Since SSRI raise serotonin levels almost immediately , why isnt there an immediate effect if depressed people lack serotonin ?
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Psychiatrist here: (but notably, my job/training is diagnosis and treatment. I am not a researcher dedicating my work to understanding how these meds work in the body. If there is someone here like pharmacist or psychiatrist/PhD,etc, please check my ass.)
There is a lot to unpack here, all of these answers are part of the answer.
1) Ultimately, we don’t FULLY understand how SSRI’s cause their effect. At this point, we certainly know that depression is FAR FAR FAR more complicated than *just* serotonin deficiency.
2) Yes, SSRIs do increase serotonin in the synapse very quickly (few days), but we know this isn’t the full explanation because of the same reason you’re asking this question.
3) we Believe part of the answer has to do with (as someone else posted here) has to do with receptor sensitivity, as well as impacting how the genetics in neurons is read (transcription levels) to produce the proteins that work with serotonin. This explanation partially would fit with why it takes a few weeks for the meds to work.
4) for several reasons (I can’t recall details off the top of my head), we believe that the benefits of SSRI’s are beyond just the impact on serotonin. Some of the general ideas that are likely related and being researched include neuroplasticity (brains ability to trim old connections and make new ones) and Brain-derived Neurotrophic Factor (BDNF), which has to do with inflammation of the brain.
5) *shrug emoji*
6) please check my ass.
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