ECT and the Chemical Imbalance Theory

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recent systematic review by psychiatrist Joanna Moncrieff, et al., debunks the long-standing theory that depression is caused by a chemical imbalance.

Background in this research method

systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. [1] A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, and summarizes interpretations into a refined conclusion. [1][2] For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine. [3]

Systematic review – Wikipedia

See simplified video explanation The Steps of a Systematic Review

The theory has been called out before but there’s something different this time. Unlike previous papers on the topic has generated overwhelming interest online. The research itself ranking highly on Altmetric has also made rounds on social media, various news websites, and forums.


The chemical imbalance theory suggests depression is caused by a lack of the neurotransmitter serotonin.


Selective serotonin reuptake inhibitors (SSRIs) were marketed as treating chemical imbalances that cause depression.

From the article, the Media and the Chemical Imbalance Theory of Depression

With the advent of the chemical imbalance theory, the companies were no longer just providing soothing tonics, they were now providing medications to treat diseases, as exemplified by an early SSRI advertisement stating: “When serotonin is in short supply, you may suffer from depression.” The wording here is all-important. The advertisement takes a correlation between serotonin shortage and psychological stress—and even this is highly questionable and unverifiable in any individual case—and makes a leap of faith to the conclusion that depression is caused by a serotonin imbalance, not that psychological stress impacts the serotonin system.

Leo, J., Lacasse, J.R. The Media and the Chemical Imbalance Theory of Depression. Soc 45, 35–45 (2008).

From the Mayo Clinic website

SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons).

SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters.

Selective serotonin reuptake inhibitors (SSRIs) – Mayo Clinic

Original Zoloft Commercial

Many are given SSRIs based on the chemical imbalance theory 

Under this theory, depressed patients were essentially told they have an incurable disease they required lifelong medication to manage.

Medical analogies were often used to convey the theory to patients like diabetics who need insulin:

For the psychiatry profession, the theory was a major driving force behind the rise of biological psychiatrists within the profession, and moved the profession from one involved in talking to patients about everyday problems, to a profession that was treating their patients’ organic diseases—just as the internists were treating diabetics suffering from insulin shortages, the psychiatrists were now treating depressed patients suffering from serotonin shortages. Depression was no longer seen as just a natural response to stress, there was now an underlying biological factor which was the cause of the depression.

Leo, J., Lacasse, J.R. The Media and the Chemical Imbalance Theory of Depression. Soc 45, 35–45 (2008).


SSRIs can cause psychiatric symptoms they are meant to treat. Many doctors often don’t recognize these symptoms as drug side effects. Instead, they interpret them as “worsening mental illness” or “disease progression.” In response, many physicians may switch meds or add more to the mix. If patients don’t improve they may be referred for more aggressive treatments.


Those who fail to improve from talk therapy and medications get diagnosed with “treatment-resistant depression” (TRD). From there they may be referred for electroconvulsive therapy (ECT).


Many ECT clinic websites, news articles, and patient leaflets suggest ECT may work by stimulating or balancing brain chemicals.


“ECT may flood the brain with neurotransmitters such as serotonin and dopamine, which are known to be involved in conditions like depression and schizophrenia.”

Frequently Asked Questions about ECT at The Johns Hopkins Hospital in Baltimore, Maryland (

See also How Accurate Are ECT Patient Information Leaflets Provided by Mental Health Services in England and the Royal College of Psychiatrists? An Independent Audit

Numerous research experiments have been done to explore ECT’s role in altering brain chemistry.

ECT chemical imbalance study examples


Just about everyone in the psychiatric survivor community has a chemical imbalance horror story. Mine begins in the 90s during the “childhood bipolar boom”. See Pediatric Bipolar Disorder in an Era of “Mindless Psychiatry” – PMC (

I was 8 when I was misdiagnosed bipolar. This misdiagnosis was aided by my reaction to stimulants and Zoloft. According to my doctor they somehow “revealed” my true mental illness. My family and I were told bipolar disorder is caused by a chemical imbalance. Psychiatric medications correct that imbalance but they are no cures; I would need to take these pills for the rest of my life, the way a diabetic needs to take insulin.

This is a significant thing to say to a child with hypoglycemia– my days were dominated by the wild spikes and dramatic crashes of chronically unstable blood sugars. I fully appreciated the need for balanced insulin levels.

Drug dependence

I rapidly became dependent on psychiatric medications. No one told me or my parents these drugs caused symptoms that mimicked mental illness. I had terrible reactions to any dosage reduction–- these tapers were likely too abrupt for my body to adapt to.

From a paper by Surviving founder Adelle Framer:

After physiological dependence is established, withdrawal symptoms may occur following any reduction in dosage, during a taper, or after a drug switch, as well as discontinuation of the drug.78 The rate of drug tapering seems to influence the development of withdrawal symptoms throughout the taper and afterward, slower tapers probably allowing some neurological re-adaptation during the tapering process.

Framer also says:

“People experiencing withdrawal may avow every possible variation of depression or anxiety. Like other ADRs, withdrawal might generate psychological symptoms, including suicidality,157,180 that are unprecedented or more severe than ever before experienced.16,28 Often bewildered by their symptoms, having no other vocabulary to describe their unusual psychological states,181 patients might claim “not feeling myself”, “I feel OCD”, “I feel psychotic”, “I’m having a breakdown”. Or, as I said when told I had relapsed, “This doesn’t feel like my depression”.16,47,49 Many go through a phase of shock: realization there is no medical safety net is a terrifying existential jolt, prone to combustion with worries about security and mortality, intense regret, self-blame, and outrage. They feel abandoned and helpless.”

