Do anti-depressants treat a “chemical imbalance?”

Dr. Moncrieff wrote an article in BBC News titled “The myth of the chemical cure” where she discusses the reasons why it has been thought that anti-depressants work.  The reason most often sited is that people with depression, anxiety, schizophrenia etc. have a “chemical imbalance” in their brain and taking these medicines treats that.  I have told patients that myself.  The problem with that is there is actually relatively little justification for that view of psychiatric drugs.  The most compelling argument it seems is that they work so that proves there is an underlying biologic or physiologic reason why they work- we just don’t know what it is yet.

She suggests that psychoactive drugs (anti-depressants like  Zoloft or Lexapro or anti-anxiolytics like Valium or Xanax) “work by producing drug-induced states which suppress or mask emotional problems.”  She compares this to the drug induced state brought on by marijuana or alcohol.

This doesn’t mean they are not helpful.  For people with severe depression or anxiety, masking their problems with drugs could help them temporary deal with the real underlying issues.  And, that could be a very good reason for people who are severely distressed to take these medications.

But the way these drugs are described by physicians affects how many people want to take them.  If it’s sold as a pill that is reversing a chemical imbalance it sounds good.  It it’s sold as a pill that masks the thoughts and feelings although we really have no idea what’s going on in their brain, it might not sound so good.

It is up to the patient to make an imformed decision about whether or not psychoactive drugs are a good choice of treatment for their emotional struggles.  It’s the physicians responsibility to accurately portray what we know about how these medicines work.  Ultimately, dealling with the source of your depression or anxiety is the treatment.  Of course, some believe the story that actually dealling with your problems is harder than taking a pill to cover them up which may be one reason why anti-depressants are one of the most commonly prescribed drugs in America.