“A theory that is wrong is considered preferable to admitting our ignorance.” - Elliot Vallenstein, Ph.D.
The idea that depression and other mental health conditions are caused by an imbalance of chemicals in the brain is so deeply ingrained in our psyche that it seems almost sacrilegious to question it.
Direct-to-consumer-advertising (DCTA) campaigns, which have expanded the size of the antidepressant market (Donohue et al., 2004), revolve around the claim that SSRIs (the most popular class of antidepressants) alleviate depression by correcting a deficiency of serotonin in the brain.
For example, Pfizer’s television advertisement for Zoloft states that “depression is a serious medical condition that may be due to a chemical imbalance”, and that “Zoloft works to correct this imbalance.”
Other SSRI advertising campaigns make similar claims. The Effexor website even has a slick video explaining that “research suggests an important link between depression and an imbalance in some of the brain’s chemical messengers. Two neurotransmitters believed to be involved in depression are serotonin and norepinephrine.” The video goes on to explain that Effexor works by increasing serotonin levels in the synapse, which is “believed to relieve symptoms of depression over time.”
These days serotonin is widely promoted as the way to achieve just about every personality trait that is desirable, including self-confidence, creativity, emotional resilience, success, achievement, sociability and high energy. And the converse is also true. Low serotonin levels have been implicated in almost every undesirable mental state and behavioral pattern, such as depression, aggressiveness, suicide, stress, lack of self-confidence, failure, low impulse control, binge eating and other forms of substance abuse.
In fact, the idea that low levels of serotonin cause depression has become so widespread that it’s not uncommon to hear people speak of the need to “boost their serotonin levels” through exercise, herbal supplements or even sexual activity. The “chemical imbalance” theory is so well established that it is now part of the popular lexicon.
It is, after all, a neat theory. It takes a complex and heterogeneous condition (depression) and boils it down to a simple imbalance of two to three neurotransmitters (out of more than 100 that have been identified), which, as it happens, can be “corrected” by long-term drug treatment. This clear and easy-to-follow theory is the driving force behind the $12 billion worth of antidepressant drugs sold each year.
However, there is one (rather large) problem with this theory: there is absolutely no evidence to support it. Recent reviews of the research have demonstrated no link between depression, or any other mental disorder, and an imbalance of chemicals in the brain (Lacasse & Leo, 2005; (Valenstein, 1998).
The ineffectiveness of antidepressant drugs when compared to placebo cast even more doubt on the “chemical imbalance” theory. (See my recent articles Placebos as effective as antidepressants and A closer look at the evidence for more on this.)
Folks, at this point you might want to grab a cup of tea. It’s going to take a while to explain the history of this theory, why it is flawed, and how continues to persist in light of the complete lack of evidence to support it. I will try to be as concise as possible, but there’s a lot of material to cover and a lot of propaganda I need to disabuse you of.
Ready? Let’s start with a bit of history.
The history of the “chemical imbalance” theory
The first antidepressant, iproniazid, was discovered by accident in 1952 after it was observed that some tubercular patients became euphoric when treated with this drug. A bacteriologist named Albert Zeller found that iproniazid was effective in inhibiting the enzyme monoamine oxydase. As its name implies, monoamine oxydase plays an essential role in inactivating monoamines such as epinephrine and norepinephrine. Thus, iproniazid raised levels of epinephrine and norepinephrine which in turn led to stimulation of the sympathetic nervous system - an effect thought to be responsible for the antidepressant action of the drug.
At around the same time, an extract from the plant Rauwolfia serpentina was introduced into western psychiatry. This extract had been used medicinally in India for more than a thousand years and was thought to have a calming effect useful to quite babies, treat insomnia, high blood pressure, insanity and much more. In 1953 chemists at Ciba, a pharmaceutical company, isolated the active compound from this herb and called it reserpine.
In 1955 researchers at the National Institutes of Health reported that reserpine reduces the levels of serotonin in the brains of animals. It was later established that all three of the major biogenic amines in the brain, norepinephrine, serotonin, and dopamine, were all decreased by reserpine (again, in animals).
In animal studies conducted at around the same time, it was found that animals administered reserpine showed a short period of increased excitement and motor activity, followed by a prolonged period of inactivity. The animals often had a hunched posture and an immobility that was thought to resemble catatonia (Valenstein, 1998). Since reserpine lowered levels of serotonin, norepinephrine and dopamine, and caused the effects observed in animals, it was concluded that depression was a result of low levels of biogenic amines. Hence, the “chemical imbalance” theory is born.
