The dangers of the “Chemical Imbalance” myth of depression. 

I often hear people defending their depression by saying “it’s a chemical imbalance in my brain”. What they really mean is, it’s a medical problem. This is true, depression (and all other mental health issues) are medical issues that need to be treated as such. However, is it both incorrect and dangerous to continue spreading the myth that depression is caused by a chemical imbalance in the brain.

First of all, there are many different potential causes for depression. There is no “one cause”. Depression is a very complex condition, and scientists are still trying to figure out what causes it. The currently accepted theories point to a mixture of what we call “predisposing factors”, which are things that can increase your likelihood to develop depression. No one “thing” is guaranteed to give you depression. There is a genetic component, but just because your mom or dad has depression does not guarantee you will get it as well. The environment also plays a part. People who experience severe trauma early in their childhood are more likely to develop depression. But the key words here are more likely. Not everyone who experiences trauma becomes depressed. Trauma in adulthood can spark a depression too. Some people become depressed after experiencing loss or financial hardship, but then again, some people don’t become depressed after these things. Circadian rhythms (sleep and wake cycles related to the sun) have also been under investigation in relation to depression. Depression seems to be caused by a very complex combination of your genetics, your childhood, your current situation, and other factors. Importantly, these factors can vary from person to person.

But what about the brain chemicals?

Don’t get me wrong, chemicals are involved. It just isn’t as simple as having not enough or too much of a certain chemical. The idea that depression is caused by an imbalance of chemicals in our brains stems from the fact that most antidepressants alter levels of a neurotransmitter called serotonin. The thing is, these antidepressants (called selective serotonin re-uptake inhibitors or SSRIs) don’t work immediately. They take 2-4 weeks to begin showing beneficial effects. If depressed people were simply lacking serotonin, then giving them these pills that increase serotonin would make them feel better almost immediately. But they don’t, and scientists have been trying to figure out why for a long time. One theory is that these pills have what we call “downstream effects”, which basically means they set of a chain of events within the brain. Some scientists think that these downstream effects promote neurogenesis (growth of brain cells) in a certain part of the brain, and that’s what may be helping some people with depression. However, these pills don’t work for everybody. They don’t even work for the vast majority of people with depression. Depending on the study, most antidepressants only helped about 40-60% of people. This means that there is something more complex going on than a simple “imbalance of chemicals”.

So why is this harmful?

Imagine you have depression, (you might not have to imagine very hard, especially with the current global state of affairs). Imagine you have felt hopeless for a very long time, and you are very close to giving up and maybe thinking about ending your life. Now imagine someone comes along and tells you about this whole “imbalance of chemicals” thing. This might sound very hopeful! If it’s just an imbalance of chemicals, that means I can just take a pill with that chemical in it, and I will get better, right?

Imagine waiting in complete misery for over six months to see a doctor and finally getting this magic pill that everyone told you about, and... it doesn’t work.  

The one thing that you held out hope for does not work.

This is very scary and damaging for people trying to recover! You can feel even more hopeless when you are told that you have a chemical imbalance and all you need is a pill, but even THAT doesn’t work for you. This is devastating.

In reality, recovering from depression is as complex as the disorder itself. It often takes a long journey of trial and error. Therapy can help, sometimes, if you can find a therapist that matches well with you. And yes, medication can help, sometimes, but it often takes a lot of trial and error to find a medication that works for you. There are multitudes, all with their own set of side effects. Often it takes a specific combination of therapy, medication, and lifestyle changes for people to finally experience relief. Finding this specific combination can take a long time and require a lot of effort, which is an extremely hard reality to accept when you feel so completely hopeless. However, being honest with what the recovery process is like is extremely important. Managing expectations is a huge part of getting better.

Depression is complex. So is recovery. Boiling it down to an imbalance of chemicals in the brain is both untrue, and extremely insulting to those trying to recover from it. We need to stop spreading misinformation about this condition so that more people can understand what it takes to recover. Maybe by spreading understanding of how complicated recovery is, more people will be empathetic towards those who are currently fighting this battle.

For more information:

What Causes Depression? (Harvard)

The Science Behind How Antidepressants Work

The Pathophysiology of Depression