THE CHEMICAL IMBALANCE MYTH

Haven’t we all been told for decades that mental disorders are biological

problems, caused by imbalances in certain critical chemicals in the brain? Our

doctors, the media, health classes in schools, even our next-door neighbor –

everyone has been giving the same message. Everyone just knows this is what

science has shown.

But has it really been proven by science?

Irving Kirsch, the psychologist and researcher who I mentioned in my first blog post,

wrote in his book The Emperor’s New Drugs that the chemical imbalance

theory “is about as close as a theory gets in science to being disproven by the

evidence”.

When I first read that statement contradicting my belief about the cause of

depression about eight years ago, I was shocked. Then confused, upset, even

downright angry. After I had carefully examined the amount of evidence behind

the claim and how long it had been known, I also had the distinct feeling of being

betrayed.

If this theory never had solid grounds proving it, and actually had – for decades – a

growing amount of evidence against it, why was it that I’d never been told?

Through my years of training in medical school and work as a family doctor, then

all through my years as a full-time psychiatric patient, I heard not even a whisper

that this theory was being shown to be false. Now, having had it confirmed by

many leading psychiatrists and psychologists, I’ve accepted the truth.

The issue as to why and how the theory became so widely publicized is a separate

one. I’m sure no one would be surprised to hear that the financial interests of the

pharmaceutical industry had a fair bit to do with it. However, there was also

another major factor – the influence of the medical associations and organized

psychiatry.

If you’re having trouble accepting the possibility that your doctor is misinforming

you, I get that. The psychiatrist I had for over three years – whom I trusted enough

to agree to receiving shock treatments from him – was compassionate, caring and seemed

completely professional. What I later came to understand was that he had been

misinformed as well. As investigative journalist Robert Whitaker puts it in his book

Psychiatry Under the Influence, for the most part it’s not a case of individual

doctors being “bad apples”, but of their associations being “bad barrels”. But

more on that at a later date.

The chemical imbalance theory did, in fact, start out as a reasonable and valid

hypothesis. However, in many cases it was publicized as a proven fact. It also

continued to be promoted long after the evidence became stacked against it.

For the sake of clarity, I’ll compare the origin of psychoactive drugs with that of

antibiotics. There’s no question about the efficacy of antibiotics – they completely

revolutionized medicine in the 20 th century.

In the development of antibiotics, the first step was the evolution of the germ

theory in the mid-1800’s. This stated that certain tiny organisms not visible to the

human eye could invade the body, and their growth and replication would cause

illness.

Alexander Fleming discovered the first antibiotic, penicillin, in 1928. He developed

this from a mold that was shown to prevent bacterial growth in culture dishes.

So this was the progression: a theory proposed that certain diseases are caused

by infectious organisms; specific organisms causing specific diseases were

identified; drugs that killed those specific organisms were developed. Not

surprisingly, the drugs worked very well – virtually wiping out some diseases like

tuberculosis and greatly reducing the risk of death from infections like

pneumonia.

The history of drug development for mental illnesses was quite different. There

was no specific theory of how mental disorders were caused when drug

treatment was introduced. The first antidepressant, isoniazid, was originally in use

as a treatment for tuberculosis. (An interesting aside: isoniazid was first produced

in 1951 from leftover German rocket fuel).

Doctors noticed that isoniazid seemed to cause a better mood in a significant

percentage of those taking it. This led to the first clinical trial in 1957 to test its

usefulness in depression.

Then, in the 1960’s, researchers discovered how the first antidepressants acted

on the brain: they increased brain levels of a class of compounds called

monoamines. Monoamines include serotonin and norepinephrine, two of the

neurotransmitters or brain hormones often referred to these days. In fact, the

chemical imbalance theory was first referred to as the monoamine hypothesis of

depression. It states that the lower levels of certain neurotransmitters is

responsible for depression.

Now the deficiency of serotonin and other neurotransmitters was certainly a

reasonable possibility. And if later research would have confirmed the hypothesis,

there would be no issue to discuss.

However, thousands of studies examining the theory have never given consistent

evidence to back it up.

What types of studies?

Good question. I think even the most scientifically challenged of us would realize

sticking needles into people’s brains, trying to get samples so that serotonin levels

could be measured, would not work. (Well, technically it could work, but it would

cause some nasty complications).

The solution some savvy researchers came up with was to measure metabolites

(break down products) of the neurotransmitters. These metabolites can be found

in the fluid that surrounds the brain and also the spinal cord. They used a spinal

tap, which, although uncomfortable – it’s similar to the needle being inserted for

spinal anesthesia or an epidural – can be done without risking brain function (I still

don’t know that I’d volunteer to have a long needle stuck in my spine, but thank

goodness some people did).

