'chemical imbalance' behind mental illness a myth?

[kath23]

This is a question which has bemused me for a while. Is the 'chemical imbalance' theory of mental illness a myth, or is there any real proof?

Apart from the argument that SSRIs work therefore seratonin must be lacking (sort of reverse causality.)

I often try to research this but don't know where to start, and if this is a myth it's very ingrained.

Love
Kath

[Mongrel]

Short answer - No.

Medium answer - there are many other drugs used for correcting brain chemistry than just SSRIs although serotonin can be measured in the body (although different people have different 'natural' levels which makes a single baseline harder to produce).

Also with the studies, seeing that increased serotonin can improve depression will lead to some experiments where the level in the test subject is reduced, the object being to see if that person then suffers depression. Another link in the testing procedure will be giving patients the drug and monitoring brain activity - we've gotten a lot better at predicting what happens when certain parts of the brain are chemically 'prodded'

Here's (http://scorpioncity.com/depr.html) a nice introduction to depression, Bandolier (http://www.jr2.ox.ac.uk/bandolier/) has some very good summinations of many clinical papers and generally Netdoctor (http://netdoctor.co.uk/) is a good place for support links. If you're looking for anything more specific give us a shout O0

[kath23]

Here's (http://scorpioncity.com/depr.html) a nice introduction to depression, Bandolier (http://www.jr2.ox.ac.uk/bandolier/) has some very good summinations of many clinical papers and generally Netdoctor (http://netdoctor.co.uk/) is a good place for support links. If you're looking for anything more specific give us a shout O0
[/quote]

I know a lot about mental illness etc but I've never been wholly convinced of this chemical imbalance thing.

Doesn't mean I am anti-medication, (a Scientologist or summat ;D) I take a mood stabiliser myself long-term. I also know full well the range of meds involved.

But I think as sceptics we should be open to be sceptical about myths present in science too.

Any people I've known with mental health problems (and I've known a lot) it can be put down to traumatic or unhealthy life circumstances, and/or a genetic propensity.

I've yet to see in life any studies which do a lot for the chemical imbalance theory but I will follow your links tomorrow, thanks for them :)

Anyone offering there opinion here and links would be much appreciated, getting the 'digest' here would be brill :)

Thanks for your reply,
Love
Kath

[kath23]

Short answer - No.

Medium answer - there are many other drugs used for correcting brain chemistry than just SSRIs although serotonin can be measured in the body (although different people have different 'natural' levels which makes a single baseline harder to produce).

Be quite hard for it to be easily subjected to studies then - a bit like alternative medicine perhaps?


Also with the studies, seeing that increased serotonin can improve depression will lead to some experiments where the level in the test subject is reduced, the object being to see if that person then suffers depression. Another link in the testing procedure will be giving patients the drug and monitoring brain activity - we've gotten a lot better at predicting what happens when certain parts of the brain are chemically 'prodded'

None of these studies have been done yet then, nothing verified/falsified whatsoever. After well over a decade of using these meds:-\ :-\ I could say that there will be a trial of homeopathy, it doesn't add anything to say 'I think such n such will be done at some future date' :-\

Also, I suspect you are being a bit tongue in cheek here ;) Because in a 'civilised' country it would be very hard to justify ethically 'experiments' such as this on humans :) Probably a brutal totalitarian regime will do it at some point in the future somewhere in the world, I suppose is the sorry truth :o :)

Actually what I was asking is not whether serotonin can effect depression, but whether there is any -evidence- that a chemical imbalance is at root?

I take lamotrigine and it helps my mood, but my brain doesn't have a deficiency of that chemical to start with- do you see what I mean? :-\ Same as my asthma isn't initially caused by a lack of ventolin. :)

Love
Kath

[Dr B]

Think about cause and effect. If there is an imbalance, what does it mean? Was it a cause, or an effect?

[kath23]

Think about cause and effect. If there is an imbalance, what does it mean? Was it a cause, or an effect?


Aaah, are you saying that its existance or non-existance may be a sort of non-issue as it still allows for counselling being valued and other forms of treatment alongside medication?

I think this may be the current view among GPs, they seem to feel that anti-depressants are not a long-term solution and counselling is also needed to prevent relapses or to help people stop taking anti-depressants. My local GP surgery is starting to run support groups as so many people are finding it hard to come off these medications. Psychiatrists themselves don't really deal with people facing this issue or appreciate it really.

I found it hard to come off my anti-depressant at first. My psychiatrist just said 'well I appreciate some people don't like to, but all these symptoms would go if you stayed on them permanently.' :o :)

Mental health user groups also push for counselling and CBT to be used in other conditions such as bipolar/schizophrenia, arguing it can have benefits, when such patients are often given only medication.

