== What's wrong with the "chemical imbalance" view of depression? ==

I want to record what I think wrong with the "chemical imbalance" view of depression. The specific idea that depression is caused by low serotonin was shown to be wrong by the late 1980s as is convincingly (to me) explained by Robert Whitaker



and others (see, for example, the Peter Gotzsche and the Cochrane Collaboration).

In spite of this, many patients still get told that they have a "chemical imbalance" in their brains and that's why they need to take medication. I suspect that many MDs and psychiatrists still say this in spite of the failure of the serotonin hypothesis simply because how you feel in general is determined by your brain chemistry. If you're feeling bad, then, there must, therefore, be something wrong with your brain chemistry. If it isn't just serotonin, further research will clarify exactly what the problem is and will lead to better drugs. In the mean time, the current antidepressants are the best we have. What could be wrong with that?

As reasonable as it seems, I think that this view can be very, very damaging. To see how, imagine that your laptop has a virus and has developed “laptop depression.” Your laptop is sluggish, unenthusiastic and sleeps too much. Suppose you then take it to the Apple store and they say that since everything happening in your laptop is determined by electrical signals, your laptop has an “electrical imbalance.” We are therefore going to try increasing your clock speed, add some more wires and pull out a few capacitors. Notice that even though it is correct that your laptop’s behavior is determined by electrical signals, the Apple store is about to make a very serious mistake that will likely harm your laptop and will likely not solve the problem. The point is that the Apple store has mistaken a software problem for a hardware problem. I think that depression is essentially a brain software problem and not a brain hardware problem. I think that depression is essentially caused by an ingrained, habitual, unconscious thinking pattern and not by neurotransmitter imbalances. If that is so, it’s not surprising that no biochemical test for depression has been found. It’s the same for laptops. You can’t get out a voltmeter and test if your laptop has a virus. Notice that technology improvements won’t change what you should do here. Even if extensive research into laptop depression shows that you can sometimes electrically determine if a laptop has a virus, the right treatment is still going to be to remove the bad software and not to have a hardware intervention.

I think that believing the chemical imbalance story can be particularly harmful for depressives because it feeds into the idea that you are helpless. If you have defective brain chemistry, it's very natural to think that you are just unlucky genetically and can't expect to fix the problem yourself. You have to rely on the experts and take the drugs. On the other hand, if depression is a brain software problem, no one has control of your brain software (your thoughts, in other words) except YOU. This is the reverse situation. NO ONE can help except you yourself!

- vital