Depression is a very complex and nuanced ailment and, unless you are living under a rock, you are probably aware that it is becoming a crisis where our modern solutions are just straight up failing. The reality is we know every little about depression or even how to treat it. We can’t even come up with a good way to diagnose it. Get this.
The DSM V, the current standard for diagnosing mental health ailments, can’t even come up with a good way to determine if you are properly depressed. For example, in the DSM IV there was a 2 month window allowed for grieving after a major life event. This makes sense because having depressive symptoms shortly after losing a loved one is normal and healthy. In a controversial move, however, when they updated the DSM to the fifth version they removed that clause. This means if you are sad because you lost someone close to you yesterday you may meet the qualifications for a major depressive disorder and have professionals start recommending their cornucopia of antidepressants. This is a bit worrying because it means we are actively interrupting the grieving process.
Here is the thing. People don’t like to simply say “I don’t know.”. This is especially true in the world of medical science where they have been trying to present themselves as unquestionably knowledgeable even when treatments involve literally blowing smoke up your butt. If you add in the marketing team from big pharmaceuticals you get a recipe for myths and straight up lies.
That brings us to the biggest myth about depression which is…
Myth: Depression is caused by a chemical imbalance in the brain.
Yup, this notion has been floating around for since the 1950s when the first antidepressant, a MAOI type of antidepressant, was accidentally discovered. They weren’t sure exactly how it worked so one of the scientists scratched his head and said “Maybe it fixes a chemical imbalance?” and thus the myth was born. Since then we have had no evidence to support this claim. The scientist wasn’t putting this forth as a hypothesis. He simply was brainstorming. Unfortunately this idea was latched onto for two reasons:
- As mentioned before, folks in the medical field are often uncomfortable saying “I don’t know.”. A theory that is wrong or severely flawed is preferable to admitting ignorance.
- It’s easier to sell medication for a ‘chemical imbalance’.
- It’s much more alluring to the patient and family members to make this a physical disease rather an issue with thought patterns, trauma, micro-trauma and behavior patterns.
Reason #2 is the big one. Pharmaceutical companies are great at marketing and they realized early on that if you tell someone their problems are due to a ‘chemical imbalance’ then taking a pill to correct that imbalance is very easy to swallow(pun intended). It’s like if the doctor says you are low on Vitamin D so you simply go out and purchase a bottle of it and you are good to go. This works for the pharmaceutical company and it works for the doctors who simply have to say “Oh, you are depressed? I have a prescription for you.”. The doctors are generally willing to accept this because otherwise they are going to get entangled in the complexities of diagnosing and then the often significantly more complex issue of actually treating depression.
At this time psychiatry has devolved into 15 minute appointments where all psychiatrist does one of the following:
- Prescribe a new medication
- Adjust dosage on existing medication.
It’s the antidepressant treadmill and this has become the typical practice for all psychiatrists because it’s the most efficient way for them to bill insurance companies.
Neither the pharmaceutical companies nor the practitioners have a vested interest in disabusing you of the chemical imbalance myth. In fact, they are profiting handsomely from it. The antidepressant industry is worth 15+ billion dollars.
So how do they get away with it?
Easy, by adding verbiage that indicates that their statement is a possibility but not a fact. For example, Here is what Pfizer’s advertisement says about it’s antidepressant Zoloft:
Depression is a serious medical condition that may be due to a chemical imbalance.
As I was researching information for this article it was disheartening to see that even Hopkins Medicine’s website claims that depression is caused by a chemical imbalance. This means I am making some bold claims and better be able to provide some evidence, right? Well, here we go.
There Is No Research To Backup The Myth
Honestly, this should be enough. As Hitchen’s Razor says “What can be asserted without evidence can also be dismissed without evidence.”. In order to make this myth into, at a minimum, a viable theory we would need research and studies that backup this claim. We simply don’t have any meaningful studies that do this. Here are some very key points to keep in mind:
- Antidepressant studies, even ones used for FDA trials, are funded by pharmaceutical companies. Studies that aren’t found favorable are buried. Studies that give a good result are published as evidence. This is a common practice but a meta-analysis of research suggests that there is no clinically meaningful advantage over placebos. The medications that are used to treat a chemical imbalance simply aren’t that effective.
- Antidepressants, like SSRIs, raise the important chemicals, such as serotonin, about 1-2 days after you start taking them yet it takes weeks or even months for the antidepressant effects to kick in. No one knows why this is but if it was a simple chemical imbalance and we fixed the imbalance it should be instant. For example, many recreational drugs provide a boost in those happy brain chemicals which is why they produce a euphoric effect so quickly. It doesn’t take 6 weeks for the feel good effects of meth or cocaine to kick in(or so I am told).
- Reducing levels of important brain chemicals such as norepinephrine, serotonin and dopamine DO NOT produce depression in humans. Creating what we think is an imbalance does NOT cause depression.
- Folks who are diagnosed with depression can have serotonin levels across a wide range, all the way from really high, to ‘normal’ and down to low. People without depression are in the same boat.
- The majority of patients with depression do not have low serotonin levels but are prescribed SSRIs, a medication that increases serotonin levels.
If you ask any researcher in this field questions about this or even just act “How do antidepressants work?” any honest person will say “We don’t know.”. There are a lot of questions here and we don’t have the answers.
We have more evidence that suggests that depression is not a chemical imbalance rather than that it is a chemical imbalance. Until someone can provide peer-reviewed evidence this entire notion should be rejected outside the clinical researchers quest for knowledge.
