The Chemical Imbalance Hypothesis & Mental Illness

[Guest [ou...]]

There are mainly 2 schools of thought.

One considers chemical imbalance a real phenomenon causing mental illness.

The other considers chemical imbalance a false concept.

I belong in a 3rd camp considering chemical imbalance to be true but not the cause of mental illness.

Since I only have experience with anxiety/depression I will restrict myself in those.

Also, the research I am going to present will tend to be towards depression,

as antidepressants are also used for anxiety.

Also also, I will be using the term monoamine a LOT.

Classical monoamines include serotonin, norepinephrine and dopamine.

 

The monoamine depletion hypothesis proposes that monoamine levels are lowered in depression,

and dysregulation in the monoaminergic system has been related to depression.

This finding suggests that monoamine depletion and depression are linked.

However, monoamine depletion has not been shown to induce depression in healthy subjects.

That finding suggests that monoamine depletion may not be the cause of depression.

Combining the 2 findings one could conclude that it is probably depression that causes monoamine depletion.

 

[sources 1 & 2]

 

If monoamine depletion is not the cause of depression, how do antidepressants work?

Let me ask a simpler yet similar question first.

If fever is not the cause of a cold, how do antipyretics work?

Antipyretics do not cure a cold; they treat its symptoms.

Likewise, antidepressants do not cure depression; they treat its symptoms.

Monoamine depletion may not cause depression but depression decreases monoamine activity,

while antidepressants are thought to act by increasing monoamine activity.

The hypothesis that antidepressants do not cure depression is supported by the fact that

depression resolves over time whether or not it is treated, not unlike a cold.

Moreover, the average duration of an episode has been estimated to be around 6 months,

which in turn is usually the recommended duration of treatment. I wonder why?

 

[Source]

 

If chemical imbalance is not the cause of mental illness, should one accept treatment?

This question may appear to be difficult but the answer is surprisingly simple.

Once again let me ask a simpler yet similar question first.

If fever is not the cause of a cold, should one take antipyretics?

That question may sound familiar but it is trickier this time,

as evidenced by one being wrong whether they answered yes or no.

The right answer is it depends; how high a fever?

Since every treatment has side effects, one should weigh the pros and cons.

Likewise, the answer to the initial question is the same.

If a condition must be treated, the goal would be finding the treatment that sucks less.

 

Now what about mental illness itself.

If chemical imbalance is not the cause, should mental disorders be considered as real illnesses?

Anxiety and depression have been thought as biological responses to dangerous situations

which cause heightened senses and emotional neutrality.

Since the possible causes of both are similar they often co-occur.

In fact there is a name for their combination: mixed anxiety-depression (MAD).

First we are SAD (seasonal affective disorder) and now we are MAD?

This is truly a puzzling question but I shall do my best to answer it.

 

Once again there are mainly 2 schools of thought.

One considers mental illness as real as AIDS.

The other considers mental illnesses as made up diseases.

Surprise surprise, I find myself in a 3rd camp considering mental illness to be real, but not as real as AIDS.

Because this time I do not have any sources to back my thesis, let me elaborate on that a little more.

Much of the debate hinges on the lack of objective tests for mental illness.

This is the Argument from Ignorance fallacy; absence of evidence is NOT evidence of absence.

Psychiatry is still in its infancy as it deals with the most complex human organ, the brain.

Despite all that, my stance on the matter does not rely on the existence of medical tests -

a person would either have AIDS or not regardless - so let us assume that there are no tests for any disease.

The difference between regular diseases and mental disorders is that the former have no middle ground.

As I already mentioned, a person can either have AIDS or not but not both.

That is not always the case with mental disorders. Take depression for example.

Depression can be a mood (a reaction to grief) or a disorder (sometimes resulting in suicide).

But it can also be both, that is a symptom of a disorder.

If one is unable to adjust to a stressor (eg persistent grief) then normality gives way to illness.

 

Lastly, there exist mental disorders caused by chemical imbalances.

I am talking of course about drug-induced syndromes.