However, it was later found that reserpine only rarely produces a true clinical depression. Despite high doses and many months of treatment with reserpine, only 6 percent of the patients developed symptoms even suggestive of depression. In addition, an examination of these 6 percent of patients revealed that all of them had a previous history of depression. (Mendels & Frazer, 1974) There were even reports from a few studies that reserpine could have an antidepressant effect (in spite of reducing levels of serotonin, norepinephrine and dopanmine).
As it turns out, that is only the tip of the iceberg when it comes to revealing the inadequacies of the “chemical imbalance” theory.
The fatal flaws of “chemical imbalance” theory
As Elliot Valenstein Ph.D., Professor Emeritus of psychology and neuroscience at Michigan University, points out in his seminal book Blaming the Brain, “Contrary to what is often claimed, no biochemical, anatomical or functional signs have been found that reliably distinguish the brains of mental patients.” (p. 125)
In his book, Valenstein clearly and systematically dismantles the chemical imbalance theory:
- Reducing levels of norepinephrine, serotonin and dopamine does not actually produce depression in humans, even though it appeared to do so in animals.
- The theory cannot explain why there are drugs that alleviate depression despite the fact that they have little or no effect on either serotonin or norepinephrine.
- Drugs that raise serotonin and norepinephrine levels, such as amphetamine and cocaine, do not alleviate depression.
- No one has explained why it takes a relatively long time before antidepressant drugs produce any elevation of mood. Antidepressants produce their maximum elevation of serotonin and norepinephrine in only a day or two, but it often takes several weeks before any improvement in mood occurs.
- Although some depressed patients have low levels of serotonin and norepinephrine, the majority do not. Estimates vary, but a reasonable average from several studies indicates that only about 25 percent of depressed patients actually have low levels of these metabolites.
- Some depressed patients actually have abnormally high levels of serotonin and norepinephrine, and some patients with no history of depression at all have low levels of these amines.
- Although there have been claims that depression may be caused by excessive levels of monoamine oxydase (the enzyme that breaks down serotonin and norepinephrine), this is only true in some depressed patients and not in others.
- Antidepressants produce a number of different effects other than increasing norepinephrine and serotonin activity that have not been accounted for when considering their activity on depression.
Another problem is that it is not now possible to measure serotonin and norepinephrine in the brains of patients. Estimates of brain neurotransmitters can only be inferred by measuring the biogenic amine breakdown products (metabolites) in the urine and cerebrospinal fluid. The assumption underlying this measurement is that the level of biogenic amine metabolites in the urine and cerebrospinal fluid reflects the amount of neurotransmitters in the brain. However, less than one-half of the serotonin and norepinephrine metabolites in the urine or cerebrospinal fluid come from the brain. The other half come from various organs in the body. Thus, there are serious problems with what is actually being measured.
Finally, there is not a single peer-reviewed article that can be accurately cited to support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence. Furthermore, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not list serotonin as the cause of any mental disorder. The American Psychiatric Press Textbook of Clinical Psychiatry addresses serotonin deficiency as an unconfirmed hypothesis, stating “Additional experience has not confirmed the monoamine depletion hypothesis” (Lacasse & Leo, 2005).
When all of this evidence is taken in full, it should be abundantly clear that depression is not caused by a chemical imbalance.
But, as Valenstein shrewdly observes, “there are few rewards waiting for the person who claims that “the emperor is really nude” or who claims that we really do not know what causes depression or why an antidepressant sometimes helps to relieve this condition.”
How have we been fooled?
There are several reasons the idea that mental disorders are caused by a chemical imbalance has become so widespread (and none of them have anything to do with the actual scientific evidence, as we have seen).
It is known that people suffering from mental disorders and especially their families prefer a diagnosis of “physical disease” because it does not convey the stigma and blame commonly associated with “psychological problems”. A “physical disease” may suggest a more optimistic prognosis, and mental patients are often more amenable to drug treatment when they are told they have a physical disease.
Patients are highly susceptible to Direct-to-Consumer-Advertising (DCTA). It has been reported that patients are now presenting to their doctors with a self-described “chemical imbalance” (Kramer, 2002). This is important because studies show that patients who are convinced they are suffering from a neurotransmitter defect are likely to request a prescription for antidepressants, and may be skeptical of physicians who suggest other interventions such as cognitive behavioral therapy (DeRubeis et al., 2005). It has also been shown that anxious and depressed patients “are probably more susceptible to the controlling influence of advertisements (Hollon MF, 2004).
The benefit of the chemical imbalance theory for insurance companies and the pharmaceutical industry is primarily economic. Medical insurers are primarily concerned with cost, and they want to discourage treatments (such as psychotherapy) that may involve many contact hours and considerable expense. Their control over payment schedules enables insurance companies to shift treatment toward drugs and away from psychotherapy.
