REPRINTED WITH PERMISSION from The Florida Jewish News

If my article, “If Its Not a Chemical Imbalance, What Is It?” threw you into a tailspin, I apologize. I believe the requirement for clarity rests on the writer, not the reader. Let me be very clear: The notion that there is a lack of serotonin in the brains of depressed people and that they consequently have a “chemical imbalance” is a fiction. Furthermore, doctors who promote this fiction are not acting in the best interests of their patients and need to rethink the matter carefully before continuing along this path.

No Evidence Of Serotonin Decrease

Elliott Valenstein is a Professor of Psychology and Neuroscience at the University of Michigan with no financial ties to any particular industry. In his book, Blaming the Brain: The Truth About Drugs and Mental Health, published in 1998, he states, “I did not write this book because I am opposed to using drugs to treat mental illness. . . I do not treat patients and have no reason to be for or against drug therapy, psychotherapy . . . or to take any side in any disagreement between nonmedical therapists and psychiatrists. . . I have spent over forty years working as a biopsychologist studying how the brain and other biological factors such as hormones and drugs influence behavior.”

Valenstein states: “There is not a shred of evidence of any . . . decrease [nowadays] in brain serotonin. In another book, a Pulitzer Prize-winning science writer describes the ‘revolutionary’ finding that major personality and behavioral traits are regulated by the balance between norepinephrine and serotonin. There is really no convincing evidence supporting this view, but by describing some weak trends as established facts and by failing adequately to acknowledge contradictory evidence, many popular writers make it appear that complex personality variables are completely dependent on the balance between two neurotransmitters.”

Further, he says, “The evidence and arguments supporting all these claims about the relationship of brain chemistry to psychological problems and personality and behavioral traits are far from compelling and are most likely wrong. . . These ideas are simply an unproven hypothesis.” For example, there is no way to measure serotonin levels in living people. “While there are some reports of finding evidence of an excess or deficiency in the activity of a particular neurotransmitter system in the brains of deceased mental patients, these claims are controversial, as other investigators cannot find any such relationship.” What’s more, the brains of normal people may show the “imbalance” in these neurotransmitters!

Correlation Is Not Cause

A big problem is the confusion of cause and effect and Valenstein takes a whole chapter to painstakingly explain the difference between correlation and causation. “Of course,” he says, “no one would suggest the carrying of umbrellas causes rainfall, although umbrella carrying is highly associated with rain.” He points out that changes in brain function of mental patients could be due to stress, or the medication that have been used to treat them. Further, learning itself changes brain structure.

As Vassilis Koliatsos, psychiatrist-researcher at Johns Hopkins Medical School says: “I never use the term ‘chemical imbalance.’ It’s unacceptable reductionism. It doesn’t have any explanatory power and it doesn’t reflect the truth.”

With all this evidence casting a shadow on the chemical imbalance hypothesis, why has it been promulgated so much?

What You Don’t Read About Drugs

In the March/April, 2000 issue of The Family Therapy Networker, Barry Duncan, Scott Miller, and Jacqueline Sparks wrote a review article of antidepressant research called “The Myth of the Magic Pill” based on studies reported in the U.S. Department of Health and Human Services, the Archives of General Psychiatry, and the Journal of Nervous and Mental Disease. They concluded that “outcome research does not confirm the miracle status these drugs have been accorded in the popular imagination. Our culture’s exaggerated faith in psychiatric medication rests not on science, but on brilliant marketing by a profit-driven industry. Outcome research—even outcome research funded by the companies that manufacture pharmaceuticals—has not found these drugs to be any better than therapy, and only marginally better than placebos” (p. 27). (I used to have a link for this article but it has been taken down. If you really want to read it, write me.)

They state: “Researchers with financial ties to drug companies usually publish results friendly to their funders, and friendly researchers, likewise, tend to get funded. An October 1999 study of 44 journal articles on anticancer drugs, for instance, published in The Journal of the American Medical Association, reported that only 5 percent of drug-company funded research found that the drugs were not cost-effective, while 38 percent of the research sponsored by universities, foundations and other nonprofit organizations found the drugs not cost-effective. A study in the January 1998 New England Journal of Medicine produced similar results.”

They go on: “Our exaggerated sense of the efficacy of psychiatric drugs may also be colored by the fact that drug companies are under no obligation to publish the results of failed clinical trials. Thomas J. Morre, a health policy analyst at George Washington University, for example, recently found, in a search of FDA files, the results of two identical trials of the antidepressant Serzone. The one showing a marginally positive result was published, but Moore found no indication that the other trial, showing no measurable drug effect, was ever published.”

Did you know that the major funders of the Anxiety Disorders Association of America are “Pfizer, Wyeth, Solvay, Eli Lilly, Smith-Kline Beecham, Pharmacia & Upjohn, Glaxo-Wellcome, Bristol-Myers Squibb, and Janssen totaling $1million, 75% of association income”? The authors produce similar information about the National Depressive and Manic Depressive Association and the National Mental Illness Screening Project.

Subsequently, the editorial policies for the Journal of the American Medical Association and the New England Journal of Medicine changed. In the last three years, they have required disclosure by all contributors of their funding sources.

What’s more, here are the most common side effects: nausea, difficulty sleeping, drowsiness, anxiety, nervousness, weakness, loss of appetite, tremors, dry mouth, sweating, decreased sex drive, impotence, or yawning (from the Prozac site).

The basic tenet of the Code of Ethics in most therapy professions is: First, do no harm. Given the harm—and absolutely unproven “help” of the antidepressants—the most sensitive, ethical, and professional approach for any doctor or therapist to use in treating depression would not be to whip out a prescription pad, but to thoroughly understand the thinking process of an unhappy or anxious individual so as to work with that person, rather than disempower the individual by suggesting it is beyond his or her control and can only be fixed by medication.

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