The Latest on Chemical Imbalance ~ It is real or fake?

Is it true that chemical balance is false? Another article appeared this week with the latest news on the chemical imbalance theory. The article challenges whether or not the chemical imbalance theory of depression is real or fake. Although this news has been swirling around wildly since late summer, the new article once again severely challenges whether it is real or not. People around the world have started questioning what is going on.[1,2,3]

 

The Chemical Imbalance Theory

The chemical imbalance theory proposed that serotonin, a neurotransmitter in the brain, was out of balance – meaning there was less serotonin than what is a normal level – which then caused anxiety and depressive disorders. The first serotonin theory was first introduced sixty years ago. In 1952, clinicians at Staten Island’s Sea View Hospital began treating tuberculosis patients with a new, experimental neurotransmitter-acting drug.[4] They found that those being treated who were severely depressed started to feel better. This led psychiatrists to believe that there must be a chemical out of balance that the drug was helping get in balance. Afterwards, drug companies began pushing the theory with the advent of more and more drugs to combat it. Look at one of the first drug commercials.

This commercial was the first of its kind and began a major ad campaign in the United States to sell the theory, and thus the drugs. Prozac and many others would come later.

 

Have they proven chemical imbalance in the past 60 years?

Simply as possible: no. As I have taught biblical counseling training over many years, I have often lectured over depression. Following the latest research and maintaining regular conversations with medical doctors Robert Smith, Dan Wickert, Charles Hodges, and others, plus interactions with Ed Welch and John Henderson, I have taught that chemical imbalance was always, presently, as best a theory without any biological etiology. In other words, psychiatrists knew drugs made patients feel better but could not say why. This is still true.

One of the early detractors to this theory was Dr. Allen Frances, a professor emeritus of psychiatry at Duke University who led the task force that created the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994. He also was the author of Saving Normal: an Insider’s Revolt against Out-of-control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.[5] He was writing about this issue years ago.

Bruce Wiseman, author and former educator writes: The “chemical imbalance” theory, popularized by marketing, is “no more than psychiatric wishful thinking. It has been thoroughly discredited by researchers, doctors and scientists. The only reason it exists is that it makes it easier for psychiatrists to drug vulnerable and often desperate individuals. It is driven by more than $23 billion in drug sales each year.“[6, emphasis original]

 

Upstream and Downstream

Since the 1990s, leading psychiatrists and medical researches have questioned the legitimacy of this study. David Powlison referred to this in my doctoral program as early as 1999. Ed Welch also discussed it with us in those early days. Powlison specifically mentioned the idea of Upstream and Downstream. The term Upstream refers to the leaders in the field, the key researchers, and those who edit the DSM. The term Downstream ultimately relates to the person on the street; however, it also includes local teachers, school counselors, primary care physicians, and others on the more local front.

Dr. Ronald Pies, the editor-in-chief emeritus of the Psychiatric Times, stated in the July 11, 2011, issue of the Times: “In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim [about chemical imbalance in the brain], except perhaps to mock it.”[7]

Upstream left this theory years ago; not Downstream. Regarding the normal person on the street, upwards to 80% of the public believe that depression is caused by chemical imbalance. Year over year, prescriptions for psycho-pharmaceuticals or psychotropic medication continues to climb. Between 1-2 people in 10 in the United States take some kind of psychotropic medication. More so in common to women than men, antidepressants increasing flood the market more and more each year.[8]

Yet, people continue to feel bad without much change in quality of life.[9]

What do we do with this information?

Please hear me carefully. Even though this diagnosis may be fraught with problems, there is no way to minimize people’s suffering. As they suffer, we must be willing and compassionate to walk with them and help where possible. I am not minimizing depression or people’s experience of their suffering in any way. However, it is clear, chemical imbalance is still at best a sixty-two year theory without any supporting evidence.

First, we must realize that chemical imbalance is one of many ways to consider depression. There are many medical reasons that people can feel quite down or depressed. As research continues, there may be many more determined. Therefore, it would be both premature and immature to suggest that depression does not have a biological etiology. No one is saying that. The research at this point is simply saying the reason is not chemical imbalance. There are a number of proven medical conditions which cause people to feel down or depressed. As always, do not forget, it is not a sin to feel down; it is only a sin to respond sinfully to feeling down.

Second, for those on antidepressants and other psycho-pharmaceutical drugs, only make medication choices with your medical doctor (or psychiatrist). Again, no person should ever suggest you come off of a medication other than your medical doctor. And, if you believe it would be wise to come off of a medication, change its dosage, or change medications, always do those things under medical supervision.

Third, whenever some individuals are going through a crisis situation, they may need to be placed on medications to help keep them alive. Sometimes intervention includes a hospital stay. When a person is considering suicide where help is minimal, talk to a medical professional to get help.

Fourth, talk with someone. Whenever you feel down or depressed whether you are on or off medication, talk with someone you trust. The best way to handle depression is through community, comradery, and biblical discipleship. Engage with the people around you. And, if you are one of the people around, listen, demonstrate the compassion of Jesus Christ, and seek to help where needed.

Fifth, pray longingly for God’s mercy and grace. We long to go to heaven where it is perfect. All of us will get to experience the joy of heaven where the presence, power, and other effects of sin are forever gone.

Six, love each other well. Regardless of how you personally feel, move toward others in love. Use the energy God provides for His glory and the good of others around you.

Seventh, remember, medicine never changes the heart of a person in the image of God. Medicine may provide mercy, offer some help, and give some relief; however, medicine does not change the person at the heart level. God leaves that to our personal effort and the process of personal discipleship through the local church. We live it out and work it out with each other in Christ in communion.

Please note: this article was written to help people think through the issue of chemical imbalance. This article does not say all that could be said by any means related to depression, the body’s influence on the heart, or steps forward for those who have been diagnosed clinically depressed.

 

Three articles which may help: here, here, and here.