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Great Post, thank you for sharing. I do take issue with the commonly parroted claim that depression can be a chemical imbalance. It's a notion arising from pha

Great Post, thank you for sharing. I do take issue with the commonly parroted claim that depression can be a chemical imbalance. It's a notion arising from pharma marketing psyops, and is largely without utility. It even risks being an antipattern. The few pros include separating responsibility and thus alleviating some guilt, which often coexists with depression, and annoying spiritualists. Tell me if I missed any. Analogy: if I told you an athlete is different to a couch potato because of chemical imbalance, you'd think I was obtuse. While technically correct on some level that explanation obfuscates useful relational information about training, motivation, routine, mindset, culture, and circumstance. Similarly if I told you to become an athlete by only taking supplements that augment the phospho creatinine ATP pathway, you'd think me a crook. Oversimplifications sell pills and make for memorable catch phrases, but fall short of empowering us to become happy and well. Let's try and move our collective understanding beyond chemical imbalance; it's a tired mantra with scant utility. Disclosure: neuro psych doctor

serverlessmom 5y ago
I agree with you that there is definitely some serious obfuscation around the chemical imbalance aspect of the biological theory approach to mental disorder. If you do any research into the history of anti-depressants it isn't hard to uncover that there has been a lot of questionable science that forms the foundation of the over prescribing of medications for mental disorder that is currently the industry norm. I spent years suffering with really severe symptoms and I was so desperate for relief I tried all sorts of treatments. The main thing I really learned during that time is that approaching mental health requires a holistic approach, but even armed with that knowledge my life was still seriously impacted by my mental disorder. For me, I had spent years in talk therapy and different behavioral therapies. I had also tried various medications which did not help me and/or had side effects that were unbearable long term. I was on lamictal for a while which seemed to help but I also stopped seeing improvements and eventually that was also not good enough and my function declined. I also tried meditation, spiritualism, self medication, yoga, exercise, different diets, journaling. I took class after class on psychology and I instituted all sorts of different systems to try to fix myself. My therapist told me over and over that I was doing the work but that the improvements we were seeing weren't what she would expect, then I was referred to TMS. Once again, I was desperate and I was willing to do or try pretty much anything because I was a wreck of a person that was spiraling dangerously. So I went, and for the first time about three weeks in... I started to see a small difference. It changed my life, and I'm still so much better. The thing about how well it worked for me though is this: the idea of TMS is that it targets the part of your brain that is damaged by depression. Whatever this means- I've come to imagine it as neurons that have formed hard wired patterns of depression that are nearly impossible to rewire through sheer force of will. So chemical imbalance- probably (even demonstrably)false. Physical patterns in the brain formed while you suffered from depression being very difficult to rewire without outer interference? Is that possible? I'm mostly thinking out loud and I don't really expect someone to just have the answer but I really want to know and it's something I wonder about constantly.
jjeaff 5y ago
I'm not sure I understand what you are saying. Just that we shouldn't recognize that depression can be a chemical issue because that doesn't help us fix the problem? Are you saying that anti-depressants don't work? So if depression is more about mental models, life choices, and drive and whatever, why do so many people suffer from depression in cycles? There is little change from one day to the next, and yet, many people with depression can feel great one day and terrible the next. Or pregnant women can feel great before giving birth and then give birth to a perfect baby and suddenly start feeling depressed soon after. How do you use therapy to cure depression if the depressed person has no reason to feel depressed?
- andybak 5y ago
  Not GP and not even sure I agree with them. However I think there's some semantic issues with "chemical imbalance" that are worthy of examination. Depending on your basic philosophical views regarding materialism and the origin of consciousness, you might be of the view that all mental states are the result of brain states. This is a reasonable view. Considering what we know about brain function and the rather broad meaning of the words "chemical" and "imbalance" arguably all brain states are the result of "chemical imbalance" of some kind. (I know the brain is also an electrical system but the electrical pathways are deeply entwined with the chemical ones)
- aabceh 5y ago
  Anti-depressant alter your brain chemicals almost immediately once you start taking them but the anti-depressant effects usually come a couple of months after. Which suggests there might be more to the issue than just a 'chemical imbalance'.
  - naasking 5y ago
    Altered brain chemistry influences the physical prevalence of the receptors that those chemicals act upon. Those adaptations can take some time.
- Valakas_ 5y ago
  There can be many reasons for that and most have nothing to do with life choices or "mental models" whatever that means. * Trauma triggers and unprocessed/unconscious trauma. You'd be surprised how common this is. People who grew up in neglectful or abusive homes tend to believe there's something wrong with them and that their childhood was fine. So when life feels like shit, like there's no point, and it's only suffering every day, that somehow other people manage and they don't, they see no light at the end of the tunnel. It must be their fault, and for some reason they can't "get over it" or "Let it go". * A person repressing stuff, which at some point reaches breaking point or saturation. * Combination of (unlucky) factors - e.g. winter/less sun, less people around for some reason, had to sacrifice exercise for extra work, (...). * Chemicals in the brain indeed, change from one day to another. And maybe the day they feel depressed is when they are seeing things more realistically and crash with that realization. I don't buy this idea that it's part of the human condition that we're bound to have depression sometimes and that it's chemical imbalance. If we look at human history of psychiatry you'll see how coldly we've been treating patients. You'd be horrified at how we treated mentally ill people in the past. Why would you think we're doing any different now, just in a more mODeRn way - "They're sad because their brain is wrong. Give them a pill."
jhanschoo 5y ago
I agree with your claim, but in my experience I encounter people who explain mood disorders as chemical imbalances mostly in a different context. Where I see it most often are good-intentioned people trying to argue against stigma and poor treatment of mental illness. The idea is that there is indeed a physical aspect to it and not just "all in your head", and hence should be treated with the same sympathy toward the patients as physical illnesses, and this is directed toward people holding a certain mindset that stigmatizes mental illness as an argument to not do so. Of course, this is a terribly insufficient characterization of mood disorders. Perhaps this characterization in a game of telephone eventually became misconstrued in the popular consciousness as essential to the disorders.

