Lately I’ve heard much discussion about something called SSRI withdrawal, meaning symptoms that can occur when an individual stops taking certain prescription drugs for anxiety, depression, and a wide range of related disorders. This “antidepressant discontinuation syndrome” can result in insomnia, flu-like symptoms, and increased anxiety, regardless of the efficacy of the drugs while a person was taking them. According to the Mayo Clinic, stopping these drugs abruptly can lead to withdrawal somewhat more often than tapering gradually, but for some, even a gradual plan can cause difficult withdrawal symptoms.

Based on a theory that depression for many is a chemical imbalance in the brain resulting from unnaturally low presence of the naturally produced neurotransmitter chemical known as serotonin, “serotonin uptake inhibitors” work by blocking the reabsorption of serotonin, leaving more of it present. (Cleveland Clinic). As the Cleveland Clinic also describes in its public information website, serotonin helps regulate mood, appetite, sleep, and digestion. These Selective Serotonin Reabsorption Inhibitors (SSRI) are also widely prescribed “off-label” for IBS, bulimia, libido issues, migraines, menstrual disorders, and more. SSRI prescriptions account for over nineteen billion dollars of pharmaceutical revenue per year, with rapid growth projected for the near future (Dimension Market Research).

And yet, not without controversy. A 2022 “umbrella review” of existing studies and meta-analyses found weakness in the idea that depression is caused by low serotonin levels and therefore can be scientifically treated by boosting those levels (University College of London). Professor Joanna Moncrieff, a working psychiatrist and lead author of the review wrote, “Many people take antidepressants because they have been led to believe their depression has a biochemical cause, but this new research suggests this belief is not grounded in evidence. It is always difficult to prove a negative, but I think we can safely say that after a vast amount of research conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin. Our view is that patients should not be told that depression is caused by low serotonin or by a chemical imbalance, and they should not be led to believe that antidepressants work by targeting these unproven abnormalities. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not. Thousands of people suffer from side effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science.” (The Serotonin Theory of Depression: a Systematic Umbrella Review of the Evidence, July 20, 2022, Molecular Psychiatry)

This may be a case of science offering corrections, but SSRI prescriptions continue to rise, and many who use them vehemently defend these drugs. The best use of a pharmaceutical is to experience a window of relief with the intention to wean off the medication into a new and stable state. Strong withdrawal problems from SSRI medications makes this complicated for too many. What we all can agree on is the profound need for better understanding of basic existential human experiences, particularly when an individual’s experience is of deep pain, paralyzing anxiety, or other strong experiential conditions.

It is to this 19 billion dollar annual misunderstanding that I would like to offer some thoughts on wellness, serotonin, and of course, food and digestion.

The first point is that our diets influence our mental and emotional experience. Even as reluctant an institution as The New York Times reported that “A 2022 study that examined the findings that followed nearly 11,000 Brazilian adults over a decade found a correlation between eating ultra-processed foods (UFPs) and worse cognitive function (the ability to learn, remember, reason and solve problems).” Natalia Goncalves, a researcher at the Sao Paulo Medical School in Brazil was the lead author of that study: “While we have a natural decline in these abilities with age, we saw that this decline accelerated by 28 percent in people who consume more than 20 percent of their calories from UPFs.” The Times noted that, on average, not 20 percent but 60 percent of calories are now coming from ultra-processed foods, often more than 70 percent for children and young adults. This dietary reality impacts more than cognitive abilities. Also from the NYTimes: “In one 2022 study of over 10,000 adults in the United States, the more UPFs participants ate, the more likely they were to report mild depression or feelings of anxiety.”

The second point is that 90 percent or more of the body’s serotonin is produced in our digestive tracts. Serotonin is not a specific “mood” chemical, rather, it is part of our complex systems of blood regulation, wound healing, bone repair, and the regulation of digestive motility, nutrient uptake, and bowel regulation. There is no part of health to which serotonin is not connected. As published in Food Science & Nutrition, December 2023, “…gut bacteria play a role in the prevention of mental disorders such as major depressive disorder, anxiety disorders, and trauma‐related diseases.” In general terms, this helps explain how ultra-processed foods are so detrimental to health, including aspects of health we have come to associate with serotonin levels. Stability of mood and emotions is anchored to digestion, which in turn depends upon good food and the digestive integrity that comes from it. Even without advanced discussions of food energetics, mainstream nutrition science has clear recommendations for reversing anxiety, depression, or auto-immune issues: eat plenty of green vegetables, root vegetables, berries, whole grains, beans, nuts and seeds, moderate animal foods, with butter and olive oil.

In my experience with wellness clients, one aspect of the mental health crisis—especially among young people—is an adamant sense of identity with junk foods. With no substantial intention to change, patients may feel no choice but to medicate, regardless of decades of the best research casting doubt on the SSRI hypothesis, or the causative influence of highly processed food on depression and anxiety. This is a self-sabotage conundrum. We are face to face with a hard truth in modern times: if an individual is suffering with depression or anxiety and has not significantly replaced highly processed foods with real cooking, they have not yet seriously acted to change their condition.

This brings us back to the question of how to use SSRI drugs responsibly. As mentioned, the proper intention of pharmaceuticals is to provide a window of relief, as a way to reset back into health. Therefore, the intention when beginning should include intention of an exit strategy. With SSRI medications, known side effects include insomnia, nausea, headaches, and sexual dysfunction (health.harvard.edu). Then, there are the potential withdrawal symptoms, also insomnia, dizziness, anxiety, full body aching, electric shock sensations in hands and feet (Cleveland Clinic website). Success through withdrawal is always an endurance test as the body recalibrates and clears toxicity. Tapering dosage before elimination can help when finally stopping. With antidepressants, walking exercise, breathing and meditation, along with real food practice can make a huge difference. As has been explored for generations, sustained success is nearly impossible without a sustained shift of mindset. In order to stop leaning on an old crutch, a new mindset is essential. One of the most tangible ways to support a new mindset is to commit to changes in diet. Several times daily we consciously prepare foods that can truly support inner health. The ritual aspect of preparing food integrates with the material of the foods for possibilities for real change. We don’t focus on symptoms, we focus on where we can be, results of which can begin growing right away.

Rinse and trim the broccoli. Include the stems, cutting off their tough peels then cutting the stems to match cooking time with the florets. Steam like the carrots, avoiding overcooking. Substitutions here include cauliflower, string beans, kale, bok choy, collard, etc.