The motivation of the pharmaceutical companies should be fairly obvious. As mentioned previously, the market for antidepressant drugs is now $12 billion. All publicly traded for-profit companies are required by law to increase the value of their investor’s stock. Perhaps it goes without saying, but it is a simple fact that pharmaceutical companies will do anything they legally (and sometimes illegally) can to maximize revenues.
Studies have shown that the advertisements placed by drug companies in professional journals or distributed directly to physicians are often exaggerated or misleading and do not accurately reflect scientific evidence (Lacasse & Leo, 2005). While physicians deny they are being influenced, it has been shown repeatedly that their prescription preferences are heavily affected by promotional material from drug companies (Moynihan, 2003). Research also suggests that doctors exposed to company reps are more likely to favor drugs over non-drug therapy, and more likely to prescribe expensive medications when equally effective but less costly ones are available (Lexchin, 1989). Some studies have even shown an association between the dose and response: in other words, the more contact between doctors and sales reps the more doctors latch on to the “commercial” messages as opposed to the “scientific” view of a product’s value (Wazana, 2000).
The motivation of psychiatrists to accept the chemical imbalance theory is somewhat more subtle. Starting around 1930, psychiatrists became increasingly aware of growing competition from nonmedical therapists such as psychologists, social workers and counselors. Because of this, psychiatrists have been attracted to physical treatments like drugs and electroshock therapy that differentiate them from nonmedical practitioners. Psychiatry may be the least respected medical specialty (U.S. General Accounting Office report). Many Americans rejected Fruedian talk therapy as quackery, and the whole field of psychiatry lacks the quality of research (randomized, placebo-controlled, double-blind experiments) that serves as the gold-standard in other branches of medicine.
Dr. Colin Ross, a psychiatrist, describes it this way:
“I also saw how badly biological psychiatrists want to be regarded as doctors and accepted by the rest of the medical profession. In their desire to be accepted as real clinical scientists, these psychiatrists were building far too dogmatic an edifice… pushing their certainty far beyond what the data could support.”
Of course there are also many “benefits” to going along with the conventional “chemical imbalance” theory, such as free dinners, symphony tickets, and trips to the Caribbean; consultancy fees, honoraria and stock options from the pharmaceutical companies; and a much larger, growing private practice as the $20 billion spent by drug companies on advertising brings patients to the office. Psychiatrists are just human, like the rest of us, and not many of them can resist all of these benefits.
In sum, the idea that depression is caused by a chemical imbalance is a myth. Pharmaceutical ads for antidepressants assert that depression is a physical diseases because that serves as a natural and easy segue to promoting drug treatment. There may well be biological factors which predispose some individuals toward depression, but predisposition is not a cause. The theory that mental disorders are physical diseases ignores the relevance of psychosocial factors and implies by omission that such factors are of little importance.
Stay tuned for future articles on the psychosocial factors of depression, the loss of sadness as a normal response to life, and the branding of new psychological conditions as a means of increasing drug sales.
Recommended resources
- Blaming the Brain, by Elliot Valenstein Ph.D.
- Rethinking Psychiatric Drugs, by Grace Jackson M.D.
- America Fooled: The truth about antidepressants, antipsychotics and how we’ve been deceived, by Timothy Scott Ph.D.
- The Loss of Sadness, by Alan Horwitz and Jerome Wakefield
- The Myth of the Chemical Cure, by Joanna Moncrieff
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27 comments
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July 1, 2008 at 4:18 am
Jacqueline Wallis
Well I’d agree that antidepressants aren’t the answer and with the psychology of the psychiatric profession.
However, andecdotal though my evidence might be, I suffered for over 40 years and now I have been calm, happy and energetic with no relapse for over two years since I changed my way of eating with Kathleen des Maisons book Potatoes not Prozac.
I know what I feel in my body after years of trying everything else and if it worked for me then there is hope for anybody.
Jacqueline
July 1, 2008 at 8:08 am
Kathleen DesMaisons, Ph.D.
I think you have presented a very valuable analysis. And yes, absolutely the market has been driven by the drug companies. However, I think you are throwing the baby out with the bathwater. I am the author of Potatoes Not Prozac a book that outlines alternatives to treating depression using a change in diet and behavior. It is not psychological, it is biochemical. And the results reported from hundreds of thousands have been profound. Depression lifts and goes away when people eat good food at regular intervals and take sugar out of their diets.
To say that depression is simply *psychosocial* is as incomplete as saying it can be treated only with drugs.
I think there is way more to the story, and I love a good dialogue.
