We’ve all heard the theory — a chemical imbalance in your brain causes depression.
Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me. Most researchers now believe depression is not caused by a chemical imbalance in the brain.
How did we come to this conclusion? Through years of additional research. But now some are jumping on the next brain bandwagon of belief — that depression is caused by a problem in the brain neuronal network.
Jonah Leher makes the case in today’s Boston Globe:
In recent years, scientists have developed a novel theory of what falters in the depressed brain. Instead of seeing the disease as the result of a chemical imbalance, these researchers argue that the brain’s cells are shrinking and dying. This theory has gained momentum in the past few months, with the publication of several high profile scientific papers. The effectiveness of Prozac, these scientists say, has little to do with the amount of serotonin in the brain. Rather, the drug works because it helps heal our neurons, allowing them to grow and thrive again.
Okay, I’m game… But Leher fails to bring any sort of balance to his article. It’s another love letter to the brain scientists studying in this field, but ignores the decades’ worth of research showing that non-medical treatments are also effective in treating depression. Like, you know, psychotherapy.
The obvious answer is that psychotherapy also helps in some way to help “heal our neurons.” Which begs the question — if healing our neurons is key, there are likely dozens of possible ways to do so. Why only focus and mention the medical cures?
Because of Leher’s deification of the power of medicine:
The progress exemplifies an important feature of modern medicine, which is the transition from a symptom-based understanding of a disease – depression is an illness of unrelenting sadness – to a more detailed biological understanding, in which the disease is categorized and treated based on its specific anatomical underpinnings.
This would be true if mental disorders were pure medical diseases. But they are not and have never been. They are human constructs of aberrant behavior or emotions. They are by no means universal (although some of the big ones, like depression, can be found in most human societies).
This new scientific understanding of depression also offers a new way to think about the role of drugs in recovery. While antidepressants help brain cells recover their vigor and form new connections, Castren says that patients must still work to cement these connections in place, perhaps with therapy. He compares antidepressants with anabolic steroids, which increase muscle mass only when subjects also go to the gym.
Yeah, because that’s how all medical treatments work, right? You need some encouragement for a drug to take effect? This is nonsense. Drugs either work or do not, they do not need to be “cemented” to the brain through therapy.
It also contradicts all of the extensive body of research that shows psychotherapy that works for depression without any drug whatsoever. What magical process occurs simply through talking with another human being that can change the very structure of your brain’s neuro networks?
Perhaps one day science will tell us. But these love letters in the media to neuroscientists have got to stop. Neuroscience will one day provide us the “keys to the kingdom” of understanding our brains. But until studies are done on humans (most of the studies Leher cites in his article — but fails to mention but once — are done on rats, not humans; a rat’s brains and a rat’s “depression” may be nothing like ours), we should approach this most recent theory with a healthy dose of skepticism.
Many researchers staked their professional careers and reputation on the theory that a “serotonin imbalance in the brain” caused depression. This was incorrect. This may also be the case of this latest fad brain theory to see the light of day and in another decade, may also be proven to be equally untrue. Until then, folks (especially the media) should keep a healthy skepticism about rat brain studies and new brain theories on depression. And ensure they account for or have a reasonable explanation for the effectiveness of psychotherapies such as cognitive-behavioral therapy (CBT) for depression.
Read the full article: How Prozac sent the science of depression in the wrong direction
35 comments
People think that you catch a “mental disorder” like you catch the flu… it’s so sad how misled the public is.
Indeed.
But as scientists explore alternative hypotheses, I don’t think we should just grab the next good-sounding thing that fits with some data and suggest that’s the cause of everything.
Medical science holds a lot of answers, but not all of them. And as the original serotonin theory of depression shows us, we can often spend decades pursuing what ultimately are dead-ends.
While I agree with most of the said opinions, I do believe that because of neuroplasticity, added work will be necessary to influence the neural network in addition to the drugs. It’s not that far fetched of an idea.
I like your skepticism, but you are making the same mistake as the article’s author. What we call depression is likely more than one condition that we cannot yet differentiate. Depending on what you have, and how it was caused, different types of treatment are appropriate. The one thing that all treatments have in common is that they don’t work for lots of people who take them. The logical conclusion is that there is no single holy grail of treatments.
