that takes an SSRI—one called sertraline, to manage symptoms of anxiety, depression and obsessive compulsive disorder. Before I talked with a psychiatrist about getting on this medication, I dealt with feelings of impending doom and dread that appeared on a whim, as well as dozens of intrusive thoughts and emotions every minute. Basically, it’s like having your very own heckler yell at you all day long. Taking the medication has been immensely helpful for me, as it has for many others.

And that makes it all the more strange to recognize that, as with many other complex diseases, researchers still aren’t sure exactly what causes depression, and whether serotonin is one of the main culprits. In the 1960s, scientists serendipitously discovered that certain drugs being used as sedatives helped alleviate depression. Since these drugs acted on the serotonin system, it led to “a very simplistic idea that low levels of serotonin lead to depression,” Gerard Sanacora, a psychiatrist at Yale University and the director of the Yale Depression Research Program, told The Daily Beast.

    Most scientists now adhere to the idea that there are many genetic, social and biological contributors to depression; and yet the idea of a chemical or serotonin imbalance is stuck in the popular zeitgeist. It has lingered on in large part thanks to its prominent placement in advertisements for drugs like Prozac in the late-1980s—even when psychiatric research was already shifting its perspective.

    That brings us to the current debate around SSRIs. Most neuroscientists, psychiatrists, and clinicians who study and treat depression agree: Antidepressant drugs like SSRIs work as well as cognitive therapy. With the right treatment, remission rates for depression can range between 5 and 50 percent. There is no question people like myself are finding real relief thanks to these drugs.

    But if depression is not quite as tied to serotonin levels as we once thought, then it raises the issue that we don’t really know how SSRIs work and why they may help some depressed people. There are several promising theories suggesting they play a role in mediating gut bacteria, to helping the brain grow new cells and require itself, to creating larger and more complex physiological changes beyond simply raising serotonin levels. But none of these theories have been proven out yet.

    The ensuing discussion has boiled over into a full-on debate, pitting mainstream psychiatry against a minority of researchers who don’t think antidepressants actually work.

    Every few years, a new spate of studies pops out from the shadows, supposedly “debunking” the notion of the serotonin hypothesis. These studies suggest that depression is either a result of social factors or caused by traumatic experiences, and that antidepressants either don’t work, numb emotions, or actively cause harm. Instead of medication, they believe that depression is better treated solely through therapy.

    “The ensuing discussion has boiled over into a full-on debate, pitting mainstream psychiatry against a minority of researchers who don’t think antidepressants actually work.”

    The spats between competing academics and researchers are just as intense and vicious as any other fight that takes place on the internet—featuring Twitter feuds, op-eds for think-tanks, and news outlets themselves. The shady history of the pharmaceutical industry further feeds skepticism around the efficacy of antidepressants. When antidepressant clinical trials didn’t bear out the results that were hoped for, drug companies essentially buried the evidence and biased the record in favor of antidepressants—which has only exacerbated mistrust over these drugs and their makers.

    Adding fuel to the fire, one recent review study published in the journal Molecular Psychiatry reevaluated decades of past data on serotonin levels in depression, finding no evidence of the link between the two and offering this up as evidence that SSRIs don’t work or only work by blunting emotions. This conclusion drew criticism from many psychiatrists and clinicians—the study didn’t even analyze whether antidepressants work—but with support from the study’s authors, right-wing media pushed this message out anyway.

    “If there are benefits, I would say that they are due to this emotion numbing effect, and otherwise, what the evidence shows is these very small differences between the drugs and placebo,” Joanna Moncrieff, a psychiatrist at University College London who led the study, told The Daily Beast. “Antidepressants are drugs that change the normal state of your brain, generally, it's not a good idea to do [that] on a long term basis.”

      Moncrieff herself is an influential figure in what’s being called “critical psychiatry,” The Critical Psychiatry Network, which Moncrieff co-chairs, describes the movement on its website: “It mounts a scientific challenge to claims about the nature and causes of mental disorder and the effects of psychiatric interventions.” The researchers associated with this movement advocate against using drugs for mental health conditions, and have even promoted COVID-19 conspiracies.

      If depression is caused by the interaction of stressful events and biology, as some within the Critical Psychiatry Network argue, Sanacora doesn’t follow why this means that antidepressants don’t work. “I just don't follow the logic,” he said.

