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Background in this research method
A systematic review is a scholarly way of looking at all the evidence on a particular topic, using strict methods to make sure only the most relevant and reliable studies are included. This kind of review allows researchers to come to a more refined conclusion about the topic. 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
The chemical imbalance theory of depression suggests that depression is caused by a lack of the neurotransmitter serotonin.
PSYCHIATRIC MEDICATIONS WERE MARKETED ON THIS THEORY
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). https://doi.org/10.1007/s12115-007-9047-3
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
Many are given SSRIs based on the chemical imbalance theory
Under this theory, depressed patients were essentially told they had 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). https://doi.org/10.1007/s12115-007-9047-3
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.
TREATMENT RESISTANT DEPRESSION & ECT
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).
ECT AND THE CHEMICAL IMBALANCE THEORY
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 (hopkinsmedicine.org)
Numerous research experiments have been done to explore ECT’s role in altering brain chemistry.
ECT chemical imbalance study examples
- Effect of electroconvulsive therapy on serum serotonin level in patients with treatment–Resistant major depressive disorder – ScienceDirect
- How Electroconvulsive Therapy Works?: Understanding the Neurobiological Mechanisms – PMC (nih.gov)
- Mechanism underlying the therapeutic effects of electroconvulsive therapy (ECT) on depression – PubMed (nih.gov)
MY CHEMICAL IMBALANCE Story
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 (nih.gov)
When I was 8, I was misdiagnosed with bipolar disorder. This was partially due to my reaction to stimulants and Zoloft, which my doctor said revealed my true mental illness. We were told that a chemical imbalance causes bipolar disorder and that psychiatric medications can correct that imbalance, but they are not a cure. I would need to take these pills for the rest of my life in the same way that a diabetic needs to take insulin.
This analogy had a big impact on me, a child whose days were filled with wild spikes and crashes of non-diabetic hypoglycemia.
I quickly became dependent on psychiatric medications. I didn’t know that these drugs could cause symptoms that mimic mental illness. Whenever I tried to reduce the dosage, I had terrible reactions. These tapers were probably too sudden for my body to adjust to.
From a paper by Surviving Antidepressants.org 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 (sagepub.com)
My taper withdrawal symptoms reinforced the chemical imbalance theory to myself, my doctors, teachers, and parents
Fearing relapse, I kept taking my medication even though it made me feel terrible, made me gain weight, and caused my hair to fall out.
THE REAL CHEMICAL IMBALANCE
These drugs gave me a chemical imbalance that would lead to self-harm and almost ended in suicide. Having 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 medications. They ruined my mental and physical health and made it harder for my body to fight off the illnesses causing my depression. The chemical imbalance theory delayed a correct diagnosis and treatment by decades!
For years, questioning this theory was heresy
Direct-to-consumer advertising (DTCA) made the chemical imbalance theory a scientific fact in the public’s consciousness, So much so that if I questioned my diagnosis or the theory, people would think I was crazy.
For a long time, people who disagreed with the chemical theory of mental illness were considered fringe or anti-science. This was made worse because questioning one’s mental illness tended to reinforce other people’s beliefs that the illness was real. The general public was more likely to believe pharmaceutical advertising than the lived experiences of people with mental illness.
Then efforts to stop the stigma around mental illness led to more support for medications to treat it. However, the same people who support those in drug treatment often attack anyone who has anything negative to say about medications, even if it is based on their own lived experience.
For over a decade, I feared social and medical backlash. Expressing my thoughts and experiences was not safe. I silently suffered from protracted withdrawal symptoms for years. I learned to keep my mouth shut or face more ostracism and unwanted medical interventions to help me accept my “disease.”
Experiences like mine
- Kidnapped part 1 & part 2
- 9 Rounds of Electroshock Therapy. 6 Years Lost. All Because Her Doctors Got It Horribly Wrong.
- Lucy Dawson: the model who got a mystery headache, a misdiagnosis – and a new mission in life
- Did we all believe a myth about depression?
- Iatrogenic Domino: I Was Poisoned by Polypharmacy
- New Paxil Warnings For Teens Prompt Fury From Former Patients
Psych meds led to ECT
I was diagnosed as “treatment resistant” at age 17 and referred for electroconvulsive therapy when I failed to improve on medications. Doctors told me they don’t know how ECT works but think it may help with chemical imbalances.
