The Chemical Imbalance Theory Officially Dead - July 11, 2011
As early as the late 1980s, doctors, mental health professionals, and pharmaceutical companies told us that anxiety disorder, depression, and a whole host of other mental illnesses were caused by a ‘chemical imbalance’ in the brain. To ‘treat’ these mental illnesses, we were told we needed to take ‘antidepressant’ and ‘anti-anxiety’ medications that ‘corrected’ this imbalance. For decades, this was common practice. In fact, it was so common, this story was told to almost every person dealing with anxiety disorder and depression (and many other ‘mental illnesses’).
During this time, antidepressant and anti-anxiety medication sales exploded worldwide - antidepressant sales rose steadily year after year to a peak of $15 Billion in the year 2003. Antidepressant use reached a point where 1 in 10 Americans was using some from of antidepressant.
The reason the "chemical imbalance" theory gained such prominence was because pharmaceutical companies said they had research that proved the chemical imbalance cause for mental illness. To support their claim, they produced numerous pieces of research, and had much of this research published in reputable medical and mental health journals.
Pharmaceutical companies also "sold" this theory to doctors and the general public through massive interpersonal and mass media marketing campaigns. It is little wonder that this theory gained such acceptance.
However, for those who worked in the mental health sector, especially cognitive and behavioral coaches/therapists, the chemical imbalance theory didn't wash, as success in overcoming anxiety and depression disorders was achieved using cognitive behavioral methods rather than medication. To accommodate CBT’s success, for a while, the standard recommended treatment for anxiety disorder and depression was a combination of CBT and medication.
After repeated successes using CBT alone, cognitive behavioral coaches/therapists could demonstrate that anxiety disorder and depression weren't caused by a chemical imbalance in the brain but caused by learned unhealthy behaviors (the ways a person thinks and acts). Once these behaviors were identified and successfully addressed, a struggle with problematic anxiety and depression ended. From a practical standpoint, the cause and ‘cure’ were obvious!
In spite of the practical and repeatable evidence, the medical, mental health, and pharmaceutical industries maintained their stance on the chemical imbalance notion and the need for medication to correct the imbalance.
So, on one hand, you had those who were working on the front lines helping people with these disorders (behavioral, anxiety, and depression coaches/therapists) achieve real success using CBT alone and claiming there was no such thing as a chemical imbalance cause. And on the other hand, you had the medical, mental health, and pharmaceutical organizations stating otherwise.
For the last 15 years, this disparity continued with proponents from both sides strongly stating their cases. Unfortunately, the pharmaceutical company marketing machines were spending large sums of money reinforcing the chemical imbalance theory and successfully using mass media to maintain their position (pharmaceutical company websites were replete with the chemical imbalance notion).
In 2005, however, independent research began to unravel the chemical imbalance claim. As each new piece of independent research arrived at findings that disproved the chemical imbalance theory, the theory began to crumble.
Moreover, when additional independent studies found antidepressants provided little value over placebo, and when investigators found that much of the research pharmaceutical companies used to support their claims was artificially fabricated – and in some cases, falsified, many began to seriously question the chemical imbalance notion.
This heated up the chemical imbalance discussion. More and more people began to realize the chemical imbalance theory never was true and that antidepressant medications, in addition to being relatively ineffective, were doing more harm than good, in many cases.
As the facts about antidepressants became more public, a greater resistance to antidepressants and the chemical imbalance theory emerged. Slowly, pharmaceutical companies silently backed away from the chemical imbalance claims. In late 2010, many pharmaceutical company websites began eliminating direct references to the chemical imbalance notion. This was the first subtle admission that a chemical imbalance cause for mental illness wasn’t true.
Then, Dr. Ronald pies, the editor-in-chief emeritus of the Psychiatric Times, laid the theory to rest in the July 11, 2011, issue of the Times with his admission:
“In the past 30 years, I don’t believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim [about chemical imbalance in the brain], except perhaps to mock it”
“And yes, the ‘chemical imbalance’ image has been vigorously promoted by some pharmaceutical companies, often to the detriment of our patients’ understanding.”
“In truth, the “chemical imbalance” notion was always a kind of urban legend - never a theory seriously propounded by well-informed psychiatrists.”
That was it! The chemical imbalance theory was dead!
In other admissions, pharmaceutical companies said they used the chemical imbalance theory as a "metaphor" and it wasn’t intended to be understood as an actual imbalance.
Of course, we take issue with Dr. Pies’s assertion that knowledgeable psychiatrists didn’t believe the chemical imbalance theory. Sure, they did! In an online poll we conducted in 2007, 80 percent of respondents who received a diagnosis of anxiety disorder were told they had a chemical imbalance and 90 percent were prescribed a medication. Why else did antidepressant and anti-anxiety medications soar? Because patients were told they needed them.
We also take issue with the pharmaceutical companies’ stance that they used the chemical imbalance notion as a metaphor only. From 2002 to 2010, many pharmaceutical company websites and mass marketing campaigns had elaborate illustrations showing, what they portrayed, as the 'actual' chemical imbalance that needed ‘correcting.’
While it's great to see the chemical imbalance notion finally officially put to rest, I think it's a great injustice that the organizations that ‘sold’ this fallacy, and the proponents who supported it, try to distance themselves by changing their story now that the truth is known. I believe it would have been far better had they admitted the chemical imbalance notion was just a marketing strategy, and for the professionals who professed and supported the theory to admit they made a mistake. But it seems for some in today's society, it's better to ‘cover up’ and deflect rather than take full responsibility.
10 years ago, we, and many others, stated emphatically that the chemical imbalance theory wasn’t true. Today, we’re glad the truth has finally come out so that people can get real help rather than pseudo-help.
Officially, the chemical imbalance theory died in 2011. If you encounter someone who continues to believe this theory, we encourage you to share the truth with him/her/organization so that this misinformation about anxiety and depression (and other mental illnesses) is discarded.
This would be an important step in demystifying anxiety and depression, and in removing harmful stigmas and barriers for people who have to deal with these behavioral challenges.
For a more complete history of the Chemical Imbalance theory and its demise, click here to download a PDF article about the Chemical Imbalance Theory.
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Authors: Jim Folk, Marilyn Folk, BScN. Last updated January 1, 2019.