To prove the chemical imbalance theory, low levels of metabolites (meaning low

levels of neurotransmitters) would be found in the groups of patients with

depression, and higher levels of metabolites (or what could be classified as a

“normal” level) would be found in those with no depression. However, no

consistent correlation was found. Some people with the worst depression

symptoms had the highest levels of metabolites.

There were some other types of studies as well. Since certain medications are

known to lower neurotransmitters levels, researchers designed studies to see if

patients on those medications had more depression. Again, no such finding

surfaced. There’s even been an antidepressant – licensed for use in France – that

decreases serotonin levels.

Daniel Carlat, a respected psychiatrist in the US, wrote in his 2007 book Unhinged:

The Problem with Psychiatry “there is no direct evidence that a serotonin or

norepinephrine deficiency is involved” in the cause of depression. (It’s also

interesting to note that he has a blog, The Carlat Psychiatry Report, with the sub-

title “Keeping Psychiatry Honest”.)

When looking at the references of the research, it is disturbing to see that there

are studies going back decades. This is not a startling new finding that was just

discovered.

I feel it’s crucial everyone, particularly depression sufferers, understands that the

chemical imbalance explanation of depression isn’t valid. There are two reasons

this is vital.

First, it frees individuals to look at what factors are known cause depression, and

empowers them to focus on taking positive steps.

Many psychologists warn that people taking medication for depression can fall

prey to a victim mentality. This means that they sit back passively, expecting the

drugs to “fix” the problem. Many times doctors will reinforce this by the advice

they give. I know I was told many times that I’d have to just be patient and “wait

for the medication to work”.

The second reason it’s important to understand the reality behind chemical

imbalance theory, is that it can motivate the medical system and society to search

for better options that will help more people.

Now the issue of antidepressant efficacy is also a very sensitive topic. More and

more is being written about the fact that in mild to moderate depression they are

not significantly better than placebo. However, many physicians argue

passionately in favor for them, and many patients swear by them.

Instead of quoting a bunch of statistics on antidepressant efficacy from the

medical literature, I say let’s just consider the big picture. Anyone can look around

these days and notice how widespread depression is. University health clinics say

it is one of the top health concerns of students. In the working population, it’s a

top cause of disability and also a significant drain in productivity for those who

continue to work while affected (in Alberta, every sixth employee is depressed).

Media stories talk about the epidemic rise in depression. Really, who doesn’t

know at least one person – and for most people it’s several – who are struggling

with it? And keep in mind, there are many people around you who aren’t

revealing their condition because stigma is still very real and very much feared.

It’s been close to three decades since the psychopharmacological revolution

began, and the new antidepressant medications have generated billions of dollars

in revenue. But are we better off at the end of it? In some cases certain

individuals might be, but as a whole, there’s definitely something missing!

For those who might be on medication currently, please DO NOT consider this as

advice to just chuck your prescription bottle in the garbage! It can be dangerous

to suddenly stop antidepressant medication – never change your dosage or stop

without discussing your plans with the prescribing doctor.

If you, or someone you know, wants to try to stop medication, it’s best to prepare

fully and then proceed very slowly (and always under your doctor’s supervision).

First, and absolutely critical, is to make sure as many contributing factors as

possible are addressed. Stay tuned for my next post which will give an overview of

all the elements that can cause depression. For long term success you need to

have a strong foundation.

Also, I’d highly recommend checking out books from Dr. Peter Breggin, who as a

psychiatrist writes a great deal about psychiatric drugs and the best ways to

“withdraw”. Although doctors will advise patients to “taper” or gradually cut

down the dose of their medication, they themselves often reduce the dose too

quickly. This can lead to symptoms which can be interpreted as the depression

returning, when in actual fact it’s a type of withdrawal reaction. The longer you’ve

been on medication, the more important it is to go very slowly and give your brain

a chance to adapt.

There are those of you who’ve had great results on medication and want to

continue them. I fully understand that – my mom, who had a severe depression

develop after heart surgery, continued her medication for the rest of her life. I

would still encourage you to become informed about general strategies for

mental wellness. They can help improve functioning and give better resiliency –

the ability to ‘bounce back’ when hit with stress.

While some may see the failure of the chemical imbalance theory as a setback, I

think it can be seen positively. We are not at the mercy of random shifts in

neurotransmitter levels. The great majority of factors contributing to depression

can be influenced. I’ll go into specifics about those factors next time.

Yes, it may take time and effort, but it’s possible to manage and even recover

from depression. Through God’s grace, I’m living proof of it.

Blessings!

 

For further information:

Read about Irving Kirsch’s interview on 60 Minutes here http://www.cbsnews.com/news/treating-depression-is-there-a-placebo-effect

 

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