ssri review & case study: an evidence-driven approach

The evidence-driven practice that we promote at House Call Media emphasizes integration of the best available evidence as well as updating our understanding & recommendations when new and evolving evidence suggests a different framework is needed. It is important that we are led by the data and do not try to either fit new data into a prior theory if it does not fit or ‘cherry pick’ the data that supports a preconceived idea.  By allowing the evidence to lead our understanding, we are better able to progress closer to what is the “truth”.

For decades, it was widely believed that alterations in brain biochemistry, particularly related to serotonin, was the cause of depression.  This theory led to the widespread clinical utilization of anti-depressants that increase the availability of serotonin in the brain.  The extent to which this treatment would be effective is, in part, related to how accurately the chemical model of depression truly reflected the cause of depression.  If new evidence were to suggest a different understanding, then our treatment recommendations should evolve as well.

Recently, Moncrieff et al. reported a systematic umbrella review of the evidence underlying the theory regarding the role of serotonin biochemistry in the development of depression.  This study design, in theory, would provide a high level of evidence as it is based upon a systematic review of existing meta-analyses.  The drawback to the study design is that the quality of the umbrella review is dependent upon the quality of the studies included in meta-analyses that are used for data analysis. The authors conducted their literature search up to December 2020 and investigated six lines of evidence and theories contributing to the overall framework regarding the role of serotonin in depression.

While limitations exist in the study, as is the case with all studies, there was no consistent and definitive association between the six areas of research investigated and the theory of decreased serotonin and causation of depression.  While the results of the study do not provide conclusive evidence of an absence of a link between serotonin and depression, there is sufficient uncertainty cast on this theory that further study is warranted to better understand the causal pathway of depression and, on the basis of the findings, update treatment recommendations.

This scenario reflects the importance of the evidence-driven practice. At the outset, definitive evidence should be sought to support a theory prior to its widespread adoption. Secondarily, treatment recommendations should be determined on the basis of an understanding of the causes of the condition in question so that the treatment is specifically directed towards the underlying cause. Without accurately determining the causal pathway, it becomes difficult to implement effective treatment. Finally, when new & evolving evidence creates uncertainty or doubt regarding either the understanding of the causal pathway or the effectiveness of treatment, our understanding should be updated and appropriate actions taken to update the causal theory and the recommended treatment.

A component of the content development process is research and integration of the best available data using the evidence driven model. This allows the content promoted on social media platforms to be as accurate and as current as possible while allowing the target audience to have confidence that recommendations are based on evidence and not a preconceived narrative that may no longer be supported by data. If you would like to hear more about what we offer, send us an inquiry to set up a discovery call.

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