Love
Kath

[median]

I think that certainly the efficacy of anti-depressants is well documented which, for me, supports an idea of chemically induced states of mind as does the effects of a variety of recreational drugs which produce similar effects in many people.
The idea of a chemical imbalance (and hence the idea of balance) may be a bit of a misnomer.
It almost suggests a biological status quo where possibly a truer picture could be one of a type of homeostasis, a dynamic equilibrium, in which baseline measurements (as Mongrel explains) may vary from person to person.

Moving on to the idea of causality and as to whether or not an ‘imbalance’ is an actual cause all depends on how you ascribe a definition to the term ‘cause’.
As Dr B notes causes can be effects or vice versa.
For example, if I down a bottle of Scotch and become extremely morose as a consequence I could say that the alcohol has caused my depressive state.
Or is this behaviour of acute alcohol abuse, the effect of a genetic predisposition towards depression reinforcing behaviour?

[Mongrel]

Well, whilst it's always harder to check medication like this than, say, antibiotics it's stil possible to do so with a strong level of confidence, Pubmed brings up nearly 10,500 papers on a seach using "serotonin and depression (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&db=pubmed&term=serotonin+and+depression&tool=fuzzy&ot=seroronin+and+depression)". And while 'chemical imbalance' may seem a little strong it's a not unreasonable summination of "When you take this drug, that supplies or increases production of a chemical your body makes naturally, and you feel better then there may well be a problem somewhere in your bodies 'production line'. "


So how can you test these drugs clinically? Well a standard clinical double blind trial is still valid. In certain illnesses parts of the brain can now be pointed at as either being not active enough or too active, we can then assess what happens when drugs are introduced over the short or long term. It's not easy and I imagine the results probably have a wider error margin due to the slighty more subjective scoring methods, but it's possible.

[Cuddles]

This is a question which has bemused me for a while. Is the 'chemical imbalance' theory of mental illness a myth, or is there any real proof?

I would say that this is a bit of a misleading question. It is very obvious that a chemical imbalance in the brain can cause mental problems, so there is no doubt that some mental problems are due to this. Just look at drugs, they mess with the brain's chemistry and as a result it's functioning is altered. It is very likely that many problems have other causes, but this does not mean that the all chemical imbalances are myths. For example, I could get ill from lead poisoning, but this does not mean germ theory is a myth, just that there are other causes of illness as well.

[kath23]

erm, I meant the theory that there is an inherent chemical imbalance (not from a poison administered from without or from a physical problem.) in the mind of someone with a mental illness.

For instance, whatever happened to the dopamine hypothesis of schizophrenia?
Love
Kath

[Araneus]

I think it really depends on the question.

That there is a strong correlation between seratonin levels and depressions is not a myth, as far as I know, however this does not in itself indicate the the chemical imbalance is the root cause of depression. This is supported by the observations that SSRIs do not permanently cure depression but alleviate the symptoms for long enough that the patient can seek counselling or other help.

My understanding is that currently the most effective known treatment is Cognitive Therapy which addresses the core beliefs and cognitive processes of the patient, rather than simply their brain chemistry.

[Harradine]

This is a question which has bemused me for a while. Is the 'chemical imbalance' theory of mental illness a myth, or is there any real proof?

Apart from the argument that SSRIs work therefore seratonin must be lacking (sort of reverse causality.)

I often try to research this but don't know where to start, and if this is a myth it's very ingrained.

Love
Kath

Hi Kath. The story is quite a bit more complex. It is true that the idea of "reduced serotonin levels" as a cause of depression is a very widespread idea in the lay media and sadly even perhaps with some doctors. But this is a massive oversimplifcation.

It refers to the orginial "monoamine hypothesis" which dates back to the 1950. Back then (and more recently) this included both noradrenline and 5-HT (serotonin's real name). Drugs which deplete synaptic stores of these (such a reserpine) can induce many of the signs of depression in humans, such as low mood, lack of movement, etc. And conversely it is true that drugs which cause an enormous rapid release of these transmitters (such as amphetamines) can cause a great rush of energy and euphoria.

But depression is a bit more complex. For one thing, antidepressants do not increase the "levels" of 5-HT or noradrenaline. What they actually do is prolonge their tranismission by blokcing their reuptake from synpases in the brain. Ok, so far so good, this makes us happy, right? Not quite because all antidepressants, whether they target 5-HT or noradrenaline, take time to work. If their action was a simple effect on transmission like that, they would work straight away.

