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
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
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
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
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
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
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.
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