The Chemical Imbalance Model of Mental Distress

psycjay

Hi Guys,

I just want to know what your thoughts are on the highly prevalent chemical imbalance model of mental distress.

What has prompted me to start this thread is that having studied the research it is pretty clear that this model is out of date, oversimplified, and simply inadequate. However, I am also away that many professionals are still peddling this theory and stating that we have a solid understanding for the causes of mental distress. If you take a google search (which most lay people will do) you will see abundant websites "explaining" problems like depression as follows.

Our brain have lots of neurons
The neurons communicate using neurotransmitters such as serotonin etc.
People with depression have lower levels of serotonin.
Antidepressants correct this imbalance.

They state this as if it's fact when it is not. There is no difference in neurotransmitter levels in depressed vs non depressed people. The theory has been rejected by researchers. So why is it that many mental health profs are still referring to it? Is it ignorance? Low tolerance for uncertainty? or is it an easy way to get people to take their medication?

MUSEIST

psycjay wrote: »

Hi Guys,

I just want to know what your thoughts are on the highly prevalent chemical imbalance model of mental distress.

What has prompted me to start this thread is that having studied the research it is pretty clear that this model is out of date, oversimplified, and simply inadequate. However, I am also away that many professionals are still peddling this theory and stating that we have a solid understanding for the causes of mental distress. If you take a google search (which most lay people will do) you will see abundant websites "explaining" problems like depression as follows.

Our brain have lots of neurons
The neurons communicate using neurotransmitters such as serotonin etc.
People with depression have lower levels of serotonin.
Antidepressants correct this imbalance.

They state this as if it's fact when it is not. There is no difference in neurotransmitter levels in depressed vs non depressed people. The theory has been rejected by researchers. So why is it that many mental health profs are still referring to it? Is it ignorance? Low tolerance for uncertainty? or is it an easy way to get people to take their medication?

The reality is that it is not fully understood and never has been but it is the medical professions belief that SOME forms of mental illness are caused by some very complex chemical imbalence within different parts of the brain. Its not understood but that model you speak of is the easiest way to explain the theory that psychiatrists have. Its certanly not hard science fact but that does not mean that its nonsense either.

You also need to remember that serotonin is not the only chemical that anti depressants work on, dopamine and so on. Psychiatrists will openly admit that they also do not know how anti depressants actually work and by what mechanisms but all they know is that in a certain % of people they DO actually work.

psycjay

I agree, but from my experience many professionals are not openly honest about the limitations of their knowledge. I used serotonin as an example of the overly simplified explanation that is given as fact. The model if often portrayed as a well established biological basis, without evidence, and personally I do not think this is ethical.

dissed doc

There are many types of serotonin receptor, and the interplay between them, and other neurotransmitters in a maintained and established affective state is well understood at current levels of technology.

Next time you drink loads of alcohol, and wonder why you feel exuberant, then later (maybe 12 hrs later) you feel low and irritable, you don't wonder if it's anything to do with the GABA (disinhibition), serotonin (mood) and dopamine (impulsivity)?

There is literally mountains of data on neurotransmitters and anxiety/mood/impulsivty. The effect of any alteration can be within seconds or days, and observed effect does not have to be synchronous to the chemical change (I drink a shot of whiskey but feel sober still 5 minutes later).

It is not a model or theory, but a scientific understanding of the chemical construction of our brains and how it is impacted and works with the experiences we give it in the environment.

You may find it oversimplified, in the that case maybe read up on ECNP articles/journals for the actual scientific data. Most people reading a lay article do not know of the huge amount of receptor subtypes (and unfrotunately how limited the technology is in developing medications targetting inidvidual subtypes).

It is very well understood how common (e.g., SSRI) antidepressants work and has been well understood for decades.

Valmont

Could someone help me find an article that was posted in this forum some time ago by a prominent psychologist who was skeptical about the chemical imbalance theory of depression?