As far as mental illnesses go, we are at about the same level of understanding we had of physical ailments in the mid 18th century. Remember that no matter how sophisticated we think we are, they will look back at us in 200 years and laugh at our ignorance and magical thinking.
The best book on this subject is “Blaming the Brain”, by Elliot Valenstein. The book is a bit dated by now but is still an excellent treatment of the biological basis (or lack thereof) of mental disorders. See the Amazon page here:
http://www.amazon.com/Blaming-Brain-Truth-Mental-Health/dp/0743237870/
The author is a respected neuroscientist at the University of Michigan (actually, I think he’s retired at this point).
While I agree that it’s misguided simply to accept as fact the newest neuropsychological theory du jour about mental illness, surely you are not suggesting that this casts doubt on the basic concept of a biological component to mental illness, right? I am no fan of the pharmaceutical industry, but as a sufferer of fairly chronic depression (and coming from a family in which several others suffer from major depression, and having had a reasonably happy and secure childhood free of abuse or significant hardship), I have gotten more relief from antidepressant medications (whether they work for the reasons stated in the tv commercials or not) than I ever did from psychotherapy. In my experience, therapy has sometimes been useful once I’m already up and functioning. But it has never sufficed to pull me out of a really deep funk—for that, antidepressants have been far more effective. I’m frankly much more sceptical of being cured by talk therapy than of neuroscientists eventually figuring out what is going wrong in the brains of people like me. That still leaves us the question of what to do in the meantime, and perhaps psychotherapy is one answer, but I think you will find many many people who, even after giving it a really genuine effort, will attest to its limitations.
I’ve kind of been expecting this for a long time. I always thought the serotonin hypothesis lacked legs, despite the bouncing smiley face commercials for Zoloft. I suppose they can now change their animation to be the healing of neurons instead of the release of serotonin.
I have to say that I am pleased with psychologists who are starting to recognize the limits of antidepressant medication, and that ‘psychotherapy only’ is a viable option. Now, if there are serious consequences that could occur if the depression is not treated as rapidly as possible, that’s when I recommend medication. Otherwise, we work on it in psychotherapy. Good article John!
I’ve kind of been expecting this for a long time. I always thought the serotonin hypothesis lacked legs, despite the bouncing smiley face commercials for Zoloft. I suppose they can now change their animation to be the healing of neurons instead of the release of serotonin.
I have to say that I am pleased with psychologists who are starting to recognize the limits of antidepressant medication, and that ‘psychotherapy only’ is a viable option. Now, if there are serious consequences that could occur if the depression is not treated as rapidly as possible, that’s when I recommend medication. Otherwise, we work on it in psychotherapy. Good article John!
Hmm, if antidepressants heal neurons, why are so many people getting cognitive side effects from being on these meds for years? Why did I get those plus a hearing loss from Remeron if these drugs are healing?
Of course, people like me who complain about this are blown off as crazy scientologists even though I know nothing about scientology. I am just sick and tired of research done on rats being passed off as facts and which has the potential to cause the same type of harm that I suffered to many more people.
Thank you Dr. Grohol for speaking the truth on this site.
In my experience anti-depressants are a short term fix for a long term problem. I have bi-polar II (undiagnosed for 15 years) and have been on Epilim for the past year and have made a decision (in consultation with my doc) to be drug free. I have been drug free for 2 months and using cognative theorpy. My opinion is that any mental health condition that does not involve psycotic episodes can be ‘managed’ without the use of drugs. I am currently in my 3rd year at uni, hoping to be accepted into the Clinical programme. For my Phd, my thesis will be on ‘drug free treatment’. Talk theorpy is just a tool to give one the confidence to deal with ones own mental health.
If you have any thoughts on the ‘drug free’ treatment of mental illness please feel free to email me. [email protected]
Thank you.
Thanks for this, Dr Grohol. When I recently saw TV ads using the chemical imbalance vocabulary, I assumed that they were reflecting some newly found evidence for this.
All the research that supposedly suggests that psychotherapy treats depression just tells me that psychiatry has failed to usefully classify different types of depression. To think that psychotherapy can treat certain types of major depression is as ridiculous as thinking it can treat Parkinson’s Disease.
