A couple of months ago, Dr. Jonathan Leo contacted me about an article he had published that asks a very important question on the relationship that we (including myself) have come to take for granted: chemical balance and depression.

The journal article is called, “The Media and the Chemical Imbalance Theory of Depression.” It is a follow up to another article published in an open source scientific journal (PLoS Medicine) about the serotonin theory of depression.

The following is an excerpt of my response to Dr. Leo about his article.

Dear Jonathan,

I’ve read your paper and find your premise intriguing. Even though I’ve been trained as a scientist and also have experienced depression as a patient, I can honestly say that I’ve never questioned the semantics used around depression, as your paper questions. (Before I continue, I’ll also declare a potential conflict of interest since I used to work in the pharma industry and currently provide consulting services to biopharma companies in the area of medical affairs.)

I’m saying this without citing any sources or references, but rather based on personal experience of having received both pharmacological agents and psychological (cognitive) intervention. While I do think there is some sort of a “chemical imbalance” that occurs in a condition such as depression, I don’t believe that serotonin alone (or even in conjunction with an array of neurotransmitters) can provide a simple enough answer to “cause” depression. …Thus your demand to distinguish between “causative” vs. “correlative” is extremely important to address.

I also believe that depression is not a chemical problem alone, nor is it a sociological problem alone (i.e. “lack of willpower” or “oversensitive individual”), but a complex condition that may very well include genetic predisposition, chemical pathways, sociological context, and a person’s emotional make-up (which obviously can hardly be adequately objectively quantified to be scientifically examined). It is unlike certain cancers where a genetic defect leading to lack of a tumor suppressor protein then leads an individual to develop a cancer.

One of the “benefits” of the unproven chemical imbalance hypothesis has been an encouragement of those to seek treatment who otherwise may never have sought help for depression. However, this also goes to the other extreme, to the point where doctors are too quick to prescribe an antidepressant because they wanted to see the next patient and make their per diem “patient quotas” and break even financially as practicing doctors. Hence the overprescribed society we live in today.

Dr. Leo is now working on a paper about ghost writing and has edited a book called, Rethinking ADHD

I’m interested to what you think about Dr. Leo’s research, and questioning the “chemical imbalance (causative) theory” of depression.

Originally published on February 2, 2008

According to the FDA, it is proposing drug companies to update their antidepressant product labeling to include warnings of increased suicidality, defined as “increased risks of suicidal thinking and behavior” in adults ages 18 to 24 during the first two months of treatment. On the other hand, data suggests that adults ages 65 and older have reduced suicidality with antidepressants. This proposal will affect the entire category of antidepressants, and that available information could not exclude a single medication from this increased suicidality risk.

Here’s what one of my (pharma industry) colleagues Steve thinks about the black box warning.

Cipralex (escitalopram, manufactured by Lundbeck; in the US the drug is called Lexapro) has been approved in Europe for treating obsessive-compulsive disorder (OCD). OCD is a chronic disorder characterized by recurrent thoughts and impulses (obsession) and/or repetitive behavior (compulsion). A 24-week study of Cipralex in OCD showed that the 10 mg/day and 20 mg/day dosage of Cipralex were effective in terating OCD. A placebo comparison showed that the 20 mg/day dose of Cipralex showed reduction of symptoms and increase in remission rates. A comparison with paroxetine (brand name Paxil in US and Seroxat in EU) showed that Cipralex had fewer withdrawal symptoms. Given that Cipralex is a member drug of the SSRI class, patients should be aware of the safety profiles and risk relating to this class of drug. Side effects may include nausea, insomnia, problems with ejaculation, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia. Source for side effect information: Cipralex and Lexapro websites.