Landmark study disproves that a “chemical imbalance” causes depression—a scientifically meaningless theory that has misled consumers, while driving up antidepressant sales to $15 billion a year. “Mental Health Watchdog forced to say ‘I told you’ about depression chemical imbalance,” says European Times

By Jan Eastgate
President CCHR International
July 22, 2022

A landmark study has debunked one of the biggest mental healthcare marketing campaigns in modern history—that a “chemical imbalance in the brain causes depression” requiring antidepressants to correct it. Scientists at the University College London reviewed 17 major studies published over several decades and found no convincing evidence to support the theory.[1] The research confirms what CCHR has been exposing since the late 1980s: the chemical imbalance theory has always been a marketing campaign with no basis in science. The fact is, the chemical imbalance myth has helped drive $15.6 billion-a-year global antidepressant sales. In light of the study’s damning findings, media dubbed this the “$15 billion hustle.”[2]

As The European Times commented, “And so, this is the very uncomfortable moment for all those who ignored it or attempted to ridicule the warnings, in which the mental health watchdog that has been warning on the issue for at least 33 years, could tell them ‘I told you so.’”[2a]

Lead author Professor Joanna Moncrieff said: “The popularity of the ‘chemical imbalance’ theory has coincided with a huge increase in the use of antidepressants.”[3]

Although the theory dates back to the 1950s, it was used in the late 1980s to launch the first SSRI antidepressant, Prozac (fluoxetine) as the next “revolution in mental health treatment” and was marketed in more than 90 countries. By 2005, more than 54 million people worldwide were taking antidepressants to treat a non-existent chemical imbalance.[4] That figure nearly doubled to 100 million in 2016.[5]

In the U.S. today, an astonishing 45 million Americans of all ages take antidepressants, of which 2.1 million are aged 0-17, per statistics CCHR obtained from IQ Via data tracking.

The study, published in Molecular Psychiatry, says the general public has been falsely led to believe that abnormalities in serotonin or other biochemical abnormalities are responsible for their moods. The idea that depression is the result of a chemical imbalance has influenced people’s decisions about whether to take or continue antidepressants and “may discourage people from discontinuing treatment, potentially leading to lifelong dependence on these drugs.”[6]

The researchers warn: “In particular, the idea that antidepressants work in the same way as insulin for diabetes is completely misleading. We do not understand what antidepressants are doing to the brain exactly, and giving people this sort of misinformation prevents them from making an informed decision about whether to take antidepressants or not.”[7]

Christopher Lane, Ph.D., author of the blog Side Effects described the study as “a decisive blow to the serotonin hypothesis of depression.”[8]

SSRI antidepressants, such as Prozac, Zoloft and Effexor, have no other proven way of working, Professor Moncrieff and colleagues said. “Thousands suffer from side effects of antidepressants, including severe withdrawal effects that can occur when people try to stop them, yet prescription rates continue to rise.”  

In an article published in The Conversation on July 21st, 2022 Moncrieff and fellow-researcher, Mark Horowitz, co-founder of a company aiming to help people safely stop unnecessary antidepressants in Canada, reported more risks: “Drug trials show that antidepressants are barely distinguishable from a placebo (dummy pill) when it comes to treating depression. Also, antidepressants appear to have a generalized emotion-numbing effect which may influence people’s moods, although we do not know how this effect is produced or much about it.”[9]

Furthermore, “The serotonin theory of depression has been one of the most influential and extensively researched biological theories of the origins of depression. Our study shows that this view is not supported by scientific evidence. It also calls into question the basis for the use of antidepressants.”

Added to this, “Most antidepressants now in use are presumed to act via their effects on serotonin. Some also affect the brain chemical noradrenaline. But experts agree that the evidence for the involvement of noradrenaline in depression is weaker than that for serotonin.”  The SNRI antidepressants include desvenlafaxine (Pristiq); duloxetine (Cymbalta), levomilnacipran (Fetzima) and nenlafaxine (Effexor XR).

Pill-prescribing psychiatrists have been aware for years that depression isn’t caused by low serotonin levels, despite continuing to prescribe the pills, Dr. Jonathan Raskin, a chair of psychology from State University of New York, told media.[10]

The disinformation given consumers is addressed in another study of which Prof. Moncrieff is also a researcher. Published in April 2022 in SSM-Mental Health and titled, “Is the chemical imbalance an ‘urban legend’?” researchers looked at highly cited reviews of the causes of depression, highly referenced papers that discussed depression and serotonin, and several textbooks published between 1990 and 2012. All of the textbooks examined and nearly all academic papers supported the chemical imbalance theory despite the lack of evidence: “The findings suggest that the serotonin theory was endorsed by the professional and academic community,” the authors wrote. “The analysis suggests that, despite protestations to the contrary, the profession bears some responsibility for the propagation of a theory that is not empirically supported and the mass antidepressant prescribing it has inspired.”[11]

This was in response to “leading psychiatrists suggesting the chemical imbalance theory was an ‘urban legend’ that was never taken seriously by the psychiatric profession.” However, the present evidence shows that “this position is patently false.”[12]

A History of Cover-Up

Since 1989, following the approval of Prozac in the U.S., CCHR has exposed the chemical imbalance lie and the disservice to consumers who were told this.