July 1, 2008 at 10:30 am
admin
Jacqueline & Kathleen,
Thanks for your comments and participation.
I happen to agree with both of you that nutritional deficiencies are likely a contributing cause of depression. I also agree that dietary changes can relieve depression, and have seen that in my own experience (although I believe that increasing intake of saturated fat and cholesterol, rather than simple carbohydrates, is the best way to do it).
However, the fact that changes in diet can contribute to or relieve depression does not prove that depression has anything to do with a “chemical imbalance” in the brain. If dietary changes had their effect on depression primarily by acting on serotonin levels, then anything else that raised serotonin levels would relieve depression and anything that depleted serotonin levels would alleviate it. The evidence I’ve included in my article clearly suggests that is not true; therefore, the serotonin-depression theory is unsupportable.
There are several different pathways by which nutritional changes could act on depression that don’t involve serotonin or other brain chemicals as a primary mechanism. For example, deficiencies in both micronutrients (such as vitamin D) and macronutrients (fatty acids) have been shown to cause depression. The fact that dietary changes affect depression is not evidence that it is caused by low serotonin levels.
For the record, I didn’t say that depression is only psychosocial. In fact, I believe that depression is a multifactorial, heterogeneous condition with many different causes that are not necessarily the same in each person. To speak of a single cause or even single set of causes that is consistent for all people is overly reductionistic.
Yet this is exactly what the “chemical imbalance” theory does: it reduces a complex phenomenon (depression) to a simple imbalance of chemicals in the brain. It’s bad enough to blame depression on a single cause, but when that cause (serotonin deficiency) has been repeatedly disproved in the scientific literature, clinging to it as a viable theory is not only reductionistic - it is also misguided and inaccurate.
Chris
July 1, 2008 at 10:55 am
Kathleen DesMaisons, Ph.D.
Well, we can have fun agreeing to disagree
I think serotonin can be a part of it. And the studies you are citing doing a test in a very short term interval. It may be that serotonin depletion that persists for 6 weeks is a more accurate measure. For example, people who do Atkins generally crash into depression reaction about 6 weeks in…
But, honestly, I am not trying to convince you, only to nudge your healthy skeptic to stay open to the store.
The interesting thing for me is watching people get well. That is what I care about. Some might say doing the food is merely placebo. Could be.
But results are what counts.
I love that you are so thoughtful.
warmly,
kathleen
July 1, 2008 at 11:25 am
admin
Hi Kathleen,
Nice to hear back from you. Indeed, serotonin may be a part of it - but is it a correlation or a cause? It has been shown that certain life events and behavior can deplete serotonin levels, so the possibility has been raised by researchers that depression may cause serotonin deficiency and not the other way around.
Actually, in a previous article on the blog I have cited longitudinal studies which indicate that treatment with antidepressant drugs (which increase serotonin levels) is associated with poor outcomes over the long-term. In contrast to the six-week clinical trials you mention, these studies are looking at results over periods of months and even years.
Although food may have a placebo effect (nearly everything does), I do believe there are biochemical mechanisms influenced by nutrition that contribute to depression. I just happen to think serotonin isn’t primary in this equation.
I also agree that getting well is what matters most. However, *how* someone conceives of their illness and *how* someone gets well is also important. I like what Joanna Moncrieff, who is one of the foremost researchers in this field, has to say about this:
“The promotion of antidepressants has convinced millions of people to ‘recode their moods and their ills’ in terms of their brain chemistry (Rose 2004).
If people believe that it is brain chemicals that have made them depressed and that they only improved because a drug helped to rectify a chemical defect or imbalance, then they are likely to fear the recurrence of depression with every difficult period in their lives. In addition, they are not likely to recognize the things that they did to help themselves out of depression, because they attribute their recovery to a drug. If in contrast they had managed to get through the period without taking a drug that they thought sorted out their biochemistry, they would have had an experience of self-efficacy that could build their confidence and help them to face future problems with greater strength.”
This is analogous to the “give a man a fish, he eats for a day; teach a man to fish, he eats for life” parable. Teaching people that depression is caused by a chemical imbalance that requires drugs to correct is profoundly disempowering (not to mention completely false, according to the scientific literature). But it does wonders for drug sales!
Thanks again for your contribution, Kathleen.
July 1, 2008 at 12:19 pm
Jacqueline Wallis
Well I found all that utterly fascinating and thank you both very much.
As a psychologist as well as a ‘patient’ could I point out the ‘double whammy’ of the PnP programme has been in addressing both seratonin levels/brain chemistry AND behaviour. Built into the steps are numerous changes in behavioural patterns which are missing in purely pharmaceutical intervention and might throw light onto the delay factor in the effectiveness of artificial seratonin raisers.