Because this is a benzo forum, one ought to look no further than benzos themselves.

Benzos can disrupt the function of monoamines by lowering their activity,

which is probably why benzo-induced depression may respond to antidepressants.

 

[Source]

 

UPDATE

 

There is a more accurate explanation for neuropsychiatric conditions:

The Communication Interference Hypothesis.

The brain uses electrochemical signals to transmit messages and control various bodily processes.

The Communication Interference Hypothesis posits that:

Neuropsychiatric conditions are manifestations of disruptions in neural pathways,

involving complicated interactions between many neurotransmitters.

Whether drugs could ever cure such conditions remains an unanswered matter.

[[Re...]]

Bump this thread along.

 

Thought provoking; you are touching on issues I've been pondering for a long time as I reflect on my own experiences.

 

However, I need to try and sleep (west coast of Canada time zone - Pacific)....

 

-RST

[Guest [ou...]]

Bump this thread along.

Thought provoking.

 

How should I go about it?

Thanks.

[[po...]]

There are mainly 2 schools of thought.

One considers chemical imbalance a real phenomenon causing mental illness.

The other considers chemical imbalance a false concept.

I belong in a 3rd camp considering chemical imbalance to be true but not the cause of mental illness.

Since I only have experience with anxiety/depression I will restrict myself in those.

Also, the research I am going to present will tend to be towards depression,

as antidepressants are also used for anxiety.

Also also, I will be using the term monoamine a LOT.

Classical monoamines include serotonin, norepinephrine and dopamine.

 

The monoamine depletion hypothesis proposes that monoamine levels are lowered in depression,

and dysregulation in the monoaminergic system has been related to depression.

This finding suggests that monoamine depletion and depression are linked.

However, monoamine depletion has not been shown to induce depression in healthy subjects.

That finding suggests that monoamine depletion may not be the cause of depression.

Combining the 2 findings one could conclude that it is probably depression that causes monoamine depletion.

 

[sources 1 & 2]

 

If monoamine depletion is not the cause of depression, how do antidepressants work?

Let me ask a simpler yet similar question first.

If fever is not the cause of a cold, how do antipyretics work?

Antipyretics do not cure a cold; they treat its symptoms.

Likewise, antidepressants do not cure depression; they treat its symptoms.

Monoamine depletion may not cause depression but depression decreases monoamine activity,

while antidepressants are thought to act by increasing monoamine activity.

The hypothesis that antidepressants do not cure depression is supported by the fact that

depression resolves over time whether or not it is treated, not unlike a cold.

Moreover, the average duration of an episode has been estimated to be around 6 months,

which in turn is usually the recommended duration of treatment. I wonder why?

 

[Source]

 

If chemical imbalance is not the cause of mental illness, should one accept treatment?

This question may appear to be difficult but the answer is surprisingly simple.

Once again let me ask a simpler yet similar question first.

If fever is not the cause of a cold, should one take antipyretics?

That question may sound familiar but it is trickier this time,

as evidenced by one being wrong whether they answered yes or no.

The right answer is it depends; how high a fever?

Since every treatment has side effects, one should weigh the pros and cons.

Likewise, the answer to the initial question is the same.

If a condition must be treated, the goal would be finding the treatment that sucks less.

 

Now what about mental illness itself.

If chemical imbalance is not the cause, should mental disorders be considered as real illnesses?

Anxiety and depression have been thought as biological responses to dangerous situations

which cause heightened senses and emotional neutrality.

Since the possible causes of both are similar they often co-occur.

In fact there is a name for their combination: mixed anxiety-depression (MAD).

First we are SAD (seasonal affective disorder) and now we are MAD?

This is truly a puzzling question but I shall do my best to answer it.

 

Once again there are mainly 2 schools of thought.

One considers mental illness as real as AIDS.

The other considers mental illnesses as made up diseases.

Surprise surprise, I find myself in a 3rd camp considering mental illness to be real, but not as real as AIDS.