      Four other experts who spoke to The Daily Beast specifically pushed back on Moncrieff’s findings, most notably emphasizing that hers and her team’s paper crudely conflates two hypotheses under the serotonin theory. There’s the chemical imbalance hypothesis that’s pretty well known, which suggests a deficit in the serotonin neurotransmitter in the body leads to depression. But according to Roger McIntyre, a professor of psychiatry and pharmacology at the University of Toronto, “the notion of chemical imbalance in your brain has never been put forward as a coherent, comprehensive, evidence based proposal.”

      Instead, the more prevailing serotonin hypothesis that psychiatry takes seriously and which McIntrye and others argue is supported by evidence, is that a dysregulation of the body’s whole serotonin system is what contributes to clinical depression. This includes problems in the amount of receptors available to bind serotonin, issues with how the cells fire, and numerous other disruptions on the biomolecular level. They argue that Moncrieff gets it wrong when it comes to making the grand claim that there isn’t any evidence of serotonin’s involvement in depression.

      “The notion of chemical imbalance in your brain has never been put forward as a coherent, comprehensive, evidence based proposal.”— Roger McIntyre, University of Toronto

      Moreover, not knowing a drug’s mechanism isn’t a good enough reason to prevent its usage if it’s demonstrably helping people. “We're very confident that SSRIs work for depression,” Tyler Randall Black, a child and adolescent psychiatrist at British Columbia’s Children’s Hospital, told The Daily Beast. “There's reams and reams of evidence showing us that they work, but not why they work.” McIntrye pointed to the fact that we don’t even completely know how Tylenol works either—despite the fact that it’s one of the most widely used pain-relievers around the world. Tylenol also impacts the brain in unexpected ways—although it numbs social or psychological pain, it isn’t grounds for removing it from the market.

      Vilifying these drugs can have unintended consequences because therapy is often unavailable, making SSRIs the only accessible option. “The demand for mental health care far outstrips the available access,” Sanacora said, adding that many Americans need to wait months to see a good cognitive behavioral therapist. Additionally, abruptly deciding to stop taking SSRIs can be dangerous: One in five patients who do this will experience flu-like symptoms, insomnia, imbalance, and other symptoms that can last for a year.

      While the psychiatrists who spoke with The Daily Beast emphasized that the serotonin hypothesis was a way of simply explaining a complex disorder like depression, they did highlight it has fostered downsides over time. The story of a “‘chemical imbalance’ narrative has negatively influenced patient decision-making and patient self-understanding,” Awais Aftaib, a psychiatrist at Case Western Reserve University in Cleveland, Ohio, told the Daily Beast.

      “The demand for mental health care far outstrips the available access.”— Gerard Sanacora, Yale University

      Phil Cowen, a psychopharmacologist at the University of Oxford in the U.K, told The Daily Beast that socioeconomic status is a contributing factor to depression, leading those in the critical psychiatry space to believe it “gives power to doctors and industry” over patients. Ironically, it ignores the millions of “people with experience” who were helped through antidepressants.

      Still, the million dollar question remains: How do SSRIs work? Aftaib explained that a new leading hypothesis is that they encourage the creation of new neurons and new connections between neurons inside the brain. The hippocampus, a seahorse-shaped region of the brain important for memory and learning, shrinks and loses neurons when depression hits. SSRIs seem to stimulate the production of neuronal stem cells, which integrate into the hippocampus to restore its function and structure. Other studies suggest SSRIs help the brain rewire the connections that cause the clinical symptoms associated with depression.

      He also added that SSRIs might work through different mechanisms in different individuals, so treatments may have to be more tailored to a case-by-case basis.

        And more specific, individual treatments might require psychiatrists to be more honest with their patients about what we know and don’t know about these medications, versus trotting out an oversimplified (and downright inaccurate) explanation.

        Black already tries to do so with his patients: “I say we know for sure it affects serotonin, but we don't know how that changes your brain and we don't know that you're lacking serotonin to begin with.” He’s found that these open discussions over what we know so far about therapy and medications pay off in the long run, and many of his patients will still opt to take the antidepressant as part of their search to find what works best for them.

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        Millions of Americans to get up to $3,300 each over the next two weeks as four direct payments go out

        TAXPAYERS around the US are set to receive rebates of up to $13,284 in the next two weeks as states continue sending relief.

        The direct payments and rebate checks are a way for states to help offset the impact of inflation.

        1States across the US have been offering payments as costs rise

        The latest Consumer Price Index rose to 8.3 percent in August with shelter, gasoline, and food contributing to the highest price increases - and Americans are feeling it.

        However, there's been some relief despite no fourth federal stimulus check.

        Over the past few months, lawmakers have had to get creative when offering payments to its residents.

        Some states provided funds through tax rebates, budget surpluses, and incentives.

