The Chemical Imbalance Theory

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The current fad in making diagnoses is the "chemical imbalance" theory. The term "chemical imbalance" is drawn from the Biological Model of the mind, which proposes that psychiatric disorders are caused by abnormalities in the biological makeup of the brain.

Two trends contributed to the rise of the Biological Model and the "chemical imbalance" theory. First, starting in the 1950s, medications were developed that improved specific symptoms of many psychiatric illnesses. The first was Thorazine, which decreased the intensity of the hallucinations and delusions of people suffering from schizophrenia. Drug companies then developed and marketed medicines that treated other psychiatric problems. Benzodiazepines like Valium and Xanax decreased anxiety. Tofranil and Elavil, first marketed in the 1960s, and Prozac, Zoloft, and Paxil released in the 1980s helped millions of people with depression.

As technology improved, our understanding of how these medicines worked in the brain grew tremendously. New theories of psychiatric problems emerged based on how the medicines worked. For example, it appeared that the effect of Thorazine was due to its ability to block the effects of dopamine, a neurotransmitter important to brain function (see Appendix A). This gave rise to the theory that schizophrenia was caused by an excess of dopamine, commonly termed the dopamine hypothesis. Researchers proposed that depression was due to a deficit in norepinephrine, the catecholamine hypothesis, based on the knowledge that different antidepressants raised levels of norepinephrine in the brain. Lithium fixed the highs and lows of Bipolar Disorder, which perhaps was caused by a periodic excess or deficiency of a brain chemical. All the theories proposed an excess or a deficiency of a brain chemical, that is, a "chemical imbalance."

The development of new medicines was complemented by other research findings. These findings, and the way they dovetailed with the understanding of how drugs worked, strengthened belief in the "chemical imbalance" theory of the Biological Model.

For example, other findings supported the dopamine hypothesis of schizophrenia. Amphetamines produced an excess of dopamine and also led to psychotic symptoms. Dopa, a drug used in Parkinson's disease, is converted to dopamine in the body and can also produce hallucinations and delusions. Other drugs with widely different chemical structures that also blocked dopamine were as effective as chlorpromazine.

Other research appeared to confirm a biological etiology of depression. It was discovered that some people with depression have lower levels of the breakdown products of norepinephrine in the urine, implying that there is less in the brain. Depressed people with low levels of 5-hydroxyindoleacetic acid, the breakdown product of serotonin, were found to be at greater risk for suicide.7

As the evidence began to pile up, drugs became increasingly popular. Their popularity was not due solely to their effectiveness, however. Different groups advanced their own separate agendas, using the "chemical imbalance" theory as a protective umbrella, but contributing to the increased use of medication beyond what was justified by the evidence. Capitalizing on the market for psychiatric medications, the pharmaceutical industry promoted drugs far more aggressively than ever before to doctors and, recently, even to the public. Third party payers (TPPs) like insurance companies, health maintenance organizations, and managed care organizations offered drugs because they were the cheapest form of treatment. Some psychiatrists increasingly concentrated their practice on the prescription of medications to preserve their patient base and income, as TPPs have refused to pay for psychotherapy and hospitalization. Family practitioners, internists, and pediatricians increasingly prescribed psychiatric medications as well. Finally, many patients used drugs for relief rather than other forms of treatment that are more costly, take more time, and are more difficult than taking medication.

This rush to medication, however, overlooks the enormous holes in the "chemical imbalance" theory derived from the Biological Model. Research has documented the presence of biological abnormalities in many psychiatric disorders, but there is no specific evidence that any of these abnormalities is the cause of any disorder. It may appear that the gaps are about to be filled in. In fact, however, there are many lines of reasoning against a pure biological etiology of psychiatric disorders.

First, no biological etiology has been proven for any psychiatric disorder (except Alzheimer's disease, which has a genetic component) in spite of decades of research. Second, life experiences contribute to the development of some psychiatric disorders. For example, parental loss prior to the age of 18 leads to an increased risk of developing panic disorder and different phobias as adults.8 Third, non-biological treatments effectively treat some psychiatric disorders. For example, a combination of practice with relaxation techniques, two to three months of cognitive-behavioral therapy, and attention to lifestyle changes can ameliorate panic attacks in many people. These facts, and others, strongly suggest that "abnormal biology" is not the sole cause of psychiatric disorders.

A more accurate model for the etiology of psychiatric disorders is the Biopsy-chosocial Model. This model proposes that three main areas of life interact to cause psychological problems: 1) Our biology through our genes, brain chemistry, medical conditions and drugs; 2) the unique constellation of feelings, desires, thoughts, and behaviors that makes up our own unique psychology; and 3) the events and people in our social experience that shape our life.

This model is more complex, obviously, which is one reason it is less popular. However, it offers far more to help you than the narrow view that only biology matters because it clarifies that many aspects of your life may be contributing to your distress. This gives you the opportunity to help your problems in many different ways, not just with medication. Diet, exercise, different forms of psychotherapy, constructive activities, and healthy relationships with others can be enormously helpful to you no matter what the problem.

So don't accept the myth that we can make an "accurate diagnosis." No one or two word label is the unquestionable "truth." Neither should you believe that your problems are due solely to a "chemical imbalance." No theory fully captures you, your life experience, or your problems. This doesn't mean that depression, hallucinations, and anxiety don't exist. But we need to recognize the difference between what we really know and what are merely hopeful theories, between the truth and what we merely think may be true.

Take the time to educate yourself about the symptoms you're experiencing, the different ways people have understood them in the past and currently, and the treatments that have been tried. Learn what is true and what is not true, what is known and what is merely guessed at. Only then can you make a sensible choice about medications and other treatments. In the next section, I'll describe what you need to consider to help you make that choice sensibly, knowledgeably, and correctly.


Is Medication for You?


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Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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