I think the human organism, for mental health, needs to be proactive in changing negative attitudes/habits at the same time as the brain is healing and this is why the subtle mixture of behavioural and nutritive intervention works so well.
Jacqueline
July 1, 2008 at 2:27 pm
admin
Hi Jacqueline,
I agree that behavioral change is likely to be important in treating depression.
However, at the risk of beating a dead horse, I feel I need to again point out that there is no evidence that antidepressant drugs or dietary changes relieve depression (when they do) by increasing serotonin levels or modifying brain chemistry in any other way.
To be fair, it is possible that the drugs and diet work on other as yet unidentified neurotransmitters, or by some unknown mechanism involving brain chemistry. However, unless we discover that is the case - which is by no means inevitable - I believe it is irresponsible to continue promoting the idea that depression is caused by a “chemical imbalance”.
July 1, 2008 at 3:14 pm
Kathleen DesMaisons, Ph.D.
And we can simply agree to disagree on the definition of *evidence*.
And I am very happy to continue with the premise that of course depression is caused by a chemical imbalance, LOL.
Lotrich FE, Pollock BG.
Free in PMC Candidate genes for antidepressant response to selective serotonin reuptake inhibitors.
Neuropsychiatr Dis Treat. 2005 Mar;1(1):17-35.
Lotrich suggests that that the differences in outcomes or impact may be a function of gene types. You might want to read that one
And here is Prakash suggested that the analysis makes a difference…
Prakash A, Risser RC, Mallinckrodt CH.
The impact of analytic method on interpretation of outcomes in longitudinal clinical trials.
Int J Clin Pract. 2008 Jun 16. s
Therefore, whether or not underestimating (overestimating) within-group changes was conservative or anticonservative depended on the relative magnitude of the bias in each treatment and on whether within-group changes represented improvement or worsening.
Perhaps the difference is that I am open to hearing the other side and you are not, LOL….
I just think your argument would be more powerful if it were balanced.
I am learning a lot in the process.
kathleen
July 1, 2008 at 3:19 pm
Kathleen DesMaisons, Ph.D.
Hey Chris,
one other thought here…
I just got some context from your personal journey.
I have a feeling that our backgrounds are very similar.
I would be delighted to talk with you about treatment of some complex issues that medical science has written off as untreatable.
We could have that dialogue off line.
kathleen
July 1, 2008 at 3:35 pm
Jacqueline Wallis
Could we review ‘irresponsible’ for a moment.
If the patient accepts this diagnosis and then puts themselves utterly in the hands of the Pharmaceutical or Psychiatric industries then this would indeed be negating self responsibility.
However if acceptance of this diagnosis (and I utterly accept it after two years of personal experience) means feeling empowered to seek a natural, science based and proven program of healing then self responsibility is actually enhanced.
Sometimes empowering the sufferer and offering sound, practical and proven advice is the most powerful tool for healing we can give.
However I am still with you that this second option is not often offered by our current health service and I am glad to see you confronting the Pharmaceutical giants. Please though don’t bring a diagnosis which so many ‘know’ to be true as ammunition in your fight - rather address what they do with it.
Jacqueline
July 1, 2008 at 5:48 pm
Rob
It’s a hard call. I’m taking a supplement called Equalibrex (http://www.equalibrex.com) which is a 5-formula system of natural ingredients intended to increase well-being or alleviate depression or whatever. Many of its ingredients affect seratonin levels(5-htp and sam-e, for instance). I’ve noticed quite a noticeable difference in how I feel which is hard to pin on the placebo-effect. Now, i’m not discounting behavioral variables in equation, as I’m now a lot more active than before, but I do feel “picked up” so-to-speak.
Seratonin levels may very well be an indicator of depression, but I’m not going to assume some people are endemic to low levels and some are not. If one forcibly or artificially raises levels to make themselves feel better (through medication/supplement/exercise), of course seratonin would be the deciding variable - this does not mean those levels are “normal” or “raised” in other people for non-medicinal reasons.
July 1, 2008 at 6:38 pm
admin
Kathleen,
I am completely open to another point of view, so long as it makes sense to me and there is evidence to support it. By evidence, I am not exclusively referring to double-blind, placebo-controlled randomized trials. I do not think that is the only type of scientific inquiry we should engage in.
You should know that before I started researching depression, I believed what everyone else believes - that it was likely caused by some chemical imbalance in the brain. I clearly saw the role of nutrition, behavior, psychosocial, and other factors, but I thought that they were simply altering brain chemistry and therefore addressing the underlying chemical imbalance.
When I started the research I approached it with an open mind, and thus my mind was changed after a thorough review of the evidence.
