About 2500 years ago Gautama Buddha outlined the four noble truths of Buddhism. The first noble truth is that life is suffering because all things fade and fall apart (Dukkha). The second noble truth is that the cause of suffering is our thirst for pleasure and happiness that can never be fully quenched (tanha). Buddhism has a prescription for this suffering which is to follow an eight fold path that includes mindfulness as key.
In the U.S., happiness is such an important concept that it is written into the declaration of independence.
“We hold these truths to be sacred & undeniable; that all men are created equal & independent, that from that equal creation they derive rights inherent & inalienable, among which are the preservation of life, & liberty, & the pursuit of happiness; …”
In the modern world we continue to follow Jefferson’s admonition to pursue happiness but many of us have fallen short. We are increasingly exhausted, run down, stressed out and depressed. And because we have fallen short, we are increasingly trying to become happy by taking antidepressants that have a profound effect not only on our physical body, but on the ecology around us.
Serotonin and Happiness
In our pursuit of happiness in the last 30 years we have become extraordinarily enamored with drugs that manipulate serotonin, a neurotransmitter that is found throughout the body and primarily in our enteric nervous system in the digestive tract. In the central nervous system of humans it is intimately entwined with the regulation of mood, cognition, sleep patterns and appetite.
In just 13 years (between 1999 and 2012) our use of serotonergic antidepressants such as zoloft, prozac and
celexa has nearly doubled with now 13 percent of us taking one of these drugs. 25 percent of women in their 40’s and 50’s now take antidepressants. The most prevalent antidepressants used today are serotonin reuptake inhibitors that flood the synaptic cleft between neurons with serotonin that would normally have been reabsorbed and broken down. This increase in serotonin has been theorized to improve mood and wellbeing in some people but there is increasing evidence that many of these serotonergic antidepressants only act modestly better than placebo and only in the case of severe depression.
In 2008, a metaanalysis of all the clinical trials of antidepressants concerning the effectiveness of antidepressants showed key findings:
“Drug–placebo differences increased as a function of initial severity, rising from virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category.”
In layman’s terms, that means antidepressants are no better than a sugar pill unless one is very severely depressed. In essence, we are prescribing a vast amount of ineffective drugs with many side effects to a large section of society.
So what made us decide serotoninergic drugs were the answer to our desire for happiness? Part of the reason is that pharmaceutical companies have sold us on the idea that those of us who are depressed have a lack of serotonin and that these drugs correct that imbalance. But what we are finding out is that is very much a myth.
” … numerous studies of norepinephrine and serotonin metabolites in plasma, urine, and cerebrospinal fluid as well as postmortem studies of the brains of patients with depression, have yet to identify the purported deficiency reliably.”
In essence, we have been sold an idea that really is not rooted in fact. There is no “correct” level of serotonin. We are not depressed because we have too little and we certainly don’t need prozac to correct a serotonin imbalance. That would be like saying we are anxious and need Johnny Walker to correct an alcohol deficiency.
Because the serotonin deficiency story has been proven to be a poor model, new models for why antidepressants can be effective for some have developed. One main idea is that serotonergic antidepressants act to change neural architecture and promote nerve growth and plasticity as a way of lessening depression. A further hypothesis is that serotonergic antidepressants reduce pro-inflammatory cytokines that are associated with depression. But since these medications are not outperforming sugar pills, perhaps the simplest explanation is that the placebo effect is enormously powerful. Just the act of going to a doctor, receiving a prescription for a drug and being told it will help reduce depression has been shown to lead to better outcomes. The power of suggestion, backed by highly esteemed medical professionals is an enormously powerful tool and there is some evidence that the placebo effect is rising.
Serotonin in Plants and the Human Brain
So what is it about this fascinating chemical that makes us deeply enamored of it in our pursuit of happiness? One of the most interesting things about serotonin is that it is found in plants, animals,and fungi as well as humans. In plants, it is involved in protection, reproduction, growth and the development of the root system. Essentially serotonin helps the roots to grow. As Stephen Buhner likes to put it, the roots of a plant are like the brain, a neuronal network branching out with root tips to extend into the soil and gather more information about the environment. Serotonin increases this root system development as well as helping to repair damaged plant cells and protect from outside incursion
In the human brain, serotonin is also deeply associated with our neurology and responsible for modulating our mood, how we think and perceive, how we sleep, dream and experience time. In essence it is a neurological homeostatic modulator and a key regulator of our very sense of ourselves and the world around us. Modifiying the function of this chemical via drug therapy can lead to large changes in our mood and cognition as well as causing wide side effects such as anxiety, dizziness, headaches, insomnia, tremors and restlessness. Not surprisingly they also have a strong effect on the stomach and can lead to nausea, diarrhea, constipation and appetite changes. They also often have a profound diminishing effect on the libido, a side effect that commonly makes people stop them.
Some of the worst effects happen when we stop taking these medications. The body has compensated for this flooding of serotonin and when there the drug is taken away, serotonin changes signal vast deeply uncomfortable changes in mood and perception. Many people become overwhelmed with anxiety, confusion, insomnia and sometimes hostile and suicidal thoughts. This is especially the case when a drug is stopped suddenly and the nervous system goes into profound shock.
Antidepressants and the Environment
We are finding that side effects are not confined to humans who take them but to marine life as well. When we excrete serotonergic drugs, or throw them away, they eventually end up in waste water and in our rivers and oceans. 250 million prescriptions are filled every year for antidepressants and they end up in our waterways and cause a host of unwanted effects such as increased behavioral problems, libido loss, aggression and anxiety amongst fish and other aquatic life.
“…the team found that tiny amounts of antidepressants in seawater can cause both behavioral and transcriptional changes in amphipods. Shrimp become more active, freshwater snails can lose their ability to anchor themselves to a stable object—zebra mussels have been shown to spontaneously spawn. The variety of impact seems limitless.”
We are prescribing tens of millions of people antidepressants with limited effectiveness, and troubling side effects- and in the process we are conducting a vast experiment to see what happens when we excrete serotonergic antidepressants into our waterways. And what we are finding is deeply troubling. Even at very low doses, we are modifying reproductive patterns, behavior and the biological patterns of a wide spectrum of aquatic wildlife.
The Pursuit of Happiness
We are a nation built on the foundation of pursuing happiness. But many of us are unhappy, restless and searching. And from that essential unhappiness, that “dukkha” as Buddhists call it, we are starting to modulate our own biochemistry, hoping to chemically manufacture happiness if we cannot discover it externally.
But in reducing happiness to a molecule, we have lost track of the ecology of our hearts, that we cannot reduce happiness to single molecules. The desire for a simple solution to pain and unhappiness, a pill that will make it all better, is a form of wishful thinking that has led many of us down a challenging road that often damages our own bodies as well as the environment around us.
Perhaps Buddhists are right and that we naturally are born with a degree of unhappiness due to the transitory quality of life and the potential for age, disease and infirmity. That is not something that can be erased by a chemical modulator. But though pain is a natural part of human existence, happiness is also a part of the bittersweet tapestry of life. And that happiness resides within the complex interplay of many factors that can never be reduced – a breath of fresh air in the forest, a nourishing meal, a cup of mint tea, a smile from a friend, ecstatic copulation with a lover, light drifting through a window, laughter from a child: ephemeral notes of a long life song filled with both sad and joyful refrains. And yes, serotonin is a part of that tapestry of joy, but it cannot be teased out as the “happiness molecule” to be simply manipulated for easy gain.
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