Disclaimer: In this article, I outline why the chemical imbalance theory was proven false. However, I do not believe that antidepressants are ineffective or that people should stop taking them. To me, that would be throwing the baby out with the bathwater.
In July, a significant umbrella study was published in the Molecular Psychiatry Journal, reviewing all existing meta-analyses and systematic evaluations of the chemical imbalance theory as it pertains to depression. The researchers claimed that there is a lack of evidence to support the decades-long, widely held idea that the source of depression lies in chemical imbalances in the brain. Inevitably, their work called into question the effectiveness of antidepressants, as most are selective serotonin reuptake inhibitors (SSRIs), which supposedly function to correct abnormally low serotonin levels.
Although other studies have criticized the chemical imbalance theory, the new study, published by Moncrieff and her colleagues, was the first paper on the topic to garner extensive media attention. One reason for this attention is perhaps that many of us – much more so than the researchers in these studies – are now eager to call the effectiveness of SSRIs into question.
Will generations after us look at the chemical imbalance theory like we look at the Freudian repression theory? I would venture to speculate that the media’s response to these findings is an example of history repeating itself. For example, psychedelics are set to revolutionise the treatment industry in the coming years, especially when it comes to depression. In fact, studies have heralded psychedelics as being capable of treating ‘treatment-resistant depression’. In other words, the new model has fewer limitations than the previous one, so it must be better, and we can forget about the chemical imbalance theory, right?
By casting doubt on the use of antidepressants, a new space has opened up in our collective understanding of mental healthtreatment, a space which the psychedelic framework could potentially fill. However, an almost identical process occurred in the late 50s and early 60s, with the chemical imbalance theory seemingly invalidating its predecessors, such as psychoanalytic psychotherapy and behavioural therapy.
But let’s be clear: I do not think this development is a bad thing. I am excited for a revolution to occur in psychiatric treatment. The chemical imbalance theory had numerous adverse side effects for those of us subjected to it. For example, it was once thought that we could finally end the mental health stigma by interpreting mental illness as a chemical imbalance. A person with depression does not choose to be like this; it is just a chemical imbalance beyond their control. However, studies show that, in reality, this often led people to think that they were ‘biologically broken’ and thus could never actually recover. Thus, it was simply stigmatisation in sheep’s clothing.
The effectiveness of any treatment method is subjective
So, in this sense, I welcome the new era with open arms. However, where I get stuck is the fact that antidepressants are stilleffective. We may no longer have a clear answer as to why, but the studies are clear: they work for some of us, and these recent findings should not be a reason to invalidate them entirely as a treatment method. I am also reminded of the many studies that show psychoanalytic psychotherapy to be an effective treatment method for some of us. Cognitive behavioural therapy also works for some but not all, and the list goes on. We even now know that in some instances, depression can be linked to inflammation in the body, such that anti-inflammatory medication works to ease symptoms.
Poignantly, there are drug trials that show antidepressants to be barely distinguishable from placebos when it comes to treating depression. This leads many of us to think that any mental health treatment can be reduced simply to whether or not you believe in the treatment.
There is something to be said for the fact you are a subject existing in the world, full of meaning derived from your unique experiences. Whatever treatment method works for you – whether that’s psychotherapy, medication, psychedelics or nutrition – depends not only on your mental and physical makeup but also on your own unique beliefs and ideas about health and wellbeing. However, we should be careful when thinking in these terms. For any study that disproves the effectiveness of one treatment, you will find as many proving its validity. Such is the nature and complexity of studying the mind.
Hence, it is important to reflect on how quick we are to create an overarching ‘one-size-fits-all’ narrative regarding mental healthtreatment, especially when we use that narrative to invalidate theories that no longer fit into a specific schema. I believe that we can make room for a new framework without turning our backs on all we achieved with the previous one. Because, if nothing else, when we fixate on finding the absolute truth of the matter, we risk losing sight of the fundamental aim of treatment: to ease suffering.
Written by Molly Fitz