What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications – Adele Framer, 2021 (

My taper withdrawal symptoms reinforced the chemical imbalance theory to myself, my doctors, teachers, and parents

Believing this was a relapse I resolved to stay on these drugs no matter how sick they made me, how much weight I gained, how much hair I lost, or how much physical torment they caused. And torment me they did.


I would later experience true chemical imbalance from these medications that would lead to self-harm and almost end in suicide. Too much serotonin is an excruciating, life-threatening experience I will never forget. Akathisia is another.

These drugs ruined my life

I barely survived these drugs. They destroyed my mental and physical health. They impaired my body’s ability to fight the infections at the core of my distress. The chemical imbalance theory delayed a correct diagnosis and treatment by decades!

For years, questioning this theory was heresy

Direct-to-consumer advertising (DTCA) drilled the chemical imbalance theory deep into society’s subconscious. So much so, that to openly question my diagnosis or the theory that supported it– I may as well have written “crazy” on my forehead with a Sharpie.

For the longest time, anything against the chemical theory was considered fringe or anti-science. It didn’t help that questioning one’s mental illness reinforced its existence to others. The public was more inclined to believe pharmaceutical ads than a “mentally ill” person’s lived experience.

Then “stop stigma” efforts led society to be more supportive of supporting those medications to treat mental illness. The same people supporting those in drug treatment would often be the same people attacking anyone who had anything bad to say about medications– even if it was lived experience of someone they cheered on before.

For over a decade I lived in fear of social and medical backlash. Expressing my thoughts and experiences wasn’t safe. I silently suffered for years from protracted withdrawal symptoms. I learned to keep my mouth shut or face further ostracism and unwanted medical interventions meant to “help” me accept my “disease.”

Experiences like mine

Psych meds led to ECT 

At age 17 when I failed to improve on these medications, I was diagnosed as “treatment resistant” and referred for electroconvulsive therapy. Doctors told me they don’t know how ECT works but think it may help with chemical imbalances.


Psychiatric meds were hell to come off of. It took years. I’ve been med–free since 2007 but still have terrible symptoms 15 years later.

My road to hell was paved with the chemical imbalance theory

Taking these drugs for 15+ years permanently damaged me in ways I’m only beginning to understand. The trauma from being falsely labeled, and forcibly drugged, will haunt me forever. The drugs themselves have permanently altered my brain and nervous system. It doesn’t stop with psych med damage– I’m now severely disabled from ECT and the associated long-term consequences of electrical injury.

I’m facing neurodegeneration in my 30s from treatments used to correct a condition that doesn’t exist.


Several changes to happen in regards to ECT now the chemical imbalance theory is crumbling:

  • Diagnostic and ECT referral methods should be revised to ensure patients are appropriately assessed and treated 
  • Patient education materials and advertising should be updated to reflect science, not marketing myths
  • Accurate medical information is a public safety matter, after all. There should be consequences for those marketing ECT to the public using inaccurate or false information

Learn how you can help address these ECT issues and more by signing the Audit ECT petition.

Many still defend the theory 

While the science seems clear, many in the medical profession and media are going into attack mode. A recent Rolling Stone article SSRI Study Fueling Right-Wing Media: Who Is Psychiatrist Behind It? – Rolling Stone, portrayed Moncrieff and her work as fringe, attempting to discredit her by lumping her in with the anti-vax movement and American right-wing talk show hosts. 

From Moncrieff’s response to Rolling Stone

“In a time-honoured tactic, the article attempts to discredit me by association. But now it is not just the Scientologists, although they are thrown in for good measure (and for the record I have never had any association with the Scientologists), but the ‘right-wing media’. The article points out that right wing commentators such as Tucker Carlson and Matt Walsh have covered our research….

‘First they ignore you. Then they ridicule you. And then they attack you …’*

Detractors aside, Moncrief’s paper continues to make waves with the likes of Robert Whitaker and Performer Russell Brand recently weighing in on the paper as well.

Final Thoughts

For people like me, the truth about chemical imbalance theory going mainstream feels like emancipation. I’m looking forward to a future with improved diagnostic and treatment options now this roadblock to progress is out of the way.

Other chemical imbalance theories

Chemical imbalance theories are at the core of many mental illness diagnoses like bipolar, ADD, and schizophrenia. Perhaps more diagnostic pillars will fall in light of this important research. In turn, this will hopefully lead to reforms for these vulnerable groups also.

Key takeaways

  • The chemical imbalance theory was a drug marketing tactic that’s had society fooled for decades
  • This theory has harmed countless individuals who were subsequently prescribed SSRIs and ECT to treat chemical imbalances they didn’t have
  • For some, correct diagnosis and treatment of underlying medical conditions are delayed as a result of this theory
  • Changes in diagnosis and ECT referrals and patient information should be made in light of this research


Joanna Moncrieff


Drug resources



Anna is a childhood psychiatric drug and a teenage electroshock survivor. She founded Life After ECT to ensure people injured by electroconvulsive therapy have easy access to resources that can help them understand their injuries and find a path to recovery.