Is Depression Really Just a Chemical Imbalance?

“It’s a chemical imbalance.”

The first time I ever heard that phrase spoken was by my best friend 25 years ago, when we were both working entry-level jobs in two of New York’s glamour professions: advertising and magazine publishing.

Anyone who works in those fields knows they are only glamorous on the surface; the nitty-gritty of getting the work done means toiling long hours in stressful jobs in a competitive, type-A environment.

We were beginning to learn and express the distinctly New York City art of feeling our stress – and its many physical repercussions – as a kind of badge of honor reflecting both our work and our striving.

Prozac, the pharmaceutical industry’s first blockbuster SSRI had recently come to market, and my friend – like many people I knew – had begun taking it.

I’ve always had an innate wariness about antidepressants. This probably reflects my own fear of dependency – on any person or any substance. I also have always had a very strong instinctive sense that depression is a lot more complex than can possibly be expressed by one single neurotransmitter, however important it might be.

I was functioning and working a job, but also battling on a daily basis with what I called “the dead feeling” inside – a lack of enjoyment of life, a deep and abiding sense that nothing really mattered, and a general “what’s the use” feeling that pervaded everything I did.

By the time I had this conversation with my friend, I had thankfully begun seeing a psychotherapist, a wonderful clinical social worker who specialized – as do many social workers – in family systems and understanding how relationships with family members impact us for life.

I had only just begun this work, and though I was no expert on any of it, I had a deep sense as I began talking with her that I was on the right track. I was uncovering and untangling long-standing emotional patterns within my family. As I put them directly under therapy’s bright light, I felt they could no longer direct me into this dead zone they had been leading me into. I felt like I was finally beginning to understand the cause of the mysterious “dead feeling” I had been carrying around for years.

My friend, on the other hand, had gone to see a psychiatrist, who told her that her depression was due to a “chemical imbalance.” And she was fortunate enough to be experiencing this at a time when science had something very promising to offer her: a selective serotonin reuptake inhibitor, called Prozac.

Her feelings of depression, he told her, were due to a chemical imbalance in her brain. Nothing to be ashamed of and nothing that was her fault. Just a pesky little brain chemical out of whack. This new drug made sure more serotonin was active longer, before the brain performed its “reuptake,” whereupon this important feel-good chemical diminished, creating her depressive symptoms.

At the time I was having this particular conversation with my friend, I had recently been feeling a remarkable uptick in energy just from the simple act of uncovering old emotional patterns left over from childhood. I asked her why she thought she might be depressed – what did she think was the deeper cause or maybe even the deeper meaning of this debilitating condition?

To which she replied – almost dismissively – “It’s a chemical imbalance in the brain.” The same words her doctor had said to her before handing her that little piece of paper with the words “Prozac 20 mg” written on it.

Flash forward 25 years. My life has had many unexpected twists and turns since then, but of all the things I could never have predicted, I think chatting in depth with top doctors about what causes and heals depression ranks right up there at the top of the list.

In my two online series The Depression Dialogues and Parenting Today (an investigation into children’s mental health), I’ve interviewed over 60 medical doctors, holistic psychiatrists, psychotherapists, functional physicians and a panoply of fascinating alternative practitioners about what’s happening at a deeper level in the body and mind when we experience depression.

One of my favorite of these doctors, Henry Emmons MD, doesn’t even refer to the “mind” or the “body” separately in these discussions. He refers to the “body-mind,” since they’re so interwoven (especially in the area of mood) that separating them becomes a kind of fool’s errand.

Viewed from this perspective, it’s mind-blowing to me how many psychiatrists still subscribe to the “chemical imbalance” theory of depression, a breathtakingly small explanation when you consider how large, multi-factorial and complex depression really is.

I see it as almost a fetishization of brain chemicals, which is laughable given that these brain chemicals are usually the last stop on the train of emotional and physical changes which occur as depression manifests.

(If you’re curious how psychiatry ended up going down this narrow road, rather than a more holistic one, I recommend Robert Whitaker’s terrific book Anatomy of an Epidemic, which tells the story of how psychiatry became increasingly medicalized, an approach many folks find unhelpful.)

So what causes depression?

So many things. Adverse childhood experiences. Genetics. Traumatic events. Low thyroid function. Loneliness. Inflammation in the body. Food allergies. Mold. Cosmic despair. Blood sugar dysregulation. And the list goes on.

And it’s rarely just one of these things. Very often with depression, we have one or more factors coming together in the body-mind to create what amounts to a “perfect storm” of depression. As the holistic psychiatrist Judy Tsafrir MD said to me in our interview, “When I think about why a particular person is depressed, I’m not usually thinking ‘Is it this OR that?’ It’s more like, ‘It’s this AND that AND that.’ ”

All things considered, it would be much more helpful if everyone began using the word “depression” as a kind of umbrella term to invite deeper investigation.

So where do we start looking?

Rather than getting overwhelmed by the many and varied causes and influences, I believe it helps to step back and look at our lives in a big-picture way first.

There are three broad areas we need to start with as we begin our detective work into what is underlying any particular depression.

These three areas are our emotions, our biology, and our meaning.

For the sake of simplicity, when I discuss these ideas with clients, I usually refer to them as:

• The Emotional Body
• The Biological Body
• The Meaning Body

In my next post, I’ll delve deeper into how these three bodies work, how distress in any one of them can trigger a depression, and how they often impact and overlap with each other in fascinating ways.

In the meantime, I would love to share my free Daily Survival Guide for Depression Ebook. Leave me a comment below and let me know what you think.