It was a short article outlining some of the results that have been withheld and others that were less than flattering and I think a bit about how the pharma companies have been distorting things a bit. Thanks.

psycjay

"GABA (disinhibition), serotonin (mood) and dopamine (impulsivity)"

While I'm not a neuroscientist, I'm not a lay person either so I do read academic research (fair enough the watered down variety and not the hardcore molecular genetics ones). What I do know is that you have just provided an example for my point. You cannot possibly attribute qualities like mood to serotonin, disinhibition to GABA, and impulsivity to dopamine. NT's are active in a huge number of discrete circuits in the brain with multiple functions.

I know there are several kinds of receptors and lots of research which has looked at the effects of chemicals on those receptors, and then there are observable changes in mood (about 6 weeks later). But there is a major gap in this knowledge. Just knowing that chemicals effect certain receptors and that this correlates to mood does not give us the understanding that you claim.

The current state of understanding is like this:

We have a good understanding of different NT receptors in the brain
We also can observe what happens when we use certain chemicals on these receptors
Then the receptors cause changes in mood the end.

There is a massive logical leap, in claiming to understand something when there are so many questions unanswered. It's not just the fine detail that's lacking, it's this leap from simple receptors all the way up to complex behaviour.

I often hear a counter argument that, "oh we DO understand, but we give the simple version to clients", well guess what, I have looked long and hard for this claimed understanding and it just isn't there, so lets stop pretending, be honest, and discuss the limitations of our knowledge, instead of peddling false claims. Especially those who prescribe these meds. Don't get me wrong I have no problem with the use of medication in certain cases, but it is the over-use I have a big problem with.

Velvety

I'm not sure what you're trying to argue here.

They state this as if it's fact when it is not. There is no difference in neurotransmitter levels in depressed vs non depressed people. The theory has been rejected by researchers. So why is it that many mental health profs are still referring to it? Is it ignorance? Low tolerance for uncertainty? or is it an easy way to get people to take their medication?

We have to accept that certain drugs have an effect on mood and cognition, don't we? Drink a cup of coffee, have a few pints. Anti-depressant, anti-anxiety and anti-psychotics also have to have an effect on mood, cognition and behaviour over and above placebo or they wouldn't make it to market.

You seem to be arguing that because we don't know enough about how drugs' effects on neurotransmitters translate to broader effects on mood etc., that we should be sceptical of their use. I'm not qualified to offer an opinion on that. I don't know how well that is understood.

But, we also know of other things that affect mood: exercise, relationships, succeeding. As far as I remember, doesn't exercise stimulate the release of serotonin? Should we be sceptical of encouraging someone to get more exercise when they are depressed?

psycjay

"You seem to be arguing that because we don't know enough about how drugs' effects on neurotransmitters translate to broader effects on mood etc., that we should be sceptical of their use."

No, I'm arguing that considering we don't know how drug's effects on NT's translate to broader effects, we shouldn't pretend that we do. I'm arguing against people thinking they can explain mental distress with an out of date theory with unsupported evidence.

We also don't know how aspirin works to relieve a headache, I have no problem with that, but I would if someone told me that they did! I am not against drug use in the treatment of mental disorders, in certain circumstances, but they are overused, and i believe misinformation is a contributing factor. That is my argument.


The chemical imbalance model (that mental disorders such as depression are caused by a lack of a certain neurotransmitters) is unsupported. The diathesis-stress model is a much better supported model and incorporates genetic vulnerability as well as environmental stressors.

When a person is told (which they are a lot), that the CAUSE of their problem is a chemical imbalance in their brains, then that person is likely to assume that environmental factors have no influence and that medication to "correct" this problem is the only solution. This person may avoid therapy which has been proven to be more effective that medication in many mild to moderate forms of mental distress.

Clients should be told something like this: We currently think that many mental disorders result from a combination of genetic vulnerabilty and environmental stress, therefore depending on the nature and extent of your condition we will try therapy and/or medication, which has been shown to alleviate your symptoms. We will start with the method's which have the greatest success and the least side effects...

