Disproven Chemical Imbalance Theory Leads To Worse Depression Outcomes

A new study finds that biological explanations for depression, including the disproven “chemical imbalance” theory, lead to poor expectations of improvement and more depressive symptoms after treatment.

Ana Florence, PhD
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A new study, published in the Journal of Affective Disorders, found patients who believe that a chemical imbalance in the brain causes depression to have worse treatment outcomes. The study was led by Hans S. Schroder, a post-doctoral researcher and clinician at the Harvard Department of Psychiatry.

The results of the study, which included a sample of 279 persons attending an intensive behavioral health program in the United States, found that the endorsement of the chemical imbalance theory of depression was associated with poorer expectations of treatment and lower perceived credibility. Additionally, the researchers found that a belief in biological causes for depression was predictive of a greater presence of depressive symptoms at the end of treatment. Schroder and his colleagues write:

“Our findings are in line with accumulating evidence that some biogenetic beliefs, like the chemical imbalance belief, are linked with poorer expectations for improvement, especially among those with the most troubling symptoms.”
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Many different explanations for the causes of emotional distress have been proposed. In recent years, the psychosocial model, which emphasizes the relationship between the environment and individual characteristics, has been widely accepted. However, biological explanations remain popular and are endorsed among mental health professionals and service users alike.

Despite growing evidence that biological explanations for emotional distress do not reduce stigma and lack scientific credibility—there is no evidence that chemical imbalances cause mental illnesses in the brain—this belief remains widespread. The defunct chemical imbalance theory, which was widely promoted by drug companies, remains prevalent on mental health websites and has been connected to both increased antidepressant prescribing and increased difficulty withdrawing from antidepressants.

Schroder and colleagues argue that beliefs in biological explanations can have adverse effects on treatment outcomes. Research suggests that persons who explain their emotional distress through chemical imbalances in the brain may feel less hopeful that they might get better and less in control of their recovery process.

According to the authors, the chemical imbalance explanation leads to an essentialist understanding of emotional distress, meaning that individuals believe that their difficulties arise from traits that cannot be changed: “biogenetic beliefs and explanations may inadvertently promote prognostic pessimism,” they explain. Additionally, the chemical imbalance explanation leads to lower treatment expectations for psychotherapy and higher expectation that medications may be beneficial.

This is the first study to assess whether there is a relationship between the biological beliefs of the causes of emotional distress and treatment outcomes in a real-world clinical setting. The authors hypothesized that in the sample of 279 persons, “biogenetic beliefs would be at least as strongly endorsed as psychogenic beliefs […] beliefs would be negatively related to treatment expectations and perceived credibility of the treatment program […] greater biogenetic beliefs would predict poorer treatment outcomes.”

Through a series of measures and scales about individual’s beliefs regarding the causes of depression and treatment expectations, diagnostic tools, and self-reported psychiatric history, the authors were able to run a series of statistical tests to determine the relationship between etiological beliefs and treatment outcomes.

The treatment program consisted of a wide array of offerings, including medication, group therapy, and case management. Individuals were hospitalized for an average of 12.6 days, and most were diagnosed with a major depressive episode.

The authors found less favorable treatment-relevant processes were associated with the endorsement of biologic beliefs:

“For individuals with more depressive symptoms, both chemical imbalance and genetic beliefs were associated with poorer treatment expectations and perceived credibility. We also found evidence that the chemical imbalance belief, but not the genetic belief or the psychogenic beliefs, predicted more depressive symptoms after the brief treatment program using a two-week, but not 24-hour, measure of depression.”

The adoption of such beliefs can be explained by a widespread narrative of the chemical imbalance hypothesis present not only in the discourse of mental health professionals but in the media, television advertisements, and public health campaigns. Additionally, nearly all participants in this study were prescribed at least one psychiatric drug, perhaps reinforcing the biologic etiology belief:

“Merely taking medication may reinforce the putative biochemical origins of the problem. If so, extensive psychiatric care may reinforce biogenetic beliefs in highly depressed patientsthose most sensitive to the negative consequences of the beliefs.”

This study provides relevant evidence that the chemical imbalance theory of psychological distress may have negative impacts on psychotherapeutic processes and act as a barrier to improvement. This study must be read side by side with the growing body of evidence showing that psychiatric drugs can have long-term disabling effects, cause severe withdrawal symptoms, and provide little if any improvement compared to placebo.

It is both timely and urgent that providers, clinicians, and policymakers review how to discuss treatment options, what messages should be offered to the public and what treatment modalities effectively improve hope that recovery is possible.

