Great Post, thank you for sharing.

I do take issue with the commonly parroted claim that depression can be a chemical imbalance. It's a notion arising from pharma marketing psyops, and is largely without utility. It even risks being an antipattern. The few pros include separating responsibility and thus alleviating some guilt, which often coexists with depression, and annoying spiritualists. Tell me if I missed any.

Analogy: if I told you an athlete is different to a couch potato because of chemical imbalance, you'd think I was obtuse. While technically correct on some level that explanation obfuscates useful relational information about training, motivation, routine, mindset, culture, and circumstance. Similarly if I told you to become an athlete by only taking supplements that augment the phospho creatinine ATP pathway, you'd think me a crook.

Oversimplifications sell pills and make for memorable catch phrases, but fall short of empowering us to become happy and well.

Let's try and move our collective understanding beyond chemical imbalance; it's a tired mantra with scant utility.

Disclosure: neuro psych doctor

I'm not sure I understand what you are saying. Just that we shouldn't recognize that depression can be a chemical issue because that doesn't help us fix the problem? Are you saying that anti-depressants don't work?

So if depression is more about mental models, life choices, and drive and whatever, why do so many people suffer from depression in cycles? There is little change from one day to the next, and yet, many people with depression can feel great one day and terrible the next. Or pregnant women can feel great before giving birth and then give birth to a perfect baby and suddenly start feeling depressed soon after.

How do you use therapy to cure depression if the depressed person has no reason to feel depressed?

Okay how about a new analogy:

Your web app malfunctions, and a diagnostic sweep suggests the code is compromised. It's cloud hosted and open source. You're part of a team and see various recent revisions that could have exposed the app to malicious use. Furthermore your cloud provider is upgrading their hardware. Your app has to come offline whilst it's patched. Its a critical service for some clients who are hounding you.

You ask for help from a professional to get things back and working.

They say, "It is due to an electrical imbalance in the computers."

In psychiatry people are analogously doing just that.

We know sure that neurotransmitters have a role in mental health, in the same way as engine oil has a role in a car. Right amount in right place is necessary, but not sufficient, for good operating. If I brough you my faulty car and you jept harking on about engine oil, I'd be miffed.

Incidentally I'm a staunch monoist materialist and believe brain states and mind are facets of the same phenomena. My gripe is with pharma marketing penetrating our collective psychology. Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

I think I might have a slightly more apt analogy, though I do understand yours and pretty much agree.

To immediately jump to the "chemical imbalance" problem/solution is like if you have a web app that's performing really slow, so you hire a consultant to take a look.

They tell you that you need to horizontally scale your app in order for it to perform better. In many cases, this would actually work (for a while anyway), but it probably doesn't explain the real issue.

In reality, the problem could be that you wrote your app to do way too many things per request rather than picking and choosing which things are going to be treated as first-class. Perhaps there's even one little thing that's O(n^2) and it simply is going to take a lot of time to work out.

> We know sure that neurotransmitters have a role in mental health

While they have a "role", differences in neurotransmitter levels do not predict mental health state.

My understanding is that "chemical imbalance" theory was a popular misunderstanding of a more limited and specific theory called the ”catecholamine hypothesis" which has itself been pretty much debunked.

For decades the explanatory psychiatric theory behind depression has been the the "bio-psycho-social" model. While we know that biology is an import part of the picture, that part can include a bunch of different factors besides neurochemi cals, such as possibly inflammation, neuron growth factors and more.

[0] https://www.psychiatrictimes.com/view/debunking-two-chemical...

> Equating depression to monoamine derangement was a very attractive notion for all but in 30 years remains unproven, and not very helpful in guiding treatment.

I believe that theory has been mostly disproven, but that doesn't change solid evidence behind the efficacy antidepressants that were developed using that theory.

If someone tells me there is an electrical imbalance with the computer, then I will know we need to fix the computer, rather than the software that runs on it.

with your engine oil analogy, it seems like you are agreeing that brain chemistry is an important part of good mental health, just not the only one.

So if all the other parts of good mental health are in order, that leaves brain chemistry, hormones, etc. As the problem.

Not GP and not even sure I agree with them.

However I think there's some semantic issues with "chemical imbalance" that are worthy of examination. Depending on your basic philosophical views regarding materialism and the origin of consciousness, you might be of the view that all mental states are the result of brain states. This is a reasonable view. Considering what we know about brain function and the rather broad meaning of the words "chemical" and "imbalance" arguably all brain states are the result of "chemical imbalance" of some kind.

(I know the brain is also an electrical system but the electrical pathways are deeply entwined with the chemical ones)

Anti-depressants do not cure depression, they only temporarily relieve it. And they eventually stop working as one inevitably gets desensitized to them.

