The Chemical Imbalance Theory: Is it really true?

A version of this article was originally written and published through Psychology Today. Find it here.

---

Disclaimer: This article was not written to downplay the seriousness of depression and any other forms of mental ill-health. Nor was it written to discount the role and benefits of antidepressants in treating serious mental health conditions. It was written instead to highlight the controversy surrounding the well-known chemical-imbalance theory, and the ‘disease-based’ model of mental heath.

Fortunately, there is another narrative out there, one that speaks to our ability to renew our minds and experience places of change and renewal.

---

What is the Chemical Imbalance Theory?

Throughout doctors’ offices and mental health clinics, when suffering individuals report ongoing symptoms of depression, anxiety, mood swings, or other challenging mental health symptoms, they are often offered an explanation rooted in the chemical imbalance theory, which asserts that certain brains are chemically altered and deficient in certain neurotransmitters (usually serotonin) and are in need of a pharmacological fix.

From here, patients are often prescribed something like Prozac, or another well known antidepressant, which is believed to increase the amount of serotonin in the brain, and thus “fix” the chemical imbalance.

For some, these medications work wonders and provide significant relief from debilitating symptoms. Others may struggle with the unpleasant side effects, and may find little to no relief. Despite how well they may work for the majority of the people taking them, this narrative that the mentally ill need psychiatric medications, perhaps indefinitely, in order to fix or correct faulty brain chemistry continues to dominate our culture’s understanding of mental health treatment and pathology. 

But what if we considered, just for a moment, how true this theory actually is? 

What if it’s not as clear cut as certain helping professionals, pharmaceutical ads, or psychopathology textbooks make it out to be? 

How might this change the way we view certain medications or our larger treatment modalities?

How might this impact the way we see ourselves, our brains, and our capacity to change?

Before moving forward, please remember that I am not here to tell you what you should, or should not do with any medications you might be taking. This is a conversation I encourage you to have with your medical provider.  As a mental health provider, I believe that medications do have their place, and can be helpful for certain times and places. I’m not here to try and sway you in any specific direction, or encourage you to jump on the anti-psychiatry bandwagon — for that won’t get us very far, nor is it helpful. 

 I do encourage you to think with an open mind and do your research wisely. All too often, we fall into traps of accepting beliefs, ideas, and ways of life, because that’s “just how they’ve been.”

May the following information shed some light on another narrative, one that rises above the notion that mental-ill health is rooted solely in a chemically deficient brain, destined to dysregulation and mental chaos without some sort of life-long pharmaceutical intervention. 

The Rise in Antidepressants

Antidepressants have dominated the field of mental health treatment, and in 2010, the CDC reported antidepressants as the 2nd most commonly prescribed medication costing almost 10 billion dollars (1). Between 2011 – 2014 about one in eight Americans aged 12 and over reported taking antidepressants, with females leading the way (2). There’s been a 65% increase in antidepressant use over a 15-year time frame, from 7.7% in 1999-2002, to 12.7% in 2011 -2014.

The Chemical Imbalance Theory: A Driving Force?

Since the 1980s, pharmaceutical companies have directly promoted something called a “chemical imbalance theory” to consumers and practitioners, to supposedly explain the nature of how antidepressants work. This theory upholds the belief that certain forms of mental illness are tied to a chemical deficiency (serotonin) within the brain. If consumers believe that their mental illness is directly related to a deficiency in their brain, then they will naturally gravitate towards a treatment that “fixes” this imbalance.

Yet, as Dr. Pies, a professor of psychiatry and Editor in Chief Emeritus of Psychiatric Times, states, this “chemical imbalance theory” is more like, “The Theory That Never Was” (3). He writes:

“… SSRIs were accorded a rock-star status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the “chemical imbalance” trope in their direct-to-consumer advertising.”

Dr. Pies goes on to claim that within the field of psychiatry, there was never a “unified, concerted effort…to promote a chemical imbalance theory of mental illness.”  

Causes of Disorders Are Unknown

While certain hypotheses and theories of mood disorders developed over the years, many have since been recognized as flawed and inadequate, including this chemical imbalance theory on trial. Currently, the precise causes of major mood disorders are still unknown. Dr. Pies references the 1978 statement from the American Psychiatric Association as the closest and most accurate position on the etiology and treatment of psychiatric disorders:

“Psychiatric disorders result from the complex interaction of physical, psychological, and social factors and treatment may be directed toward any or all three of these areas” (4).

