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serotonin illustration“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:

  1. Reducing levels of norepinephrine, serotonin and dopamine does not actually produce depression in humans, even though it appeared to do so in animals.
  2. 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.
  3. Drugs that raise serotonin and norepinephrine levels, such as amphetamine and cocaine, do not alleviate depression.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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

New research has just been published in the Journal of the American Society of Nephrology that questions the long-held popular belief that drinking eight glasses of water a day benefits our health.

According to Dr. Stanley Goldfarb and Dr. Dan Negoianu of the University of Pennsylvania in Philadelphia, there are four prevalent myths about water intake:

  1. Leads to more toxin excretion
  2. Improves skin tone
  3. Makes one less hungry
  4. Reduces headache frequency

Dr. Goldfarb and Dr. Negoianu reviewed all of the published studies which examined the health benefits of water consumption. They concluded that people in hot, dry climates, athletes or people with certain diseases might do better with increased fluid intake, but for average healthy people, more water did not mean better health.

“There is no clear evidence of benefit from drinking increased amounts of water,” Dr. Goldfarb wrote, but he also added, “There is also no clear evidence of lack of benefit.” In other words, the scientific research doesn’t tell us one way or the other whether there’s a benefit or not.

Fortunately, nature has endowed us with a mechanism that can in fact help us determine how much water we need to be drinking per day. It’s called thirst. If we simply pay attention to our thirst and respond appropriately, it’s likely that we will take in as much water as we need. Four to six glasses per day is probably sufficient for most people; but then again, the evidence indicates there is no harm in drinking more, so if you enjoy drinking a lot of water then knock yourself out!

There is no evidence that increased water consumption helps to excrete toxins. The kidneys perform that function in the body, and as long as they are healthy they do it very well. Dr. Goldfarb: “The kidneys clear toxins. This is what the kidneys do. They do it very effectively. And they do it independently of how much water you take in. when you take in a lot of water, all you do is put out more urine but not more toxins in the urine.”

There is no evidence supporting the other three myths either; namely, that it improves skin tone, reduces hunger and alleviates headaches. But again, if your experience is different and you find that water does help with these conditions – then there is absolutely no reason not to continue what you’re doing now (other than perhaps more frequent trips to the bathroom!) Just don’t go crazy with the water intake, because extremely high levels of water consumption can affect the fluid balance in the body, causing “water intoxication” and even death.

Finally, I’d be remiss if I didn’t emphasize that the quality of the water we drink is much more important than the quantity. My recommendation is that you invest in a high-quality water filter and install it in your home. Avoid bottled water, which is often simply tap water packaged in a plastic bottle that can potentially leach toxins into the water – especially when left in the sun. (You know that “plasticky” smell when you drink water from a plastic bottle that has been around for a while? Not good. Not good at all.) Nalgene bottles should also be avoided as they can leach another unsafe chemical called BPA into your water. Instead, buy a stainless steel water bottle and fill it up with your filtered water at home before you go out.

Also, both tap water and filtered bottled water contain fluoride, a highly toxic bone poison that should be avoided at all costs. Many commercial water filters unfortunately do not remove fluoride, which is present in our water supply because of the gross misconception that it supports dental health. But more on that myth in another article.

Make sure to check out part I of “Why grass-fed is best” for the environmental and ethical benefits of pasture-raised animal products.

In part I we reviewed the environmental and ethical benefits of pasture-raised animal products, along with some general information about why they are more nutritious. In this article, we’ll look more specifically at exactly why grass-fed animal products are superior to commercially-raised alternatives.

Meat

  • Meat from grass-fed animals has two to four times more omega-3 fatty acids than meat from grain- fed animals.
  • When chickens are housed indoors and deprived of greens, their meat and eggs also become artificially low in omega-3s.
  • Eggs from pastured hens can contain as much as 19 times more omega-3s than eggs from factory hens.
  • When ruminants are raised on fresh pasture alone, their products contain from three to five times more CLA than products from animals fed conventional diets. CLA is a fatty acid that has recently been studied as a potent cancer fighter.
  • The meat from the pastured cattle is four times higher in vitamin E than the meat from the feedlot cattle and, interestingly, almost twice as high as the meat from the feedlot cattle given vitamin E supplements.

Milk

  • Unfortunately, 85 to 95 percent of the cows in the United States are now being raised in confinement, not on pasture. The only grass they eat comes in the form of hay, and the ground that they stand on is a blend of dirt and manure.
  • Milk from a pastured cow can have five times as much CLA as a grainfed animal.
  • Milk from pastured cows also contains an ideal ratio of essential fatty acids or EFAs. Studies suggest that if your diet contains roughly equal amounts of these two fats, you will have a lower risk of cancer, cardiovascular disease, autoimmune disorders, allergies, obesity, diabetes, dementia, and various other mental disorders.
  • When a cow is raised on pasture , her milk has an ideal ratio of omega-6 to omega-3 fatty acids. Replace two-thirds of the pasture with a grain-based diet and the milk will have more than five times the amount of omega-6 fatty acids than omega-3s, a ratio that has been linked with an increased risk of a wide variety of conditions, including obesity, diabetes, depression, and cancer.
  • Grassfed milk is higher in beta-carotene, vitamin A, and vitamin E. This vitamin bonus comes, in part, from the fact that fresh pasture has more of these nutrients than grain or hay. These extra helpings of vitamins are then transferred to the cow’s milk.

Free-range (pastured) eggs

  • When compared to commercially raised, supermarket eggs, free-range eggs have:
    2/3 more vitamin A
  • 7 times more beta carotene
  • Up to 19 times more omega-3 fatty acids
  • Significantly more folic acid and vitamin B12

Raw dairy products – another step up

The information above should convince you that grass-fed dairy products are superior in every way to dairy products that come from grain-fed cows. Another important distinction to be made is the difference between raw and pasteurized dairy products.

I will be covering this in further detail in a future article, but in short raw dairy products have several significant advantages over pasteurized alternatives:

  • Raw milk is an outstanding source of nutrients including beneficial bacteria such as lactobacillus acidolphilus, vitamins and enzymes, as well as the finest source of calcium available.
  • Pasteurizing milk destroys enzymes, diminishes vitamin, denatures fragile milk proteins, destroys vitamin B12, and vitamin B6, kills beneficial bacteria and promotes pathogens.
  • Raw milk is not associated with any the problems of pasteurized milk, and even people who have been allergic to pasteurized milk for many years can typically tolerate and even thrive on raw milk.

Contrary to popular belief, raw milk is safe to consume. There has never been a pathogen found in the milk of the two largest raw dairy producers in California, Organic Pastures and Claravale. In fact, the USDA has been unable to even find pathogens in the soil at Organic Pastures – which is highly unusual. This is due to the much more stringent standards for sanitation that raw dairies must comply with in order to be licensed to sell their products.

Again, I will cover this in more detail in a future article. Stay tuned!

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