All the research that supposedly suggests that psychotherapy treats depression just tells me that psychiatry has failed to usefully classify different types of depression. To think that psychotherapy can treat depression in general is as ridiculous as thinking it can treat Parkinson’s Disease.
After suffering my initial major depression, I tried and failed at remaining “drug free” 3 different times. After being drug free for a couple of months, I would need to restart my medication (different depending on the MD)every time. I now have been on longterm drug therapy for the last 4 years without any relapses. Psychotherapy did nothing for me, except to accept that I needed medication. SSRI’s such as Zoloft/Wellbutrin etc etc. are the only things that keep me from crawling in a hole and pulling a lid over me. I feel great now…but if I stopped taking them I’d be right back in a Psych ward.
At this stage I trust the drugs over the psychotherapists. I had one who went mad on me and thought he was being attacked by Satan, another who very blatantly and deeply picked his nose in front of me the whole time and whose colleague told me he’d damaged a lot of people – and those were just the NHS ones. The ones I saw privately were equally loopy and dangerous. I was living in a small town where everyone knew everyone else and so you got to really know about these people aside from their professional facade. The therapy group was even worse – I was physically threatended by a rather violent girl and they all thought I was a snob because I read books and could speak properly.
drug cos., drs. have forgotten the ‘do no harm’ of medical ethics simply for money. a chief ‘error of reasoning'(even if they were ethical)
comes down to the fact that ‘one man’s meat is another’s poison’. no 2 people are remotely alike, so how may any claims of drug efficacy be taken seriously, as a ‘catch-all’? read dr. mosher’s letter of resignation from the APA–there is truth. the unethical deeds of both drug cos. and their ‘captured-by-loot’ ‘shrinks’ have become simple perps of a global holocaust, unrivaled
historically–hitler was an underachiever vs. this bunch. IMHO, only when drug test are performed on drs. will the scope of lethal ‘core-personality-killing’ abuse stop. make no mistake–this is a Capital Crime against humanity–and there is an ultimate ‘Justice’ of Life–it may be slow, yet it is certain.
Face it – when it comes to treating mental disorders, there is only one Truth you can speak of any and all treatments, be they chemical, psychotherapeutic, or spiritual; and it’s the same thing you can say for healing the same things with prayer:
They work. Except when they don’t.
~~~
@jamworks — Agree or disagree with the research, but there’s decades worth of large-scale, randomized studies that shows psychotherapy works for virtually all types of depression (there are even some that shows it can work on its own against the most severe depressions).
@LilyRose — That’s true of all treatments for depression, absolutely. I only wish we had some way, some *reliable* way, of determining which treatments would be best for which person ahead of time. Today, despite a solid decade of significant brain research and MRI scans, it’s nothing short of educated guesses and trial and error.
anyway, this business of causality is really becoming a kind of incidental addendum to what the real news is: thus and such study has shown that there is a correlate between thus and such cognitive state and thus and such chemical action/reaction/imbalance/deficit/preponderance.
And why is this so? Because lacking any real definitive, empirical evidence of *any* causality between cognitive states and any other factor, chemical states are the easiest to change, alter, and control. And if there is a correlation between inhibiting the reuptake of serotonin and the alleviation of certain subject’s symptoms of depression, then which is the chicken and which is the egg becomes an academic question, when the real motivating factor is an economic one.
N’est pas?
~
Dr. Grohol, your reply to jamworks seems to dismiss those of us who report that psychotherapy has not helped us. Some study or studies might claim that psychotherapy works for all types of depression, but what makes these studies any more credible than the ones by neuroscientists that you discredit? Why should I believe a study that contradicts my own personal experience?
And, regarding your reply to LilyRose: do you think that, because neuroscience has failed to come up with a solution in the last decade, we should give up on scientific research? The fact that we haven’t solved the problem yet does NOT suggest to me that perhaps psychotherapy is the answer after all–that seems like faulty logic.
I never said one treatment fits all people. I firmly believe the research already points us to the answer — most people benefit from a combined treatment approach of medications + psychotherapy.
