Depression: The myth of "Chemical Imbalance"

by Beth McHugh | More from this Blogger

28 Oct 2006 06:45 PM

Just about everyone knows that depression is caused by a chemical imbalance in the brain. Right? Well, that's what popular mythology has led the man in the street to believe but there has never been any scientific proof for this "truism."

Finally researchers are speaking out about this "lie" that is spun to people in doctors' consulting rooms around the world. Johnathan Leo of Lake Erie College of Osteopathic Medicine in Florida and Jeffrey Lacasse at Florida State University concur that advertising that claims that depression is caused by a chemical imbalance is misleading and should be banned. Such advertisements send out the wrong message to patients, implying that they are passive victims of a brain gone awry, thus potentially leading to further depression. Such advertisements are not only untrue, but profoundly unethical.

While popular antidepressants, such the SSRI family of drugs including Prozac, are believed to block the uptake of the neurotransmitter serotonin, they have been shown in trials to be only marginally better than a placebo in treating depression.

And, as Johnathan Leo argues, "low serotonin levels are no more the cause of depression than low aspirin levels are the cause of headaches." You can read the Leo and Lacasee article in the journal Public Library of Science Medicine, DOI: 10.1371/journal.pmed.002092.

Leo goes on to state that this myth involving a chemical imbalance "has become a mainstay of popular culture. But there's very little support for this. We really don't know what chemicals are involved." Moreover, if such a chemical imbalance exists, it has not yet been determined whether the imbalance is caused by the depression, or the depression causes the imbalance. Neither scenario has been scientifically established, but it is in the interest of multinational drug companies to propagate the myth.

More support for the chemical imbalance myth comes from the chairperson of the US Food and Drug Administration, Wayne Goodman. A "good man" indeed, he admits that the chemical imbalance story is a "useful metaphor" but claims that he would never tell his own patients that they were suffering from a chemical imbalance. "I can't get myself to say that," he stated.

The Irish Medicines Board, an equivalent body to the FDA in Ireland, has banned the drug company GlaxoSmithKline from making claims that depression is caused by a chemical imbalance. Such information is no longer permitted to be printed in patient information brochures. Leo and Lacasse want the US FDA to follow suit.

This is a great breakthrough for depression sufferers around the world. The myth of chemical imbalance effectively renders the sufferer a victim of circumstances seemingly beyond their control. Systematic deletion of this myth from popular folklore will hopefully encourage sufferers of depression to look for more effective ways of dealing with and eliminating their depression.

Related articles:

What is Depression?

Depression: Symptoms and Treatment (1)

Depression: Symptoms and Treatment (2)

What is the best treatment for depression?

Feeling bad about taking antidepressants?

When antidepressants aren't the best option (1)

When antidepressants aren't the best option (2)

When antidepressants aren't the best option (3)

Depression, antidepressants and sex

Chocolate can make your depression worse!

Contact Beth McHugh for further information or assistance regarding this issue.

Learn more about Beth McHugh

Beth McHugh began her career as a geologist and worked both in industry and as a university researcher.

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Michele Cheplic (37169) 28 Oct 2006 06:51 PM

Great blog Beth! I cringe when I hear people randomly throwing around the words "chemical imbalance" and "crazy" or "nutcase" (I'm straying a bit from your topic), but seriously when I hear people hurl these words around to describe a condition they have no clue about I tend to think the words more accurately describe them than the person to whom the words are intended for.

Beth McHugh (13186) 28 Oct 2006 06:58 PM

Hi Michele, it's even more scary when the so-called experts use the term when there is no scientific basis for it whatsover. Thanks for your "quick-draw" feedback!!

Megan Bayliss (3586) 28 Oct 2006 07:14 PM

Go Beth! The power of the Medical Model has a lot to answer for. I wonder if people ever think about the taking of drugs that have been designed for one particular illness but appear to work equally well on another - without in-depth study, analysis or control. Good blog. Thanks.

Gwyllum (301) 28 Oct 2006 11:58 PM

So very good to read your blog, Beth. In addition to the "chemical imbalance" line, how about referring to people with an illness as he or she is a "schizophrenic", or some other like comment - these coments make me cringe. Surely the PERSON is the focus, not an illness. It is like being in the waiting room of the family doctor waiting to be called as "ingrown toenail, please come in, how are you today?" I like your blogs. Sue Bayliss.