Sure, but that just further affirms my point that some types of depression are simply chemical.

There can be many reasons for that and most have nothing to do with life choices or "mental models" whatever that means.

* Trauma triggers and unprocessed/unconscious trauma. You'd be surprised how common this is. People who grew up in neglectful or abusive homes tend to believe there's something wrong with them and that their childhood was fine. So when life feels like shit, like there's no point, and it's only suffering every day, that somehow other people manage and they don't, they see no light at the end of the tunnel. It must be their fault, and for some reason they can't "get over it" or "Let it go".

* A person repressing stuff, which at some point reaches breaking point or saturation.

* Combination of (unlucky) factors - e.g. winter/less sun, less people around for some reason, had to sacrifice exercise for extra work, (...).

* Chemicals in the brain indeed, change from one day to another. And maybe the day they feel depressed is when they are seeing things more realistically and crash with that realization.

I don't buy this idea that it's part of the human condition that we're bound to have depression sometimes and that it's chemical imbalance. If we look at human history of psychiatry you'll see how coldly we've been treating patients. You'd be horrified at how we treated mentally ill people in the past. Why would you think we're doing any different now, just in a more mODeRn way - "They're sad because their brain is wrong. Give them a pill."

>Chemicals in the brain indeed, change from one day to another. And maybe the day they feel depressed is when they are seeing things more realistically and crash with that realization.

So, you think that chemical changes in the brain can affect how realistically one perceives their situation, but a chemical change that causes one to feel depressed is not something that happens? That doesn't seem like a logical conclusion.

What they are trying to say is that depression pills are as helpful as vitamin supplements are for sports.

If you happen to be a top athlete that’s just not getting enough vitamins, the supplements might help a bit (not as much as correcting the diet though). If you are a couch potato, you might have a Vitamine imbalance, and the supplements might correct it, but the supplements won’t turn the couch potato into a top athlete.

That would require a complete lifestyle change. From maybe new sport affine friends, to better diet, motivation, schedule, training routines, and a big time investment.

The analogy of the OP is that curing depression with pills “is like” trying to turn a couch potato into a top athlete using pills. The fact that the pills do something doesn’t mean that they achieve the goal.

I think we have a lot of double blind clinical trials that show that anti-depressants do work. Not with super high success rates, but higher than vitamin supplementation.

The discussion is often over-simplified in one direction or another, so thank you for bringing up post-partum depression and depression that can be influenced by hormonal cycles. (And by the way, men can also experience post-partum depression -- men also go through hormonal and life changes when bringing home a baby.)

We're all a product of our thoughts, our environment, and the mediating chemicals in our brains and guts. I'll throw in a different complex connection: the connection between hormones (estrogen and progesterone) and histamine. A woman can have seasonal allergies that wax and wane monthly due to the role estrogen plays in regulating mast cell release of histamine. The environment may stay the same over that month, but the chemical soup changes. This change may also be further mediated by what the person eats, as consuming high-histamine foods on top of that might be enough to really set off a physical reaction. Because we're talking about seasonal allergies here, few people would find this controversial.

So, let's move to the mind and emotions, which are certainly more controversial. All these factors are still there. Yes, CBT can be enormously helpful in getting you out of cognitive traps that decrease the quality of your life experience. At the same time, it can be true that you've been eating a diet that is not good for you and your stomach hurts all of the time not because of anxiety but because of your food. Let's take me for instance: I'm in grad school, I'm not feeling good, having trouble getting out of bed, I'm trying to drag myself through the thesis on caffeine and sugar, I keep beating myself up because I'm not as brilliant as Gauss or Kovalevskaya or even that guy who got that TT job at Virginia Tech and I have writer's block, I see the psych person at the health center 'cause why not. She says I have stress-induced stomach problems. Mindfulness doesn't help. What finally helps? An elimination diet that allows me to discover that one simple trick (eliminating a type of food) makes my stomach not hurt, means I don't wake up tired and hurting in the mornings, etc! Amazing to sleep and then wake up rested! Suddenly I have half the problems I had before and have more energy to deal with them. I'm still not Gauss, and that takes another 10 years of life progress to acknowledge. Whatever.

There are many ways to attack problems. Change the input, change the process, change the environment, decide the desired output isn't actually desired. Childhood experiences, diet and exercise (physical upkeep), the "shit life" phenomenon another poster mentions, hormones and chemical imbalances. Therapy is not the cure to everything. Neither is medication. Neither is diet. Sometimes we actually need reform so that people aren't stalked by medical debt or huge bills for having their kids put into foster care or whatever (lots of literature on the connection between financial instability and depression).