 

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Schroder, H. S., Duda, J. M., Christensen, K., Beard, C., & Björgvinsson, T. (2020). Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. Journal of Affective Disorders. 537-545. (Link)

21 COMMENTS

  1. “Disproven Chemical Imbalance Theory Leads To Worse Depression Outcomes,” but that’s good for business for the “mental health” industry. They want their clients to believe all the DSM disorders are “lifelong, incurable, genetic mental illnesses” caused by “chemical imbalances” in peoples’ brains.

    What the “mental health” industry has done, the systemic lies they’ve told…. When you understand the sheer magnitude of the deception and crimes they’ve committed against humanity. You realize it is truly an evil system, that should be taken down.

    What is the number one actual societal function of the “mental health” industry today? Covering up child abuse and rape, for profit. Despite the fact that’s illegal.

    What is the number of people murdered due to psychiatric/psychologic lies every year? “8 million”

    No country should maintain a “mental health” industry, whose primary actual societal function – intentionally or unknowingly – is aiding, abetting, and empowering pedophiles. And we need to end our modern day, on going, psychiatric holocaust – 8 million people killed EVERY year is genocide.

    Our current “mental health” industry is an industry hell bent on killing or stealing from all child abuse and rape survivors, and all those who stand against child abuse. And it’s all by DSM design. It’s sick, the entire system is sick.

  2. “what messages should be offered to the public”

    Those messages continue to be debunked, so we do not need “research”. Psychiatry is dead, no theories are valid, true or useful. Their messages are adverts. In fact, most of their “work” is about studying the undoing of their theories, to try and create counter arguments, (although the one’s I have read are pretty weak coming from “academics””, and how to create new models, new language to keep their biz alive.
    They exist by power alone and that power is part of a bigger force.
    Psychiatry is the little itty bitty disrespected tool, with massive power, hellbent on saving their profession, at the cost of losing their own humanity, and taking the vulnerable with them.

    • “Messaging” is marketing. The public should not be “given a message,” they should be given the truth, in terms they are able to understand and personally digest. “Messaging” is already a move into authoritarian thinking, that we should tell people the things that make them do what we want instead of just informing them of what we know and don’t know and allowing them to make adult decisions about how to proceed.

      • The problem is that the truth arrives in the form of a message as well. Marketing is not by necessity deceptive. Though it often is by choice. Thus, we tend to distrust any message received on any marketing channel. And what other channels of communication exist between people? I do favor conversational content, as this tends to show more clearly whether or not the people involved are being sincere. But that doesn’t mean they aren’t trying to market ideas.

        • When I am speaking of marketing, I’m talking about the self-centered kind, where you have no concern for the truth but only for convincing the person to buy your product, regardless of the quality. This is different than couching one’s message in terms the other person can understand. But it’s a slippery slope as soon as one starts assuming one knows better than the subject what is or is not going to be helpful. Educating about real ideas can certainly require a certain about of framing or consideration of the other person’s ability to receive the message. But that is different in my mind from knowing that something is false and attempting to convince someone otherwise by manipulative means. And if you think about it, even if something IS helpful, if a person feels coerced or manipulated into doing it, they’re not usually going to be able to realize the benefits, are they? Compared to a situation where they drew their own conclusions from the honest data?

          • Well, that’s fine. My point is that marketing is a fact of life. We all use it and we all need it. If it has been misused by some (and it certainly has) that gives it a bad name. That’s a problem (as is my central argument) of ill-intentioned people, not of a subject that is inherently flawed.

          • But should marketing be a part of “medical” diagnosis? Would you want your doctor to tell you the truth, or to sell you on a concept which will make you more willing to accept his drug-based “solution?”

          • Hi Steve. My viewpoint is that whenever a doctor tells you what he thinks is the right treatment for you, he’s engaged in marketing. He needs your “buy in.” If he lies to you in doing that, because he somehow sees his own personal financial outcomes as more important than your personal health outcomes, he’s simply being unethical. We have a huge problem with ethics in medicine. It is acute in the “mental health” sphere, but if it didn’t also exist in “regular” medicine, psychiatry would have been kicked out of the profession a long time ago.

          • That is very true. I also see “marketing” of surgeries and various drug interventions like anti-cholesterol drugs and flu shots and blood thinners and “ED” drugs and even botulism toxin injections to smooth out one’s wrinkles. It isn’t always for money specifically, either. Sometimes it is a need for their training and system to be “right” and to assert control over the patient. Which is one reason that nutritional approaches and chiropractors and acupuncturists get attacked by the mainstream – they are elbowing in on the MD’s control of the market. It’s not only financial, but also prestige and power that are at stake.