serverlessmom 5y ago

I agree with you that there is definitely some serious obfuscation around the chemical imbalance aspect of the biological theory approach to mental disorder. If you do any research into the history of anti-depressants it isn't hard to uncover that there has been a lot of questionable science that forms the foundation of the over prescribing of medications for mental disorder that is currently the industry norm. I spent years suffering with really severe symptoms and I was so desperate for relief I tried all sorts of treatments. The main thing I really learned during that time is that approaching mental health requires a holistic approach, but even armed with that knowledge my life was still seriously impacted by my mental disorder. For me, I had spent years in talk therapy and different behavioral therapies. I had also tried various medications which did not help me and/or had side effects that were unbearable long term. I was on lamictal for a while which seemed to help but I also stopped seeing improvements and eventually that was also not good enough and my function declined. I also tried meditation, spiritualism, self medication, yoga, exercise, different diets, journaling. I took class after class on psychology and I instituted all sorts of different systems to try to fix myself. My therapist told me over and over that I was doing the work but that the improvements we were seeing weren't what she would expect, then I was referred to TMS. Once again, I was desperate and I was willing to do or try pretty much anything because I was a wreck of a person that was spiraling dangerously. So I went, and for the first time about three weeks in... I started to see a small difference. It changed my life, and I'm still so much better. The thing about how well it worked for me though is this: the idea of TMS is that it targets the part of your brain that is damaged by depression. Whatever this means- I've come to imagine it as neurons that have formed hard wired patterns of depression that are nearly impossible to rewire through sheer force of will. So chemical imbalance- probably (even demonstrably)false. Physical patterns in the brain formed while you suffered from depression being very difficult to rewire without outer interference? Is that possible? I'm mostly thinking out loud and I don't really expect someone to just have the answer but I really want to know and it's something I wonder about constantly.

jjeaff 5y ago

I'm not sure I understand what you are saying. Just that we shouldn't recognize that depression can be a chemical issue because that doesn't help us fix the problem? Are you saying that anti-depressants don't work? So if depression is more about mental models, life choices, and drive and whatever, why do so many people suffer from depression in cycles? There is little change from one day to the next, and yet, many people with depression can feel great one day and terrible the next. Or pregnant women can feel great before giving birth and then give birth to a perfect baby and suddenly start feeling depressed soon after. How do you use therapy to cure depression if the depressed person has no reason to feel depressed?

andybak 5y ago
Not GP and not even sure I agree with them. However I think there's some semantic issues with "chemical imbalance" that are worthy of examination. Depending on your basic philosophical views regarding materialism and the origin of consciousness, you might be of the view that all mental states are the result of brain states. This is a reasonable view. Considering what we know about brain function and the rather broad meaning of the words "chemical" and "imbalance" arguably all brain states are the result of "chemical imbalance" of some kind. (I know the brain is also an electrical system but the electrical pathways are deeply entwined with the chemical ones)
aabceh 5y ago
Anti-depressant alter your brain chemicals almost immediately once you start taking them but the anti-depressant effects usually come a couple of months after. Which suggests there might be more to the issue than just a 'chemical imbalance'.
- naasking 5y ago
  Altered brain chemistry influences the physical prevalence of the receptors that those chemicals act upon. Those adaptations can take some time.
Valakas_ 5y ago
There can be many reasons for that and most have nothing to do with life choices or "mental models" whatever that means. * Trauma triggers and unprocessed/unconscious trauma. You'd be surprised how common this is. People who grew up in neglectful or abusive homes tend to believe there's something wrong with them and that their childhood was fine. So when life feels like shit, like there's no point, and it's only suffering every day, that somehow other people manage and they don't, they see no light at the end of the tunnel. It must be their fault, and for some reason they can't "get over it" or "Let it go". * A person repressing stuff, which at some point reaches breaking point or saturation. * Combination of (unlucky) factors - e.g. winter/less sun, less people around for some reason, had to sacrifice exercise for extra work, (...). * Chemicals in the brain indeed, change from one day to another. And maybe the day they feel depressed is when they are seeing things more realistically and crash with that realization. I don't buy this idea that it's part of the human condition that we're bound to have depression sometimes and that it's chemical imbalance. If we look at human history of psychiatry you'll see how coldly we've been treating patients. You'd be horrified at how we treated mentally ill people in the past. Why would you think we're doing any different now, just in a more mODeRn way - "They're sad because their brain is wrong. Give them a pill."

jhanschoo 5y ago

I agree with your claim, but in my experience I encounter people who explain mood disorders as chemical imbalances mostly in a different context. Where I see it most often are good-intentioned people trying to argue against stigma and poor treatment of mental illness. The idea is that there is indeed a physical aspect to it and not just "all in your head", and hence should be treated with the same sympathy toward the patients as physical illnesses, and this is directed toward people holding a certain mindset that stigmatizes mental illness as an argument to not do so. Of course, this is a terribly insufficient characterization of mood disorders. Perhaps this characterization in a game of telephone eventually became misconstrued in the popular consciousness as essential to the disorders.