We Don’t Know What A Chemically Balanced Brain Looks Like
In order to assert that depression is caused by a chemically imbalanced brain we first need to know what a chemically balanced brain looks like. We don’t. It’s that simple. Turns out measuring chemicals in the brain is difficult and we are still in the early stages of neuroscience and neurochemistry. How they currently try to measure serotonin is by estimating the neurotransmitters from broken down metabolites in urine and spinal fluid. It’s known this isn’t a good method because less than a half of the metabolites are from the brain. The rest come from other organs in the body that produce serotonin.
Serotonin itself can be measured through a blood draw but this doesn’t accurately represent what is being processed in the brain.
Lastly, as noted previously, people who suffer from depression and people who don’t suffer from depression have serotonin levels all over the charts. A mentally well person might have high, medium or low serotonin levels. A depressed person might have high, medium or low serotonin levels. So what should our serotonin levels be?
We don’t know but we also have no problem handing out medication that will affect those levels and pray for the best.
Quite simply if we don’t know what a chemically balanced brain looks like then we also don’t know what a chemically imbalanced brain looks like.
We Don’t Diagnose Depression Based On Chemical Levels
If you haven’t had the chance to be diagnosed with depression from a general practitioner or a psychiatrist I’ll let you know how it generally goes. They hand you two quick questionnaires. The first is a PHQ test which is used to diagnose depression. The other is GAD which is used to diagnose anxiety disorders. Currently the PHQ is on version 9 and GAD is on version 7. It asks simple questions that you rate from ‘Not At All’ to ‘Nearly Everyday’. The questions will be something like the following:
- Little interest or pleasure in doing things?
- Feeling bad about yourself or that you are a failure or have let yourself or your family down?
- Trouble concentrating on things, such as reading the newspaper or watching television?
- Thoughts that you would be better off dead or of hurting yourself in some way?
Once you are done they tally up the score and ‘tah-dah’. You are diagnosed.
Honestly, it’s a terrible system. Antidepressants can sometimes raise this score while still overall lowering your quality of life which gives the practitioners a reason to pat themselves on the back and say it’s working even though our life experience is just getting worse. The plus side is it’s easy to administer and can at least give a diagnosis no matter how non-nuanced it is.
But here is the thing. If depression is a chemical imbalance why do we just not do a simple blood draw or urinary test? Surely if we know depression is caused by a chemical imbalance we can simply run a few tests to get some hard numbers on the imbalance and then correct it, right? This isn’t done. As stated before, we don’t know what a chemical imbalance would even look like and people’s chemical levels are all over the charts. Performing these tests aren’t a meaningful or effective way to diagnose depression. How can we assert that a chemical imbalance is the problem if we can’t even use it as a means for diagnosis?
Keep in mind the DSM V doesn’t list any sort of chemical test as a valid means of diagnosing depression.
Depression being caused by a chemical imbalance is a myth at this point. Could there be some truth to it? Maybe. There also might be some truth to me having an invisible pet dragon in my garage but until researchers can provide ample evidence about a chemical imbalance causing depression or I can somehow prove to you I have an invisible pet dragon the assertions should be ignored.
I’m not totally against antidepressants. I think for some severe cases it can help calm things down and allow other methods, such as talk therapy, to become effective. Currently antidepressants are the default treatment for all cases of depression which I think is completely wrong. While depression is complex and can be caused for a variety of reasons, automatically going on antidepressants often concedes the desire to fix any sort of root problem. We should be very slow to medicate because the side effects and then the withdrawal effects can be detrimental. They certainly should not be prescribed to treat a chemical imbalance that we can’t even begin to validate.
So what should you do? I do encourage the use of professional help and here is a route I would take:
- Talk to your primary doctor. If you aren’t so severe that you might cause harm to yourself or others let the doctor know you aren’t interested in antidepressants at this time. The doctor will likely perform a blood test. While we can’t diagnose depression with a blood test we can sometimes detect other problems such as thyroid issues or a vitamin deficiency that can have symptoms similar to depression or be enough to make depression more likely.
- Work with a good therapist. It can take time to find a therapist that is a good fit but getting to the root of your problem is key to living a better life. A good therapist can make a huge difference.
- Read Nicole LePera’s “How To Do The Work” which covers a variety of self-therapy techniques. I have seen therapists recommend this book to clients because it’s so effective. I personally think it’s the best self-help book when it comes to mental health issues.
- Try making small changes to improve your life. Exercise, eat healthy, establish a routine, make important social connections, make plans to get excited about, start a gratitude practice, meditate, etc. Small changes add up. If you put effort into making fertile soil it becomes easier to cultivating joy. If you need help with direction or establishing positive habits and mindset changes then a coach is a great option. Guess what? I happen to be one so if you are interested contact me. If I have availability I will work with you and if I don’t I can refer you to a great coach that can help you.
- Consider looking into alternative therapeutic options such as psychedelic integration. I am an advocate for using plant medicines because of the profound positive changes it has enabled in my life when coupled with a professional who could help. I have written an article that explains how psychedelics can be used for both personal growth and healing here. I also do integration coaching.
I also have another article “4 Alternative Treatment Options For Depression” that might be worth a read.
Ultimately whatever path you choose to work in your depression is completely up to you but make sure you go in with knowledge to make good decisions. Don’t make a decision based on fixing a chemical imbalance until medical science can confidently make that assertion and we can use it as a diagnosis tool. It’s an immoral and lazy cash grab that leaves you as the mark.