Because this time I do not have any sources to back my thesis, let me elaborate on that a little more.

Much of the debate hinges on the lack of objective tests for mental illness.

This is the Argument from Ignorance fallacy; absence of evidence is NOT evidence of absence.

Psychiatry is still in its infancy as it deals with the most complex human organ, the brain.

Despite all that, my stance on the matter does not rely on the existence of medical tests -

a person would either have AIDS or not regardless - so let us assume that there are no tests for any disease.

The difference between regular diseases and mental disorders is that the former have no middle ground.

As I already mentioned, a person can either have AIDS or not but not both.

That is not always the case with mental disorders. Take depression for example.

Depression can be a mood (a reaction to grief) or a disorder (sometimes resulting in suicide).

But it can also be both, that is a symptom of a disorder.

If one is unable to adjust to a stressor (eg persistent grief) then normality gives way to illness.

 

Lastly, there exist mental disorders caused by chemical imbalances.

I am talking of course about drug-induced syndromes.

Because this is a benzo forum, one ought to look no further than benzos themselves.

Benzos can disrupt the function of monoamines by lowering their activity,

which is probably why benzo-induced depression may respond to antidepressants.

 

[Source]

 

Super interesting take on mental illness. I appreciate your insight.  I am a life long major depressive with general anxiety disorder. Never went on medications until 1984.

To treat symptoms, not the "illness"

 

I have gone through all the psychological and physical tests a person can go through to "discover" what is the root cause of my depression. I have been to so many different pdocs in Florida, Oregon, Texas, and now back to Florida, I have lost count (ALL but 1 was just a script writer: hit or miss prescribing drugs). I have seen too many therapists in 3 states, all giving me their "sage" advice to cope (quite a few were worthless), all kinds of groups both in and out of hospitals. 

 

As you pointed out in your post, there is NO test to determine mental illness. Here in the States they use "criteria" based on the DSM5 to categorize someone's illness. Kinda like a check list of symptoms.

 

You didn't mention gene studies . . . is this mental illness inherited? Both sides of my family suffer. Paternally I have lost 3 cousins to suicide with 5 years due to mental illness.

 

You really brought up some interesting thoughts that have occurred to me often. You expressed yourself well.  Thanks for the post and I hope others chime in here.

 

Smiles (not tears today - yet) and a little rain (not sunshine) from Central Florida, Pooh 

[Guest [ou...]]

Super interesting take on mental illness. I appreciate your insight.

Here in the States they use "criteria" based on the DSM5 to categorize someone's illness. Kinda like a check list of symptoms.

You didn't mention gene studies . . . is this mental illness inherited?

Thanks for the post and I hope others chime in here.

 

1. I very much appreciate your appreciation.

2. I know about the DSM. Emphasis on the Statistical.

3. I did not mention genetics because results have been inconsistent.

4. I hope so too.

[[po...]]

Totally agree about genetics. And with the world situation as it is now, and the technology out there, I am NOT about the share my genes with any medical research team.

 

Hey, where is everyone???

 

This is a great thread, we need some more input

 

And yeah, the DSM5 is just a check list of symptoms based on statistics. At UCF (master's degree in math) we had multiple stats class. Of course one of the first basic courses required us to read (is it still in print?): "how to lie with statistics"

 

Ha, ha, ha, ha,

 

After 40+ years of having pdocs use that DSM, I don't trust it or them. Just an easy way for them and their pharm buddies to prescribe more and more drugs to unsuspecting people. Oh my goodness, I could get on a soapbox about my conspiracy theory of pdocs and the pharms.

 

Enough, I hope more people respond, too

[[ne...]]

Great post, Outis!

I have been pondreing about this issues too lately.

Need some more thinking though. 

[Guest [ou...]]

DSM5 is just a check list of symptoms based on statistics. At UCF (master's degree in math) we had multiple stats class. Of course one of the first basic courses required us to read: "how to lie with statistics"

 

1. Unfortunately statistics is the best we can do right now. Paraphrasing you,

the problem is Correlation VS Causation.

