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What Causes Depression? Myths About Chemical Imbalances

A closer look at physicians, drug companies, and the medicalizing of depression.

Every few days I watch Brian Williams for his NBC Nightly News report. I know that this 30-minute program is about more than world events. NBC wants me to think I am clinically depressed, my insides are rotting from cholesterol, and my sexual performance is inadequate. Why? Because each commercial segment is brought courtesy of Cialis, Lipitor, Celebrex, and Cymbalta or another antidepressant drug of the week. Thanks to Lasik surgery (one of the 10 best decisions I've ever made) and intense concentration honed by graduate school, the Arial 6 font, rolling list of Cymbalta side effects cannot escape my scrutiny.

In case you're thinking that the proper pill will rid depression and bring a state of bliss, here are a few of Cymbalta's side effects worthy of consideration...

  • nausea
  • pain in your upper stomach
  • dark urine
  • clay-colored stools
  • jaundice (yellowing of the skin or eyes)
  • feeling like you might pass out
  • hallucinations
  • overactive reflexes
  • fast or uneven heartbeats
  • tremors
  • unusual bleeding
  • painful or difficult urination
  • memory problems
  • loss of coordination
  • seizures
  • severe skin reaction – fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling

(click here for a handy data on the prevalence rates of side effects, many of which are double the rate for placebos and then there are these facts on discontinuation).

Cymbalta no longer appears to be the panacea for first dates and exceptional performance during an eight-hour workday. And the qualities on this list aren't ideal for helping a person break free from the depths of sadness, self-loathing, loss of interest, loneliness, concentration difficulties, fatigue, and suicidal ideations that characterize depressive disorders. Sometimes the so-called cure is worse than the disease.

In a prior blog post, I mentioned that as of February 11, 2014, perhaps the greatest book ever to be written on depression was released—The Depths: The Evolutionary Origins of the Depression Epidemic. In this masterpiece, Dr. Jonathan Rottenberg, argues that the "chemical imbalance" theory of depression is wrong. Yes, biological factors are important to understanding depression but it is a mistake to think that these chemicals are what cause, maintain, or exacerbate suffering. Psychology has advanced quite a bit and we now know that our perceptions, expectations, choices, relationship patterns, and strategies for regulating emotions and thoughts influence our psychological health. Fail to acknowledge this, and you are essentially refusing to examine yourself.

By no means am I saying that depressed people are to blame. I began this post by mentioning the pernicious commercials of pharmaceutical companies that portray psychological suffering as a biological illness that they alone can fix. And there is plenty of research suggesting that your local, trusted physician is influenced by these same pharmaceutical companies, bolstering the belief that depression is a biological illness that can be cured with a tiny pill.

Instead of challenging your beliefs in this chemical imbalance theory of depression, let me stimulate your curiosity. Let me share a yet to be published study by Dr. Brett Deacon and his colleagues. They recruited 91 adults who are clinically depressed or once was. To make this credible, he gave everyone a fake "Rapid Depression Test" that determined whether their serotonin levels were abnormally low compared to other neurotransmitters. To make this test seem legit, they swiped the inside of people's mouths with a cotton swab and the saliva was carefully moved to a sealed container to be taken to the lab for examination. Afterwards, everyone received detailed test results and a random half of participants were told that their serotonin levels were problematic and there is a clear chemical explanation for their depression. The other half were told their serotonin levels were normal and their depression cannot be purely explained by brain chemistry.

The big question: What happens to people when they buy in to a biomedical explanation for their depression?

The answer: Bad things. They become pessimistic that recovery is possible. They become less confident that they can manage and regulate negative moods that arise (and they always do). The notion that depression is their brain's fault does not lessen the stigma or self-blame one bit. And they no longer believe that psychotherapy is a credible or useful strategy for treating their depression and instead, are ready to be dispensed a pill cure. Essentially, they become less flexible in their options for treating depression and less confident that they will escape its clutches.

It is going to be tough to battle the science fiction promoted by pharmaceutical companies. What makes the challenge increasingly difficult is that these companies spent $57.5 billion to promote drugs in 2004, and the numbers are only getting bigger. If we care about reducing human suffering, it's time to bring on the noise and ensure that everyone knows the science. We are fortunate to have scientists that are willing to fight powerful companies and dominant beliefs in search for the truth.

 

For further information

Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its assumptions, consequences, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846-861.

 

Dr. Todd B. Kashdan is a public speaker, psychologist and professor of psychology at George Mason University. He authored Curious? Discover the Missing Ingredient to a Fulfilling Life and Designing Positive Psychology and most recently, Mindfulness, Acceptance, and Positive Psychology. His secret book with Robert-Biswas-Diener will be released with Hudson Press in December, 2014. If you're interested in speaking engagements or workshops, go to: toddkashdan.com

Todd B. Kashdan, Ph.D., is Professor of Psychology at George Mason University and author of The Upside of Your Dark Side: Why Being Your Whole Self–Not Just Your 'Good' Self–Drives Success and Fulfillment more...

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