I have looked at the studies you linked to, and when considered against the bulk of published research I do not believe they offer compelling evidence to support the serotonin hypothesis. As you well know, it is always possible to choose a study or even group of studies to support one’s view.
That’s why I have great respect for the work of researchers like Kirsch, Moncrieff, Valenstein, Hollon, Healy and others. They’ve spent the majority of their careers investigating this issue and reviewing all available and relevant studies, and their conclusions are all the same: when taken as a whole, the research does not support the theory that depression is caused by a chemical imbalance.
Is there a study out there that contradicts their conclusion? Sure there is. But there are so many more studies that support it. There are also fundamental flaws in the reasoning of the “chemical imbalance” hypothesis:
1. The psychiatric literature has rarely addressed how or why an excess or deficiency of serotonin or dopamine explains any particular mental disorder. There have been few attempts to explain how the proposed changes in neurochemistry actually affect the psychological phenomena called depression.
2. More than one hundred different neurotransmitters have been identified in the brain. Some of the NTs bind to as many as fifteen receptor types, each of which can presumably trigger a different cascading sequence of physiological changes. Add to this seemingly overwhelming complexity the fact that the receptors are continually changing in number, sensitivity and state and it becomes clear why their ensuing effects may differ from moment to moment.
3. In the case of serotonin, fifteen different receptors (5-HT1-15) have already been identified, and there may be more. Each of the fifteen receptor subtypes can be further subdivided (5-HT1 can be divided into 5-HT1-2, 5-HT1-3, etc.) There is virtually no information about what behavior or psychological states are likely to be affected by stimulating or blocking a particular receptor subtype.
4. There is no scientifically established ideal “chemical balance” of serotonin, let alone an identifiable pathological imbalance.
5. The claimed efficacy (which has been successfully disputed by Kirsch et al.) of SSRIs is often cited as support for the serotonin hypothesis. This is ex juvantibus reasoning - the fact that aspirin cures headache does not prove that headaches are due to low levels of aspirin in the brain.
6. EVEN IF it we could find a biochemical, anatomical or functional difference in the brains of mental patients (which no one has been able to consistently demonstrate), it would be wrong to assume that such differences are the *cause* of the disorder. The abnormalities could just as easily be the result, rather than the cause, of the disorder. Furthermore, it is well established that psychotherapeutic drugs used to treat mental disorders may induce long-lasting biochemical and even structural changes, which in the past were claimed to be the cause of the disorder, but again could just as easily be an effect of the treatment. It is now difficult to find mental patients who have not had a history of drug treatment, and because of this many of the brain abnormalities found in these patients are probably iatrogenic (produced by the treatment rather than being the cause).
7. Various experiences can also modify brain anatomy and function. Numerous experiments have shown that exposure to stressful situations can produce long-lasting brain changes. There is also evidence that stress can produce long-lasting changes in the same class of dopamine neurons that make them hypersensitive not only to drugs such as amphetamine, but also to subsequent exposure to stress.
The idea that serotonin isn’t the cause of depression may sound radical, but in fact it is not. As I pointed out in the article neither the DSM nor major psychiatry textbooks claim that depression is caused by serotonin. Furthermore, many well-known and influential psychiatrists (even those who prescribe antidepressants) and researchers have publicly stated their disagreement with this hypothesis:
“Given the ubiquity of a neurotransmitter such as serotonin and the multiplicity of its functions, it is almost as meaningless to implicate it in depression as it is to implicate blood.” - John Horgan, The Undiscovered Mind
“A serotonin deficiency for depression has not been found.” - Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School
“Indeed, no abnormality of serotonin has ever been demonstrated.” - Psychiatrist David Healy, former secretary of the British Association for Psychopharmacology
“We have hunted for big simple neurochemical explanations for psychiatric disorders and we have not found them.” - Psychiatrist Kenneth Kendler, co-editor-in-chief of Psychological Medicine
“Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts those claims.” - Professor Emeritus Elliot Valenstein, Michigan University
“I spent the first several years of my career doing full-time research on brain serotonin metabolism, but i never saw any convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.” - Stanford psychiatrist David Burns, winner of the A.E. Bennett Award given by the Society for Biological Psychiatry for his research on serotonin metabolism
Kathleen, you suggested that I perhaps am not approaching this with an open mind. With respect, I ask you to consider whether that may not be true for you? I have presented what I think most people would agree is very compelling evidence against the serotonin hypothesis, and so far it would seem that you have been unaffected by this data. You have responded with two studies, neither of which indicate a role for serotonin in depression and neither of which contradict any of the claims I have made in my article.
