A major study published this summer in the Journal of Molecular Psychiatry is making strides in finally putting the chemical imbalance theory of depression to rest. The chemical imbalance theory suggests that depression is caused by low serotonin in the brain. This theory has lead to the sale and use of many psychiatric medications that claim to correct that supposed chemical imbalance. The recent study shows a shocking lack of evidence for this theory and confirms what many in psychiatry have been saying for years: that depression is not singularly caused by biological factors, such as genetics or brain chemicals being out of whack.
About the study
The study itself was massive in scale. A study of studies, or a meta-analysis, is when scientists look at multiple studies and compile data based on all those studies combined. This was an umbrella study, which is a meta-analysis of meta-analyses. When accounting for all the studies included under the umbrella, this study covers decades worth of research and includes hundreds of thousands of participants.
What the research did NOT find
The authors conclude: “Our comprehensive review of the major strands of research shows there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity.” This lack of evidence is complimented by powerful and large genetic studies that have found no evidence of specific genes that cause depression.
What the research DID find
The authors cite evidence that “this belief [that depression is caused by a chemical imbalance] shapes how people understand their moods, leading to a pessimistic outlook on the outcome of depression and negative expectancy about the possibility of self-regulation of mood.” In other words, believing in this theory disempowers people from believing they can overcome their depression, which makes their depression worse, not better.
Furthermore, the study states, “the idea that depression is the result of a chemical imbalance also influences decisions about whether to take or continue antidepressant medication and may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.” Evidence was examined revealing that long anti-depressant use can cause “compensatory adaptations” leading to worsening depression. Lower serotonin levels were found in humans and animals after long-term anti-depressant use, which is the opposite of what antidepressants are purported to do. These drugs can often cause more harm than good.
Lastly, the authors concluded that there is strong evidence that depression is associated with trauma and negative life experiences. The belief that mental health issues are caused by chemicals in the brain can deter people from seeking solutions to depression that address those issues and that we know are effective, namely counseling.
How did this get so popular?
The question remains, if evidence for this theory has been lacking from the start, then how did the chemical imbalance theory become so popular? Surveys suggest that 80% or more of the general public believe the chemical imbalance theory to be established truth, while many mental health professionals have known all along that this is not the case.
This question can be answered by understanding the power of continued multi-billion dollar pharmaceutical advertising. This was notably present in the late 80s and early 90s as Prozac was being promoted in the United States. Only the US and New Zealand allow pharmaceutical companies to advertise on television. It seems that other countries realize that advertising dollars shouldn’t be the foundation for the general understanding of how medications work and which to take for what condition. To be clear, this theory got popular because of advertising, not science.
Of course, this advertising wouldn’t work so well if it didn’t strike a need in our culture for a quick fix. It is much easier to sell a pill to “cure” depression than putting in the hard work involved in counseling or other life changes.
Lastly, psychiatry has become intentionally medicalized as each successive edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM) pulls more and more of the human experience under the umbrella of mental illness, while using language that implies biological roots. This began with the term “reaction” being removed between the publishing of the DSM I and the DSM II. “Depressive reaction,” for example, became “major depressive disorder.” Considering normal emotional reactions to stressful life events as a medical issue, sets the stage for medications as the only reasonable answer.
Why does it matter?
Why is this a big deal? Well, we must think twice about anyone selling “simple and easy” solutions when it comes to mental health. Humans are beautifully complex creatures, each with our own heroic stories. We are all on a journey of self-discovery that cannot be reduced to a quick fix. Psychiatry has made a habit of trying to cheapen this journey with solutions ranging from lobotomies, insulin coma therapy, blood-letting, and even physical beatings. Each “solution” being promoted as the “simple, easy and well-established” medical breakthrough of its time.
What we do know through common sense, personal life experience, and more robust research, is that emotional pain is caused by our circumstances, experiences, and beliefs. This doesn’t imply a broken brain, but our minds way of intelligently minimizing pain that might have otherwise been unbearable. There is hope in this explanation because the painful things we believe about ourselves can be permanently and radically changed without the devastating side-effects, disempowerment, and life-long dependence that comes from taking anti-depressants.
Implications for us today
We need to ask ourselves, if anti-depressants aren’t correcting a chemical imbalance, then what are they doing? We do know they temporarily blunt emotions, and that might be helpful for a short season. But we also know that they alter our natural neural chemistry, especially if taken long-term. So it’s best to avoid them if we can.
At Atlas, we don’t have a problem with prescribing psychiatric medication short-term to a client who is fully informed of their actual function and possible side effects. At times blunting roiling emotions for a time can help just enough to get someone started making progress in therapy. What we do have a problem with is people taking these medications without being informed of the potential cost and what they are actually doing to the brain. And we have a problem with these medications being prescribed for years on end with no plan or expectation of coming back off them.
That being said, if you are taking one or more psychiatric medications, do not just stop them abruptly! It takes time for the brain to adjust back to its natural neurochemistry, so please seek the guidance of a mental health professional before making that decision. If you would like someone to walk alongside you as withdraw, please contact Atlas.