Advice: The Brain and Depression

Can anyone miss the heavy advertising on television of the various antidepressants? I watch these commercials and note the careful language they use in suggesting that depression "may" be caused by a chemical imbalance in the brain. Then they go on to tell you how the medication can "correct" this biochemical imbalance. Are they just being careful in the way they talk about the antidepressant medication, or are they somehow being evasive in not stating their case more forcefully? I can't really tell. Is depression caused by a chemical imbalance in the brain?

I have often used this column to point out the confusion that people experience when they are given incomplete or even contradictory information about depression, its causes and treatments. And I will do so now.

If we ask the question straight out, "What causes depression?" the most accurate answer I can give is, "Many things." There are biological factors (including a degree of genetic vulnerability and biochemical factors), psychological factors (such as your coping style and temperament), and social factors (your family atmosphere and presence of a support network).

Those that suggest an entirely biological view of depression, even declaring it a "serious disease only your doctor can diagnose," as some of the commercials state, ignore the huge amount of irrefutable evidence that depression involves much, much more than just "bad chemistry." They lead people to believe that depression is entirely about a "chemical imbalance in the brain."

There are many reasons why the information about other factors in depression, some at least as important as the biochemical, is not as available to the general population as the "chemical imbalance" theories. Advertising budgets of the pharmaceutical companies for depression medications alone was in the billions of dollars last year. That's an enormous amount of money being spent to promote the view of depression as a "disease" requiring drug treatment.

First and foremost, drug companies want to sell drugs, and physicians still have the unique privilege of writing drug prescriptions. Thus, the general population is inundated with pharmaceutical advertising in magazines and in newspapers and on television, all advising you that if you have "this" symptom, then you should ask your doctor for "that" drug. It's a very successful marketing strategy, but it may not serve people as well as it should, in my opinion.

Another reason the "chemical imbalance" theory has such strong support is that doctors are intensively trained to define and treat most problems biologically. There is a great tendency, almost reflexive, to prescribe physical treatments.

Last, but not least, there is a cultural shift to explain all our problems by biology ("I have a shopping addiction"). The result is that we don't have to take personal responsibility and make personal changes. It's not unlike the joke Jay Leno made on his show one night when he said, "They came out with a new weight loss drug this week. Thank God! I was afraid I was going to have to watch my diet and exercise!"

The chief problem with the view of depression as a consequence of a "chemical imbalance in the brain" is the fact that depression can be both triggered by and resolved by life events. The misconception the commercials foster is that the brain somehow develops a chemical imbalance and the result is depression, occurring in a single directional process.

In fact, the relationship between brain chemistry and experience is a two-directional phenomenon: Life experience affects brain chemistry at least as much as brain chemistry affects life experience. There is a growing body of evidence that psychotherapy, so-called "talk therapy," can alter brain chemistry in ways similar to drugs, without the adverse side effects.

The "chemical imbalance" hypothesis is not wrong. It's just not entirely correct.