Chemical imbalance myth takes a big public fall (no, antidepressants do NOT correct an imbalance of serotonin, nor do other psychiatric drugs correct anything at all)

Updated with some new links and quotations on June 1, 2014

Beyond Meds and anyone who’s actually paid attention to the science for the last many years has known that the serotonin myth about depression and how antidepressants work has no evidence to back it up whatsoever. So when it all came out in an NPR interview I pretty much just yawned. Yes, I’m tired and I’ve been steeped in some of this stuff for far too long.

Embracing this critique doesn’t mean there is no biological factor to such that which gets labeled mental illness…we are holistic beings, so of course there is biology involved in everything about us. What it means is the answer does not lie in the biological reductionism that psychiatry most often espouses and makes up stories about.  Everything matters. Until we start attending to the individual as part of the whole of life, intertwined with everyone and everything, we’ll continue to harm.

So, I am now realizing that for the vast majority of folks this is shocking news. So…I will do a little round-up here for some of my readers who may not be so familiar with this issue.

First the NPR piece:

●  When It Comes To Depression, Serotonin Isn’t The Whole Story – (it’s quite often most likely not part of the story at all!)

Then there is the response at Mad in America by Jonathan Leo, Ph.D. / Jeffrey Lacasse, Ph.D. – an excerpt below:

Psychiatry’s Grand Confession

Several months ago Ronald Pies published an interesting article in Psychiatric Times entitled, “Psychiatry’s New Brain-Mind and the Legend of the Chemical Imbalance.” Pies, just like the experts on NPR, acknowledges that the Chemical Imbalance theory is not true. However, according to Pies, it was the pharmaceutical companies who espoused the theory, and not well-informed, practicing clinicians, because the psychiatry community has known all along that the theory is not true.

But if the Psychiatry Community knew all along that the theory was not true, then why did they not clarify this issue for the general public? Shouldn’t they have pointed out to the general public and patients that what the pharmaceutical companies were saying about psychological stress was not true? Why did the professional societies not publicly set the record straight?

There are many angry comments on the NPR website. These comments are interesting, because apparently many patients who were told that depression is caused by a chemical imbalance never understood that were hearing a metaphor and not science. Since the chemical imbalance theory is often presented as a rationale for taking SSRIs, such patients now understandably feel lied to by their clinicians. read the rest

I just woke up to Paula Caplan’s piece now too. I’m glad she took on NPR which has an egregious history of misreporting mental health news, all the while enjoying a fine reputation:

Powerful Psychiatrists Push False Theory on Unknowing Souls

It is widely believed that National Public Radio has a liberal bias. Let us then consider the following: Yesterday on “Morning Edition,”(1) several psychiatrists acknowledged there is not a shred of evidence that low serotonin level causes depression, revolutionary talk in light of the rampant bias in the mental health system – accepted unquestioningly by far too many laypeople – that troubling emotions come from well-established chemical imbalances and thus can be cured with drugs that affect those chemicals.

Consider this quotation from the NPR story: “Chemical imbalance is sort of last-century thinking. It’s much more complicated than that,” says Dr. Joseph Coyle, a professor of neuroscience at Harvard Medical School. “It’s really an outmoded way of thinking.” Pretty clear message from Coyle, who edits the Archives of General Psychiatry.

Here is the bizarre and deeply disturbing part of the NPR story: Alan Frazer, who chairs the pharmacology department at the University of Texas Health Science Center at San Antonio and researcher of the drugs that are marketed under the label (and promise) “antidepressants,” announces that it is fine for patients to believe in this unproven theory. Why? It enables them to “come out of the closet” about being depressed. Did Frazer not think how stunningly unethical and probably illegal it is to tell, or allow patients to believe, something that has never been proven? And did the NPR interviewer fail to challenge this practice, or did an editor higher up the chain cut the question (if it was asked) and answer? (read more)

This is not the first time a high profile psychiatrist spoke on NPR and said such disturbing things. Daniel Carlat did it on Fresh Air almost 2 years ago. Giovanna Pompele wrote a brilliant piece calling him on his lies at that time. It was exclusive to Beyond Meds:

He (Daniel Carlat) express no ethical qualms, regrets, or remorse about pimping for pharmaceutical companies.

He regularly lies to patients.

Carlat’s words:
What we don’t know is we don’t know how the medications actually work in the brain. So whereas it’s not uncommon – and I still do this, actually, when patients ask me about these medications, I’ll often say something like, well, the way Zoloft works is it increases the levels of serotonin in your brain, in your synapses, the neurons, and presumably the reason you’re depressed or anxious is that you have some sort of a deficiency. And I say that not because I really believe it, because I know that the evidence isn’t really there for us to understand the mechanism. I think I say that because patients want to know something, and they want to know that we as physicians have some basic understanding of what we’re doing when we’re prescribing medications. And they certainly don’t want to hear that a psychiatrist essentially has no idea how these medications work. (read the rest of the article)

Also from a couple of years ago on Beyond Meds, I published the Chemical Imbalance Myth by Chris Kresser, which has become a long-standing favorite article on this blog still getting thousands of hits per year. It’s a very good scientifically based article, well worth the read.

After laying out the science (or lack thereof) Kresser asks:


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. read the whole article

UPDATE:

another more recent piece from Bruce Levine at Mad in America:

Psychiatry’s Manufactured Consent: Chemical Imbalance Theory and the Antidepressant Explosion

Editor-in-Chief Emeritus of the Psychiatric Times Ronald Pies, a staunch defender of psychiatry and the American Psychiatric Association, believes that the APA fulfilled its obligation to inform the general public of the truth with a 2005 statement for the general public about depression that begins: “The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.” But how many Americans read APA statements? And even if they had read that statement, they would not necessarily have come to the conclusion that the chemical imbalance theory was fiction and that drug commercials were deceptive. Even Pies admitted on April 15, 2014, “But still, shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.”

Thomas Insel, director of the National Institute of Mental Health (NIMH), in recent years has been increasingly critical of some of psychiatry’s theories and practices. In a February 25, 2007 interview withNewsweek, Insel did more explicitly tell the American people the truth that depression is not caused by low levels of the neurotransmitters serotonin or norepinephrine. However, he did not proclaim that drug commercials’ depiction of the cause of depression was patently false. (read more)

And one more update from Joanne Moncrieff, MD:  The Chemical Imbalance Theory of Depression: still promoted but still unfounded

Well, again, there are dozens of other places on Beyond Meds where this fact is discussed. Chemical imbalance theory for mental illness, in general, is not in the least bit supported by science!

Here is one more place it’s brought up by Robert Whitaker: “The chemical imbalance theory of mental disorders was disproven long ago” — in that article Whitaker highlights that Marcia Angell (former Editor in Chief of The New England Journal of Medicine), too, in her pieces in the New York Review of Books mentions that the chemical imbalance story didn’t appear to have merit.

So I guess now it’s official since NPR finally said something, eh?

Updated ongoing list:

*it is potentially dangerous to come off medications without careful planning. Please be sure to be well educated before undertaking any sort of discontinuation of medications. Do not assume your MD will know how to do it either. They are generally not trained in discontiuation. They don’t always understand that they don’t know how to help either. See: Psychiatric drug withdrawal and protracted withdrawal syndrome round-up

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