I haven’t discredited any neuroscience study. I’m simply suggesting that brain studies on rats shouldn’t be generalized too soon to humans’ brains. Let’s wait until we actually have some more human brain research before we all climb aboard the latest neuroscience explanation for mental disorders, shall we?
Psychological research, btw, *is* “scientific research.” I’m all for all types of scientific research. But I’m also for waiting until science shows reliable, consistent, reproducible results. Which it has yet to do confirming this latest brain theory of depression.
I’m in a grey zone as far as how I feel about all this biodeterminism. At first, I was pretty skeptical of what seemed to me to be one more attempt to define something as the Philosopher’s Stone re: psychology. Then I started questioning my own motives for being so dismissive of it. I don’t like the idea of consciousness essentially being a product of neuro-electro-chemical activity. How much does that color the way I perceive these theories?
Perhaps you’re aware of the work being done studying the Pet Scans revealing that a region of the brain called the Brodman Area 25 which showed to be overactive during periods of “profound negative mood (sadness)” That’s their phraseology – don’tcha just love jargon?
They’re stimulating the area (it’s in the prefrontal cortex) with electrode implants to create a paradoxical effect and calm the area down, the theory being that there’s a co-realation – perhaps causal – between BA25 and depression.
They keep looking. But co-incidence does not equal causality. On the other hand, is determining causality a requisite for using the knowledge as treatment?
Dr. Grohol,
I have had the experience of recovery from panic attacks and depression from “talk therapy” as well as medication. However, looking back over my life from a perspective of a now-medicated brain, (for clinical depression) I can clearly see that there was always something “not right” about my thinking and behavior from childhood. Medication saved my life and has given me the ability to feel “normal”. I thank God every day for the science that provided antidepressant medication. My medication is there for me every day. I can’t say the same about any of my therapists…or can’t afford to say that about any of my therapists. And it wouldn’t be right to expect that either. So, please don’t knock what works for so many of us. For the depressed and anxiety-ridden, it just adds more anxiety, and thoughts like, “Am I a loser cause I need meds?” Not!
I have had depression for many years, using both medical and psychotherapy intervention. Seems to me that we may benefit from calling it a “spectrum” disorder, as they do for Autism (I am a special education teacher). In autism, though they are still working on causes/treatments, they are discovering many therapies that work for some, don’t work for others, involve meds, don’t involve meds, etc. Looking at autism as a spectrum disorder helps me in my intervention of each individual child, as opposed to looking at it like he/she “has autism”. Which leads me to wondering if it is our over-all health care system/perspective of “cures” that is the problem. We are trained to want everything fast and furious. One-pill-will-cure-all, one-therapist/therapy-will-cure-all thinking doesn’t work. Let the scientists do their work, demand more time from our doctors, treat ourselves as individuals with individual needs. Isn’t this what’s “wrong” with our educational system, as well?
Maybe people are depressed because their lives are crummy. Maybe they are depressed because a moron is running the country. It has nothing to do with an “imbalance”; thats just a corporate marketing ploy for the drug companies.
maybe there is more than one type of depression. Not all depression is because you have a crummy life or because a moron is running the country. Why is a chemical imbalnce so far fetched? Is a diabetic only a diabetic because he/she eats too much sugar?
Just read any good thick book on the history of psychiatry. When you’re not weeping for the sufferings of their victims, you’re rolling on the floor with laughter at their ignorance. I have had psychiatrists threaten to tell my boss if they didn’t get their fees paid on time. They are charlatans, and even worse charlatans now that they are in the pockets of BigPharma and writing prescriptions based on who pays them the most. I have depression, have seen no less than 5 shrinks about it, never been helped although have been put every drug-of-the-month from lithium to Prozac, and all I have to show for it is huge bills and -oh yeah – one lost job. I fight it with cognitive therapy (this is the way you are, work around it) and just laugh as the “profession” of psychiatry becomes even more of a joke. Can’t wait to see their new ICDM. I understand that demon possession is coming back.
it is possible
I agree Hassan it is possible.
When I was first given Prozac it was as if someone had turned all the lights on. Years of therapy and stays in psychiatric hospitals and in a psychotherapeutic community-getting worse.
