A cool part of my job is getting a lot of training in mental health related matters. Something I went to recently was a workshop run by Mind Recovery College here in Melbourne. The workshop was discussing psychiatric medications, and how we think about them.
The presenters included a psychiatrist and a mental health consultant with lived experience, and they discussed three different theories about medications and how they work:
- That depression and other diagnoses are caused by a chemical imbalance in the brain, and that medication rights this. Interestingly, there isn’t actually a whole lot of supportive data to back up this theory, but just a whole lot of…theories, about how the inside of the brain is working. SSRI’s, for example, were originally developed to be used for another purpose (related to tuberculosis), but in the testing of them they realized people felt less depressed when they were taking them. That was what led them to come up with the theory that depression was an imbalance in serotonin levels. Not the other way around! Now the thinking is that in fact the SSRI’s have an effect on the serotonin receptors, and that has something to do with why they work. But researchers still don’t know exactly what exactly happens to the receptors, or why. Or if that is indeed even the reason that people feel better.
- That antidepressants and other psychiatric meds have a ‘psychoactive’ effect (psychoactive means that it changes brain function and thus has an effect on things like mood, perception and cognition). This one is spoken about in depth by Dr Joanna Moncreif – she basically proposes that psychiatric medications are like other, even recreational, drugs – they have an effect on anyone who takes them. The nature of antidepressants is to lift mood, decrease moodswings, etc – and it would do this to anyone, not just someone who’s depressed. The nature of valium is to create a sense of drowsiness and relaxation, and would do this for anyone who took it – but for someone with anxiety, this might be especially useful. I guess the main point here is that she proposes people who are experiencing mental distress are not lacking in any chemical in their brains – rather there is a distressing symptom occurring and the drug just helps to decrease the symptom. Rather like having a headache, and taking a paracetamol – but the fact that this drug works in this situation, doesn’t make a headache a paracetamol deficiency.
- The placebo effect – there is a lot written about the placebo effect, and how it can account for a significant amount of people’s improvement when they receive any number of different health care treatments – from sham surgery, to sham acupuncture, to sugar pills. (In case you’re wondering, sham surgery for arthritis in the knee was as effective as the real surgery, in a particular study). Thinking and believing that you’re getting something that will help you, can help you. Rather than this being an emabarassing reality about our gullibility as humans, I find it exciting – it gives so much hope that our own brains can help ourselves to feel better! Indeed, I’ve often wished for an ethically-questionable doctor who would prescribe me sugar pills without telling me. (Although in this day and age, perhaps a sugar-free pill would be more fitting. Hah! Joke.)
As stated in the workshop I went to, these three theories are not the only ones. But it was a good reminder to me that the ‘chemical imbalance’ theory is just that: a theory. I believed this about myself without question when I first got a diagnosis of depression. If you’ve ever been to a doctor, or had a well-meaning friend or family member talk to you about whatever you’re experiencing, chances are they’ve mentioned chemical imbalances to you too. It’s a common explanation for depression and other mental distresses that is often assumed to be ‘true’.
I’m not trying to shut down anyone who does believe in an imbalance, or who finds any sort of comfort or meaning from that. What I do believe in, is people finding their own path through this crazy journey, and offering ideas about things that might trigger a new thought is something that seems to be a part of my path, right now. I accepted the chemical imbalance theory for many years, and it’s only recently that I’ve been reconsidering how I feel about it. I’m as yet undecided.
What do you think about all this? Do you believe in the chemical imbalance?