The chemical imbalance theory gave Big Pharma a very profitable revenue stream, physicians an out-of-the-box tool that pleases the patient. It gave the media new advertisers, and it gave Wall Street new stocks that are still popular.
“Lexapro appears to relieve symptoms of depression and anxiety by increasing serotonin,” reads an ad on the Bonkers Institute, a website that archives drug ads and also lampoons pharmaceutical claims, and shaky science. “Zoloft works to correct a chemical imbalance in the brain that may be related to symptoms of depression“, reads another ad. “Paxil CR prevents serotonin from being reabsorbed back into the sending nerve cell. This process increases the availability of serotonin to the receiving nerve cell and may help return [depression] message transmission to normal”, reads a third ad.
The serotonin “chemical imbalance” theory of depression was recently dismissed by a group of scientists at University College London, in the journal Molecular Psychiatry. After reviewing decades of research, there is no evidence that serotonin levels or serotonin activity are responsible for depression.
In other words, the theory that was the basis of selective serotonin reuptake inhibitor (SSRI) antidepressants and their wildly profitable theory now turns out to be false. While the theory has been disputed by scientists for decades, molecular psychiatry research appears to be the final nail in the theory’s coffin: a technical knockout.
The popularity of the ‘chemical imbalance’ theory of depression has coincided with a huge increase in the use of antidepressants. Antidepressant prescriptions have increased dramatically since the 1990s, said the paper’s lead author, Joanna Moncrieff, a professor of psychiatry at University College London.
Thousands of people suffer from the side effects of antidepressants, including severe withdrawal effects that can occur when people try to stop them, but prescription rates continue to rise. We believe that this situation has been driven in part by the false belief that depression is due to a chemical imbalance. It is time to inform the public that this belief is not based on science, Moncrieff said.
A powerful drug franchise
It is difficult to overestimate the medical, financial and sociological consequences of the chemical imbalance theory, which prompted the approval of the SSRI antidepressant Prozac by the US Food and Drug Administration (FDA) in 1987, and which is still being used today, continues. Several years ago, Harvard Health Publishing estimated that about 1 out of 4 American women, between the ages of 40 and 50, were taking antidepressants.
Thanks to direct-to-consumer marketing about depression, people with life problems or occasional bad moods absorbed the chemical imbalance message, diagnosed themselves with depression, and showed up at doctors’ offices. Problems with family, work, health, money or housing were no longer a reason to feel depressed or defeated, aggressive SSRI advertising campaigns suggested. If you were depressed, you had a chemical imbalance, regardless of anything else that might have explained your depression (such as the loss of meaning and social connection often seen in modern society).
Whereas the antidepressants that preceded the SSRIs, some called monoamine oxidase inhibitors, were linked to neurotransmitters in the brain like serotonin, dopamine, and norepinephrine, the SSRIs reduced chemistry to a simple problem-solution equation, which the public readily accepted. Worldwide sales of SSRIs are estimated to skyrocket to US$18.29 billion by 2027.
Response of traditional medicine
Psychiatrists and the American Psychiatric Association (APA), which is highly funded by drug manufacturers, were the first to reject the Molecular Psychiatry article. In fact, 70% of the authors of the APA Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were funded by drug manufacturers, according to ABC News.
The main protest was “we never promoted the chemical imbalance theory” and “nobody really understands why or how antidepressants work”. The “third rail” for doctors -funded by drugmakers- is the suggestion that mental illness may not be due to physical conditions at all.
As Mark Horowitz, co-author of the Molecular Psychiatry paper, put it: An interesting aspect of the studies we examined was how strong the effect of adverse life events was on depression, suggesting that low mood is a response to people’s lives and you can’t boil it down to a simple chemical equation.
If depression stems from stress, trauma, pain, loneliness, and social conditions such as poverty, as Horowitz suggests, it would not be amenable to drug treatment. Worse yet; if it were not a permanent chemical imbalance as the serotonin depression theory implies, it wouldn’t turn into lifelong drug prescriptions, which drugmakers seek and treasure most.
Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact, research has shown the opposite, and also that people who believe their own depression is due to a chemical imbalance are more pessimistic about their chances of recovery Moncrieff said.
Psychiatrist Peter Breggin, who has been called the Conscience of Psychiatry, elaborated on this idea: Since the ancient Greeks, physicians have wanted to believe that mental and emotional distress must have biological origins. That allowed them to include ‘mental illnesses’ within their specialty.