Tracy Woods (772) 06 Nov 2006 04:07 AM

Very interesting blog, Beth. Definately something for people to think about. While I think these drugs DO have their place, they are treatment of symptoms, not a cure. I think the most important step in treatment is finding a doctor who will treat the illness, and treat the PATIENT, in a responsible manner. Therapy needs to go along WITH drugs. I know my doctor will not write a scrip for anti depressants for more than three months, then you have to go back and see him. He's always got suggestions for other things to help as well, non medicinal ways...getting more exercise, eating right, etc. One of my "prescribed" treatments was to start keeping a journal. It's helped really!

cal1 (75) 27 Dec 2007 02:18 PM

The 'chemical imbalance' concept is not a lie. It's a big oversimplification. Our bains are exceedingly complex organs, and they function largely via the interactions of cells and neurotransmitters. Our brain chemistry is influenced by any number of factors, including diet, physical activity and behavior, our thoughts and perceptions, genetics, and drugs (both perscribed and otherwise). In turn this brain chemistry influences our thoughts, moods, behaviors, and somatic responses (such as anxiety attacks). Therefore, excepting such purely physical maladies like tumors and such, virtually any disorder of the mind could be described as a chemical imbalance. The thing is- that's the beginning, not the end of the story. The fact that one's brain chemistry is off, doesn't really say much - it merely reiterates what you already know- that's something is wrong. Then we get into the tougher questions of; why? and how to fix it?. These are harder to address. It relates to the basic question of what is free will vs. predetermined? Is substance abuse a choice or a disease or both? are you depressed because of your brain chemistry, or is your brain chemistry that way because you just got divorced, aren't eating right, and have a stressful job? Note that the brain chemistry is the same - the issue is 'chicken or egg'. Brain scans can show real differences in depressed people, alcoholics, and others compared to controls, but it doesn't tell us why. When you get to the How to fix? question, the answer is there are many ways to improve both your mood and brain chemistry (they go together, remember) therapy and concepts such as CBT, exercise, sunlight, a better environment, and for some, drugs, can all be part of the recovery process. For most people it takes a combination of some kind. We function via constant biochemical reactions, that have many influences and outcomes. The 'chemical imbalance' theory is bad only in the way it's presented, as a huge simplification that suggests depressives have a single, easily defined problem, and that Brand X pill is the only way to fix it. But then, it is an ad after all, should we expect any different?

Beth McHugh (13186) 27 Dec 2007 02:45 PM

I'm not going to argue with the psychiatric head of the FDA, who made this claim, or more particularly with hundreds of my clients who have tried antidepressants yet find their lives remain unhappy and unfulfilled. Changing thoughts however does change feelings and my job is to help free people from the idea that they are doomed by a mythical belief in a chemical imbalance that is both permanent and beyond their control. Also telling people they have a chemical imbalance causes some people to abdicate responsibility for their own input into their condition, conveniently blaming it on something which is seemingly beyond their control, which in most cases it is not. Taking away hope for recovery is yet another damaging side effect of drug company hype and the doctors who propagate the myth. Sure, drugs have their place, and are particularly valuable in cases of major depression and suicidal ideation, but they don't actually cure anything.

cal1 (75) 27 Dec 2007 03:01 PM

Sorry to run on here, but one reason why the simplified 'chemical imbalance' concept has taken such hold in the United States is our culture and fears. Complicated explanations? No thanks! We want soundbite answers and quick solutions. It's enormously reassuring to hear that the reason your teenager cries all the time and won't come out of his room can be explained as a physical illness that requires only a pill to fix. We're very uncomfortable with emotional distress. In the past, many times that depressed kid would be told to 'snap out of it' 'grow up' 'you just want attention' or perhaps get beaten until he has a 'reason to cry'. But in a sense, the imbalance theory's had the positive effect of getting society to accept depression and other forms of mental ilness as "real" diseases, that are not the sufferer's fault. We've always been skeptical of mental and behavioral disorders, determining that the broken nose from a barroom brawl is worth treating and covering under insurance, but the underlying anti-social personality disorder is not. Moreover, we apply a strong sense of morality to what we accept as 'legitimate illness'. Physical maladies are mostly acceptable, garner sympathy and support, and are generally covered by insurance or government. Mental illness brings shame, discrimination, blame, and usually receives a lower level of coverage. We often view the mentally ill as somehow culpable in their own illness. I grew up in the early 1970's and have suffered from depression most of my life. As a child, my mood and behavioral disorders were treated strictly as disiplinary issues by my schools and teachers, and I was shunned by the other students. If labelling something as a 'chemical imbalance' is what it takes to be able to come out of the shadows, and get insurance coverage for something that is not my fault, is every bit as legitimate as a physical ilness, and has made my life exceedingly difficult, than I'll take it.

cal1 (75) 27 Dec 2007 03:22 PM

Ms.McHugh: Thank you for your post. My previous post wasn't really intended to disagree with you at all. I guess there's two ways to interpret the Chemical Imbalance thory; from a biological standpoint (which is where I was coming from), it's a "yeah, but so what?" statement that doesn't really say anything. From a lay public perception standpoint it has a 'double-edge sword' consequence. It has helped 'legitimise' depression as an illness (that it needs to be made physically-based to get that status is unfortunate), but as you quite correctly point out, it's made people feel that their moods are both permenant and beyond their control when in fact they are neither. The reality is that our moods and brain chemistry, are constantly changing, and are in fact affected by almost everything we do or think. As for the responsibility question, that's a tough one, there's a fine line between accepting responsibility for yourself and your recovery, and feeling full of self-blame and recrimination. The challenge is to get past the latter and move on to the former.