        Read More on Direct PaymentsMO' MONEY Direct payments of up to $3,284 for thousands will hit accounts todayACT NOW Deadline for payments up to $300 exactly one month away - see who's eligible

        Below are the four states offering financial aid to residents in the coming weeks.

        1. Alaska - $3,284

        Governor Mike Dunleavy recently announced that eligible Alaskans will pocket $3,284 checks.

        Residents will score a $650 energy relief payment and another $2,550 as part of the state’s Permanent Fund dividend.

        Most read in MoneyFUNNY MONEY I'm a money collector - see detail that makes a $20 bill worth up to $400,000TAKE TWO Direct payments worth up to $300 to be sent to Americans after delivery snagSALE AWAY Walmart secret clearance with items as low as 50 cents, from toys to clothesSILVER LINING I’m a coin collector - your 50 cent coin could be worth up to $48,000

        The Permanent Fund Dividend (PFD) is a dividend from the state’s oil profits that is sent to residents each year and comes in a lump sum of $2,550.

        Last year, an estimated 643,000 Alaskans received about $1,114 per person. 

        The Permanent Fund dividend pays an amount of the state’s oil wealth to residents each year.

        Both payments were issued as a lump sum on September 20, according to the state, and Alaskans who receive direct deposits should have gotten the funds almost immediately.

        However, paper checks will start going out the week of October 3.

        In other words, if you requested a paper check instead of a direct deposit, you have to wait longer to get the cash.

        2. California - $1,050

        California Governor Gavin Newsom signed the state's budget in June including $17billion worth of inflation relief in form of tax rebates. 

        Roughly 23million people are in line for payments of $200 to $1,050 as these are offered on a sliding scale.

        The payments are set to be distributed starting in October and continue into January 2023.

        Eligibility and payment amounts are dependent on income, tax filing status, and household size.

        The maximum payment for individuals earning less than $75,000 per year is set at $350.

        While couples who file jointly and earn less than $150,000 per year will get a maximum amount of $700.

        Plus, if those families have at least one dependent, they can also grab an extra $350.

        The minimum payment for individuals earning between $125,001 and $250,000 per year is $200.

        Couples who file jointly and earn more than $250,000 but less than $500,000 per year will receive a minimum amount of $400.

        Additional payouts for those families who have at least one dependent is $200.

        The state has an estimator that can help you determine your eligibility and see how much cash you can expect to receive.

        3. Colorado - $1,500

        Thanks to Colorado Governor Jared Polis, taxpayers will get back rebates of up to $1,500 in just weeks.

        The Colorado Cash Back program provides checks of either $750 for single taxpayers or $1,500 for married couples.

        You’re eligible if the following applies to you:

        • 18 years old as of December 31, 2021
        • Was a Colorado resident for all of 2021
        • File a 2021 Colorado state income tax return or apply for a Property Tax/Rent/Heat Credit (PTC) Rebate

        Those who filed a 2021 Colorado tax return but moved out of the state in 2022 are still eligible.

        Additionally, if you've already filed your return by June 30, you should receive yours by September 30, 2022.

        However, those filing an extension are set to receive checks at a later date.

        The deadline for filing your state income tax return is on October 17.

        Those checks are likely to arrive by January 31.

        4. Rhode Island - $750

        Eligible Rhode Island families may be able to receive rebates worth up to $250 per child for a maximum of three children.

        The maximum amount a family could grab would be $750.

        Any Rhode Island taxpayer with dependents 18 or under is eligible for the credit, and no application is necessary.

        The program was signed by the Governor in June and will offer rebates for residents making up to $100,000 for an individual and $200,000 for joint filers. 

        Roughly 115,000 Rhode Island families will benefit from the aid. 

        Taxpayers who filed by August 31 will automatically be issued to all eligible tax filers beginning in October.

        The state hasn't yet confirmed an exact date.

        All rebates will be sent by check, and there will be no direct deposits.

        However, for those taking advantage of the October 17 extended filing deadline, rebates will be issued starting in December.

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        The Sun reveals the $1.1billion plan in tax relief – see the full list of provisions and who would be eligible if it passes.

        Plus, the 33 states that boost SSI benefits by up to $120 as second September payments worth $841 are sent out next week.

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        I'm a money collector - see detail that makes a $20 bill worth up to $400,000

        TAKE TWO

        Direct payments worth up to $300 to be sent to Americans after delivery snag

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        Walmart secret clearance with items as low as 50 cents, from toys to clothes


        I’m a coin collector - your 50 cent coin could be worth up to $48,000

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