Doctors Stopped Believing in the ‘Chemical Imbalance’ Theory. But They Didn’t Tell Us


Out of National Post: “Psychiatry has long known that the ‘serotonin theory’ of depression, the notion that too little of the brain chemical can be a cause of depression, is a decades-old hypothesis and deeply rooted icon in society that contributed to it Promoting a class of antidepressants used by millions of Canadians is wrong, says Montreal psychiatrist Dr. Joel Paris.

“They want to know why it took so long for the truth to come out,” wrote Paris, a professor of psychiatry at McGill University, in an email. “I’m afraid it has something to do with the toxic relationship between industry and academia.” Drug companies encourage doctors to prescribe frequently and heavily, he said, and have “paid many academic psychiatrists to promote their products.”

Two months after a major review found no support for the hypothesis that depression is caused by decreased serotonin activity or levels, no convincing evidence of a “chemical imbalance,” the study still sparks controversy. Its authors say they have been ridiculed and attacked, and accused of whistling at “far-right” commentators who have “unreasonably” linked antidepressants to mass shootings. Responses from psychiatrists have been oddly contradictory, ranging from “nothing new here, of course we knew it was never serotonin, it was never that easy” to criticism that it was premature to dismiss the serotonin theory entirely, and that the authors missed some studies and misinterpreted others.

“But the main thing that upsets people is that we dared to draw conclusions about antidepressants,” said the study’s lead author, Dr. Joanna Moncrieff [told National Post this week] . . .

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Moncrieff’s study did not look at the effectiveness of SSRIs, but rather at the likelihood of them doing what people were told. . .

“It seems the main criticism is that ‘antidepressants work,'” Moncrieff said. “It doesn’t matter how they work. It doesn’t matter that the original idea, the original theory of how they work is unproven. “They work,” and that’s all that matters.”

It’s important to Moncrieff. “Because whether they work or not depends on how we understand what they do.” And if they don’t correct a serotonin imbalance or reverse an underlying mechanism of depression, what then? are Do you? . . .

The serotonin “bombshell” created an international media frenzy, although it was largely ignored in Canada, with many headlines such as “How were so many duped?”. Some psychiatric opinion leaders dismissed the study as “old wine in new bottles,” arguing that no reputable psychiatrist today believes that depression is due to a neat, simple imbalance in brain chemicals, or “serotonergic deficit.” Apparently no one told the public. A survey of Australian adults found that 88 per cent believe in the ‘chemical imbalance’ hypothesis of depression. A British Columbia government website states that the SSRI escitalopram “works by helping to restore the balance of a certain natural substance (serotonin) in the brain”. Forbes Health last week quoted a Vanderbilt University psychiatrist as saying that SSRIs like Prozac, Paxil, Zoloft and their generic equivalents work by increasing serotonin activity in the brain. “The idea is that the more serotonin there is in your synapses (regions in the brain where nerve impulses are sent and received), the better your mood.”

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“It may well be that psychiatrists have a more ‘sophisticated’ understanding of the role of serotonin than the layperson,” wrote Moncrieff and one of her co-authors, Dr. Mark Horowitz, later for Mad in America, ‘but psychiatrists have failed to correct this misunderstanding.’

The serotonin theory seemed promising when it was first introduced 60 years ago, “but was soon discarded,” said Dr. Allen Frances, professor emeritus of psychiatry at Duke University who led the task force that produced the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994.

The association was weak and often did not replicate. . .

But the “chemical imbalance” theory was a godsend for drug companies’ marketing after the benzodiazepine crisis of the ’60s and ’70s, when the highly addictive tranquilizers were distributed “buckets” to people, especially women, who “just… so “were dissatisfied numb their dissatisfaction,” Moncrieff said.

In the 1980s, when the first SSRI, Prozac, came out, “the pharmaceutical industry knew they couldn’t market them the same way (as benzos) because numbing someone’s dissatisfaction with benzodiazepines was a bad… reputation,” said Moncrieff. “So it had to convince people that they had an underlying condition and needed to take the medication for an underlying condition.”

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. . . But if psychiatry knew the chemical imbalance theory wasn’t real, they had a professional duty to tell people so, said Marnie Wedlake, a psychotherapist and an assistant professor in Western University’s School of Health Studies.

“If they had known this was a false narrative, they, as the self-appointed and publicly recognized key experts out there, should have said, ‘No, no, no. Correction. ‘But they didn’t. They just let it go.’

While it would be easy to blame psychiatry and the drug industry, “that’s too neat,” Wedlake said.

As a species, we no longer know what to do with despair

We have allowed a “pathologization” of our human existence, she said. “If I’m feeling happy and peaceful, that’s great, but everything else has become a ‘symptom.'” When high school kids talk about their feelings today, “they use language that medicalizes their thoughts and feelings,” he said you. “It’s just my OCD,” OCD. “I was a shy kid. Kids in my class who are now at college have social anxiety disorder.

. . . “As a species, we no longer know what to do with despair. Ideally we’d say, ‘okay, I’m a bit desperate, it’s just part of my life, the full colorful spectrum of who I am. Sometimes I’m angry, sometimes I’m sad…’ But it’s been pathologized, and we don’t know what to do with it.'”

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