Illustration of a man with anchors tied to his head, by Gérard DuBois

Mental Illness and the Outdated/Unsupported Hypothesis of "A Chemical Imbalance"


I realise that most people probably don't care about (much less discuss) depression, mental health and mental illness (particularly on this crypto-centric site), but I do because it is important to me. Please feel free to move onto something to do with the cryptosphere if you can't be bothered to entertain my ranting (citing medical research) to prove a point.

One thing that really cooks my goose is people telling me that "depression and mental illness is caused by a chemical imbalance in the brain", particularly if they are encouraging me to spend what little money I have on snake oil meds of dubious efficacy to "correct" that so-called imbalance.

From what I understand from the research I've read on the "chemical imbalance" hypothesis, there is little to no clear evidence that this is actually the case, nor that selective serotonin reuptake inhibitors (SSRIs) and related drugs actually have any long-term beneficial effect. (They do seem to work, briefly, in extreme/severe cases, but there's no value in taking them once a sufferer passes the initial hump.) However, they are still over-prescribed by psychiatrists (1 in 4 adults in the UK and 1 in 5 in the USA), many of whom have questionable ço-dependant" relationships with Big Pharma corporations (according to Dr. James Davies in his book, Cracked: Why Psychiatry is Doing More Harm than Good).

"Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. ... the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness ..."
 — Effectiveness of Antidepressants: An evidence myth constructed from a thousand random trials?; John PA Ionnidis; Philosophies, Ethics and Humanities in Medicine; 2008


"There was no real evidence that serotonin deficiency caused depression."
 — Irving Kirsch, a psychologist and lecturer at Harvard who's studied antidepressants and their placebo effect for many decades

 


Mental-health experts, like Mimi Winsberg, say this isn't new information. We've known for a while that low serotonin doesn't necessarily cause depression, and the diagnosis cannot be reduced to a simple, single biochemical root cause. But that doesn't mean SSRIs can never work for anyone.  

"Depression itself is a very complex and nuanced diagnosis. SSRIs don't cure people by raising their serotonin levels."
 — Mimi Winsberg; Psychiatrist and chief Medical Officer of Brightside Health

In fact, studies have shown that even artificially lowering a person's serotonin levels does not reliably lead them into a depressed state. SSRIs are more successful for anxiety, rumination, and OCD than for "low-energy" depression cases, according to Winsberg. 

Based on the many studies/meta-analysis reports I have read, it is my strong conviction that mental illness is a psychological condition, not a physiological one. Treating it as if it's the latter (by prescribing brain/behaviour-altering drugs) is a waste of energy, time and money. The drugs/pills (assuming they do have any measurably beneficial effect beyond severe depression) are merely a crutch, a short-term solution at most; they do not solve the underlying/root problem, do not cure the condition, no matter how much they muck around with chemicals in the brain or body for up to a year after the initial few months of taking them. For the record, I have found exactly one study that concludes that SSRIs/drug-based treatment of non-severe depression is actually effective. The majority of others generally have this (or a similar) conclusion:

"SRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects."
 — Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder: A systematic review with meta-analysis and Trial Sequential Analysis; Janus Christian Jakobsen, Kiran Kumar Katakam, Anne Schou, et al; BMC Psychiatry volume 17, Article number: 58 (2017)


"It has been extensively debated whether selective serotonin reuptake inhibitors (SSRIs) are more efficacious than placebo in affective disorders, and it is not fully understood how SSRIs exert their beneficial effects. Along with serotonin transporter blockade, altered dopamine signaling and psychological factors may contribute. [...] Findings support that the anxiolytic effects of SSRIs involve psychological factors contingent on dopaminergic neurotransmission while serotonin transporter blockade alone is insufficient for clinical response."
 — Olof R. Hjorth, Andreas Frick, et al; Expectancy Effects on Serotonin and Dopamine Transporters During SSRI Treatment of Social Anxiety Disorder; 2021/11/03

If you're skeptical or flat out refuse to believe the good doctor(s) or me, feel free to read the links in the "resources" section. I doubt that doing so will change your mind, though ...

Why Facts Don't Change Beliefs: Cognitive Bias, Believe Perseverance and Other Limitations

Illustration of a man with anchors on his head, by Gérard DuBois Illustration by Gerard DuBois

Sure, you can certainly flat out refuse to believe a conflicting point of view, label it a crazy/far-out conspiracy theory or you could do the uncommon thing: Open your mind to the possibility that your preconceived notions are outdated/wrong, read the research, examine the evidence presented, move with the times and update your ideas. There are no prizes for correctly guessing that many opt for the former because it's the easier route (particularly when Science and Medicine are involved; people want simple explanations for complex phenomena). However, given that many in the cryptoshere are more open to new approaches, ideas and technologies to solve old problems, I'm taking the risk of hoping that my audience is at least willing to consider and assess what might be new information to them. However, if you're in the first camp, here are explanations as to why that might be:

Plain talking has ruined us now. You'll never know how.