What clients are told: You have this disorder which means you have a chemical imbalance in your brain. This medicine will correct this imbalance and alleviate your symptoms.

I would prefer if the latter were true, it sounds like there is a quick, easy and well understood solution. But there isn't, and even though the first description is more complicated and less concrete, it's where we are, in terms of our understanding.

Waking-Dreams

Valmont wrote: »

Could someone help me find an article that was posted in this forum some time ago by a prominent psychologist who was skeptical about the chemical imbalance theory of depression?

It was a short article outlining some of the results that have been withheld and others that were less than flattering and I think a bit about how the pharma companies have been distorting things a bit. Thanks.

Are you thinking of Irving Kirsch? I haven't got around to reading his book but it appears to be worth a look.

http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.html

Freiheit

It's a trillion dollar industry. Honesty would have a detrimental affect on share prices.
http://www.democracynow.org/2010/3/1/gary_greenberg_manufacturing_depression_the_secret

Brillant author and Psychotherapist speaks on the topic.

It's well established that anti-depressants success rate on all but the most severe cases is only slightly better than placebo. A report stating this came out a year or two ago. The psychiatrists I heard were happy to agree with it.

Valmont

Waking-Dreams wrote: »

Are you thinking of Irving Kirsch? I haven't got around to reading his book but it appears to be worth a look.

http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.html

Don't think that was the one, but interesting reading nonetheless. Thanks.

JuliusCaesar

There's a reason why most of us look to a Biopsychosocial model. Some of us look to a biopsychosocial model, some to a biopsychosocial model and very few to a biopsychosocial model.

It's an INTERACTION.

metrovelvet

Isnt this just all phrenology dressed up as science? Why cant the psych professions admit its an art and not a science?

dissed doc

psycjay wrote: »

We also don't know how aspirin works to relieve a headache, I have no problem with that, but I would if someone told me that they did!

Eh, how aspirin works to stop "headaches" is very well understood! "Headache" is a lay term. Aspirin works to manage inflammatory responses that result in pain.

Even a quick Wiki will show you mechanism for aspirin in control of inflammation (and therefore "headaches" - which is such a non-specific term it's meaningless) has been understood since 1971 when the guy who discovered it got a Nobel prize.

FFS!

Saying we don't understand how SSRIs or Aspirin works is like saying we don't understand why the grass is green or the sky is blue. Sometimes, you are making a statement that simply shows lack of knowledge.

JuliusCaesar

dissed doc wrote: »

There are many types of serotonin receptor, and the interplay between them, and other neurotransmitters in a maintained and established affective state is well understood at current levels of technology.

Next time you drink loads of alcohol, and wonder why you feel exuberant, then later (maybe 12 hrs later) you feel low and irritable, you don't wonder if it's anything to do with the GABA (disinhibition), serotonin (mood) and dopamine (impulsivity)?

There is literally mountains of data on neurotransmitters and anxiety/mood/impulsivty. The effect of any alteration can be within seconds or days, and observed effect does not have to be synchronous to the chemical change (I drink a shot of whiskey but feel sober still 5 minutes later).

It is not a model or theory, but a scientific understanding of the chemical construction of our brains and how it is impacted and works with the experiences we give it in the environment.

You may find it oversimplified, in the that case maybe read up on ECNP articles/journals for the actual scientific data. Most people reading a lay article do not know of the huge amount of receptor subtypes (and unfrotunately how limited the technology is in developing medications targetting inidvidual subtypes).

It is very well understood how common (e.g., SSRI) antidepressants work and has been well understood for decades.

Well now, I doubt that most psychiatrists - well, the ones that I work with - would entirely agree with the 'well understood' notion above. Many things are well-explained but brain/mind interaction isn't. Not yet anyway.

I think the headache example above was originally the analogy or non-analogy that if SSRIs are effective, it must be because of low levels of serotonin in the synaptic cleft; then headaches must be due to a lack of aspirin.