I am honestly curious to know what *evidence*, however you are defining it, is the basis for your continued belief that depression is caused by serotonin deficiency? I really would like to see this evidence, because, contrary to what you implied in your last comment, I *am* approaching this with an open mind and have been from the begninning… way back when I also thought depression was caused by a lack of serotonin.
My review of the evidence changed my mind completely. Is there room for yours to change as well?
I’m not sure what part of my personal journey you’re referring to, but I would be happy to have a dialog offline with you. I do not believe there is any such thing as an “untreatable condition”, and I reject the validity of several Western medical diagnoses that use this language. There are too many examples that prove otherwise, and if even one person recovers, then the condition is no longer “untreatable” or “incurable”.
July 1, 2008 at 6:47 pm
admin
Jacqueline,
I can certainly see your perspective, i.e. that learning you had a “serotonin imbalance” led you to seek out natural remedies that could improve your condition.
I will steadfastly continue to point out that there is absolutely no way you can know whether you had a serotonin deficiency or not, nor does the evidence support a role for said deficiency in causing depression even if it exists.
I’m sorry to sound like a broken record here, but I’m sticking to my guns until someone presents evidence that changes my mind. While I greatly value personal experience and intuition in the healing process, one person (or even an entire country’s) belief that their depression is caused by serotonin deficiency doesn’t convince me that it’s so.
As Anatole France said, “Even if 50 million people say a foolish thing, it is still a foolish thing”. At one time nearly everyone thought the world was flat, and the earth was the center of the universe.
I certainly don’t mean to imply that what you are saying is foolish. Rather, I simply wish to point out that sometimes even our most sacred and unchallenged beliefs turn out to be false.
I completely agree with your statement that “empowering the sufferer and offering sound, practical and proven advice is the most powerful tool for healing we can give.”
July 1, 2008 at 6:53 pm
admin
Hi Rob,
Welcome to the Healthy Skeptic and thanks for your comment.
Again, sorry to be a stickler here but the fact that you improved on Equalibrex doesn’t prove that serotonin deficiency is at the root of your problem. As you mentioned, it could well be a placebo effect. Placebo is very powerful and can’t be discounted. Also, a product with several ingredients could have non-specific effects (i.e. effects not specifically related to serotonin) that could relieve the depression. It’s more than possible that the life changes you referred to could be responsible for the improvement. Finally, the shift could simply be due to regression to the mean.
And of course, it is *possible* that you improved because the supplement increased levels of serotonin in your brain. I am not saying it’s impossible. I’m just saying that the overwhelming majority of evidence doesn’t support that as the most likely explanation.
July 1, 2008 at 7:19 pm
admin
Kathleen,
I tried to email you but when I clicked on your name I am taken to a URL that must have a typo:
http://www,radiantreecovery.com
Even when I changed the comma to a period, it still didn’t work. You can send me an email through the “Contact” form on the blog.
Best,
Chris
July 1, 2008 at 7:32 pm
Kathleen DesMaisons, Ph.D.
Thanks, Chris.
I appreciate the dialogue.
warmly,
kathleen
July 1, 2008 at 7:50 pm
admin
Me too!
warmly as well,
chris
July 2, 2008 at 3:57 am
Jacqueline Wallis
Sticking to the simpler version you are happily admitting that no-one actually knows what causes it.
If we make an assumption (even if it is erroneous or incomplete) and in seeking a cure for this assumption we discover something which works then is this not a good thing.
We could argue about the science for an eternity, even if this mysterious little neurotransmitter were discovered and labelled, but the bottom line surely is that people are suffering. Some of those people, in pursuing healing, have discovered something which really works.
Would further investigation of this human proof of pudding not warrant further refining?
Thank you for making me even more sure of my diagnosis though and do continue to make us think.
Jacqueline
July 2, 2008 at 10:21 am
admin
Jacqueline,
I would not state the simple version as “no one knows what causes it”.
The simple version is: “the evidence is clear that depression is not caused by serotonin deficiency.”
That statement is not controversial according to the scientific literature. Furthermore, as I pointed out in my last post, it is extremely unlikely that depression is caused by a single “mysterious little neurotransmitter” - whether identified or unidentified.
I am glad that people like you have discovered something that works. That does not, however, prove anything about serotonin’s role in depression. The dietary and behavioral changes suggested in Kathleen’s program address depression through many different mechanisms of action. There is no proof that any of these mechanisms involve changing serotonin levels in the brain.
And of course, there is abundant proof that her program doesn’t work by raising serotonin levels. How do I know this? Because if that is how her program had its effect, then any intervention that raised serotonin would alleviate depression and any intervention that depleted serotonin would cause it. We have repeatedly seen that this is not the case.
