In abnormal psychology, you learn of the theory that psychological disorders are caused by chemical imbalances. I didn’t think much of it since it was just a theory with no significant clinical proof.
Moreover, when you read case studies, you come to understand that there are a number of factors that could give rise to someone exhibiting a psychological disorder. Stress, genetics, illnesses (such as hyperthyroidism) and environment are four that are commonly cited.
The chemical imbalance argument was always a strange one to me. For starters, what is the appropriate chemical balance that one needs to have? How much of each neurotransmitter should one have? Wouldn’t it vary from person to person, given that each person has varying levels of hormones and different genetics?
What causes these chemical imbalances? Is it stress that causes the neurotransmitters to go haywire? If it was stress, wouldn’t that be the real culprit?
Perhaps the only way to know if the chemical imbalance theory had weight was to examine the drugs that are based on this theory. Did they successfully curb psychological disorders?
The Food and Drug Administration (FDA) provides prescribing information on each drug that they approve. Patients rely on the information provided by the FDA so that doctors prescribe the right drug or treatment to the right patient.
Prozac is a selective serotonin reuptake inhibitor (SSRI) that is used to treat Major Depressive Disorder, Obsessive Compulsive Disorder, bulimia and panic disorders. It can be prescribed for adults and children, depending on the disorder.
When we take a look at the prescribing information for Prozac, we find that, “Although the exact mechanism of PROZAC is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.”
That’s odd. Why is it only presumed to be linked to the inhibition of serotonin uptake? That means that there’s no proof that this is true. Moreover, by saying that the mechanism of PROZAC is unknown, the FDA is admitting that they don’t know how PROZAC works.
Let’s look at another psychotropic drug.
Paxil is a SSRI that is used to treat Major Depressive Disorder, Social Anxiety Disorder, Obsessive Compulsive Disorder, Panic Disorder, Generalized Anxiety Disorder and Posttraumatic Stress Disorder.
Once again, we find that it is “…presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin.”
Remeron is a tricyclic antidepressant. The prescribing information states that, “The mechanism of action of REMERON® (mirtazapine) Tablets, as with other drugs effective in the treatment of major depressive disorder, is unknown.”
Now we’re being told that all drugs that treat major depressive disorder do so in a way that no one really understands. All we know is that these drugs may be effective at alleviating a symptom of the disorder.
You may think that if these drugs treat the symptoms then that would mean that these drugs are good enough to be prescribed.
I know people who are thankful for these psychotropic drugs but I also know people who regret taking them. But the one thing these two different folks have in common is that they changed.
The argument isn’t whether or not the drugs do something. Clearly they do, for better or for worse. The issue is if they treat the disorder and it seems that regardless of where you stand, these drugs treat a symptom.
You may sing a drug’s praises because it alleviated a symptom but it may have also caused a different issue.
For example, in an article from the Psychiatric Times, Dr. Simon Sobo regaled the story of a thirty-year-old patient named Mr. T. This patient was very unhappy in his marriage to a woman who he assumed would eventually want children but never changed her mind. He then became depressed.
Dr. Sobo makes a compelling argument:
“What if Prozac worked like a charm and completely rid him of his depression? What if Prozac returned bounce to his life and now he found he could, after all, live happily with the status quo? What if 25 years from now, Mr. T. were to wake up and suddenly realize he had wasted his life? He really had wanted children and a family all along. What if he wouldn’t allow a doubling of his Prozac dose at that point, seeing it as a drug that had deceived him and cheated him of what had been meant to be?”
Was this a matter of a chemical imbalance? No one can say for sure. But what is clear is that this man presented symptoms only after realizing that his dream could not be accomplished with his spouse.
Was a drug required in this situation? Perhaps not. Perhaps what was required was for him to take the painful decision to divorce so that he could then enjoy what he really wanted, which was a family.
Then of course there’s the link people have made between mass-shootings and these psychotropic drugs used to treat anxiety and depression.
Let me be clear. I am not saying that these drugs cause people to commit mass homicides and suicide. Even if they were a cause, they may not be the only cause.
Many of the people who have committed these crimes were on multiple drugs and at very high dosages. Some people commit these crimes without being on any drug.
But what is clear is that people like James Holmes, Eric Harris, Seung-Hui Cho and Aaron Alexis had problems that drugs could not and did not solve.
What is also clear is that people like Omar Mateen who shot up the Pulse nightclub in Orlando, Florida in 2016 and other mass shooters who weren’t on antidepressants, SSRIs or the like were also deeply disturbed and had mental problems. They needed help too and the psychiatric/psychological authorities failed them.
These authorities also failed society because without the appropriate treatment for people who suffer from psychological distress and disorders, they may take out their pain on others or on themselves.
On every SSRI, SSNI and antidepressant, there is a warning on the prescribing information that explains that there is an increased risk of suicidality. We hear it in the commercials for these drugs all the time. We laugh at the irony that a drug that is used to treat depression may actually worsen it.
I want to state again that I’m not against these drugs. At the right dosage, for the right people, in the right context, these things work well. But no one knows how they work.
What we do know is that people are suffering and they need the proper help to address their issues. Merely prescribing a pill due to an unfounded theory of chemical imbalances is a problem that needs to be known and addressed.
I close with another quote from Dr. Sobo:
“Axis I disorders are boldly portrayed as “chemical imbalances” in patient brochures, news articles and other educational materials.
The problem with this portrayal is that, while some day we may accumulate the knowledge to demonstrate the particulars of this perspective, no such chemical imbalances have been unequivocally demonstrated for any disorder.
I would argue that there are certain psychological effects of medications that make them useful in a variety of DSM-IV-defined disorders not because they are necessarily correcting a chemical imbalance, but because the psychological effect is useful.
Rat pups that are isolated from their mother and littermates produce ultrasonic sounds that are indicative of stress. SSRIs reduce these sounds. Is a chemical imbalance being corrected? I doubt it.”