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

 

SPIRITUAL DEPRESSION VERSUS BIOLOGICAL DISEASE

Have you ever heard a Christian say, “If you’re strong in your faith, you shouldn’t

suffer from depression”?

Although it’s a misconception that is becoming less prevalent, I have heard that

sentiment numerous times. Let’s clarify: depression certainly can be of a spiritual

nature. In this case the feelings of hopelessness and sadness will be helped by

primarily focusing on spiritual disciplines (For an awesome resource on spiritual

depression, see the classic book “Spiritual Depression” by Martin Lloyd Jones. He

was actually a physician before he trained as a pastor).

However, depression can also be caused by other factors.

In these cases, depression will actually produce biological effects in the body, and

it is what can be called a physical depression. Medical professionals would call it

major depressive disorder or clinical depression. (For simplicity, from this point on

when I mention depression, I am referring to physical depression).

This type of depression commonly gives symptoms such as sleep disturbance,

extreme fatigue and poor concentration. These can make it very difficult, if not

impossible, to successfully practice spiritual disciplines.

So if someone with a physically based depression is given the advice –however

well-intentioned – to spend more time in prayer, and in the study and meditation

of the Word, it can backfire. When one is trying, but literally can’t focus or make

sense of the Bible, damaging conclusions can be made. Things like, “I’m so

hopeless, even God can’t help me” or “This faith stuff just doesn’t work”.

Feelings of frustration, shame and guilt can easily take over. At worst, these

feelings can cause individuals to withdraw from the fellowship of other believers

and give up entirely on a pursuing a relationship with Christ.

I’ve been in such a severe depression that I stopped reading anything. When I’d

try to read a paragraph I literally could not remember a thing. Although I’d always

been a bookworm and very fast reader, I couldn’t make sense of the simplest

newspaper articles. That’s discouraging enough, but imagine feeling spiritually

inept in addition. And then, if one is getting advice from someone who doesn’t

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believe in physical depression, to possibly be judged and condemned as if not

putting forth enough effort. Not a good situation, for sure.

Why can there be such confusion as to whether depression is physical or spiritual

in origin? One big reason is that both types of depression can produce the same

end result: intense feelings of hopelessness and worthlessness. Also, since there

are no biological tests for any of the mental disorders, the diagnosis of a physical

depression is not cut and dried.

How do we know that depression even exists?

Although there are no lab tests that can be used for diagnosis, the evidence of

depression on the brain can be seen. A slide I often show in my presentations is

one of special CT scans (called enhanced CT scans) of two individuals. One

individual has clinical depression, while the other does not – and there is a huge

difference in the two images.

In these enhanced CT scans, a dye is given intravenously which then circulates

through the body and the brain. The dye is taken up by neurons that are active,

and shows up as a bright yellow color on the CT scans. Thus the normally

functioning brain, with lots of activity, is mostly yellow. The image of the

depressed person’s brain, in contrast, is much darker.

There are numerous areas in the brain where activity can be decreased by

depression. One very important area is called the left prefrontal cortex. It’s the

area of your brain behind your left forehead. You can think of it as the CEO of

your body. It is responsible for motivation, initiating activities, planning things

out. Really, everything you do in life starts with the neurons there. They have to

start firing and give the rest of the brain (and thus your body) instructions.

I saw my mom in a state of severe physical depression. She was in hospital after

major heart surgery and had slowed down so much she was practically catatonic.

She’d just lie in bed and hardly move, she wouldn’t eat and she could barely get a

short sentence out. When speaking to her, all you’d get would be a blank stare. It

wasn’t hard to accept that for her, there was something physically wrong.

However, in less severe cases depression can be much more subtle. It can show

up as having a hard time making decisions and feeling constantly overwhelmed;

becoming messy and disorganized; withdrawing from social activities and even

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close relationships; even having difficulty losing weight. The lack of activity in the

pre-frontal cortex could mean just less interest and “get up and go”.