A few papers that I can find to be widely available as no point in me quoting here only the ones I've access to, through the university:
Pasternak 2006
Elovainio et al 2004
Psychology Today 2010 (why not?)
The Guardian, if I'm going down that path....
Lacasse & Leo 05 from PLoS

Actually, while doing the search (above) I was killing myself laughing at the almost complete absense of social factors being taking into account. When I was training, I was told- if a depression is diagnosed as endogenous, it's because the doctor didn't ask enough questions. I have found this to be true in many years of clinical practice.

Freiheit

I really found Patrica Casey disturbing on the radio in relation to Catherine Zeta Jone's depression. That i't's a life long condition which will require life long medication'. No reference to how cognitive behavioural therapy can modify moods by changing thought patterns and thus lessening at least the severity of such phases. The woman in general depresses me,feel like the world is a bad place when I hear her. She is teaching the next generation her, what are to me deeply disturbing views, very depressing.

JuliusCaesar

It's not called the Medical Model for no reason!

metrovelvet

JuliusCaesar wrote: »

It's not called the Medical Model for no reason!

The reason would be pharmaceutical stock holders.

Oh and this..."DSM: Diagnosing for Money and Power"

http://www.zurinstitute.com/dsmcritique.html

psycjay

dissed doc wrote: »

Eh, how aspirin works to stop "headaches" is very well understood! "Headache" is a lay term. Aspirin works to manage inflammatory responses that result in pain.

Even a quick Wiki will show you mechanism for aspirin in control of inflammation (and therefore "headaches" - which is such a non-specific term it's meaningless) has been understood since 1971 when the guy who discovered it got a Nobel prize.

FFS!

Saying we don't understand how SSRIs or Aspirin works is like saying we don't understand why the grass is green or the sky is blue. Sometimes, you are making a statement that simply shows lack of knowledge.

By your logic "headache" is a meaningless term, why is this exactly? Is it because it is a subjective experience, which may present in different forms, which has no tangible way of testing? If so then by that logic, mental illness is also meaningless, as is mood for that matter! The experiences of depression may vary from person to person, but that does not mean the term "depression" has no meaning.

I will admit that I have not studied aspirin, and used that example without checking it, my bad, it's mechanism is well understood as you correctly pointed out. However while I may have ignorance in pain killers, I do know that there is no way near the same level of knowledge with regard to psychiatric medication. Also, even IF the mechanism is perfectly understood as to how it alleviates the symptoms of pain, should the doctor ignore environmental factors, such as stress, which can lead to the development of inflamation and pain? Would it not be better to help the person reduce their stress and avoid the headache in the first place, and so reduce their need for the medication?

Your last example is hilarious. I can give you a very detailed explanation for why the grass is green and the sky is blue, right from the nature of light, to how it interacts with matter at a subatomic level, refraction and the angle of the sun's rays (for the sky), to how this energy enters the eye, the way it is focused on the retina, the way the retina works to respond to bands of frequencies, how this information is carried through the optic nerve, optic chiasm, and the optic tract into the lateral geniculate nucleus in the thalamus, which projects to the visual cortex where colour information is passed to area V5 (I think). After that I don't know the mechanism for how we perceive these wavelengths of electromagnetic radiation as colours, so I wont pretend to. Please feel free to ask me to clarify any area.

You say we understand SSRI's to the same extend, well be my guest in explaining the mechanism..

Anyway, to return to the poin. My argument is that the chemical imbalance theory is out of date, oversimplified, and misleading, and should no longer be used by mental health prof's to explain mental illness. I have heard clinical psychologists tell me that clients have refused therapy because they fully believe that their environment (social and physical) has nothing to do with their problem and that it is a biological illness that can only be treated with medication.

BTW no need for the FFS's, as the old saying goes, stamping your foot does not make your point any better!

ross191

hi guys.


on the whole topic of chemical imbalance i have a guery.
can a chemical imbalance disoreder be passed from mother to son?
reason im asking is because i have applied for the garda reserve and wonder if it will affect me getting in....