Depression and Chemical Imbalance: Truth or Propaganda?

As a psychologist I am always interested in anything the drug companies have to offer to assist in the treatment of mental health problems, ranging from schizophrenia to anxiety.

As I have previously written, my views on the efficacy of antidepressants differ significantly from the information supplied by the drug companies. The link below illustrates my earlier views on the myth pushed by drug manufacturers that depression is caused by a chemical imbalance.

The topic came to my attention again recently while reading a brochure put out by the drug company Pfizer, which was promoted as "An educational program sponsored by Pfizer." I was alarmed but not surprised that drug companies are still pushing the myth of a chemical imbalance in the brain as the reason for the development of depression.

Because this idea has never been proven — it is merely a theory — companies must be careful in what they say to consumers. In this particular brochure, the company is careful to state:

"Depression is thought (author's emphasis) to be caused by an imbalance of chemicals in the brain".

The fact that this has never been proven does not halt the enthusiasm with which these companies promote this unproven theory. So successful is their sales pitch that virtually everyone, from doctors and pharmacists through to the general public, haven't picked up on the fine-print and simply accept the implication that imbalanced brain chemicals cause depression.

But worse was to come in this particular brochure:

"Treatment with antidepressants can be compared with treating an infection with antibiotics. The symptoms of infection will start to clear within a few days, but you should always take the complete course of antibiotics to prevent the return of the infection. With antidepressant medication, the symptoms of your illness should clear within a few weeks, but although you will feel well, you may need to take the medication for a few months to make sure the depression does not come back."

Although this information provided by Pfizer sounds reassuring, it is quite unethical to suggest to a potential user of their product that the depression will "clear within a few weeks".

This is both misleading and even detrimental to the patient. Depression will not "clear" within a few weeks unless the reason for that depression is addressed. And I have yet to meet a depressed person who does not have a valid reason for their depression.

Until that reason is addressed, accepted and dealt with, the depression continues, even though it may appear to be partially masked by the antidepressant. And that is all antidepressants do - mask the underlying problem. This is why tens of thousands of people continue to take antidepressants for periods of time far beyond what they were originally intended for.
Some people have been taking antidepressants for years, even decades, although they are naturally upgraded over the years as newer varieties appear on the market. And yet these people are not "well". The depression is not "cleared". It has merely been suppressed.

The other appalling analogy in the above spiel by Pfizer is to compare an antidepressant to an antibiotic. Antibiotics are used to kill bacteria, organisms that cause illness in the body. As we all know, antibiotics are used for only a short period of time in most illnesses -- usually just over a week. But even now, most people are aware of the over-use of antibiotics and sensible doctors are reluctant to dispense them and for good reason - the bacteria they are supposed to kill are rapidly mutating developing immunity, creating the potential for superbugs.

But to equate using antibiotics with the use of antidepressants is not only unethical, it is nonsensical. Antibiotics merely seek out and destroy foreign bacteria in the body and destroy it. Further, using this analogy lulls the user into a false sense of security since we are all relatively comfortable with the use of antibiotics. There is hardly a person in the developed world who has not taken a course, hence the brilliance of using this as a potent example to promote antidepressant medication.

But unlike antibiotics, antidepressants act directly on the brain in a way that neuroscientists do not yet fully understand. The neurotransmitters that drug companies speak so confidently of still cannot be accurately measured in order to determine whether or not there actually is an imbalance present.

While the drug companies speak in certainties, the truth is far from certain. As those in the know will readily admit, there is no firm evidence for the cause of depression in terms of chemicals at all. Yet there exists abundant evidence for both adverse life events and our own belief systems in influencing how we feel. This extends to becoming depressed when irrational thoughts and beliefs are formed, focused and acted upon.

Back again to the analogy of the antibiotics, suggesting to patients that they continue using antidepressants for a few months "to make sure the symptoms do not come back" is also misleading. The symptoms will come back when the medication is stopped if the reason for the depression has not been addressed through therapy or life changes.

To equate depression with a bacterial infection that is easily treatable only makes for further problems down the line for the patient. The reasons for depression are often multifactorial and cannot simply be fixed either with a pretty colored tablet or a quick talk to your best friend. Having this idea instilled by the drug companies only serves to make a depressed person feel even more hopeless and helpless if they fail to be "clear" of symptoms in a few weeks.

Fortunately drug companies are beginning to be held accountable for their advertising and it is good to see countries like the Republic of Ireland now refusing to allow drug companies to advertise in their product information guides that depression is caused by a chemical imbalance. Hopefully this will be the start of governmental action around the world and a better deal for those suffering from this often debilitating illness.

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