 

2. Since you have a degree in math you might find this thread interesting.

[[ne...]]

So, I have searched for The Communication Interference Hypothesis, and could find no reference to it on Google. Do you have some sources on it, Outis? 

 

Also, everybody is talking about neurotransmitter imbalance, but what about disruptions in synaptic morphology?

[Guest [ch...]]

"chemical imbalance" is too vague a concept to be the explanation of anything. It would be like saying the bug in the computer program I am trying to fix is caused by an imbalance of 0's and 1's in the computer. Maybe in some very vague abstract sense that is the case, but it is a useless and meaningless statement. So let's say we try to make "chemical imbalance" more precise. Maybe it is intended to mean too much or too little of some specific chemical? But which one? Proponents of the "chemical imbalance" theory rarely say which specific chemical is in imbalance, mainly because they can't, because they are just spewing bullsh*t. So let's say we try to infer it from the actions of the drugs they are selling (note it is always the people trying to sell drugs that propose the chemical imbalance theory). Antipsychotics reduce dopamine. But do never-treated schizophrenics have too much dopamine? Study after study says "no". Anti-anxiety drugs increase the action of GABA. But do never-treated anxious people have too little GABA? No. Antidepressants increase serotonin. But do never-treated depressed people have too little serotonin? No. The chemical imbalance theory, which barely deserves to be called a theory, does not hold up to even a minimal amount of scrutiny.

 

The human brain is extremely complex. Much more so than any computer program. You can't explain bugs in computer programs with simplistic formulas like "too few 1's" or "too few 'if' statements in the C code". Instead bugs are the result of very complex processes gone awry (and can't be explained at all without a detailed understanding of how the program works when it works correctly). Similarly, an explanation of the various ways the human brain can malfunction will likely be quite complex and will require a more detailed understanding of how the brain works than we currently have.

 

Unfortunately, that leaves the medical/psychiatric community unable to offer any real help for so-called mental illnesses. However I feel it would be better to honestly say "I can't help you" than it is to push drugs that don't help and in fact do harm. Which (in my experience) is what happens today.

 

Good topic. Thanks for starting it!

 

CP

[Guest [...]]

Spot on, CP! 

The chemical imbalance blabber is yesterday's news anyway, it was quashed ages ago.

[[ne...]]

Yes, but sadly, there are people, even here on the forum that still believe in this theory. I would say it's alive and well. 

 

Great analogy, CP! 

[[be...]]

Yes, but sadly, there are people, even here on the forum that still believe in this theory. I would say it's alive and well. 

 

Great analogy, CP! 

 

I'm not sure I agree with this. NG. Really don't know.

[[ne...]]

No worries, BG, I don't mind. 

but what do you mean?

 

[[be...]]

I've heard both sides and still cannot make up my mind. I think I will have to do some more research on the matter.

[[ne...]]

I searched for some recent articles debunking the neurotransmitter imbalance theory, but all that I have are a few years old. I don't they can prove it though to be true, as there is no test to measure neurotransmitter levels. They don't circulate in the blood, like hormones, to be measured.

 

And then, what about the receptors themselves?

[[be...]]

And then, what about the receptors themselves?

 

That's what I was thinking. Gonna have to ask my pdoc about that......

[Guest [...]]

Yes, but sadly, there are people, even here on the forum that still believe in this theory. I would say it's alive and well. 

 

Great analogy, CP! 

 

 

Yes, I'm sure many still do, there's really so much nonsense written all over BB, unfortunately.  People paying good money to have their neurotransmitters tested ... via bloodwork, yep.  Someone even swearing they knew someone else who'd had their actual receptors tested and the test showed they were all in perfect working order.  Yep, can't make this sh1te up!

 

I have my paper all planned out (in my head only though) on the debunking of the whole Benzo/GABAa theory.  Too bad I'm way too compromised to actually execute, it would be quite a riot! 

[[ne...]]

Awwwwww abcd, don't say that! I'm always looking forward to your contribution!

