Antidepressants and the Myth of the Chemical Imbalance
The therapist told me not to worry and explained that my recent bout with sadness was just a manifestation of the grief caused by the "mourning of the loss of my youth". As a graduate student in my thirties I was forced to let go of my dreams of pitching in the Majors, becoming an astronaut, or playing guitar for a sold out Madison Square Garden. I was experiencing the realities of aging. In spite of the vigorous exercise routines and obsessive diets, my body became less and less attractive and the shining examples of youth and energy strutting the university campus were a stabbing reminder. In our increasingly vain culture, the slow decline of the body and mind sends many people spiraling down into listlessness. The experience is quite common but I felt isolated and alone. According to the random tests I found online,(http://www.depressedtest.com/), my mood could be classified as a high to moderate for Major Depression. Looking up the disorder in the Diagnostic and Statistical Manual of Mental Disorders(DSM) http://www.psnpaloalto.com/wp/wp-content/uploads/2010/12/Depression-Diagnostic-Criteria-and-Severity-Rating.pdf, the updated bible of the field of Psychiatry, my symptoms showed that I was in fact clinically depressed. I sought help from a psychologist who practiced a very common talk therapy over a psychiatrist who easily could've prescribed Paxil or Prozac. Influenced by the stigma of antidepressants being a quick fix solution and the fear of any unwanted side effects of the drugs the decision was easy for me. But was I qualified to make what some professionals consider a medical decision of diagnosing and treating my condition? Was I truly suffering from major depressive disorder characterized by a chemical imbalance in my brain and if so would I have benefited more from taking medications that supposedly "balanced" those chemicals?
Depression is a tough diagnosis to make even for a doctor. There are varied degrees and various types of the disorder. Causal theories range from the psychological to the social to the spiritual explanation. Symptoms, either of mild intermittent bouts of sadness or of the feelings of constant hopelessness associated with suicide, are of less concern in the field of neuroscience has no problems grouping them together under one label. Both communities of neuroscience and psychiatry generally agree that genetically predisposed individuals show certain changes in neurotransmitters inside the brain that affect their mood. The murky understanding of how these changes occur has not stopped either part of the scientific community from labeling depression as a disease or disorder mainly characterized by a "chemical imbalance" in the afflicted. In the last fifty years the rationalist view of depression has in most cases outweighed empiricism. The inconclusive evidence of contradictory studies with regard to treatments has not deterred the influences of the pharmaceutical industry and the vast business of psychiatry from propagating their "cures" for the "chemical imbalance." The effectiveness of antidepressant drugs and what they essentially do in treatment has recently come into question and along with it the whole arguably unsubstantiated theory of the biochemical cause of depression. In light of the new studies, neuroscience which for years has maintained a "chemical imbalance" theory of depression is now claiming that this hypotheses is invalid and therefore calling the effectiveness of anti-depressant medications into question. Their rationalist view that has held strong to the idea of serotonin levels as the key to treating depression is now succumbing to the evidence of new and older studies and beginning to walk away from the science behind current medications. The field of psychiatry, arguably more humanistic by nature, is interested finding the best ways to combat the symptoms of what in some cases is chronic mental illness. Psychiatrists seek to treat suffering patients with combinations of therapies and the inconclusive science is less relevant than what treatment works best. Along with the pharmaceutical companies that produce antidepressants, the science of psychiatry has a vested interest in standing by the labeling of depression as a "chemical imbalance."
The modern neuroscience that first posited the theory of an imbalance has its origins in the physiological or biological view of the condition. Depression has always been a health problem for human beings. Accounts have been found in ancient Mesopotamian texts of what was first called "melancholia." At that time only priests attended to those suffering mental illnesses because they were believed to be possessed by demonic spirits while physicians only treated physical injuries. Moving forward through history one finds divisions in the perception of melancholia. Most societies see it as a spiritual malady but instances of more scientific thought are found in such cases as Hippocrates, an Ancient Greek physician, who thought that depression, "was caused by too much black bile in the spleen."http://www.gulfbend.org/poc/view_doc.php?&id=12995&cn=5 . Archaic as it seems, this approach is biological in nature and bears resemblance to the practice of lobotomy or electro-shock therapy in the treatment of mental illness that continued well into the 20th century. The prominent view of melancholia shifted back and forth from one based in science to one in the spiritual or theological, until the advent of psychodynamic theory. In 1917, Freud wrote that the condition was a response to loss. The depressed, angry over the loss, had a weakened ego which then resulted in self-destructive behavior. Later on in the twentieth century psychotherapy took the place of the spiritual remedy, and to a degree analysts took on the responsibility of the priests. But despite of the relief provided to patients by these modern day confessions, these therapeutic sessions did not stop neuroscience and the medical community from finding a biochemical treatment. In 1951 it was discovered that a tuberculosis medication reduced symptoms of depression in patients. In 1954 patients in another hospital prescribed Raudixin for there blood pressure began feeling lethargic and in some cases suicidal. The first drug raised the chemical or neurotransmitter Serotonin in the brain of patients while the Raudixin lowered the concentration within the brain. The connection to serotonin made by the medical community would lead to the chemical-imbalance theory and would provide the more scientific answer to depression than Freud's myth of the mind. Eventually the theory would give birth to a market for antidepressant medications within the industry of psychiatric drugs.
