While the theory has been questioned by scientists for decades, the Molecular Psychiatry research seems to be the final nail in the coffin for the theory—a technical knockout.
“Thousands of people suffer from side effects of antidepressants, including the severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise.
A Powerful Drug FranchiseIt's hard to overestimate the medical, financial, and sociological consequences of the chemical imbalance theory, which propelled the 1987 FDA approval of the SSRI antidepressant Prozac and which is still followed to this day. Several years ago, Harvard Health Publishing estimated that about 1 in 4 American women in their 40s and 50s were taking antidepressants.
Thanks to direct-to-consumer marketing (or “mongering,” as some say) about depression, people with life problems or occasional bad moods absorbed the chemical imbalance messaging, diagnosed themselves with depression, and presented themselves to doctors’ offices.
Family, job, health, money, or housing problems were no longer a reason for feeling down or defeated, suggested aggressive SSRI advertising campaigns; if you were depressed, you had a chemical imbalance—regardless of whatever else may have accounted for your depression (such as the loss of meaning and social connection often observed in modern society).
Response From Mainstream MedicinePsychiatrists and the American Psychiatric Association (APA), which is highly funded by drugmakers—70 percent of authors of the APA’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition were drugmaker funded, as reported by ABC news—were among the first to push back against the Molecular Psychiatry article. Chief among protestations were “we never promoted the ‘chemical imbalance’ theory”—no, you let drug makers do that, cynics might say—and “no one really understands why or how antidepressants work.”
If depression comes from stress, trauma, grief, loneliness, and social conditions such as poverty, as Horowitz suggests, it wouldn't be amenable to medication treatment. Worse, if it weren’t a permanent chemical imbalance as the serotonin theory of depression implies, it wouldn't turn into lifelong medication prescriptions, which drugmakers seek and treasure the most.
“Since the ancient Greeks, physicians have wanted to believe the mental and emotional distress must have biological origins. That allowed them to include ‘mental diseases’ within their specialty.
"With the development of massive drug company involvement in routine psychiatric practice during the advent of the antipsychotic drugs in 1954, drug companies also began pushing the biochemical and biological basis of human experiences such as anxiety, depression, manic-depression (now bipolar-disorder), and schizophrenia.
“Then, in the late 1980s, in anticipation of the approval of Prozac for depression by the FDA, Eli Lilly and Company conducted an international advertising campaign claiming that depression is caused by a biochemical imbalance in serotonin. It was apparent from the start that this was pure fantasy.
"In my books and scientific articles as far back as 1983, I pointed out the continuing truth that there are no known biochemical imbalances in the brains of mental patients until they are put there by the neurotoxic effects of all psychiatric drugs.
Don’t Stop SSRIs Abruptly, Warn Both SidesWhether they believe SSRIs are specious and over-prescribed or valuable treatments, clinicians warn patients not to stop the drugs abruptly.
Brian, a 29-year-old Chicagoan who asked not to give his last name, said that he has remained on an SSRI antidepressant for years despite his wish to quit.
“Every time I try to stop, I get something that feels like an electrical current in my head, and I can’t do it,” he said.
Then, Why Do SSRIs Work?It's generally agreed that SSRI antidepressants sometimes work, though not impressively, and not for all patients. But why? According to a follow-up paper by Moncrieff and Horowitz, “Any drug that changes normal brain activity is likely to have some impact on mood, and ... by virtue of changing brain chemistry, antidepressants also produce changes to normal mental activity and experiences.”
Antidepressants also cause numbing of the moods, the researchers say—“including not just sadness and anxiety but welcome emotions like happiness and joy”—which can reduce depression scores, making the drugs appear to be effective.
A paper in the Springer journal Inflammopharmacology suggests a possible SSRI mechanism could be decreasing “neuroinflammation [in the brain] through multiple mechanisms including the reduction of blood or tissue cytokines or regulating complex inflammatory pathways.”
A Final IronyEven as the premise through which millions of Americans were put on psychoactive drugs has been demolished, raising questions about the interface between medical care and misleading drug marketing, some news outlets have sought to politicize the contretemps.
Many media outlets went on the attack after Fox News host Tucker Carlson said: “First, we were told that SSRIs would save lives. Now, we learn they don’t actually work as intended. In fact, the whole idea behind the drug was completely wrong. And yet—and here is the best part—people are ignoring this news, and the drugs are still being prescribed.”
Meanwhile, millions on SSRI antidepressants now face the prospect of quitting.