that 'chemical imbalance' myth

[Alameda]

so nice to see this notion that has been used to oppress and repress women for decades finally discussed as a dangerous myth - chemical imbalances and other black unicorns

although I despair at how sort of prevalent it is, how regressive and how effective it is at distracting women from the cultural determinants of their unhappiness

as usual have killed my own thread

think MN should hand out medals for this sort of thing, perhaps annually?

I dunno, Alameda. What you say is fascinating and I think there's truth in it. (Majority of my bi-polar friends had horrendous episodes in their childhoods.)

But my own experience is that the chemical imbalance suggestion fits best. I've had depression since childhood. For agonising years upon years I cringed in various therapists rooms while they overplayed the importance of the tiniest misdemeanours of my parents or boyfriend as causes of my illness. I tried SSRIs and they didn't work. They stifled the depression and everything else too. I thought I was destined to an entire life of this battle. It felt like walking uphill into a wind that pushes you backwards, forever.

Then I hit a really bad phase with PND which I tried to self-manage for four years with very little success (surprise) I went to the doctor and tried a different SSRI. It was like someone had waved a wand over my life. I felt happy and normal, energetic and capable. And I've felt that way for the whole time I've been on this medicine. If something bad happens I feel sad. If something really awful happens I feel low and cry. Just like people who don't have depression. After time I start to feel fine again. Nothing is out of proportion any more. Sad events don't trigger a vertiginous spiral. I don't ever feel sad for no reason. I feel like I owe my life to the SSRI I'm on now.

One of my DC is low by nature. I've done everything I can think of to teach him positive thinking, to feel good about himself, and he is certainly deeply loved in a stable, secure and very happy family. But I keep my eye out because I think he might have inherited the illness from me. He and I both know we can feel deeply sad for no reason, or bad about life even when it's good. No one has shoved him aside socially or personally. He's just wired that way.

None of what I am saying is meant to discredit what you're saying. I just think there is a vast range of reasons why people have mental illness. Chemical imbalance is, IMO, one. Social pressures and life experiences are certainly two others.

As you pointed out, not nearly enough research is funded into the vast range of illnesses known as mental health. Imagine if research into 'physical health' was lumped together in that way.

No I know what you mean, am probably veering too far to the other extreme and probably because have never quite come to terms with being told I have something wrong with me - I obviously did inherit a predisposition to something, it's all through my family for generations (bipolar I mean) along with related problems like alcoholism, schizoaffective disorder, depression. But am going through yet another phase of HATING lithium. I don't know if it even does anything helpful for me, although they say it does, I think I forget what happens when I'm ill. And perhaps it is more dangerous to explain away each episode as occurring because of this or that environmental trigger and more helpful for me to ponder the possible biological basis. Although I think at times I have felt quite annoyed at self help suggestions and wanted to scream at people 'if I COULD I WOULD'. Have had my diagnosis confirmed over and over throughout the years by different consultants and self proclaimed foremost diagnosticians.

But be that as it may, say most people in my family inherit the genetic predisposition - why do some develop the full blown disorder and not others? Even in the major mental disorders like my one and schizophrenia there are social and other forces at work, I don't think we are just unexploded bombs waiting to go off. I want to know what else is going on to trigger that first and subsequent episodes and what sort of additional supports might reduce the risk of relapse. It can't be all about the drugs!

Alameda - a close family member of mine has bipolar. My views are that with bipolar there is a biological or maybe genetic propensity. That propensity can be triggered by environmental factors e.g. stress, abuse, but without the biological propensity, it would never happen.

My personal experience with 1 close peson with bipolar is that she does forgerty how horrendous the manic or depressive episodes were - I don't.

That lithium is crucial, but other things can help as well. For example not having as far as you can manage it, a very stressful live. Avoiding over stimulation, getting enough sleep, etc. So no its not all about drugs, but drugs are part of it.

yes sleep v important for me, probably more so than lithium - no chatting on the phone and posting shite on the internet at 2am for example

hello - interesting to see some discussion based on my article! Mental illnesses are extremely complex and the causes will vary somewhat between individuals. Obviously, mood, cognition, and behavior have a biological basis and thus extremities of these facets of mental life will also have a biological basis. However, much of what people are told - e.g. depression is due to low serotonin is just not true. There are no way of actually measuring levels of serotonin in the brain, although we are now able to look at neurotransmitter function. The notion of chemical imbalances in the brain being responsible for mental illnesses is such a gross oversimplification and a reduction of horrific mental pain taken out of the context in which it occurs that is a myth and one that seems to make people feel sick. My patients who have a non-biological explanation tend to do better that those who have an exclusively biological explanation, and be more optimistic about there illness. This is not just a facet of the severity of their problem.