Beth McHugh (13186) 27 Dec 2007 03:30 PM

I am sorry to hear that you have experienced depression throughout much of your formative years and if you read my articles on the stigmas of mental illness, you will know that I feel very strongly against people discriminating against people with emotional problems as being "weak." I don't believe that peopke become depressed for no reason, therefore I hold that people do have a way out of depression and anxiety which is not based solely around drugs. In fact, I know that the drugs actually mask a lot of feelings that are both valid and valuable. Valid in that these feelings are appropritate given the sitautiion the sufferer finds themselves in, and valuable because addressing them forms the basis fo rthe way out of the pain.

Beth McHugh (13186) 27 Dec 2007 03:42 PM

Hi Cal, Your last two sentences are very pertinent! It is a fine line to tread, and I encourage my clients to accept the responsibility to change but without self-blaming, which obviously only causes further problems. There is power in taking responsibility for the way one is feeling because then real change can occur. This is not saying that a person is solely responsible for their anxiety or depression. We don't want to get bogged down in "it's all my fault" because that is not true and the sufferer gets enough of that from society anyway. It is both scary and exciting to grasp the idea that we have control of what we think and ultimately where our thinking takes us.

cal1 (75) 06 Jan 2008 09:20 PM

Ms. McHugh: thanks for the very interesting comments. I personally am struggling terribly with the issue of personal responsibility for myself and my own recovery, partly because I have been struggling so long, in so many different ways, and see very few results. Intellectually I agree with most of what the psychological field says, but the hard part is doing it. Often it seems like monumental tasks just to do basic things, which I never do very well or completely despite my effort, and the payoff for it is usually minimal. I've done all kinds of therapy, many different meds, hospitals, church, etc, but I remain at the end of my rope. I do find it quite interesting to discuss mental health issues as I have backgrounds both in biological sciences, and in being crazy, so I can bring a rather unique perspective. I dare say that I understand much of what the professionals discuss in these type of boards in an often very sophisticated way, but when it comes to my own malaise, I can often only share why it hasn't worked for me. I may intellectually agree that a certain treatment or thought concept holds great promise, but I just *can't* *get* *there* when it comes to me. The demon thoughts just push out the good ones. So I've been thinking of next steps, endgames. Where to go from here. I sheepishly concede that I'm kind of giving up on myself. I've tried drinking, which of course as a CNS depressant is absolutely contraindicated in persons such as myself, but boy it's good at numbing the pain. Perhaps life as an alcoholic despite it's numerous drawbacks might be a good choice for me. Beyond the slow-motion suicide that is alcholism, a more immediate resolution to my quandry might be idicated. I've researched some potential modalities, none are pleasant as you can imagine, but some seem at least reliably effective. Then there's all the baggage, the effects on the non-target family and friends, etc. that needs to be considered. Even a seemingly simple thing becomes complicated when you really get into it. So for the short term anyway, I stick around. I don't want to live, but I'm here for a little while longer, I think, and I go to my therapy, not expecting to get better (what can they POSSIBLY do to help me??), and trying to be glib enough in my answers to avoid an involuntary hospitalization, and I guess that's it. I don't see any hope for me any longer, but in the meantime, I'm glad there's some boards like this that I can contribute to while I'm wailting for the ritalin from this afternoon to be counteracted by the klonopin I just took now so I can sleep.

Beth McHugh (13186) 06 Jan 2008 09:40 PM

Cal, I do understand how you feel and the hopelessness of the situation that we can find ourselves in at times. The fact that you are still here, no matter how poorly you perceive that you perform, is a sign of immense strength. It IS hard to do simple things when you are bogged down with depression and anxiety. Have you read my series on Recovery from a Breakdown? See if that says anything to you. If you think you'd like to talk to me professionally, you can contact me at http://youronlinecounselor.com

tiberiu (24) 14 Jan 2008 10:02 AM

Medication that it is said to cure depression is a joke. This medication will get you an addiction an after you will need some suboxone treatment to get rid of it. Please think twice before taking medication for depression.

cal1 (75) 14 Jan 2008 07:40 PM

tiberiu: Medication can be a useful tool for people suffering from depression, I think if people need it, they shouldn't be afraid of it. But it is merely one of many options, and some may argue an option too quickly used in many cases. You are of course entitled to your opinion on the matter, but I can say no currently used anti-depressants are addictive in the traditional sense. Some (most notably paxil and effexor) do have unpleasant withdrawal symptoms and need to be tapered off to minimize discomfort, but this is more of a tolerance effect than an addiction such as is seen with drugs of abuse.