In the 1980s, the 1990s, and beyond, pharmaceutical companies heavily promoted something resembling a chemical imbalance theory of mood disorders directly to consumers—or, at least, used the “chemical imbalance” trope to explain how antidepressants supposedly work. In recent years, as psychologist Dr John Grohol has pointed out, some non-professional websites have provided misleading graphics that reinforce the “chemical imbalance” trope.24 It is not surprising that the “Theory That Never Was” has taken hold in the minds of so many.
While some prominent psychiatrists have used the term “chemical imbalance” in their public comments about antidepressants—and possibly in their clinical practices (Sidebar)—there was never a unified, concerted effort within American psychiatry to promote a chemical imbalance theory of mental illness.
The original catecholamine hypothesis of mood disorders was carefully qualified by its originators in the 1960s, and has been recognized as significantly flawed and inadequate by US psychiatrists since at least 2003—and probably much earlier. The hypothesis has since been modified and corrected to reflect more complex biological mechanisms in major mood disorders. These disorders are best understood using a bio-psycho-sociocultural model, which has been the mainstay of academic psychiatry for over 30 years.
As with many other neuropsychiatric diseases, including Alzheimer disease, the precise causes of major mood disorders are still unknown. Almost certainly, there is a plethora of causal processes involved, depending on the diagnostic criteria and subtype of the illness (similar to the subtyping of anemia). Fortunately, we have effective pharmacologic and psychosocial treatments for mood disorders. As for the bogus chemical imbalance theory and its misattribution to the profession of psychiatry, it is time to drive the stake into its misbegotten heart. We must focus on providing our patients greater access to holistic, comprehensive psychiatric care.
Acknowledgement—My thanks to Dr George Dawson for commenting on an early draft of this essay.
This article was originally published on April 30, 2019 and has since been updated.
The author reports no conflict of interest concerning the subject matter of this article.
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