The theory as it still stands today is that nerve cells called neurons interact through chemical signals called neurotransmitters, which come in the form of serotonin, dopamine and norepinephrine. Depression shows a decrease in the concentration of these chemicals and weakens the signals between neurons. Anti-depressant medications raise these levels of chemicals in your brain.(Click Here: http://www.youtube.com/watch?v=sc-4zhqViQ4)
The problem today is that this theory, which is the justification for how depression is currently treated and how mass marketed drugs such as Prozac or Paxil "work", is on the verge of crumbling. Scientists have believed for centuries that depression has a variety of causal factors some of which were physiological but for nearly fifty years the idea had held that, despite whatever initially set off the reaction inside the brain, the core of depression was a chemical imbalance. The label "chemical imbalance" has been stamped on mental illness and used to describe the central cause of any mild mood disorder. Arguably this has led to people outside of the science community and the field of psychiatry speaking about decreased levels of serotonin or dopamine as casually as they would psychoanalyze their friends or coworkers in standard Freudian terms. Sadly and just like with much of Freud's work the scientific evidence is not there. Through decades of research and clinical tests on the effects of raising serotonin in depressed patients the data was not conclusive. Science has had no legitimate proof that mood would always be altered by serotonin levels in the brain and yet for decades this was the commonly accepted theory. Siddhartha Mukherjee, a professor of medicine in the oncology division at Columbia University writes in her New York Times Magazine article "Post-Prozac Nation":
"An antidepressant like Paxil or Prozac, these new studies suggest, is most likely not acting as a passive signal-strengthener. It does not, as previously suspected, simply increase serotonin or send more current down a brain’s mood-maintaining wire. Rather, it appears to change the wiring itself. Neurochemicals like serotonin still remain central to this new theory of depression, but they function differently: as dynamic factors that make nerves grow, perhaps forming new circuits."
This is the latest theory on how serotonin levels affect mood. Research has led scientists to believe that neurotransmitters make nerves grow. Luckily for the pharmaceutical companies, neurochemicals are still crucial to the new theory. Paxil, Prozac, and Zoloft will still be prescribed along with other drugs of their kind until the science renders them entirely useless in combating depression. The most extreme cases of the disorder, more chronic cases of depression, have shown to respond positively to antidepressants but only momentarily. Studies have shown that the alleviated symptoms can return multiple times in patients within a lifetime suggesting that the existing treatment is not a cure for the underlying condition. The lack of a definitive understanding of the chemical stew that is the brain has not stopped the science community from standing it's ground regarding the importance of serotonin and other chemicals acting as neurotransmitters. Many psychiatrists and scientists know for certain that the chemical imbalance or low-serotonin theories are gross simplifications and yet they still remain at the core of the rhetoric. The hard proof is thought to be in the chemistry even though some studies of antidepressants show little effect on patients and in some cases a placebo seems to work just as well. The attacks on these studies and theories surrounding them only show a reluctance to relinquish a particular paradigmatic phase in the neurological analyzation and the medical treatment of depression.
The Harvard scientist Irving Kirsch has done substantial work over the last twenty years on the placebo effect of antidepressants. His in depth research shows how the pills that seventeen million Americans take today to fight depression are no more effective than a sugar pill. For any small superiority that antidepressants display statistically over the effectiveness of a placebo, Kirsch claims that the side-effects of the pharmaceutical drugs a patient experiences makes them acutely aware that they are on a medication and start to feel better. To further prove his theory, Kirsch replaced the placebo drugs for other physical conditions and got the same results. The expectation of healing is extremely powerful in a placebo and as the scientist explored the clinical studies done by the pharmaceutical industry(results of which approved by the FDA), he found how it could be exploited. Kirsch found that some of the results of clinical trials were omitted in some cases skewing the data. http://www.newyorker.com/arts/critics/atlarge/2010/03/01/100301crat_atlarge_menand?currentPage=2
Of course this scientist's findings and others like them have immediately been marginalized. Psychiatrists see the positive effects of the antidepressants in their patients and seem to shrug their shoulders at the placebo effect. Many admit that the effect exists in a large percentage of cases of those with mild depression but seem to believe that as long as the patient is feeling better, the science explaining why is in a sense not relevant. If a patient is being cured of the debilitating symptoms of depression and sees a positive change in mood then the doctor is doing his or her job. Disregarding the placebo effect studies and the evolving neuroscience of treating depression suits the pharmaceutical industry's bottom line. The multi-billion dollar industry has an interest in keeping the debate over the science going. Drug companies need to keep pushing pills whether they are placebos or not. So they produce advertisements promoting these antidepressants as chemical cures for the sadness that comes with More people everyday are diagnosed or are diagnosing themselves with depression. http://youtu.be/twhvtzd6gXA
This lapse in the science concerning treatment perpetuates the use of anti-depressant drugs and the belief in the serotonin deficiency theory. Disregarding years of data shows little correlation between the production of neurotransmitter chemicals and symptoms of depression is a blatant denial of science in the name of business. The lack of attention and credence given to these current studies into antidepressants by the media is in large part due to the contradictory evidence given by the pharmaceutical industry's independent studies into the effectiveness of their product. Their job is to sell you more pills. They would like you to think that the reason you are feeling blue is because you have a chemical imbalance in your brain, one easily remedied by a doctor's prescription. They would like you to know that if, like myself, you are mourning the loss of your youth and are having are difficult time coping, you do not have to share those very normal but seemingly intimate feelings with a paid stranger with a degree in psychology. You can talk to your doctor about Zoloft instead.