Why Depression Isn’t Just a Chemical Imbalance

Depression has often been simplified to a chemical imbalance in the brain, where the brains of those who are clinically depressed have lower levels of serotonin, norepinephrine, and dopamine. It’s what many medical treatments are based on, with the most common on the NHS being selective serotonin reuptake inhibitors (SSRI’s), which works by blocking the uptake of serotonin by the brain, meaning more serotonin is readily available. However, the idea that depression is caused by too much or too little of a chemical in the brain simplifies the issue at hand and prevents us from tackling the complexity of depression as an illness.

The evidence the serotonin hypothesis is based on is that the brains of depressed people have a significantly lower concentration of serotonin, but correlation doesn’t mean causation. There is little evidence to support a causal relationship, and what prescribed SSRI’s are doing is easing something which may be a symptom of depression. It would explain why many antidepressants aren’t great preventing relapse compared to talking therapies such as cognitive behavioural therapy.

In fact, there are very few studies that show a cause-and-effect relationship between any neurological dysfunction and depression itself, despite there being many associations. For example, it’s known that having a family history of depression will mean you may be vulnerable to developing the condition. But whether that’s because something is inherited, or if behaviours and unhealthy thought patterns are mirrored and learnt, is still under question.

There are many different types of depression, and the significance of the factor of chemical imbalances vary amongst them. For example, premenstrual dysphoric disorder (PMDD) is a severe form of PMS and can severely affect a person’s mental health 7-8 days before their period, monthly. One symptom of PMDD is depression – and in this case is more closely associated with the monthly chemical changes in a persons body. Not only this, some people with a history of depression report feeling considerably worse before their period.

Another example is seasonal affective disorder (SAD), a form of depression which is experienced annually, more commonly in the winter months. Many of the theories surrounding the cause of SAD is the differences in sunlight between winter and summer. Very recently, there have been studies suggesting SAD as we know it doesn’t exist – or exists in a very small percentage of patients. Major depression tends to occur in cycles, or episodes, and those with SAD may be experiencing just that. It could also be possible that the changes in sleep cycles, diet and the amount of exercise we do during the winter months are contributing factors.

So why do we do it? A simple answer is we constantly strive for a scientific explanation to make valid our own experiences, or the experiences of others. It happens in many areas of science – most notably gender and sexuality (but perhaps the absence of solid scientific evidence for either just fuels the arguments bigots use, but that’s a different story). It can be comforting from the perspective of the patient, in coming to terms with their condition and acknowledging it as an issue, but as with any science misconception, there are problems that accompany it.

One of the biggest problems with ending a discussion about depression with the statement that it is only a chemical imbalance is that it disempowers the individual from dealing with their depression effectively. It encourages the idea that there is little you can do to deal with it, because it’s built into your biology. It might not seem like a big deal but for people stuck in a vicious cycle of unhealthy thoughts, it can silently affect them.

Not only can depression be a chemical imbalance, but it could equally be a result of life events that have badly impacted how you deal with difficult situations. It’s equally a result of prolonged stress, bad coping mechanisms and an unhealthy lifestyle. All of which are valid and all of which deserve proper medical attention.


A side note for those who live in the UK

Rates of depression and anxiety amongst teenagers has risen by 70% in the last 25 years and the number of young people arriving in A&E with psychiatric problems has doubled since 2009. At the same time, in the last 4 years the funding for NHS mental health trusts has dropped by £150m and between 2010 and 2015, funding dropped by about £600m. Child and Adolescent Mental Health Services (CAMHS) have also had to reject 1 in 5 referrals sent to them. Young people are waiting months for a first appointment after a referral and then months again to start treatment.

The Conservatives have decimated the mental health services, so if you’re eligible to vote this June, make sure you’re registered by May 22nd, do your research and vote.

Organisations to support/get support from!

Mind – a mental health charity that provides support and campaigns for better services as well as raise awareness.

CALM – dedicated to preventing male suicide. In 2015, 75% of all suicides in the UK were male.

TESS – for young women under 24 who struggle with self harm. They provide a texting and email service.

BEAT – UK’s leading eating disorder charity.

42nd Street – supports young people (11-25) in Greater Manchester. Provides a range of services for all sorts of issues.


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