Chemical imbalances do not exist; dying brain cells do

Researchers have never been fully confident in the chemical imbalance theory, yet the media continue to purport it as fact. Dr. John Grohol over at PsychCentral recently wrote:

We’ve all heard the theory — a chemical imbalance in your brain causes depression.

Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me. Most researchers now believe depression is not caused by a chemical imbalance in the brain.

How did we come to this conclusion? Through years of additional research. But now some are jumping on the next brain bandwagon of belief — that depression is caused by a problem in the brain neuronal network.

Grohol cites Jonah Lehrer's article in the Boston Globe in which he posits that researchers now think depression comes from "brain cells shrinking and dying." Lehrer writes:

Read the rest of this entry »

Depression: Theory or fact?

UPI has an article on a study which finds that the media presents depression's "chemical imbalance" as a fact instead of a theory. According to Jeffrey Lacasse and Jonathan Leo, the DSM says "the cause of depression and anxiety is unknown." Lacasse and Leo asked members of the media to submit evidence that supports chemical imbalance as a fact but no one did. This finding comes after the near-damning U of Hull study that asserts antidepressants don't work much better than a placebo on the majority of depressed patients. If the efficacy of antidepressants are this dubious, how much more are antipsychotics?

This article gets me thinking about the idea of media responsibility. I feel like what we call "news" has reverted to the days of yellow journalism. Sometimes, even worse than that. While the majority of publications strive to adhere to ethical practices and accuracy, many major publications will resort to printing anything that sells — even if it's libelous. But I'm getting off track here.

I can't wholly blame the media for sensationalism on certain topics like depression.  Most of them aren't scientists or research experts – they only report what they're told. Take NIMH's explanation of the way medication works for depression:

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

NIMH isn't presenting the way antidepressants work as a theory. It's an authoritative paragraph that sounds as though it's fact. If the chemical imbalance that causes depression is only theory then one must conclude the way antidepressants work as a theory as well, no? The NIMH has a section that explains what causes depression:

There is no single known cause of depression. Rather, it likely
results from a combination of genetic, biochemical, environmental, and
psychological factors.

"Likely results" leaves the door open to interpret the sentence as "maybe it's a combination of…" However, most people aren't scrutinizing words that carefully. Most people see this: "Rather, it results from a combination of…" Yes, I'm being nitpicky but the word "likely" still strikes me with a more authoritative connotation than maybe or perhaps. Here's a quote from a recent report from a local news station News 8 Austin:

Depression is more than just a negative state of mind. There are physical changes that occur in the brain that disrupt that natural balance of chemicals called neurotransmitters. (emphasis mine)

There is no single factor that causes depression. In fact, many experts believe most cases
[sic] of depression are a result of several sources. (emphasis mine)  

Again, I'm being nitpicky. "There are" is an authoritative phrase. People are unlikely to argue with a statement that includes the verb "are." Take for example, "There are people outside" or "There are five cats at the door." There's no question in the speaker's mind about whether people exist outside or the number of cats at the door. With subjects like depression that involve psychiatry and neuroscience, the majority of people aren't going to question these assertions either. I'm surprised that second paragraph didn't read, "many experts say …" Unless you're an expert yourself, you'd be unlikely to argue on what an expert says versus what the expert believes.

While I appreciate Lacasse and Leo's study on the inaccurate way depression is presented in the media, the "authoritative" sources on the issue would be loathe to correct it. Right now,  the big picture of raising awareness about depression is more important than to correct a trivial thing about the chemical imbalance being a theory. Pharmaceutical companies don't like correcting minor nuisances like theories.

To sum it up, I think the idea of a chemical imbalance causing depression is a theory. That's not a dubious statement. Unless it depends on your definition of what is is. 

Well-intentioned but not completely right

medicating the brainI read this commentary from the Philly Inquirer on mental illness and the author insists that mental illnesses are all “chemical imbalances.” While I do think many mental illnesses are the result of chemical imbalances, some mental illnesses are not physical. Some mental illnesses come from a spiritual and/or psychological battle. There are many people who recover from mental illness without medication. If a chemical imbalance was the case for these people, they would never get better. Pharma companies have sold the American public and countless mental health organizations on the idea that millions of people suffer from a “chemical imbalance.” I don’t buy that – well, come to think of it, actually, I do – my dollars contribute to Wyeth and GlaxoSmithKline‘s profits.

After suffering from bipolar disorder (or depression, depending on which psychiatrist I listen to) for 10 years, my husband and I are leaning toward the “chemical imbalance” theory that many doctors and pharmaceutical companies push. But a person who is depressed over a temporary situation does NOT have a chemical imbalance and simply may need psychological counseling.

America is overmedicated, drugged-up, and the victims of the smartest ad campaigns from pharma companies. What concerns me even more is that the FDA and mental health organizations like NIMH buy into many of the pharmaceutical companies’ lies and tactics. What further concerns me are the doctors involved in clinical trials who fail to disclose their affiliations with many of these pharmaceutical companies.

So yes, chemical imbalances do exist for many people. Millions? It’s possible. But unlikely. And I could go off on another rant about how PCPs shouldn’t be prescribing psych meds, but I’ll leave that argument for another day.