Dorothy Rowe

The End of Chemical Imbalance

In his letter in the summer edition of A Single Step Tim Shanks referred to an article in Saga Magazine where I'd written about how the Royal College of Psychiatrists, the professional body which sets the standards for psychiatrists practising in the UK, had removed all mention of chemical imbalance as the cause of depression from its website. Tim seemed to have the impression that my article was no more than the statement of my opinion. I have been an Associate of the Royal College of Psychiatry since 1970. I read all its journals to inform myself of new research findings. I also read books written by leading psychiatrists like David Healey and Julian Leff. I try to pass what I have learnt on to those people who might find this information interesting and important. In the hope that facts will not be taken as merely my opinion, in this article I shall carefully label what is fact and what is my opinion.

FACT There has never been any evidence that depression was caused by a chemical imbalance in the brain. The psychiatrist David Healy gives the history of the idea of chemical imbalance in his book Let Them Eat Prozac. Psychiatrists have always known that there was no evidence for a chemical imbalance as the cause of depression but for many years they have called this idea an hypothesis and hoped that one day is would be proved. Many psychiatrists have told me that they tell patients that they have a chemical imbalance because they think this is a comfort to them. MY OPINION Whether patients want to be told a tooth fairy kind of lie is debatable.

FACT Last year the Royal College of Psychiatrists dropped any reference to chemical imbalance from their website. If you look up the fact sheet on depression which is on their website you will see that factors such as circumstances and life events are listed as causes of depression. The fact sheet is very cautious about mentioning genetics other than to say that depression runs in families. The fact that a behaviour is found in succeeding generations in a family does not prove that this behaviour is caused by a gene. For example, my father voted Labour, I vote Labour, my son votes Labour. Does this mean that we have a voting Labour gene?

MY OPINION Psychiatrists are caught in a bind. They know that all the scientific research shows that depression is not caused by a chemical imbalance and that complex behaviour like being depressed cannot be explained by a gene. They want to practise evidence-based medicine. So, they abandoned chemical imbalance but they don't want anyone to know. Psychiatrists and GPs who don't keep up with what their professional body is telling them are continuing to present patients with what David Healy calls 'a myth'.

FACT Drug companies used the chemical imbalance idea to create what have proved to be a very profitable set of drugs, the SSRIs. These drugs undoubtedly put serotonin in the person's brain but, as the brain wasn't imbalanced originally, these drugs don't right the balance. Psychiatrists who value truth over profits or personal prestige like Dr Joanne Moncrieff, senior lecturer in psychiatry at University College London, now are showing that what these drugs do is to treat symptoms which accompany being depressed. They do not cure an illness in the way that antibiotics cure an infection.

FACT This is the current situation. MY OPINION It is a tragedy that those people who are depressed are not being properly informed so that they can choose how they wish to see their depression. They can see it as an illness or as a result of the way they live their life. Like everything in life, each alternative has advantages and disadvantages. If you see it as an illness you are not responsible for it, but, for your psychiatrist, it is a chronic illness like diabetes which cannot be cured but only managed. If you see it as a result of the way you live your life, you are responsible for your depression, but you can choose to change how you see yourself and your life and thus cease to be depressed.

Taking responsibility for yourself isn't easy but it does lead to a satisfactory life.

David Healy Let Them Eat Prozac New York University Press

Dorothy Rowe Depression: The Way Out of Your Prison third edition Routledge.