Anti-depressant alter your brain chemicals almost immediately once you start taking them but the anti-depressant effects usually come a couple of months after. Which suggests there might be more to the issue than just a 'chemical imbalance'.

Altered brain chemistry influences the physical prevalence of the receptors that those chemicals act upon. Those adaptations can take some time.

I agree with your claim, but in my experience I encounter people who explain mood disorders as chemical imbalances mostly in a different context. Where I see it most often are good-intentioned people trying to argue against stigma and poor treatment of mental illness. The idea is that there is indeed a physical aspect to it and not just "all in your head", and hence should be treated with the same sympathy toward the patients as physical illnesses, and this is directed toward people holding a certain mindset that stigmatizes mental illness as an argument to not do so. Of course, this is a terribly insufficient characterization of mood disorders. Perhaps this characterization in a game of telephone eventually became misconstrued in the popular consciousness as essential to the disorders.

I agree with you that there is definitely some serious obfuscation around the chemical imbalance aspect of the biological theory approach to mental disorder. If you do any research into the history of anti-depressants it isn't hard to uncover that there has been a lot of questionable science that forms the foundation of the over prescribing of medications for mental disorder that is currently the industry norm.

I spent years suffering with really severe symptoms and I was so desperate for relief I tried all sorts of treatments. The main thing I really learned during that time is that approaching mental health requires a holistic approach, but even armed with that knowledge my life was still seriously impacted by my mental disorder. For me, I had spent years in talk therapy and different behavioral therapies. I had also tried various medications which did not help me and/or had side effects that were unbearable long term. I was on lamictal for a while which seemed to help but I also stopped seeing improvements and eventually that was also not good enough and my function declined. I also tried meditation, spiritualism, self medication, yoga, exercise, different diets, journaling. I took class after class on psychology and I instituted all sorts of different systems to try to fix myself. My therapist told me over and over that I was doing the work but that the improvements we were seeing weren't what she would expect, then I was referred to TMS. Once again, I was desperate and I was willing to do or try pretty much anything because I was a wreck of a person that was spiraling dangerously. So I went, and for the first time about three weeks in... I started to see a small difference. It changed my life, and I'm still so much better. The thing about how well it worked for me though is this: the idea of TMS is that it targets the part of your brain that is damaged by depression. Whatever this means- I've come to imagine it as neurons that have formed hard wired patterns of depression that are nearly impossible to rewire through sheer force of will. So chemical imbalance- probably (even demonstrably)false. Physical patterns in the brain formed while you suffered from depression being very difficult to rewire without outer interference? Is that possible? I'm mostly thinking out loud and I don't really expect someone to just have the answer but I really want to know and it's something I wonder about constantly.

I think the main problem we view depression as a disease when it is a symptom with several possible causes. Most people I know haven't done the deep introspection when life circumstances or past in some cases preverbal traumas exist.

Additionally, we're generally told quite a lot of lies and made to believe fantasies from the earliest ages about - the world, who we are, and our place in the world. I have a theory and it's just a theory when we get misaligned with certain, let's call them, cosmic truths - there's a mind and body reaction, often outside of our conscious ability to recognize the problem.

> I think the main problem we view depression as a disease when it is a symptom with several possible causes.

I agree. The fact that depression and mental illnesses highly correlate with lack of religion and rise of the secular nation is something that should be investigated more.

Do you mind expanding on your theory a bit? I think I agree with you.

There are a few psychological constructs in our head that really tie deep into the mental pain

I forgot who i saw recently that said we have a strong mirroring need in our brain, which means our happiness is extremely relative, if you suffer while people don't .. it hurts more; if people are in the same boat the pain gets softer.

Oh and yeah unconscious fears are often the root of so many mental issues.. abandoning (to) fears is often a massive trick.

I'm not sure what you mean when you say abandon (to) fears. But my experience was that when I could pinpoint the fear, overcoming it by facing it was the way out.

Often as infants we develop legitimate fears in the context of our vulnerable position and extreme dependency on maintaining the parental relationship. These fears made sense then and helped us keep our parents calm, but interrupt our adult lives. These fears are also extremely powerful as our infant brain associates breaking them with a risk of death (typically through abandonment).

However, the brain seems to be remarkably fast at unlearning these fears when it realises they no longer are needed (I will not die/risk death by doing the "forbidden action"). So my experience was that pinpointing the fear, facing it in my life (perhaps initially in the context of the safe relationship with my therapist, and then outside in the "real world"), and watching my anxious reactions which were previously flared up in situations where I was avoiding the forbidden behaviour fade away. It leads to a calmer mind with fewer and fewer situations in daily life which cause anxiety to arise.