So, the theoory goes that it is not the acute effect of these drugs, but the brains adaptive response to their presence that leads to the reversal of symptoms we see in patients. 5-HT and noradrenaline systems form a vastly complicated self regulation, inhibiting, promoting, multilevel interacting systems and even just figuring out how the brain responds to a months treatment of SSRI is a job we are far from completing!

Still, its worth remembering that the monoamine hypothesis does not answering everything. It hasn't proven easy to find any real difference in these systems of depressed patients vs controls. Some signs but nothing really convincing. Certainly by depelting 5-HT you can induce replase in depressed patients.

In short, depression does appear to respond to manipulations of the monoamine system in many cases, but the story in far more complex than simple "imbalance" which has largely been promoted by SSRI manufacturers as a simple marketing tool based on ideas that are 50 years old and have since vastly moved on.

[Aside from anything else SSRIs provide neuropharmacologists with useful tools for studying the monoamine systems of the brain!]

[VoodooJoe]

Apart from the argument that SSRIs work therefore seratonin must be lacking (sort of reverse causality.)

Actually the evidence is mounting up that says the opposite, SSRIs and SNRIs are actually less effective than changes in diet and increased exercise when treating depression.

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/antidepressant-drugs-udontu-work-ndash-official-study-787264.html

Personally, after witnessing a few people on SSRIs, I wouldnt touch the damned things if you paid me, they seem a bit dodgy IMO and GlaxoSmithKline (the company who pioneered this family of drugs) seems even shiftier.

http://commentisfree.guardian.co.uk/holly_finch/2007/01/post_1022.html

http://seroxatsecrets.wordpress.com/2007/09/11/what-does-seroxat-do-and-just-how-is-it-supposed-to-work/

Also I think people have funny ideas about what serotonin actually is, there is a common misconception that serotonin is a chemical specific to the brain, it isnt, serotonin is a nuerotransmitter and is found throughout the central nervous system, not only that it is closely tied in with the chemistry of the gut and liver, in fact 90% of it is actually in the gastrointestinal tract, the rest is found in the blood and in the central nervous system.

Hence introduce SSRIs into your body and not only are you altering your brain chemistry you are altering the chemistry of much of the rest of your body, even GSK admit they dont what they are doing

(taken from a patient information leaflet)

Seroxat is one of a group of medicines called SSRIs (selective serotonin reuptake inhibitors). Everyone has a substance called serotonin in their brain. People who are depressed or anxious have lower levels of serotonin than others. It is not fully understood how Seroxat and other SSRIs work but they may help by increasing the level of serotonin in the brain.

http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=3185

WTF!! im sorry, but i find that deeply disturbing, yeah i got to admit im dubious about many areas of psychiatry and i think people are right to question the science involved in its theories.

[Electric Angel]

I'm going to quote a brief extract from The Users and Abusers of Psychiatry (by Lucy Johnstone) which deals (briefly) with the dopamine hypothesis suggested to be responsible for schizophrenia:


Two arguments deserve brief attention. It has been suggested that because neuroleptic drugs block dopamine and seem to help in the treatment of "schizophrenia", then, by a form of backwards logic, "shizophrenia" must result from overactivity of the dopamine system. This is rather like arguing that headaches are caused by a lack of aspirin.

The fact that substances that increase dopamine production, such as amphetamines, can also produce "schizophrenic"-type symptoms has also been put forward in support of the dopamine hypothesis. This is like arguing that because caffeine can cause anxiety, anxiety must be caused by caffeine.

[Graham Lappin]

Interesting topic. I would love to see Steve Novella's view on this as neurology is one of his specialities. From my end, I can say that one reason this is a topic of debate (on these message boards and by neurologists) is because the brain is so difficult to study, data is sparse and therefore theories become speculative. There is evidence to equate 5HT (Serotonin) with mood and bipolarism but the causal link is poorly understood. Animal models are generally not that good in this area. Positron Emission Tomography (PET) can be used to image receptor uptake in the brain and although this is very useful, it still does not get closer to any real mechanism.

At the end of the day, in science, it really is OK to say "we don't know" (yet).

By the way - PET is awesome. The science of PET sounds like Star Trek but it's all real. It's far, far better than anything pseudo-science can dream up.

[Dr B]

Does that include the radioactive tracer? :shocked:

[Graham Lappin]

Does that include the radioactive tracer? :shocked:

Talking about PET? I could bore you stupid for hours on this, best not get me started. But since you brought it up, the tracer is positron emitting and the image is formed from photons of gamma generated from a matter - anti-matter annihilation .... enough

[Dr B]

To be honest I find event-related fMRI, ERPs, MEG and SSVEPs more useful than PET - but PET is of course, very useful indeed. O0

Just dont be a participant in more than one study every five years;D;D