Yes- they don’t work for everyone and a lot does have to be done by you. The best ‘talking cure’ I have found is in 12 step groups-and once the lights are on you can face your fears with folks who have been there and don’t want your money!
Bravo, Dr. Grohol. This is an excellent post.
BRAVO Dr Grohol! My experience was EXACTLY like Tang Brown’s above. I also agree 100& with Jason and Jamworks above. The evolution of the ICDM shows that Science is not at work… merely the parroted-for-profit “opinions of the day”.
I also couldn’t agree more with your answers, Dr. Grohol- to
“@jamworks — Agree or disagree with the research, but there’s decades worth of large-scale, randomized studies that shows psychotherapy works for virtually all types of depression (there are even some that shows it can work on its own against the most severe depressions).
@LilyRose — That’s true of all treatments for depression, absolutely. I only wish we had some way, some *reliable* way, of determining which treatments would be best for which person ahead of time. Today, despite a solid decade of significant brain research and MRI scans, it’s nothing short of educated guesses and trial and error.
———–
My readings in the History of Psychiatry are truly terrifying.
Here’s a wonderful insight into the REAL-LIFE fate of Medical Innovators who are 100% CORRECT! Look at what happened to the first Dr. (Ignaz Semmelweiss) who insisted in about 1850-60 on requiring OB/GYN physicians in his clinic to just WASH THEIR HANDS between patients – after coming from the dissecting room, see:
http://en.wikipedia.org/wiki/Ignaz_Semmelweis
Semmelweis’ observations went against all established scientific medical opinion of the time. For his brilliant and pioneering discovery, he was thrown out of the Vienna Medical Society, deemed insane, and eventually beaten to death in an “asylum” by the attendants.
His eventual fate?
In 1865 János Balassa wrote a document referring Semmelweis to a mental institution. On 30 July Ferdinand von Hebra lured him, under the pretense of visiting one of Hebra’s “new Institutes”, to a Viennese insane asylum located in Lazarettgasse, not far from the General Hospital — definitely not one of Vienna’s best. Semmelweis surmised what was happening and tried to leave. He was severely beaten by several guards, secured in a straitjacket and confined to a darkened cell. Apart from the straitjacket, treatments at the mental institution included dousing with cold water and administering castor oil, a laxative. He died after two weeks, on 13 August 1865, aged 47, from a gangrenous wound, possibly inflicted by the beating. The autopsy revealed extensive internal injuries, the cause of death pyemia — blood poisoning.
This is STILL essentially the fate of medical geniuses among us who DARE to disagree with the long-held but 100% WRONG Opinions of their O-so-pompous Colleagues. Modern Psychiatry is a truly horrific joke on the patients, BUT a HUGE $$$-maker for these MD-charlatans and BigPharma.
Guess which wins – MONEY or HEALING THE PATIENT? The profession itself is sick. And propagates KNOWN LIES for $$MONEY$$. To call them “unethical” is merely scratching the surface- their (in general) UTTER LACK of common medical Ethics is DISGUSTING.
There is obviously a lot to know about this. I think you made some good points in Features also.
My own experience with what is now called bipolar 2 has been that whereas “psychotherapy” does help..it is basically nothing more than having someone listen empathetically and with some degree of knowledge of human behavior. The advent of Prozac and the ssri drugs have made a great advance in lessening the actual suffering of the patient.
The drugs may not be a cure or any real support for any one theory but they certainly have been the first real decrease in human suffering and disability. This is true, regardless of the full explanation of the details of how they work to reduce pathological depression.
The success of these drugs is worth SO MUCH more than useless speculation (at this point) of how they do this. Theory is not always as useful in the lessening of misery as experimental fact.
When people say that psychotherapy did’t work for them, I ask them if they worked for psychotherapy. I remember every week that I was in therapy I was given assignments to work on. Sometime it was something as simple as making my bed everyday. The road out of depression is long and hard filled with pitfalls and stumbling blocks. I have had mild releases since my recovery but I now have the tools to work my way through it. And I am always a better person when I come out of depression than when I go in. Taking a pill is much easier but it robs you of personal growth. We have become a culture of instant gratification and not willing to put forth any effort into self awareness.