:hug:

 

 

And that article of yours!

[Guest [ou...]]

...searched for The Communication Interference Hypothesis, and could find no reference to it...

...what about disruptions in synaptic morphology?

 

The Communication Interference Hypothesis is basically a refined version of the Chemical Imbalance Hypothesis,

not unlike disruptions in neuromorphology.

 

...let's say we try to make "chemical imbalance" more precise.

Maybe it is intended to mean too much or too little of some specific chemical? But which one?

So let's say we try to infer it from the actions of the drugs.

 

Antipsychotics reduce dopamine. But do never-treated schizophrenics have too much dopamine? Study after study says "no".

Anti-anxiety drugs increase the action of GABA. But do never-treated anxious people have too little GABA? No.

Antidepressants increase serotonin. But do never-treated depressed people have too little serotonin? No.

 

...an explanation of the various ways the human brain can malfunction will likely be quite complex...

 

...that leaves the medical/psychiatric community unable to offer any real help...

...it would be better to honestly say "I can't help you" than it is to push drugs that don't help and in fact do harm.

 

Inferences are often incorrect leading to fallacies:

1. Reduced dopamine is not the only explanation for why antipsychotics may work on schizophrenics.

Schizophrenia may be genetic perhaps caused by abnormal dopaminergic pathways.

2. Not all anxiolytics work on GABA. Take antidepressants for instance.

3. Sometimes. Check the first 2 sources I provided.

 

You might also wanna check my UPDATE.

Lastly, ALL drugs may be helpful and ALL come with side effects.

I devoted a whole paragraph on that very issue.

[[pi...]]

"chemical imbalance" is too vague a concept to be the explanation of anything. It would be like saying the bug in the computer program I am trying to fix is caused by an imbalance of 0's and 1's in the computer. Maybe in some very vague abstract sense that is the case, but it is a useless and meaningless statement. So let's say we try to make "chemical imbalance" more precise. Maybe it is intended to mean too much or too little of some specific chemical? But which one? Proponents of the "chemical imbalance" theory rarely say which specific chemical is in imbalance, mainly because they can't, because they are just spewing bullsh*t. So let's say we try to infer it from the actions of the drugs they are selling (note it is always the people trying to sell drugs that propose the chemical imbalance theory). Antipsychotics reduce dopamine. But do never-treated schizophrenics have too much dopamine? Study after study says "no". Anti-anxiety drugs increase the action of GABA. But do never-treated anxious people have too little GABA? No. Antidepressants increase serotonin. But do never-treated depressed people have too little serotonin? No. The chemical imbalance theory, which barely deserves to be called a theory, does not hold up to even a minimal amount of scrutiny.

 

The human brain is extremely complex. Much more so than any computer program. You can't explain bugs in computer programs with simplistic formulas like "too few 1's" or "too few 'if' statements in the C code". Instead bugs are the result of very complex processes gone awry (and can't be explained at all without a detailed understanding of how the program works when it works correctly). Similarly, an explanation of the various ways the human brain can malfunction will likely be quite complex and will require a more detailed understanding of how the brain works than we currently have.

 

Unfortunately, that leaves the medical/psychiatric community unable to offer any real help for so-called mental illnesses. However I feel it would be better to honestly say "I can't help you" than it is to push drugs that don't help and in fact do harm. Which (in my experience) is what happens today.

 

Good topic. Thanks for starting it!

 

CP

 

very very interesting perspective CP. I agree with you from a logical stand point. Playing devils advocate for a second however, I know many doctors who would argue we have seen results in treatment well documented and the fact we dont know the exact mechanism is an irrelevance if we can provide relief to a debilitating condition. This rationale is very controversial but its commonly held and is standard practice. Just one example thats alarming; we dont know the mechanism of action on the molecular level for paracetamol (panadol). This is a best guess from a study looking into it in 2005:

 