In 1991, CCHR helped instigate a Food and Drug Administration (FDA) advisory panel hearing into the evidence that Prozac could induce violent and suicidal behavior.[13] The finding of this had the potential to adversely impact the newly launched marketing of the idea that a chemical imbalance caused depression, if the drugs prescribed to treat it could chemically induce violence. It was not surprising that the psychiatrists on the panel, steeped in conflicts of interests with antidepressant manufacturers, rejected the evidence.

In 1997, international psychopharmacologist expert, Prof. David Healy, a psychiatrist, debunked the imbalance concept in his book The Antidepressant Era. He said there was plenty of evidence to confirm that doctors used the idea of an underlying chemical imbalance or serotonin abnormality to justify the prescription of antidepressants.[14]  In his book Let Them Eat Prozac Healy said that even in the 1970s research concluded that whatever was wrong in depression it was not lowered serotonin.[15]

The “chemical imbalance” theory potentially spawned other dangerous ideas such as that the “serotonin deficiency hypothesis” could be responsible for violent behavior—rather than the drugs used to treat it.[16] Psychiatrists and colleagues continued to reject the evidence that antidepressants can induce violent adverse reactions in some people taking them, while wide usage of antidepressants has coincided with increased acts of senseless violence in schools and the community.

In 2001, Healy testified in a trial in Cheyenne, Wyoming, involving Donald Schell, 60, who had been taking Paxil (paroxetine) for just 48 hours when he shot and killed his wife, his daughter, his granddaughter and himself. Healy said his own studies showed that SSRIs could cause one in four healthy volunteers to become agitated, and in some cases suicidal. The manufacturer’s internal documents exposed in the trial showed the company was aware that a small number of people could become agitated or violent from Paxil. Despite this knowledge, Paxil packaging did not at the time include a warning about suicide, violence or aggression, which made the company liable, according to a jury verdict that awarded $6.4 million to Schell’s surviving family.[17] The FDA later rectified this for all antidepressants.

CCHR’s online report How Psychiatric Drugs Create Violence & Suicide is a resource detailing more than 30 studies and over 60 cases of mass shootings and acts of violence committed by those taking or withdrawing from prescribed psychotropic drugs. For example, the British Medical Journal published: “Perpetrators of school shootings and similar events have often been reported to be users of antidepressants….”[18]

The mounting evidence of these potential risks did nothing to dissuade the marketing of the chemical imbalance theory and the need for more people to get hooked into taking antidepressants or other psychotropics.

Consumer Fraud

“A direct-to-consumer advertisement from 2003 told consumers that ‘while the cause is not known, depression may be related to an imbalance of natural chemicals between nerve cells in the brain’ and that ‘prescription Zoloft works to correct this imbalance.’” As the study published in SSM-Mental Health notes: “This message was propagated on popular websites,” and “best-selling books, such as Listening to Prozac” by Peter Kramer.[19]

In 2004, CCHR wrote a series of 20 widely distributed booklets in 17 languages about different aspects of coercive psychiatry, each of which included an important notice to readers on the inside cover:

• THE THEORY THAT MENTAL DISORDERS DERIVE FROM A ‘CHEMICAL IMBALANCE’ IN THE BRAIN IS UNPROVEN OPINION, NOT FACT. One prevailing psychiatric theory (key to psychotropic drug sales) is that mental disorders result from a chemical imbalance in the brain. As with its other theories, there is no biological or other evidence to prove this. Representative of a large group of medical and biochemistry experts, Elliot Valenstein, Ph.D., author of Blaming the Brain says: “[T]here are no tests available for assessing the chemical status of a living person’s brain.”

In a published study that same year, Jonathan Leo, Associate Professor of Anatomy at Western University of Health Sciences, advised patients: “If a psychiatrist says you have a shortage of a chemical, ask for a blood test and watch the psychiatrist’s reaction. The number of people who believe that scientists have proven that depressed people have low serotonin is a glorious testament to the power of marketing.”[20]

In 2005, there was continued national exposure of the chemical imbalance fraud, especially as by then, the FDA had done a turn-around on its 1991 hearing into Prozac and in October 2004 had ordered a black box on antidepressant packaging to warn the drugs could cause suicide.

A representative of People Magazine phoned CCHR for a comment and was urged to do as Jonathon Leo suggested—contact the American Psychiatric Association (APA) president to ask what test psychiatrists relied upon to confirm a chemical imbalance. People obtained the admission from Dr. Steven Sharfstein, then APA president, that: “We do not have a clean-cut lab test” to determine a chemical imbalance in the brain.[21]

Then followed Dr. Mark Graff, Chair of Public Affairs of the APA telling CBS Studio 2 News that the theory was “probably drug industry derived.” “We don’t have tests because to do it, you’d probably have to take a chunk of brain out of someone—not a good idea,” he said.[22]

At which point, APA could and should have put an end to the façade, but didn’t.