            The first thing I do when I meet any doctor I need something from is to explain to them that I’m an intelligent and well-educated individual and will be making my own decisions about what to do, which may or may not coincide with their expert advice. I’m paying them mostly for information and suggestions, but bottom line, it’s my body and I get to make the final call. And I let them know if they have a problem with this, I can find another practitioner. They almost always assure me that it’s my right to decide what I do, but I don’t think that happens with all of their patients. I think most doctors like to BELIEVE they are empowering or providing informed consent, but a lot of them don’t like to be questioned or contradicted by their patients and will use pressuring tactics and outright dishonesty sometimes to get the patient to do what they want. Of course, this is easiest and most pronounced in psychiatry, where there is no actual accountability for even defining the entity being “treated,” so they can say almost anything and can’t be “proven wrong.” But that kind of attitude is what makes US medicine more expensive and less effective than most other industrialized countries.

  3. The real problem with these theories of imbalances is that a number of them don’t primarily effect the brain at all. Another problem is that the psychiatrist frequently doesn’t know squat about real medicine, making it likely that he/she will completely miss the problem. For example, a depressed individual who lacks energy, is sensitive to cold and has trouble with unwanted weight gain unimproved by dieting probably won’t respond to antidepressants at all, because their problem isn’t “psychiatric” depression, but more likely an underactive thyroid.
    There are a number of such conditions that can deceive the unwary shrink into mistreating them with psych drugs.

  4. This is such important data to promote. As a clinician for the last 40 years seeing the blatant overuse of poorly studied drugs, I sometimes wonder how psychiatrists manage to sleep at night. The biopsychosocial model has been around since, well Galen. How did we lose our way?
    Well written and needed information for so many who have suffered so long. How do we get this into Psychology Today!

    • So, what is the best treatment for my depression? Suffering for over 30 years. I believe medicine has kept me stable. Although, I often feel like I am just existing and not living. But if it weren’t for the medication I don’t think I would be here. So, I ask you and all the others. If the medication is soo evil then what is the treatment? I’m not being sarcastic or negative towards you or anyone else – I am just desperate to live a more satisfying life. I know you can’t give individual advise. I am just curious as to what everyone on this website thinks the treatment should be for people who suffer if it is not medication.

      Respectfully!

      • I’d say the first problem is seeking a “treatment for depression.” This assumes that “depression” is the problem and that all people having “depression” have the same thing wrong with them and need the same “treatment.” I certainly don’t know enough about you to say what you might need or benefit from in terms of intervention, but “depression” has multiple possible causes that vary from past abuse/neglect/trauma to dietary problems to physiological issues like thyroid malfunction or Lyme Disease to current life circumstances like domestic abuse or a job you hate to existential questions about the meaning of life. Everyone is different, and the idea there is one “cause” for depression is a myth created by psychiatrists and the pharmaceutical industry in the interest of selling their wares.

        This is not to say that antidepressants or any other intervention can’t be felt to be workable by a particular person. It’s more that pretending that you have a medical problem when they actually have not the slightest idea what, if anything, is wrong with you is never going to lead to any real solutions. If you think about it, drinking controlled amounts of alcohol can and does provide direct relief from intense anxiety, and frankly with fewer side effects than the benzodiazepines so readily prescribed for that “diagnosis.” But drinking alcohol would never be considered a “treatment” for anything, and benzodiazepines should not be, either. They are just a drug people take that makes them temporarily feel better. Unless you really understand what is causing the anxiety, there is no “treatment plan” that will predictably handle the problem. There are drugs that create all kinds of effects, some desirable, some undesirable, some desirable to people dealing with the “problem person” while undesirable to that person him/herself.

        So I don’t think there is a simple answer to your question. Every person is different. But I think telling people that they have a “chemical imbalance” or that something is wrong with their brains is utterly irresponsible and lends to further feelings of depression and hopelessness.