Now, I’m not saying that everyone who’s desk is cluttered or who doesn’t feel like

going out to a hockey game is depressed! Everyone can have down periods and

certain weaknesses (I’ll admit, my struggle is keeping my desktop visible). One has

to be consider how intense and long-lasting the issues are. Are they interfering

with day-to- day life, and doing so for a lengthy period of time? In the overall

picture, even though my desk may be cluttered, it doesn’t keep me from doing

what I need and want to do.

Many psychologists now think of mental functioning in terms of a continuum or

range. At one end of the range you have optimal mental wellness and functioning,

and at the other end you have actual disease. The area in between has a

progressive amount of ‘symptoms’ and distress.

The key question is, what is most helpful in helping to overcome distress and

move toward wellness?

There is no scientific evidence that mental disorders are due to chemical

imbalances (stay tuned for a discussion on this in my next post). The best research

shows that the most effective first step for depression is to focus on lifestyle

change. The specifics of what’s most important lifestyle-wise, and tips on how to

get implement strategies will also be looked at in detail in the future. I do think

most of us already know that the basics are proper rest, good nutrition, and

physical activity.

But how can we know whether someone’s depression is mainly physical and that

the focus should be on lifestyle?

Well, here comes the good news/bad news response (sorry it can’t be all good

news, but that’s life). Bad news first: there’s no easy way to tell for sure.

Now the good news: most of the time it really isn’t necessary to know for sure. I

think the best approach – likely because most people have some combination of

both factors – is to apply fairly simple principles that support both the spiritual

and the physical life. Please note: I said simple, not necessarily easy. I recognize

that they can be hard to put into practice. That’s why I think it’s so crucial to have

social support – and why I think the Bible stresses the importance of fellowship.

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The beauty with these principles is that they are foundational for good health.

There are no risks to worry about.

If we start living in a healthier fashion and lose some weight as a “side effect”,

how many of us are going to complain? If our blood pressure normalizes and our

achy joints hurt less, is that going to be an issue? And guess what, even if

someone’s depression is more spiritual in nature, living a healthier lifestyle will

give more energy and improve concentration, which in turn will make

incorporating the principles for a healthy spiritual life that much easier.

So what are those principles? They probably won’t come as a surprise. Reading

the Word regularly (daily is definitely the best), meditating on scripture, spending

time in prayer, fellowship with other believers.

Now, in certain situations – as in my mom’s case of severe depression – it may not

be possible to apply some or any of these principles. She really could not do the

spiritual practices, nor the lifestyle changes. In her case, medication was the most

feasible choice.

For someone whose concentration is so poor they can’t focus enough to read or

pray, an emphasis on the more physical things (exercise, for example) would

make sense. I’d suggest, though, that whatever form of spiritual activity can still

be done be incorporated regularly. Things like repeating short Bible verses,

attending worship services or listening to worship music require less focus and

can still have a very positive effect. Then, as concentration and focus improve,

start doing more. Go deeper in the Word, meditate on it and have more prayer

time.

So, in conclusion, don’t be exclusive, focusing on either just the spiritual or the

physical. Life works best when you incorporate the fundamental principles for

health in both areas.

My challenge to you: Identify one thing you will work on in both areas. Perhaps

it’s committing to walk for half an hour three times a week and having a daily

devotional time. Maybe it’s making the time for breakfast every day and joining a

Bible study. Or cutting out soft drinks in favor of water and memorizing some

scripture. Be specific and get started!

Blessings and good health!

Welcome

Welcome to Renewing Your Mind, a blog dedicated to the mental wellness of Christians.

I am a believer who trained as a medical doctor, someone who has experienced severe depression – to the point of being hospitalized seven times and receiving 99 shock treatments. Thankfully, I’ve also experienced recovery. Recovery that came about from the use of basic lifestyle strategies and the strengthening of my faith. I currently do not practice medicine, but specialize in mental wellness education and peer support.

This blog will be more than dry info on mental disorders and checklists of symptoms and suggested therapies. I want to dispel misinformation and myths about mental illness. I feel called to share powerful principles that can help people on a recovery journey.

