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If anxiety is not caused by a chemical imbalance, why do antidepressants help some people feel better?

Marilyn Folk BScN medical reviewer
Written by: Jim Folk.
Medically reviewed by: Marilyn Folk, BScN.
Updated: May 11, 2019

You say that anxiety disorder is not caused by a chemical imbalance in the brain. I tend to agree. But why is it that some people see a benefit from medication then? Is it because of the placebo effect, or because of something else?

It’s true that anxiety disorder is not caused by a chemical imbalance in the brain. The chemical imbalance theory was completely discarded in 2011. It’s also true, however, that approximately one third of people who take antidepressants experience some symptom relief. The benefits are not caused by restoring a ‘chemical imbalance,’ but because of two main factors

Before I talk about these factors, it’s important to understand that anxiety disorder is NOT caused by a chemical or biological problem. And anxiety disorder is NOT a medical condition.

Anxiety disorder occurs when a person’s anxious behaviors interfere with a normal lifestyle. The root of anxiety disorder is anxious behaviors – the unhealthy ways we think and act. Since the root cause of anxiety disorder is unhealthy behaviors, we eliminate anxiety disorder by learning healthy ways—non anxious ways—of behaving.

So the cure of anxiety disorder is through behavioral modification, and not through chemical or biological intervention. Identifying and addressing the unhealthy behaviors at the root of anxiety disorder is the ONLY way to achieve lasting success over problematic anxiety.

Unfortunately, many people equate anxiety disorder with its sensations and symptoms. But we have to keep in mind that being overly anxious stresses the body, and a body that becomes abnormally stressed can become symptomatic. So the sensations and symptoms associated with anxiety disorder are actually the sensations and symptoms of abnormal stress. They are commonly referred to as anxiety symptoms because being overly anxious is the main source of the abnormal stress that causes stress-caused sensations and symptoms.

So when it comes to helping people feel better, this is usually associated with their sensations and symptoms of stress, and not the anxious behaviors themselves.

That said, here are the two main factors that can help people feel better when they take antidepressants:

1. Yes, many people experience a benefit due to the placebo effect – if they think their pill will help, they are calmer and less stressed and anxious, which will naturally reduce symptoms. Since the symptoms associated with anxiety disorder are symptoms of stress, ANY activity that reduces stress will reduce symptoms. So a reduction in fretting and stress WILL cause a reduction in symptoms.

2. Antidepressants cause a change in how the brain functions. It’s this change that causes a reduction in symptoms for some people (approximately one third). But it’s also this change that can cause some people to experience an increase in symptoms. Because each body is somewhat chemically unique, what can reduce symptoms for one person may cause an increase for another. This is why two thirds of people who take antidepressants either see no benefit or feel worse.

You also have to keep in mind that many people feel better when they drink alcohol because of how alcohol can relax the body. So in keeping with the theory behind antidepressants – that people feel better because antidepressants ‘restore’ the natural serotonin (or other neurotransmitters in the brain) levels in the brain synapses - that must mean that people feel better when drinking alcohol because consuming alcohol restores the natural ‘alcohol’ levels in the brain. But as you can see, this is nonsense. Some people feel better when ingesting alcohol because of how alcohol affects the body. The same is true with antidepressants. Some people feel better NOT because antidepressants restore a ‘faulty’ chemical balance in the brain, but because of how a boost in serotonin (or other neurotransmitters) affect the brain and how that change can affect some people.

Because psychoactive drugs are powerful, because no one is really sure how they affect the brain, because no one is sure what the long-term implications of antidepressants are, and because anxiety disorder is NOT caused by a chemical imbalance that needs ‘restoring,’ we aren’t advocates of antidepressants. Since similar (if not better) sensation and symptom relief can be achieved through natural means, such as through regular exercise, relaxed breathing, deep relaxation, and having fun, to name a few, we are advocates of managing sensations and symptoms naturally and not chemically.

And since anxiety disorder, and its sensations and symptoms, can be completely eliminated by doing the right work, we prefer people deal with their struggle with anxiety disorder correctly so that it can be eliminated for good and without introducing what could be harmful drugs. Since antidepressants don’t correct unhealthy behavior, they don’t do anything other than help manage symptoms for some people. When you compare this to the many adverse reactions of antidepressants (not to mention the long-term harm that some people experience), we view antidepressants as being a negative rather than positive option.

Much more could be said, but the above addresses the basics of this topic.

The combination of good self-help information and working with an experienced anxiety disorder therapist is the most effective way to address anxiety disorder and its many symptoms. Until the core causes of anxiety are addressed - the underlying factors that motivate apprehensive behavior - a struggle with anxiety disorder can return again and again. Identifying and successfully addressing anxiety's underlying factors is the best way to overcome problematic anxiety.

Additional Resources:

Return to our Anxiety Frequent Questions.

anxietycentre.com: Information, support, and coaching/counseling/therapy for problematic anxiety and its sensations and symptoms, including information about anxiety and antidepressant medications.