American Psychiatric Association. Position statement on active treatment. 1979

Dr. Shipko, a psychiatrist who focuses on anxiety/panic disorders and the side effects/withdrawal effects of antidepressants and benzodiazepines, has also spoken out on the flaws of this “chemical imbalance theory.” Based on observations in the field, he developed an informed consent,that addresses certain myths related to SSRI treatment along with areas to consider before starting or stopping antidepressants (5).

In his consent, Dr. Shipko writes:

“There is no such things as a ‘chemical imbalance.’ This phrase evolved largely as a means to market the antidepressant drugs but has been erroneously picked up by physicians as explanation why patients should take antidepressants forever. Often physicians will tell their patients that they have a “chemical imbalance” and that the medications will correct this chemical imbalance. To date there has been no demonstration that patients with depression or anxiety have anything fundamentally wrong with their brain chemistry that causes depression.

Although the drugs alter serotonin in the nerve synapses, depression is not a result of a diseased synapse. The decision to take an SSRI antidepressant should not be based on a mistaken belief that the drugs are correcting or curing a diseased brain. To be specific, the manufacturer’s labels note that the mechanism of how the drugs work is unknown”

Dr. Shipko’s Informed Consent for SSRI Antidepressants. 2012.

Now, claims stating that antidepressant treatment can cause long term, permanent damage are largely unsubstantiated. It seems as though much of these areas are still up for debate, as we have yet to fully understand the mechanisms behind these medications, and even the brain itself. 

Hardwired for Renewal

In our bodies, we can suffer really hard things, and as I’ve stated above, medications can be helpful for certain cases. There is no shame there. For some people, a genetic or biological component may also play a role in mental illness, and medications can help relieve certain symptoms.  

Yet thankfully, we’re never stuck in any dysregulated brain chemistry or challenging genetic expressions.  God gave us brains that are incredibly gifted at changing and reprogramming —  a process typically referred to as neurogenesis, or neuroplasticity. We don’t have to live entangled within a disease-based model any longer, assuming that we’re stuck with what we have, and largely incapable of change (e.g. often an underlying notion of the chemical imbalance theory). We’re hardwired, instead, for renewal.

The notion of a “chemical imbalance” continues to saturate our culture’s understanding of mental illness, and may limit us to narrow minded perspectives and treatment modalities. Depression, anxiety, mood dysregulation, and other forms of mental distress may be tied to other underlying conditions (e.g. poor diet, inflammation, autoimmune problems), life-stressors, trauma, and/or other factors at stake — not merely a chemically deficient brain (Read more on the connections between thyroid dysfunction and mental ill-health here)

As Dr. Pies states,

“As for the bogus chemical imbalance theory and its misattribution to the profession of psychiatry, it is time to drive the stake into its misbegotten heart. We must focus on providing our patients greater access to holistic, comprehensive psychiatric care.”

If you’re interested in pursuing additional holistic approaches for health and mental health, that go beyond the traditional medical model, start by addressing any underlying medical conditions (e.g. thyroid dysfunction, chronic inflammation, nutritional deficits, or hormonal problems) that could contribute to, or exacerbate any challenging symptoms. Read and explore articles from holistic psychiatrists, Kelly Brogan and Ellen Vora on ideas and direction for next steps.

References:

1. Weil, Andrew. Mind Over Meds: Know When Drugs Are Necessary, When Alternatives Are Better and When to Let Your Body Heal on Its Own. , 2017. Print.

2. Pratt, Laura A et al. “Antidepressant Use Among Persons Aged 12 and Over:United States,2011-2014.” NCHS data brief ,283 (2017): 1-8.

3. Pies, Ronald. “Debunking the Two Chemical Imbalance Myths, Again.” Psychiatric Times, 2019, www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again.

4. American Psychiatric Association. Position statement on active treatment. Am J Psychiatry. 1979;136:753. http://www.psychiatry.org/File%20Library/Learn/Archives/Position-1978-Active-Treatment.pdf. Accessed September 1, 2020.

5. Shipko, Stuart. Dr. Shipko’s Informed Consent for SSRI Antidepressants. Kindle ed., 2012.