To give examples of facts that are not widely known:

  • The chemical imbalance theory has had mounting evidence against it for decades. It is officially considered “dead”
  • People with mild to moderate depression (the majority of sufferers) respond better and have more favorable long term results with lifestyle therapy
  • Long term use of psychotropic medication (antidepressants and antipsychotics) can lead to a huge reduction in life expectancy
  • The majority of depression is not caused purely by genetics

Please note, I am not “anti- medication”. I am “pro” effective treatment. I am also “pro” a thoughtful use of pharmaceuticals, always weighing the benefits versus the potential risks.

Evidence shows that lifestyle approaches are more effective as the first approach for mild to moderate depression. So much so that in other parts of the world (such as the UK) guidelines were changed many years ago to make lifestyle change the first proposed “treatment”. In more severe cases of depression, or if lifestyle approaches are not possible or are not enough, certainly there times where medication is appropriate and necessary.

Warning: If you are on medication, DO NOT change your dose or stop it without consulting your prescribing physician. It can be dangerous to suddenly change or stop these types of medications.

I encourage people to take control and use holistic methods (those which are aligned with Biblical truths) to help them live their lives full of passion and energy. It is about a spirit-filled, intentional life founded on a healthy lifestyle. The way, I believe, God designed us to live. The way that if applied faithfully will help prevent, manage and – at times – even resolve illnesses.

I’ve always had an interest in health and helping people – definitely a good thing for someone who worked as a family doctor for eight years! But for the purpose of my current work, my own personal experience is even more important that my medical training. For years I was completely disabled; a hopeless shell of a person wearing the official label of severe, chronic, treatment-resistant depression. Even with trying every drug available and numerous drug “cocktails”, as well as seven courses of shock treatments, I remained severely depressed. I had to give up my medical practice, and at times couldn’t even take care of my own pre-school age son.

The fact is, I didn’t recover because of medications and treatments. (I did have some psychotherapy that was helpful.  I’ll write at a later date on which forms of psychotherapy are proven effective and are consistent with a Christian perspective). I got better mainly because I got engaged, took responsibility, and started asking myself, “What can I do personally to get myself better?” I then was blessed to be guided and supported in my journey.

Mental wellness depends on a healthy lifestyle and the intentional application of basic principles.

You may be thinking, “That’s it? A healthy lifestyle resolved a chronic, severe depression? One that wasn’t helped by the most intense medical treatments?”

That’s exactly what I’m saying.

Currently I’ve been relapse-free for over a decade, and off antidepressants for nine years. I’m passionate, productive and most importantly have a personal relationship with Christ. I work part time facilitating peer support groups and giving presentations on depression education. Not bad for someone for whom returning to work was not even discussed any more. Who was given grave counselling that her risk of suicide was ten to fifteen per cent. Who was told that she’d need to be on medications the rest of her life, and that even if she had stable periods the likelihood of relapse was practically 100%.

What if my experience was just a fluke? Or a miracle from God in my own personal situation?

There are those who know me personally now, who’ve witnessed all or part of my journey to recovery, who say my healing was a miracle. However, not an instantaneous miracle: one day I was suicidal and the next I was cheerful and completely functional. It was a gradual progression that resulted from a steady provision of key relationships and knowledge. I was provided the right tools and supports by the right people at the right times. Then, when I applied the principles consistently, I slowly came out of my severe depression.

Please note that as I got better, I started doing research into the strategies I was using. I wanted to be certain I was doing everything possible to maintain my mental health and prevent the dreaded relapse (I call it “the big R”). I was also curious as to how common it was for a depression sufferer to be so unresponsive to the widely promoted conventional treatments.

The very first book I read – The Emperor’s New Drugs by Irving Kirsch – was suggested to me by a neuropsychologist. My new family doctor had referred me to this specialist after I requested some memory testing. I had discovered years earlier that I suffered from amnesia due to the shock treatments, however none of my previous doctors had done any testing. ***

It was that book that first suggested to me the possibility that I wasn’t an exceptional case in my failure to respond to antidepressants. The author showed, after reviewing the study data submitted to the FDA (the Food and Drug Administration in the U.S., responsible for the approval and regulation of pharmaceuticals) on four major antidepressants, that the effectiveness of antidepressants in mild to moderate depression was not really much better than a sugar pill or placebo. Even in severe depression the difference between the medications and the placebo was not huge (although it was significant).