        I say this as a person who has struggled plenty with depression in my life, including feeling suicidal at times. I no longer feel depressed most of the time, and have learned to recognize when I’m going down that path and have things I can do to redirect my attention and behavior into a new route. For me, things that helped have been meditation, caring friends, inspiring work that forced me to face my fears, real talk therapy (none of this “evidence based practice” crap, just a real person who got interested in my life and helped me realize some things about my family and my own way of thinking about the world), self-help books, exercise, and creative activities like singing, home film making, and the like. Others will have their own approaches. You can develop one, as well. Maybe it will continue to include antidepressants. Maybe it won’t. That’s your call. But the beginning of wisdom is realizing that the psychiatric profession has nothing else to offer but their speculative “disorders” and their pharmaceuticals, and there are SO many other things that can be done! It starts by recognizing that you are not “treating an illness,” but dealing with a life circumstance that has its reasons for being there, whether they are physiological, psychological, or spiritual in nature.

        Best of luck to you in finding your path!

        Steve

        • WOW! Great reply! I appreciate your insight. I am aware of personal medicine and the like. Been in therapy for 30 years but I still have no desire to really do anything. Thankfully, I’ve been functional for the most part being able to hold down a job etc.. but still no real enjoyment. I appreciate your feedback. I always go back and forth whether I should come off the anti-depressants but there aren’t not too many alternatives(Dr. who could ween me off safely) where I live. Thank you again!

      • I don’t like to use the word “depression”, psychiatry bought all the words and owns them, so if I say I feel depressed, people believe I am “ill” and need “treatment”. And with aging, I know that the word “depressed”, has a rich language, with many words. Are you “depressed” because you are intelligent enough to sense situations, and people? World unrest?
        I know many who are on AD’s, who are “depressed” or “get depressed”. They can;t remember if it was different before. They also do not have enriched environments, or people therapy.
        I stay by my opinion, it is not an illness, and psychiatry does not have medication. They have chemicals that cause changes, often for the worst.
        I know what feeling “depressed” feels like, and the reasons for each person are unique.
        I don’t recommend any big changes in life unless you have sincere support, support that is encouraging and believes in you. People believing you are “ill” is not helpful, it is harmful.
        It is not good for who you are, your “spirit”.

        If you have pain and a doctor tells you that you have cancer, you will believe it even if he was wrong. That belief can bring you down, even after he admits his wrong.

        We can get very hooked on feelings and one needs to surround oneself with empowering people, not people who feel sorry for us, or think we are hopeless.

  5. Being told you have an incurable brain disease that will keep you depressed forever is depressing.

    Since (many believe) depression exists as a feeling, hopelessness will make the feeling worse. Plus the drugs make you sluggish and apathetic which can also cause “low grade” depression.

    • Do chemical imbalances that are as deadly as an alcohol addiction count as an an incurable disease? If so technically people do have that because psychiatric drugs cause deadly chemical imbalances. Pretty sly to lie and say your patients will never recover and put them on drugs that cause chronic illness. They will assume the effects of the drugs is their mental illness and keep taking the drugs. Even more crafty to lie and claim the drugs take 4-6 weeks to work because by that time a person is addicted. The withdrawal is then used as evidence the drug works. Their studies that claim these drugs work use the same idea. They put the placebo group through withdrawal. Because of this these biased studies actually find the effectiveness of the drug declines after several weeks.

      • My thoughts exactly Willoweed.
        My odd behaviors and personality changes were similar to those of an alcoholic. My mom mentioned this but we never put two and two together.

        Took me over twenty years to find stuff online saying the drugs I took were anything but life saving and essential. Or telling how to go off them without melting down. Ages 20 to 44 in psychiatry.

  6. My understanding of the “medical” or “biological” model is that it was put forward completely and only for the purpose of putting psychiatrists on a par with other doctors. In other words, all medicine works on the basis that there is a body part that can get diseased, and that the indicated treatment should be a medical treatment (drugs or surgery) which is expected to result in patient recovery, except in the case of “chronic illness” which will require a “maintenance” treatment of some sort.

    Environmental factors are rarely considered in any branch of medicine; they just don’t see it as their role. Psychological stressors, nutritional stressors, economic limitations are minimized by all sectors of medicine. While we are willing to excuse ordinary MDs for this oversight (not all of us are), in the case of psychiatry this renders their “work” null and void.

    All of Medicine has problems with etiology. In “regular” medicine these problems do not result in their “treatments” being totally unworkable, whereas in psychiatry that is the result. All of Medicine has problems with malpractice. But only in psychiatry (until very recently) have those problems escalated to the level of civil rights abuses.

    Thus, we can “get away” with the biological etiology model in the case of “real” disease, but it utterly fails us – as patients – in the realm of mental health. Because it makes us think that the only solution to the problem is a drug (or surgery). For psychiatry this has been a terminal mistake. For the rest of medicine, it has stalled our progress, but not yet proved totally fatal.

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