The Mechanics of Depression ― Follow the Science, how small wonders lead to large ’wonder drugs’

R3 Files Podcast ― The Success of Failure

In this installment my main focus is to critically analyze the infamous Chemical Imbalance Theory (or CIT) which argues that depression is caused by a deficiency of neurotransmitters, such as serotonin, thus affecting mood in a person’s brain. This represents the main causal factor underpinning the biological explanation of depression. In particular, why does the CIT remain the most dominant biological explanation to justify the etiology of depression? One of the main reasons is, because it is given the “rubber stamp” of legitimacy by the scientific community and provides a label of convenience in helping to explain a problem which has tormented mankind for centuries. In the contemporary era, the layperson has been conditioned to simply “follow the science” because this approach offers universal benefits.

In addition, the CIT has established itself within broader society as a mainstream narrative, using pharmaceutical lobbying, the critical mass of the medical profession and also government endorsement, thereby crowding out other “alternative accounts” or theories. Consequently, the science of chemistry becomes a focal point of academic intrigue and scientific mystique. I expand on this concept by first exploring in greater detail, the “chemistry of depression” or more specifically the bio-chemical basis of depression. Although chemicals are certainly involved in the process, it’s not a simple case of one chemical being too low and another too high. Indeed, there are millions of chemical reactions that dynamically govern our mood system, sensory perceptions, and how we experience life.

As a prerequisite to understand and critique the CIT, it is first necessary to provide an overview of how brain chemicals affect depression. In particular, the importance of three key neurotransmitters which are relevant to depression; dopamine, norepinephrine and serotonin. This information provides a broader understanding of the different classes of antidepressant medications because they in turn, influence neurotransmitter levels in the brain. The most commonly prescribed class of anti-depressants are known as SSRI’s (short for, Selective Serotonin Reuptake Inhibitors), which are designed to block the reabsorption of serotonin, a neurotransmitter which directly affects mood. Consequently, the CIT suggests that low levels of this neurotransmitter are linked to depression and by increasing serotonin levels this helps to improve mood and relieve symptoms of depression.

My main critique of the chemical imbalance theory references the academic work of two controversial scholars, David Healy and Irving Kirsch. Healy offers a comprehensive account of the phenomenon of antidepressants, and how depression has become one of the most common disorders of our day as well as a booming business. He argues that pharmaceutical companies have purposefully promoted and expanded the concept of depression as a disease in order to perpetuate the sale of antidepressants. I also provide a personal perspective based on my own use of antidepressants arguing that there is a tenuous link between continued usage and long term uplifting benefits via brain chemistry. This viewpoint is based solely on my own observations and is not a medical opinion. I believe that, if the side effects of using antidepressants outweigh any tenuous benefits, then this is the precise moment to pause and reflect on continued usage, rather than keeping blind faith in a dubious wonder drug.

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