Thus began my quest for more information.

I had many questions. What has been show to work better than medications? Why isn’t that information being made more widely known? Why are the side effects of drugs not being discussed in greater detail? Is it possible to come off of medications, even if one has been on them a long time? And so on.

A key point I’d like to make is that I couldn’t have made this journey without Jesus. At my deepest point, I was desperate. After I realized my memory was getting progressively worse with the shock treatments, I knew I had to stop them. I also knew the medical options had been exhausted.

It was then that I turned to Jesus. I’m certainly not proud of how it came about; it was more of a “What have I got to lose” philosophy than anything else.

Although I had grown up in a Christian home, the experience was one of saying rote prayers and attending church services. In later years, even attending services became secondary to working on call or other “more important” activities. I hadn’t really known my saviour or been familiar with the Word. My many years of scientific training influenced me, raising doubts about God as creator and sustainer of the universe. As I became more and more ill, I withdrew and stopped even attending worship services.

Then at the time of my crisis God, in His grace, provided. Even though my attitude was not right, God honored His promise – as I drew nearer to Him, He drew nearer to me. Over time, as I started reading the Word, attending Bible studies and learning about Him, I was greatly strengthened and discovered that He is my rock. I have realized the glorious meaning of Jesus’ finished work on the cross.

I’ve learned that there are times He provides solutions and the strength to apply them, there are times I’ve had to wait for solutions, and there are times when it seems there is no solution when I can still lean on Him, feel His presence, and know that He does have a plan.

Faith has been proven in research studies to positively affect physical and mental health.

I’m excited to support believers in their journey to mental wellness. Although I do work in secular circles as well, with you I can fully share about how fundamental faith is to a balanced, purposeful life. Note that although I may talk in principal about spiritual disciplines and faith, that will not be my focus. I would encourage everyone to spend time in the Word and find a Bible-believing church for fellowship and spiritual support.

Will the lifestyle principles I advocate about bring about cures for everyone?

No. People benefit to varying degrees by applying these concepts – although most can expect to feel much better. And the benefits will be physical as well mental. That’s because we’re talking about basic health principles that will have “side effects” such as weight loss and improved blood sugar control. It’s a common sense approach to depression. God’s design is awesome – given the basics the body (including the brain) will maintain itself.

Please realize, though, that even with following the best lifestyle, bad things can happen. God is sovereign, and we do not understand His ways. What we are told is to take responsibility for what we can change.

To be absolutely transparent, even though I’ve been encouraged for years to start a blog, I never had the nerve to do it. I still am somewhat (OK, make that moderately or significantly) anxious! I’m not a techie, I’m not blog-savvy, I’m not even on Facebook regularly. Change scares me, as my husband who sees me get nervous about trying out a new app on my phone will tell you. It took me months before I stopped carrying printed-out directions and trusted Google Maps.

But it’s time. Time for word to get out that there is an alternative to a medication-only approach. Time for people to know that organized psychiatry has – for decades – been presenting a less-than-complete view of depression and mental illness. Time for believers to know that the principles of healthy living are presented in the Bible and it’s crucial to follow them. Time for an integration of spiritual life and sound physical health practices.

In future posts, look for information on the causes of depression, the myth of chemical imbalance, specifics about how the pharmaceutical industry influenced psychiatry guidelines and treatments, details on which lifestyle strategies work and tips on how to implement them, which supplements may be helpful, the influence of social media, and more.

To God be the glory throughout this process, as He made it all possible!

 

**The lack of monitoring for severe side effects from treatments is also a concerning issue, but I won’t get into that here. I have what is called retrograde amnesia, which is a memory loss for events that occurred before my treatments. Mine is quite severe, so that I have no recollection of the majority of my life before the shock treatments.