LIFE AFTER MEDS AND ECT
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
The drugs I was forced to take for 15+ years have damaged me in ways that I’m only just starting to understand. The trauma of being falsely labeled and involuntarily treated will haunt me forever. The drugs have permanently changed my brain and nervous system, and that’s not even counting the damage from ECT and the long-term effects of electrical injury.
- Aging after ECT, episodic paroxsomal neuromuscular symptoms and blood-brain barrier
- Vision Therapy for ECT Injury (Electroconvulsive therapy)
- Electroconvulsive Therapy Side Effects
I’m facing neurodegeneration in my 30s from treatments used to correct a condition that doesn’t exist.
WHAT THE END OF THIS THEORY MEANS FOR ECT
Several changes to happen in regards to ECT now the chemical imbalance theory is crumbling:
- Diagnostic and referral methods for ECT should be revised to make sure patients are getting the right diagnosis and treatment.
- Patient education materials and advertising should be updated to reflect the latest scientific findings, not marketing myths.
- Incorrect medical information is a public safety issue, and there should be consequences for those who market ECT to the public inaccurately or falsely.
- Doctors should be required to do a genetic test to see if a patient can tolerate certain psychiatric medications before prescribing them.
If you want to help improve the outcomes for future patients who may be harmed by ECT, please sign our petition.
Many still defend the theory
Many in the medical profession and media are attacking Moncrieff and her work. A recent Rolling Stone article, SSRI Study Fueling Right-Wing Media: Who Is Psychiatrist Behind It? – Rolling Stone, portrays her as a fringe figure, attempting to discredit her by lumping her in with the anti-vax movement and right-wing talk show hosts in America.
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 …’*
Despite the detractors, Moncrief’s paper continues to generate discussion, with the likes of Robert Whitaker and Performer Russell Brand recently agreeing with its arguments.
- “Holy Shit!” Psychiatry’s Cognitive Dissonance on Display – Mad In America
- It Was All A F*cking Lie – Russel Brand
The truth about chemical imbalance theory going mainstream feels like emancipation for people like me. I’m looking forward to a future with improved diagnostic and treatment options now that this roadblock to progress is out of the way.
Other chemical imbalance theories
Theories about chemical imbalances in the brain are at the root of many mental illness diagnoses, such as bipolar disorder, Attention Deficit Disorder (ADD), and schizophrenia. I hope that further research into this area will lead to changes in how these conditions are diagnosed and treated.
The chemical imbalance theory is a drug marketing tactic that has fooled society for decades. This theory has harmed countless individuals who were 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.
- How to take the news that depression has not been shown to be caused by a chemical imbalance | Joanna Moncrieff
- Systematic review: The serotonin theory of depression: a systematic umbrella review of the evidence | Molecular Psychiatry (nature.com)
- Meet Dr Joanna Moncrieff – psychiatrist who capsized depression, serotonin hypothesis (biznews.com)
- Serotonin Theory of Depression Debunked | Sci-News.com
- Little evidence that chemical imbalance causes depression, UCL scientists find | Depression | The Guardian
- Depression is probably not caused by a chemical imbalance in the brain – new study (theconversation.com)
- Did we all believe a myth about depression? – BBC News
- Why has the misleading chemical imbalance theory of mental illness persisted for so long? (slate.com)
- Scientists Find No Evidence That Depression Is Caused by “Chemical Imbalance” or Low Serotonin Levels (scitechdaily.com)
- Mental Health Watchdog forced to say “I told you” about depression chemical imbalance
- The European Times News
- Akathisia Alliance for Education and Research
- Direct-to-Consumer Pharmaceutical Advertising – PMC (nih.gov)
- The Emperor’s New Drugs: An Analysis of Antidepressant Medication Data Submitted to the U.S. Food and Drug Administration (researchgate.net)
- MISSD – The Medication-Induced Suicide Prevention and Education Foundation
- Most antidepressants don’t work on kids, teens, study finds (statnews.com)
- Serotonin Syndrome – PMC (nih.gov)
- See our psychiatric drug resource section
- Surviving Antidepressants
- What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications – Adele Framer, 2021 (sagepub.com)
- View our psychiatric drug resource section
- Explaining Depression in Clinical Settings: Shortcomings and Dangers of Simplified Analogies (springerpub.com)
- Original Zoloft Commercial – YouTube
- Study: Media perpetuates unsubstantiated chemical imbalance theory of depression – Florida State University News (fsu.edu)
- The Media and the Chemical Imbalance Theory of Depression | SpringerLink
- Why Depression Is Not “Just Like” Diabetes | Psychology Today