May I respectfully ask why it so important for you to be sure of a diagnosis of “chemical imbalance”? In the face of so much evidence to the contrary, why and how do you continue to embrace this diagnosis? Does it somehow validate your experience in a way that wouldn’t happen if it were absent?
If we remove the “chemical imbalance” diagnosis from your equation, the fact remains that you were able to heal yourself using food and behavioral modifications from depression. Is that not enough? Why is the “chemical imbalance” theory necessary at all?
Jacqueline, is it possible that there is a belief system operating here that you are unwilling or unable to truly question? I ask because I still have not heard any compelling reason from you or Dr. DesMaisons why you continue to believe in “chemical imbalance” in light of the complete lack of evidence to support it.
There is no “argument” in the scientific literature. The literature is resoundingly clear that depression isn’t caused by serotonin deficiency, as I have presented in great detail here. The only argument is in the minds of people who have been conditioned to believe in the “chemical imbalance” theory by years of advertising, promotion and misinformed health care professional and media.
Best,
Chris
July 2, 2008 at 1:03 pm
Jacqueline Wallis
I am smiling at your hint that I am somehow unable or unwilling to question my diagnosis after 40+ years of untiring research on my own behalf.
I think there is some confusion between ‘chemical imbalance’ and ’seratonin deficiency’ in this. No it is not seratonin on its own - there are other chemicals and hormones out of ‘balance’ but we could argue terminology for days and probably get a huge Betaendorphin lift from the process LOL
I wish you well with your blog - I will continue to pursue my interest in Radiant Recovery and would invite anyone who is suffereing from depression, insomnia or addiction who is reading your blog to have a look at us on the website.
Jacqueline
July 2, 2008 at 1:16 pm
admin
Jacqueline,
I have defined “chemical imbalance” in this particular article as the idea that depression is caused by a deficiency of serotonin or norepinephrine in the brain.
I certainly don’t dispute that there is likely some biochemical involvement in depression. If that is what you mean by “chemical imbalance”, then we have had a very big miscommunication!
I am glad that Radiant Recovery has helped you to heal, and I was not suggesting that you don’t pursue it. If it works, it works! I was only curious (genuinely) to know what evidence you were basing your belief in “chemical imbalance” on.
Best wishes,
Chris
July 13, 2008 at 4:45 pm
Jessiqua
I knew there was a huge conspiracy behind it all. This is why I absolutely refused to believe anti-depressants and the like would ever help me, and eventually I learned how to be happy on my own and deal with my problems. Time is the best cure.
More people need to read this, and I’m so happy to have found it because now there is a way for me to explain to people why I believe it’s not the way to go.
Thank you for the wonderful article!
July 13, 2008 at 4:50 pm
Chris
Hi Jessiqua,
Welcome to The Healthy Skeptic and thanks for your participation.
I’m glad to know the article will be useful to you in the future. I also hope that many doctors, patients and parents will read this before deciding on antidepressants.
Warmly,
Chris
July 21, 2008 at 5:25 pm
Rob
Whoah - I forget I had written on here! Chris - very true.
August 18, 2008 at 2:18 pm
Toby
Thanks for the good work, Chris.
You are absolutely correct in stating that there is no such thing as a “chemical imbalance” in the brain. Sure, there may be vitamin or mineral deficiencies, and these can be found with simple blood tests or hair analyses.
What outrages me the most is that psychiatrists will tell you that you have a “chemical imbalance in the brain” to convinced you to take psychotropics, knowing full well that a) they haven’t given you a test to determine if you have one, and b) knowing full well that no such test exists, and c) that no imbalance even exists!
If any other doctor gave such a serious diagnosis involving a lifetime of care (i.e., drugs), without even so much as a simple blood test, they would most probably be brought up on malpractice charges and their license pulled.
August 18, 2008 at 2:33 pm
Chris
@Toby:
I couldn’t agree more, Toby. The so-called biological diagnosis of depression is analogous to the diagnosis of so-called diseases like “high cholesterol”, “seasonal affective disorder” and “pre-menstrual dysphoric disorder” which are indistinguishable from normal physiology. It’s all an attempt to push drugs to healthy people.
30 years ago the CEO of Merck upon retirement stated that his dream was always to “covert healthy people into customers”. Looks like his dream came true.
Only 10% of psychiatrists practice psychotherapy now. People are often prescribed drugs on their first visit and told they’ll have to take them for life.
This is criminal IMO.
August 20, 2008 at 1:11 pm
Toby
The answer to this insanity is websites like yours, Chris. Neither drug companies nor psychiatrists are going to give you the truth.