Curiosity: what if you've done so and your fears have been reinforced instead?

Background: after a difficult childhood, I did a therapy, discovered self improvement and lived a few years where I faced fears regularly and expanded massively. However, multiple debatable decisions built up to a point where everything broke down. Lost my job, hoped on 3 jobs even worse afterwards, was morally harassed, and the resulting bad mood and general negativity made me lose friends, and be even more vulnerable. Loss of confidence made me sabotage more or less voluntarily other aspects of my health, balance and projects. Therapists, SSRI, etc. no way to get out of it (just lots of money taken away => even more pressure/problems). It felt like death since I had to go through these many years, helpless, hopeless. It was worth than any experience in my childhood, and still traumatizing.

Now, the absence of "death" at an instant t when doing a "dangerous" action doesn't mean that death can't come later as a consequence (ex. tell your opinion at work -> doesn't kill you but if it leads to be fired later and start a cycle like above, it can be dangerous). Therefore there's never validation that my actions don't kill, they're just written on a list, with consequences pending, and the fear of the ultimate judgment is impossible to confront, unless it all happens again and this time I manage it. How would you confront this kind of fears?

Sorry you had to endure this. It's true that adult life is wide and chaotic and you can slowly end up in a black hole situation.

A bed room theory is live small and grow through tiny risks. Small means your life is easier to secure and you can try stuff and fallback as soon as something goes wrong.

It's only a theory, that came up through the realization that a lot of pain comes from bad obligations. Too much mortgage, obligation to stay in a toxic job. Also contexts too large to really know if what you can do or not (such as politics at work).

Thanks, very thoughtful of you.

I was saying almost the same thing as your last line to a colleague, taking many responsibilities in parallel before waiting for full closure, can lead to failing something that you would normally be able to do, just because you were stressed out by the other things you had to do in parallel.

what I found hard is:

- being able to recognize what are too large obligations, with time your nose becomes better at avoiding them quick

- being able to recognize how much I want to bear

- learning to say no thanks

It was a poetic wording that popped into my mind a times. The image of abandoning all defensive reflexes and walking into whatever context you were afraid of and see how it feels.

There's a tendency to avoid seeking reality and stay in fearful predictions based on limited data that we gathered.

All this is probably close (if not same as) CBT. And Yoda :)

That said I often fail to do so. But I used to never try at all.

> There are a few psychological constructs in our head that really tie deep into the mental pain

Indeed, one of those is the 'chemical imbalance' theory of depression, which in itself can lead to a person believing there is no hope because they just are a bag of chemicals.

The way out of this particular conundrum is as the OP stated - therapy which addresses the cause of the imbalance, which has every indication of being an effect of the depression, rather than the direct cause. Change your mind through therapy and non-physical means, then watch the bag of chemicals transform...

So, what type of therapy should one seek out if they get severe depression for a week or so every month, always during their period?

If the "theory" that depression can be caused by chemical or hormonal imbalances is wrong, then what externality is causing such severe depressive swings on such a regular basis, like clockwork?

What "mindset" should a pregnant mother with a history of post partum depression put herself in so that she doesn't feel depressed even after everything goes great and she has a perfect baby and all the support she needs?

> which in itself can lead to a person believing there is no hope because they just are a bag of chemicals.

I'd expect the opposite effect. If we are bags of chemicals, we can change ourselves by altering the composition of chemicals. The hard part is finding the proper balance.

It may not be as simple, i had pills that did influence chemistry (first take was a surprising experience.. feeling your nervous system shift toward mellow was strange). But mental construct of loss were still causing pain as high as before.

> While depression can certainly be caused by chemical imbalance

I'm still not convinced this is true. I think it is just as probable that any apparent "chemical imbalance" is actually a symptom, not the cause, and while treating the symptoms can alleviate some of the suffering it is not a cure.

I want to echo this. I spent many years in therapy getting to the root of my issues stemming from childhood. It was the most fantastic and arduous experience I’ve ever done.

Therapy helps cultivate self awareness which in turn strengthens inner dialog and allows you to reflect on yourself, almost in third person.

It’s a shame our society stigmatizes therapy to such an extent but it really is a miracle cure for many mental health issues if you put the work in.

I agree about dreams, but I don't know that Jung was quite so prescriptive; he tends to eschew frameworks himself. He essentially says about dreams: we don't know why they work, but they do.

From my limited readings I think you are correct, Jung's technique seems very dissimilar to Freud's. AFAIU Jung emphasized that the terminology used unconsciously by the patient in first describing a dream contained most if not all material from which to derive potential theraputic benefit, and that dwelling on some deeper meaning or symbolism was generally a waste of time as then the patient (or therapist!) begins seeing what they want to see.