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When discussing depression and medication, people use the argument that medication is ineffective because they don’t agree with the chemical imbalance theory (that low serotonin causes depression.) Not only is this an obvious logical fallacy, but the chemical imbalance theory is no longer in vogue in the science circle. It hasn’t been in decades. It mainly gained traction because it was used in a few anti-depressant commercials and is now perpetuated by people who are anti-psychiatry and anti-pharmaceauticals.

Many people don’t realize this but we don’t know how many drugs work. It’s pretty irrelevant to the patient. If a drug is safe and effective according to studies, then the drug may be administered to help a patient, regardless of whether we know exactly how it works or not. If we knew enough about depression, then anti-depressant’s wouldn’t cause so many side effects and psychiatry for depression wouldn’t be hit or miss. But these facts don’t disprove that the medications as effective. If you’re depressed, what choice do you really have? You can suffer from depression for another 10 years waiting for new studies and medications, or you can take whatever treatment(s) work today and live a ridiculously higher quality of life.

There are many plausible theories on what causes depression that don’t involve low serotonin. In fact, a drug called Tianeptine is an SSRE—Selective Serotonin Reuptake Enhancer—meaning it works the opposite of SSRIs and it’s as effective for depression. (“SSREs have been demonstrated to be as effective as SSRIs against depression, have a much faster onset of action (immediate), and have a much better tolerability profile”)

Remember that in psychiatry, meds are prescribed based on the patient’s own experiences. Medication is changed, augmented and doses adjusted purely based on how the patient feels. The patient is not tested for having low serotonin or low dopamine. HOW the medication works is irrelevant to most patients and even to most doctors. Doctors may keep up with the latest studies, but to them, their primary goal is making you healthy again.

Let’s look at a scenario:

Jane is depressed. It gets worse over the years, to the point where she lost her job and cannot emotionally work anymore. She’s overwhelmed and chronically fatigued, and cannot bring herself to do much anymore. Just taking out the trash feel’s like a hard day’s work, and most of her time is spent surfing the net or asleep. She can see her life turning to shit day by day, but cannot muster up enough motivation and enthusiasm to do anything about it. She may not be suicidal, but death by atrophy or homelessness is preferred to the efforts of living.

She has friends that insist that prayer, exercise, “going out” and so forth will cure her depression. Jane likes her friends but takes her advice with a grain of salt. They’ve obviously not been depressed, otherwise how do they expect a depressed person to go out and exercise? When you’re overwhelmed, there’s a feeling that there are far bigger things to worry about and philosophize over than going out to exercise.

Things get so bad that Jane considers seeing a doctor. She feels somewhat embarrassed but knows that it’s for her own good.

Jane begins taking Prozac (or Zoloft or Celexa or any other SSRI) and feels even worse for the first 2-3 weeks. She expects this and remains persistent in taking her meds. She wakes up one morning and things begin looking up. Things are different, though she can’t quite put her finger on why. Things aren’t as bad as she had been seeing them the past few months. Living may not feel easy, but it certainly feels feasible. She gets out of bed and her house and room look different. When did it become such a mess? When did she stop caring about the stench coming from the piles of laundry all over her room? Did breakfast always taste this good? She steps outside and notices how beautiful the world is. Trees, people running about, a breeze of fresh air, was the world always like this? Just last week this same scene was monochrome. Today it’s vivid.

Now would it really matter to Jane if the chemical imbalance theory is wrong? If she were to pick up a newspaper that says in bold “Scientists Prove Low Serotonin is NOT the Cause of Depression” would that suddenly make Jane’s world monochrome again?

Jane may feel great and then one day decide to stop taking the meds. Her life goes to shit within 3-6 months. When she starts the medication again, her life is fixed, again. That’s all that really matters to Jane.

Whether the Prozac helps her depression by inducing neurogenesis (growing new neurons,) increasing serotonin, reducing the damage caused by cytokines (stress), whether it’s a placebo, or whether it signals for Zeus to zap Jane’s brain with a lightening bolt, none of that matters. Jane probably doesn’t care how Aspirin, Penicillin, her Ipod or her microwave works. These serve functions to Jane, much like the function to live offered by her anti-depressants.

Posted in Depression, mental illness at October 4th, 2010. Trackback URI: trackback
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One Response to “So What If the Chemical Imbalance Theory is Wrong?”

  1. March 29th, 2013 at 5:15 am #Jenni

    She needs to see someone and get her shit together. It’s hard work to get better. You do not need meds. Her friends are right the mind does amazing things to heal itself. Studies HAVE shown positive changes do mske a difference. It is easier to take a pill Like I said it’s work. Scotch makes people feel better as well. We need to learn to change behaviors. It is proven to work. You have to start. Just like someone that weighs 600 lbs. Surgery will work but what have they learned? The one who does it slow and works really hard has better and safer results and resolve the root of the problem.

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