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

Therese Borchard at Beliefnet’s Beyond Blue interviewed me in October 2007. She asked many insightful questions including, “how do you think you know when or if you can go off your meds?” and “What did you do when you relapsed?”

I had no idea that my answers were interpreted as controversial based on the comments that flooded the interview!

For the most part, people understood (correctly) that my answer to the first question had to do with my early perception of what I was going through, when I knew just enough to admit that I had a condition that required medical intervention, and when I was still naive to know that depression can return like a vengeance, as I had personally experienced when my depression relapsed in 2001. Did I genuinely believe I could “fix myself” with one year of vigilant medication therapy and psychotherapy back in 1998? Yes, that was my naive personal belief at the time, based on my rudimentary understanding of my own depression, mixed in with a lot of denial that I would be managing the risks for this condition on a life-long basis. Am I saying that this is what people should aim for? NO!

There were some who interpreted my personal experiences and choices with medication as “anti-medication” and therefore expressed concern that I was advocating against medication. This was, of course, neither my intention nor my personal practice or belief. It would be strange for me to be antagonistic in biochemical intervention when I had earned a doctorate in biochemistry and specifically trained in looking at the biochemical basis of living systems. Those who are regular visitors to this website will find that I talk about medications and medication therapy as often as I talk about other complementary therapies (for example: exercise). I have a lot of respect for drugs because I have worked with many of them both in research and in clinical trials during the course of my health care career. I’ve always emphasized (here and on my other sites) that drugs are powerful agents with risks and benefits, and should always be administered judiciously, based on a partnership between doctors and patients.

During my relapse, I immediately went for both routes - the chemical route (antidepressants) and the psychotherapy route - as I had done when I was first seeking help for depression. Unfortunately for me, I tried 3 or 4 antidepressants and the side effects were intolerable. I remember taking two antidepressants made by a drug company that I used to work for; one made me extremely drowsy, the other made me so dizzy and nauseous that I was unable to stand up and walk a straight line.

I was forced to resort to psychotherapy as my main line of treatment, and just to be on the safe side, actually enlisted both a psychologist and a psychiatrist for double dose of psychotherapy weekly. The psychiatrist and I tried to find a drug that would work, but after almost 3 months, ultimately decided that given the suboptimal dose of a SSRI that I could tolerate, I wasn’t getting the therapeutic effects anyway, and we would stop trying to find the med that would work given that I was doing well on psychotherapy. If I wasn’t improving on psychotherapy alone, would I continue trying different medication therapies? You bet. My goal was to get better.

My approach to health - including mental health - is quite simple: I have personal responsibility for my own wellness.

This means I am accountable as a partner with my doctor(s) for my health, and given that I know I have risk factors (depression is one), I have a responsibility to monitor my own mental health so that I can recognize early warning signs before something more serious emerges.

This means I need to educate others around me, especially people close to me, so that they can help me detect abnormalities if I miss the signals.

My goal is to be well and stay well. When warranted, I make sure that the treatment decisions I make with my doctor is based on sound scientific evidence, and I make sure that I do my part in whatever non-medical (i.e. lifestyle) changes I need to make to get better.

Read the Interview.

Dave made the following comment regarding his experience with two antidepressants:

I’m taking Welbutrin 300 mg.. And also on Paxil. The problem I have is I am unable to ejaculate.. I would think it was the paxil, but I was taking only 5 mg of paxil only and sometimes could ejaculate sometimes not.. I went back on the Wellbutrin and trying to stop the paxil. Went from 5mg to 2.5 mg.. Since I’m on the welbutrin, Can’t ejaculate at all.. Any Ideas? Any Medications I can add to help with this?? I don’t think Viagra will help.

As always, I’m obligated to say “Please consult with your doctor!” That said, here are a few things to consider when you do discuss this issue with a physician: (more…)