I think the question of chemical imbalances and psychiatric drugs are separate. I prescribe (judiciously) antidepressants, antipsychotics and other psychiatric medication where I think it will benefit the individual. If it has the possibility to help, where nothing else has, or the suffering too great, then medication can be helpful. But let's not conflate that with believing these meds, all of which were accidentally discovered to have an effect on the problems they treat are getting at the root cause. That is what my objection is. When we start narrowly displacing the problem onto the imagined 'broken brain', we ignore the wider determinants of mental health. Whilst genes influence how we think and feel, and a number of genetic polymorphisms and other genetic variations have been found to occur more often in those with 'schizophrenia' and bipolar illness, there are no 'genes for' these conditions insofar as the same genetic variations also occur in people who never experience mental illness.

I think the OP is correct to highlight that the notion of chemical imbalances causing depression, has detracted us from looking at how the structure of a patriarchal society has contributed to depression, which occurs twice as frequently in women as in men in the community (so not related to help-seeking behavior).

canardtheduck

I do think AD's are very over prescribed, our surgery is very very prescription happy, agree with everything carnardtheduck put so eloquently. The drugs are meant to be used judiciously and with care, not dished out like smarties and people like me left to deal with the consequences of not being able to get off. No one ever offered to measure my chemical imbalance, no tests were conducted, I was just "told" I had a chemical imbalance, how did anyone know?

but does low serotonin in the blood mean low amounts of serotonin swilling around in your brain?

I remember having various blood tests but I think they were looking at thyroid function and I don't know what else, not measuring serotonin levels anyway. Why don't they do this if there is a connection between blood levels and mood?

I think it's a miracle that more people struggling along in our uber competitive materialist society aren't seriously and permanently depressed...

I also think there are a myriad of causes and complex interreactions between environment and genetics that we are only beginning to understand.

Bipolar now has six categories (!), more and more are developed so that lovely new expensive drugs can be developed...so that has to be thrown into the mix too.

So you have genetic inheritance/predisposition + environment + vested interests + human desire to "fix" things and the belief in perfectability.

I'm just wondering why it's not a diagnostic test for depression - do people who are not depressed sometimes have low serum serotonin levels? Of course we don't know which way round it goes, we don't know if the depression lowers serotonin or if low serotonin causes depression, we just know the two often happen together?

I'm a bit shocked that depression affects twice as many women as men, so this does mean it is more than women being more likely to seek help (I didn't, I had no idea I was depressed) - this is where I think it is incredibly unhelpful to have so much emphasis on chemistry. Is it true everywhere in the world? Or just in Europe/US?

are there six categories? Is this to differentiate between cycles and mixed states and things? That's probably not a bad thing, look at how many sorts of schizophrenia there are!

cycle length I mean

I don't think the categories exist so drugs can be developed, they have yet to develop so much as one drug specifically for bipolar!

Hully - I do think the definition of bipolar is being widened to take in more and more people. IMO this is not helpful. WHO have a very lengthy assessment tool to diagnose bipolar that imo is much more helpful than some of the dianostic criteria now being used/proposed in UK.

Basically until very very recently it was difficult to get a diagnosis of bipolar and even after diagnosis as part of monitoring, decent psychiatrists would question the diagnosis - as it is easy to misdiagnose what is recurrent depression as bipolar. Mood stabilisers like lithium, although life savers literally for people with bipolar, are powerful drugs that should not be prescribed to those who don't need them

There was a good article at the weekend about bipolar categories and drug devpt, of course I'll never find it now.

I don't know about powerful, all it does is make me thirsty and sort of scabby. I suppose it is quite poisonous.

This wasn't the one I read, but it has the same information.

I would actually be quite pleased if there were drugs developed for bipolar. I don't think many people, like me, can have antidepressants if our mood is low because they make bipolar worse. There isn't anything that has been designed specifically for mania either. There's just lithium and drugs designed to treat schizophrenia and epilepsy. Oh and benzos, obviously quite like those ones.

oh thanks

Alameda - If you take lithium then you know you have to have regular blood tests to check liver function, etc. This is because it is a powerful drug.