With the development of the massive involvement of pharmaceutical companies in routine psychiatric practice during the advent of antipsychotic medications in 1954, pharmaceutical companies also began to push the biochemical and biological bases of human experiences such as anxiety, depression, manic-depressive (now bipolar disorder), and schizophrenia.
Then, in the late 1980s, in anticipation of the FDA approval of Prozac for depression, Eli Lilly ran an international ad campaign claiming that depression is caused by a biochemical imbalance in serotonin. It was obvious from the start that this was pure fantasy.
In my scientific books and articles since 1983, I have pointed out the consistent truth that biochemical imbalances in the brains of mental patients are not known until they are caused by the neurotoxic effects of all psychiatric drugs. Now, a review article by British psychiatrist Johanna Moncrieff has reconfirmed that research fails to show any connection between depression and abnormalities in serotonin metabolism in the brain.
So-called ‘mental illnesses’ are not known to be genetic or biochemical in origin; It’s all hype from the medical and pharmaceutical companies. Breggin and his wife, Ginger, wrote the new book “Covid-19 and The Global Predators: We Are the Prey”.
Do not stop SSRIs abruptly, warn both parties
Whether they believe SSRIs to be misleading and overprescribed or valuable treatments, doctors warn patients not to stop drugs abruptly. In 2018, The New York Times exposed that SSRI antidepressants can be difficult to quit and downright addictive (although drugmakers prefer to call the effects of addiction “discontinuation syndrome”).
Some patients say they were not warned by their doctors that they could be parked on the drugs indefinitely, due to side effects such as dizziness, nausea, headaches and brain shocks they experience when they try to stop the drugs, the newspaper reported.
Brian, a 29-year-old Chicago resident who asked not to give his last name, said he has continued to take an SSRI antidepressant for years despite his desire to stop. “Every time I try to stop, I feel something that feels like an electric current in my head and I cannot do it”, he said.
The NY Times article provoked a backlash from psychiatrists. “By amplifying the echo chamber of social media, the article creates the unfortunate impression that the majority of patients are forced to continue antidepressants for fear of withdrawal rather than preventing recurrence”, read a letter to the editor signed by a group of 39 psychiatrists, who described depression as “chronic” and “little treated”.
At least 35 of the signatories to the letter were affiliated with the Columbia University College of Physicians and Surgeons, an institution that received a US$250 million donation from former Merck CEO Roy Vagelos and his wife, Diana, in 2017. Since their original marketing, SSRI antidepressants are now also known to increase bone loss and fracture risk, as well as the risk of the dreaded intestinal condition Clostridium difficile.
So why do SSRIs work?
It is generally accepted that SSRI antidepressants sometimes work, although not impressively and not for all patients. But why is that?
According to a follow-up article by Moncrieff and Horowitz: Any medication that changes normal brain activity is likely to have some impact on mood, and…by virtue of changing brain chemistry, antidepressants also produce changes in mental activity and emotion normal experiences. Antidepressants also numb mood, including not just sadness and anxiety, but pleasant emotions like happiness and joy”, which can lower depression scores, making the drugs appear effective.
An article in the journal Springer Inflammopharmacology suggests that a possible SSRI mechanism could be decreasing “neuroinflammation [in the brain] through multiple mechanisms, including the reduction of cytokines in blood or tissues or the regulation of complex inflammatory pathways. Whatever the explanation, it remains true that other methods of treating depression, including exercise and cognitive behavioral therapy, have proven efficacy with additional benefits and no side effects.
One last irony
Although the premise through which millions of people receive psychoactive drugs has been demolished, questions have been raised about the interface between medical care and misleading drug marketing.
Many media outlets went on the attack after Fox News host Tucker Carlson said: First, they told us SSRIs would save lives. Now, we learn that they don’t actually work as intended. In fact, the whole idea behind the drug was completely wrong. And yet, and here’s the best part, people are ignoring this news and the drugs are still being prescribed.
Rolling Stone magazine published a best-selling article portraying Moncrieff as a conspiracy nut with a history of criticizing the overmedication of mental illness and attributing some mass shootings to psychoactive drugs.
The article, “Who is the psychiatrist behind the antidepressant study taking over the right-wing media?”, reveals the 180º turn that the progressive media has made towards drug manufacturers since Covid-19: Forgive and forget the original distrust of corporatism, capitalism and monopolies, and the scourge of opiates caused by drug manufacturers, in order to demonize rivals.
Meanwhile, millions of people taking SSRI antidepressants now face the same feeling that comes from quitting smoking.