In the past two months, a really interesting study has been published by a group of researchers in the United Kingdom, including Joanna Moncrieff of the Division of Psychiatry at the University College London.[1] The article was the product of research that examined a large number of studies dealing with the chemical imbalance theory of depression. Specifically, the article discussed whether or not a lack of serotonin can be demonstrated to be the cause of depression.
For the last 50 years, the popular explanation for persistently sad moods was a lack of serotonin in the human brain or at least an imbalance in the chemicals that allow our nervous system to function. I can remember the print and television commercials showing the empty balloons in our heads that the medication was supposed to fill. Correcting our lack of serotonin was supposed to cure the sadness. It was a simple explanation that all of us could understand. The only problem with it was a lack of proof.
After searching published studies, the researchers concluded that “The main areas of serotonin research provide no consistent evidence of there being association between serotonin and depression and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long term antidepressant use reduces serotonin concentration.”[2] And just like that, the curtain fell on the era of the chemical imbalance theory of depression.
There have been many responses in the news. Noted psychiatrist Dr. Ronald Pies took the opportunity to state that psychiatry was not responsible for the spread of the chemical imbalance theory. He more or less denied they had ever said it.[3] At the same time, The American Psychiatric Association has the following statement on its website: “Brain chemistry may contribute to an individual’s depression and may factor into their treatment. For this reason, antidepressants might be prescribed to help modify one’s brain chemistry.”[4]
Twitter has been ablaze with 300 keystroke criticisms from secular critics in terms that few would call speaking the truth in love. Another group is calling for a class action lawsuit against the APA, alleging that they promoted the theory to the hurt of patients/clients.[5] All told, it seems like a dark day for medicine in general and psychiatry specifically.
So, what does this mean for all of us, and how should we respond? How is this important to those who counsel from the Scriptures? What does it mean for patients and physicians? How will it affect those who deal with sad moods and their loved ones?
Let’s start with those of us in biblical counseling. For most of us, it really does not change how we understand the societal definition of depression or the way we approach it. In twenty-five years of teaching biblical counseling, I’ve been saying that there is no substantiating evidence that chemical imbalances cause depression. I suppose we can feel vindicated without taking a victory lap.
More important than being correct, knowing that the serotonin hypothesis is not true does do one important thing. This theory can no longer be used to say that everyone who struggles with a sad mood has a disease. And it cannot be used to support the idea that the only appropriate place for care for depression is in a doctor’s office.
This research should turn our attention away from a neuro-biological theory and back to the life circumstance causes that surround sadness. For those of us in biblical counseling, it should focus our attention on the old concept of normal versus disordered sadness. Horwitz and Wakefield made a great case for this in their research, which showed that 90% of those labeled with a depression diagnosis were grieving the loss of something important to them.[6]
As one of the authors of the study, Mike Horwitz, said, “The endless search for a single chemical that causes depression is probably looking in the wrong place because there’s such strong evidence that circumstances of our lives—stressful life events, poverty, work, insecurity, relationships—have a strong effect on the risk of depression.”[7] Biblical counseling has hope and answers for those who struggle with sadness over lost things, relationships, jobs, and anything else we think we cannot live without. We should pursue the opportunity to help those who suffer.
What Does This Mean for Physicians and Patients?
Without a doubt, this research will affect the way physicians and patients view antidepressants. But first, it is important to ask what the research does not do. It is important to note that it does not address the question of whether or not medication for depression is safe and effective. Other research studies have examined this question, and these medications are not nearly as helpful as was hoped.[8]
At the same time, this research does not say that no one benefits from taking an SSRI antidepressant. Research would say that some do. The problem for the last 30 years has been over-prescription of these medications to individuals suffering with normal sadness over an identifiable loss. When antidepressants are given to the 90%, Wakefield and Horowitz explained that nearly 90% of those taking antidepressants do not benefit from taking them more than they would from taking a placebo.[9]
Since it is not clear how they work, physicians and patients should be having detailed discussions about the limitation of benefits and the known side effects of these medicines. And perhaps the best outcome will be that patients will be talking longer with physicians about other options such as counseling. Research has shown that the majority of patients benefit as much or more from counseling in the long run.
What Does This Mean for Medicine?
The passing of the chemical imbalance theory is a good thing for medicine. It is not disappointing in the least. When an old, long-held, and incorrect theory bites the dust, it opens up research in a different direction. Instead of being stuck with the one magic bullet theory, now young, eager researchers will be looking for better explanations. And already, research is being published that offers a different explanation for depression.
Perhaps as medicine pursues research, we will come to understand the 10% with disordered sadness. Further, we may be able to find how much of that group has pathologically defined causes for their sad mood and medically correct and cure the problem. Biblical counseling has a role in this as well as we encourage counselees who do not fit the description of normal sadness to see their physician to make certain there is no identifiable, treatable cause for their mood. We also can help them respond to difficult circumstances with scriptural principles.
Serving Those Who Suffer and Their Loved Ones Well
The last question is, how can we best respond to this news in a way that helps those who suffer and those who love them? As biblical counselors, we should be aware that we have counselees struggling with whom they should believe. They may also fear losing what has been an explanation of their struggle. We should approach them in kindness with a heart tendered by Christ’s love.
I rarely talk with counselees about chemical imbalances. It isn’t why they come to counseling. Ninety percent will likely be working in loss recovery, struggling with the sadness that Scripture directly addresses. I would suggest that is what we should be doing. It is equally true in medicine and biblical counseling that if we do a better job of identifying those with normal sadness instead of labeling them as depressed, we will do a far better job helping them.
Questions for Reflection
- For the counselee with depression: Have you had a thorough physical with your physician to exclude medical causes of depression?
- For the counselor: How will you answer your counselee’s questions about the demise of the chemical imbalance theory?
[1] Joanna Moncrieff, Ruth E. Cooper, Tom Stockmann, Simone Amendola, Michael P. Hengartner, Mark A. Horowitz, “The serotonin theory of depression: a systematic umbrella review of the evidence,” Molecular Psychiatry, 2022, DOI: 10.1038/s41380-022-01661-0.
[2] Ibid.
[3] Ronald Pies, “The Serotonin Fixation: Much Ado About Nothing New,” Psychiatric Times, August 3, 2022, electronically retrieved August 21, 2022, https://www.psychiatrictimes.com/view/the-serotonin-fixation-much-ado-about-nothing-new.
[4] Quote retrieved from the American Psychiatric Association website on August 21, 2022, Psychiatry.org – What Is Depression?.
[5] Robert Whitaker, “Psychiatry, Fraud, and the Case for a Class-Action Lawsuit,” Mad in America, August 13, 2022 retrieved electronically August 21, 2022, https://www.madinamerica.com/2022/08/psychiatry-fraud-and-the-case-for-a-class-action-lawsuit/.
[6] Alan Horwitz, Jerome Wakefield, The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, (New York: Oxford University Press, 2007), 19. Also see, Jerome Wakefield, Mark Schmitz, Michael First, Alan Horwitz, “Extending the Bereavement Exclusion for Major Depression to Other Losses” Archives of General Psychiatry, vol. 64 (April 2007), 438.
[7] Batya Swift Yasgur, “No Evidence Low Serotonin Causes Depression?” Medscape, July 22, 2022, Electronically retrieved August 21, 2022, https://www.medscape.com/viewarticle/977753.
[8] Charles Hodges, Good Mood Bad Mood: Help and Hope for Depression and Bipolar Disorder, (Wapwallopen; Shepherd Press, 2013), 48.
[9] Ibid., 48.
