The chemical imbalance theory of mental illness


I can’t even count the number of times someone gravely informed me they were on antidepressants for a “chemical imbalance.” Now, I can’t blame them for believing their doctors, but come on, use your brain! For most people, these drugs seem to make people worse:

In Anatomy of an Epidemic, you also discussed the pseudoscience behind the “chemical imbalance” theories of mental illness – theories that made it easy to sell psychiatric drugs. In the last few years, I’ve noticed establishment psychiatry figures doing some major backpedaling on these chemical imbalance theories. For example, Ronald Pies, editor-in-chief emeritus of the Psychiatric Times stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.” What’s your take on this?

The “disease model,” as a basis for making psychiatric diagnoses, has failed.

This is quite interesting and revealing, I would say. In a sense, Ronald Pies is right.Those psychiatrists who were “well informed” about investigations into the chemical imbalance theory of mental disorders knew it hadn’t really panned out, with such findings dating back to the late 1970s and early 1980s. But why, then, did we as a society come to believe that mental disorders were due to chemical imbalances, which were then fixed by the drugs?

Dr. Pies puts the blame on the drug companies. But if you track the rise of this belief, it is easy to see that the American Psychiatric Association promoted it in some of their promotional materials to the public and that “well informed” psychiatrists often spoke of this metaphor in their interviews with the media. So what you find in this statement by Dr. Pies is a remarkable confession: Psychiatry, all along, knew that the evidence wasn’t really there to support the chemical imbalance notion, that it was a hypothesis that hadn’t panned out, and yet psychiatry failed to inform the public of that crucial fact.

The low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable.

By doing so, psychiatry allowed a “little white lie” to take hold in the public mind, which helped sell drugs and, of course, made it seem that psychiatry had magic bullets for psychiatric disorders. That is an astonishing betrayal of the trust that the public puts in a medical discipline; we don’t expect to be misled in such a basic way.

But why now? Why are we hearing these admissions from Dr. Pies and others now? I am not sure, but I think there are two reasons.

One, the low-serotonin theory of depression has been so completely discredited by leading researchers that maintaining the story with the public has just become untenable. It is too easy for critics and the public to point to the scientific findings that contradict it.

Second, a number of pharmaceutical companies have shut down their research into psychiatric drugs [see Science, 2010], and they are doing so because, as they note, there is a lack of science providing good molecular targets for drug development. Even the drug companies are moving away from the chemical-imbalance story, and thus, what we are seeing now is the public collapse of a fabrication, which can no longer be maintained. In the statement by Dr. Pies, you see an effort by psychiatry to distance itself from that fabrication, putting the blame instead on the drug companies.

If you or anyone you know takes psychiatric drugs, go read the rest.

6 thoughts on “The chemical imbalance theory of mental illness

  1. The thing is that he is entirely negative and ideological in this article. He is offering nothing as an alternative, nothing that exists for people right now. He says that the drugs may relieve symptoms but don’t offer a cure. That may be true, but that is the function of most drugs – to relieve symptoms while the body’s immune systems do the healing.

    I have been in therapy and on anti-depressants on and off for more than 15 years. The talk therapy is more helpful, but it is hard to find and expensive. Prozac is cheap and it seems to take the edge off. (I may be imagining it. I am never sure, but I have not been spending all day in a chair thinking of how to do away with myself like I was when my prescriptions ran out and I could not afford to go to the doctor for a refill.)

    So what should I do, lobby against the psychiatric profession and the DSM?

  2. Of course not. If it helps, it helps. But it only helps about 30% of the people who take them, and the people taking it should know that. Every time they tried to put me on anti-depressants, I felt a lot worse — and of course no one believed me.

    I’ve had better results with taking amino acids like 5-HTP and GABA. And they’re pretty cheap.

  3. Of course that is your experience- being in the mental health field for over 25 years, I have seen a lot of changes, mainly from what we have learned from brain mapping and brain chemistry. There are meds that are good and some bad. A ton of marketing and hype. Yet, I have been privileged to see some schizophrenics getting relief from the voices in his/her head, anxiety and obsessive behaviors reduced and manageable, and a reduction in self destructive thoughts and behaviors. None are miracles, and finding the right mix is difficult at best.

  4. Of course some people are helped. I also know people who are now full-blown paranoids from the cocktail of psychiatric meds for their “chemical imbalance.”

    And let’s not forget that no less a person than the president of Glaxo said drugs in general are effective in only 30% of the people for whom they’re prescribed. Seems like it might be good to mention that to the consumers who have to take them.

  5. Insulin doesn’t cure diabetes, it only relieves the symptoms. And it doesn’t help all diabetics by any measure.
    So effin what? There’s no convoluted argument about doing away with insulin or teaching diabetics that insulin is bunk.
    What is it about mental health issues that so routinely brings out such clearly flawed arguments that never get made about non-mental health issues?
    And Susie, in all sincerity I’m happy you have found ways to alleviate your depression without pharmaceuticals but why you think that relevant to ALL people suffering from mental issues is beyond me.
    I’ve taken 90 milligrams of Nardil a day for the last 30 years. It would never dawn on me to lecture you to do the same. It’s your health, it’s for you to decide.

  6. You’re comparing apples and oranges. Insulin works for all Type 1 diabetics. Anti-depressants do not work for all depressed people — and in many cases, make them suicidal.

    Nor does taking insulin cause your body to stop producing insulin — your body’s already broken. See the difference? There is a lot of research that indicates that long-term use of anti-depressants actually suppresses the brain’s ability to make needed chemicals. The problem is, they still don’t know which ones. Look at Prozac: Hailed as a miracle drug and “personality brightener,” but it’s now known to be a neurologically “dirty” drug and experts only prescribe it as a last resort.

    I just get angry at how so-called scientists just make shit up. Why not admit “We don’t know”?

    Finally, I am a big believer in informed decision making. You get to say, “Yeah, this drug may cause problems, but at this point, I’ll try anything.” For me, unfortunately, the side effects have always outweighed the original problem.

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