"There is considerable evidence that the analgesic effect of paracetamol is central and is due to activation of descending serotonergic pathways, but its primary site of action may still be inhibition of PG synthesis. The action of paracetamol at a molecular level is unclear but could be related to the production of reactive metabolites by the peroxidase function of COX-2, which could deplete glutathione, a cofactor of enzymes such as PGE synthase" https://www.ncbi.nlm.nih.gov/pubmed/15662292

 

As you can see they're still hypothesizing (guessing) and even more recently in 2014 https://www.ncbi.nlm.nih.gov/pubmed/24779190

 

AND this is panadol!!! everyone takes it, alot of it....you can get this over the counter. It thins your blood and is a long term stroke treatment on top of pain relief. How does it work? no idea, we think its like this......blah blah

 

So the medical community and society take the stand, well we know the result from taking it? does it matter if we know how it works?

 

It blows your mind how little we actually KNOW in medicine. Its not a hard science like chemistry or physics. Clinical Medicine is an applied science whcih means working with imperfect data to offer the best solution possible. Unfortunately the do no Harm principle isnt considered as much as it should be compared to this when making the decision to leap into treatments

 

just my 2 cents

 

 

[[ma...]]

following 

[[be...]]

I'm trying to follow.

[Guest [ch...]]

Hey Pinky, how's it going?

 

Physics isn't as settled as you think. The fundamental laws of the universe are not known. There are a lot of questions around the leading candidate theories. See https://www.amazon.com/Trouble-Physics-String-Theory-Science/dp/061891868X and https://www.amazon.com/Not-Even-Wrong-Failure-Physical/dp/0465092764 .

 

The trouble with psychiatry is that its leading theory of mental illness - "chemical imbalance" - is (borrowing the title of the above physics book) not even *wrong*.

 

I have a problem with the question "what is the cause of your mental illness?". Like the question "when did you stop beating your wife?", the question itself presupposes the existence of something that I don't believe exists.

 

At one point in time, I was a healthy functioning man with a good life. Was I sometimes anxious? Sometimes sad? Of course, yes and yes. That's a normal part of being a human being. Then: "Take this drug, it'll reduce your anxiety, which will reduce your cardiac risk factors. It'll be good for you.". My *doctor* said this. Not the neighborhood drug pusher in a hoodie. Though honestly, I don't see much difference. Actually the drug pusher is less objectionable since he doesn't arrogantly claim to know everything. Roll the clock forward a bit. Now I was truly anxious. Doctor refers me to a shrink. "You have developed Generalized Anxiety Disorder" says the psychiatrist to me. So now, I have "mental illness"? Because some drug-pushing-shrink says so? Out of nowhere in my 50's and for no reason I become "mentally ill"? Due to a "chemical imbalance"? And, according to the shrink, these other pills (which by the way are what the shrink makes his living pushing) will correct this chemical imbalance?

 

I now have finally struggled free of all these awful drugs. I now realize that the only mental illness I ever had was the one caused by the pills doctors have given me.

 

I better stop now. I get emotional on this topic because I lost years of my life to psychiatrists and their self-serving theories.

 

CP

 

 

[[Lo...]]

I think the self-fulfilling prophecy of the chemical imbalance hypothesis is the worst aspect of it. Buying into that hypothesis (or even having some healthy dose of skepticism, but eventually buying into it) will eventually lead to psych meds, which will cause those feared chemical imbalances that these psychotropics were supposed to fix. Then the psychotropics end up causing the chemical imbalance, and the waters get very muddied, because, if people can't get off their meds, they obviously have some chemical imbalance that needs to be fixed. Someone on 3mg Xanax/day after a year on it can't just stop it, so, apparently Xanax is "fixinig" the chemical imbalance. And in reality it's not really fixing it, but it's not just a band-aid either, since it cannot just be stopped. It's almost as if a part of that brain has been exported into that pill bottle.

 

And since the recovery movement has always been very small and often silenced, and that combined with the fact that most of us will not dare talk about this due to profound fear or embarrassment, the real truth doesn't come out. I appreciate when people speak about such things outside recovery circles, because each story out there may prevent someone new from walking into the same trap.