Is 'Chemical Imbalance' a Real Thing?

Mental health related issues seem to be increasing throughout the world at an alarming rate.

What seems to still drive the theory of mental health is the 'chemical imbalance' theory.

I found myself recently reflecting on whether the chemical imbalance theory was a myth or fact. Is there another theory that can explain this, especially from a trauma-informed lens?

Traditional approaches to mental health treatment have been grounded in the chemical imbalance theory.

What has been identified globally by Syme & Hagen from Washington State University is "as the prevalence of infectious disease declines, mental disorders are emerging as major contributors to the global burden of disease. Scientists understand little about the etiology of mental disorders, however, and many of the most popular psychopharmacological treatments, such as antidepressants and antipsychotics, have only moderate-to-weak efficacy in treating symptoms and fail to target biological systems that correspond to discrete psychiatric syndromes. Consequently, despite dramatic increases in the treatment of some mental disorders, there has been no decrease in the prevalence of most mental disorders since accurate record keeping began." This should raise alarm bells for everyone.

Where did the chemical imbalance theory emerge? Well, the Chemical Imbalance theory has been floating around for a significant time, starting as far back as early 1960's by a British Physician Alex Coppen, who questioned if a drug to treat tuberculous, Marsilad, was causing an increase in serotonin levels in the brain,causing patients to dance up and down the hallways in hospital after receiving treatments.

Andrew Skull, a Professor at Princeton University stated that linking depression to low levels of serotonin is "deeply misleading and unscientific." This seems to only question further the anecdotal influence of the actual medication themselves, at least in the early observations of these patients.

As professionals, we are always trying to challenge our beliefs and ways of how we think about social problems. What we are learning is that despite all of the new antidepressants treatment between 1990-2010, the prevalence of major depressive disorder and anxiety has remained constant at ~ 4% during this period.

Some research is suggesting that antidepressants are performing no better than placebo. The global rates of these disorders remains around 1 in 14 people suffer with these diagnoses.

If that sounds unlikely, then consider that neuroscientists have increasingly mapped these disorders to branches of the threat detection system. Anxiety may be due to chronic activation of the fight or flight system. PTSD may occur when trauma triggers the freeze response which helps animals disconnect from pain before they die, and depression may be a chronic activation of that same freeze response.


Neuroscience has opened the door for us to reflect on what we understand anxiety, depression and trauma to be, a response to adaptation rather than solely thinking about these disorders as 'chemical imbalance'. There may be more going on within our nervous system, and how the body through neuroception is scanning for safety, even when the brain is not aware of any perceived threats. We now understand that through neuroception, the body is able to activate the defense mechanisms of fight or flight, even when the brain is not aware. What happens when one's autonomic nervous system operates, and has learned to operate in overload, as a form of adaptation for survival?

So the question is - is it really 'chemical imbalance' or an overactive nervous system struggling with fight, flight, or freeze?

Be well

Ian


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