"In my experience, when a critic criticizes me or a coauthor personally, it means that they lack a specific argument against the points made, but do not like the conclusions reached."
 — Irving Kirsch

While it's true that "facts don't care about your feelings", research shows it's also true that your feelings don't care about facts.

"Faced with a choice between changing one’s mind and proving there is no need to do so, almost everyone gets busy with the proof."
 — J.K. Galbraith; Economist


"The first principle is that you must not fool yourself – and you are the easiest person to fool."
 — Richard Feynman; world-renowned theoretical physicist (quantum electrodynamics), Nobel Prize winner and former CALTECH professor

Just as we all know that smoking is bad for a person's health, that knowledge isn't sufficient to persuade smokers to quit. Likewise, knowing that Abrahamic religion is mostly a horrific and ghastly bunch of bronze-age bullshit usually isn't sufficient to stop people believing in it (or at least claiming to). The cult of big pharma (blindly trusting so-called medical "professionals", such as psychiatrists, because they are authority figures/"experts") is no different. (Anyone whom follows me should be pretty familiar with the fact that I strongly encourage people to not blindly trust what I write, even if it's as an expert/"credible source", but to DYOR and verify for themselves. That's why I put so many links into the "Resources" sections of my posts. They're not there to impress you with how much research I did, but so that you can verify for yourself that I've drawn the right conclusions from it.)

No matter how logical/reasonable people claim to be, the human brain has limitations (including cognitive biases) that make it susceptible to brainwashing/indoctrination and manipulation that bypass the logical centres (the "executive functioning" areas).

“Once formed, impressions are remarkably perseverant.”
 — Why Facts Don't Change Our Minds; Elizabeth Kolbert; The New Yorker; 2017/02/19; accessed 2023/06/26 @ 15:15 SAST

"Even after the evidence for their beliefs has been totally refuted, people fail to make appropriate revisions in those beliefs."
 — Anderson, Leper, et al (circa 1980); cited by Mz. Kolbert


"Reason developed not to enable us to solve abstract, logical problems or even to help us draw conclusions from unfamiliar data; rather, it developed to resolve the problems posed by living in collaborative groups. [...] Rationality is less about making decisions based on logic but providing justifications for decisions one has already made."
 — The Enigma of Reason; Hugo Mercier and Dan Sperber

If you're still not convinced and couldn't be bothered to read the linked material, please feel free to exit stage right and consult a psychiatrist or six, since they'll be more than happy to take your money in exchange for giving you expensive blister-packed rubbish for whatever it is that ails your mind ... Then again, that's not true for all of them, as it turns out:

"The routine use of antidepressants for mild depressive symptoms is not generally recommended. More research is needed on the benefits and harms of long-term use."
 — The Royal College of Psychiatrists in the UK (2019)

So please, go ahead, call me crazy (I am) and tell me more about how all those scientists and medical professionals around the world questioning the over-prescription of drugs for mental illnesses are involved in a "conspiracy theory" to discredit the psychiatric and Big Pharma sales and murketing propaganda machine (just like they were to fake the moon landing), why don't ya? Preferably, do it before my psych evaluation appointment on Wednesday morning, so that I can tell the psychologist I'm going to see a funny story about which we can both have a good laugh.

Further Reading

There are other books on the subject (and related ones) that I want to read and may well support my argument. However, since I haven't read them and formed opinions on the content thereof, I feel it would be unwise (and possibly self-defeating) to quote from or cite them here:

  • Sedated: How Modern Capitalism Created our Mental Health Crisis by Dr. James Davies
  • Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions by Johann Hari; journalist and cultural commentator
  • Stolen Focus: Why You Can't Pay Attention by Johann Hari

Disclaimer

I am not a medical professional or psychiatrist. My opinions on mental illness are exactly that and should not be construed as medical advice nor justification for not taking your medication; they are here to provide you with a strong argument you can use if you feel the medication you're on is not working with you and you need to discuss options with your mental health professional. My interest in psychology is purely from the position of someone whom suffers from a number of mental health conditions (ADD, chronic depression and CPTSD) for which I am currently seeking the right treatment (including drugs if necessary).


Thumbnail image: Illustration by Gérard DuBois

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Great White Snark
Great White Snark

I'm currently seeking fixed employment as a S/W & Web developer (C# & ASP .NET MVC, PHP 8+, Python 3), hoping to stash the farmed fiat and go full Crypto, quit the 07:30-18:00 grind. Unsigned music producer; snarky; white; balding; smashes Patriarchy.


The Snark Returns: Random Musings from The GWS
The Snark Returns: Random Musings from The GWS

SW/Web developer: ~12 years of C# (yay!) & ASP .Net MVC, Java (blargh!), Python (woot!) experience. I'm currently hitting faucets and writing for crypto to stake/invest . | I work part-time with animals. Sadly, my cerebellum and medulla oblongata aren't Einsteinian in proportion. However, I possess a Brobdingnagian vocabulary and get by with being a barbigerous logophile. I can probably write you into bed, if smashing Capitalism and Patriarchy turns you on. Kink is political!

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