In December that year, professors and researchers Jonathon Leo and Jeffrey Lacasse’s article, “Serotonin and Depression: A Disconnect Between the Advertisements and the Scientific Literature,” published in PLoS Medicine, found repeated evidence, as Christopher Lane recently wrote, “that the FDA had approved the marketing of SSRIs with two phrases still heavily in the subjunctive tense—that depression ‘may be due to a serotonin deficiency’ and that SSRI efficacy, ‘modestly’ outcompeting placebo, was ‘presumed to be linked to potentiation of serotonergic activity.’ However, the research itself could not identify the precise mechanism.”[23]

Lane further noted: “The FDA had accepted aspirational language that the drugs ‘help to restore the brain’s chemical balance’ and ‘bring serotonin levels closer to normal,’ even though both claims were, and remain, scientifically meaningless.” “There is no such thing as a scientifically established correct ‘balance’ of serotonin,” Lacasse and Leo cautioned. [24]

In 2010, Andrew Scull, Professor of Sociology at the University of California, San Diego, issued a scathing rebuke about the theory: “Patients and their families learned to attribute mental illness to faulty brain biochemistry, defects of dopamine, or a shortage of serotonin. It was bio-babble as deeply misleading and unscientific as the psychobabble it replaced, but as marketing copy it was priceless.”[25]

There were psychiatrists that tried to distance themselves from the scandal blaming the pharmaceutical industry rather than psychiatrists.

In 2011, Ronald Pies, editor-in-Chief Emeritus of Psychiatric Times reacted to a report that CCHR, established by the Church of Scientology, had published about the chemical imbalance, and asserted that no well-informed psychiatrist had ever believed the chemical imbalance myth, calling it an “urban legend.”

A “bumper-sticker phrase”

He went even further writing, “It’s a kind of bumper-sticker phrase that saves time, and allows the physician to write out that prescription while feeling that the patient has been ‘educated.’ If you are thinking that this is a little lazy on the doctor’s part, you are right. But to be fair, remember that the doctor is often scrambling to see those other twenty depressed patients in her waiting room.”[26]

However, Moncrief and colleagues refute this, stating: “Unfortunately, he continued this had not been widely understood, and ‘opponents of psychiatry mendaciously attribute the phrase to psychiatrists themselves.’ According to Pies, the theory had been propagated by the pharmaceutical industry alone, and should be ‘consigned to the dust-bin of ill-informed and malicious caricatures.’”

But that was not true.

In a 2005 APA patient leaflet, the association—representative of its membership—continued to parrot the theory, declaring, “antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.”[27]

The APA still tells the public that “differences in certain chemicals in the brain may contribute to symptoms of depression”[28]

Lane, writing in Psychology Today in 2016, addressed Pies’ assertion that it was only the pharmaceutical industry that propagated the chemical imbalance “urban legend.” Pies made such claims “even as a future president to the APA (Nada Stotland) was busy contending that antidepressants “restore brain chemistry to normal” and a leading psychiatrist for the National Alliance for the Mentally Ill (Peter Weiden) argued that older antipsychotic medication “correct[s] brain chemistry,” while newer treatments “seem to do a better job of balancing all of the brain chemicals, including dopamine and serotonin.”[29]

And as Lacasse and Leo put forward: “Pies blames the drug companies for running misleading advertisements about chemical imbalance, belatedly admits he should have said something sooner, but fails to mention that he was paid to help them promote their products at the time the advertisements were running.” Further, “Thus, while we don’t know why Ronald Pies himself didn’t speak out on the chemical imbalance issue decades ago, readers should be aware of his past financial relationship with pharmaceutical companies.” [Emphasis added]

Pies has received funding from GlaxoSmithKline, Abbot Laboratories, and Janssen Pharmaceuticals—the makers of Paxil, Wellbutrin, Lamictal, Depakote, and Risperdal. For years, Paxil and Wellbutrin were advertised as correcting a chemical imbalance in the brain.[30]

Pies continued to defend the profession but later amended his stance slightly: “He confessed that many psychiatrists do use the chemical imbalance explanation. He went on to claim, however, that psychiatrists don’t fully believe it, so they ‘feel uncomfortable and a little embarrassed’ when they do so,” the SSM-Mental Health study says.

Uncomfortable and embarrassed?

The priority concern should have been that millions of Americans were lied to and have continued to be led to this day to believe their emotional upheavals in life are chemically caused, thus blocking avenues that may offer real recovery.

Psychiatrists such as Australia’s Professors Patrick McGorry and Ian Hickie continue to defend their turf, dismissing the London college study as irrelevant. Hickie had once conducted a clinical trial that involved giving antidepressants to the elderly who were “at risk” of depression –drugging them before they were even confirmed to be “depressed.”[31]

In response to the London college study, he defended: “It’s been repeatedly shown that if you increase the concentration of serotonin or noradrenaline or dopamine, you observe an antidepressant effect.”

McGorry, who practiced pre-drugging teens and adults “at risk” of developing “psychosis” with antipsychotics, doesn’t want people to stop taking their antidepressants. He claimed, “There are many drugs that we have in medicine, across the board that are very effective, but we still are unclear exactly why they’re effective, and that’s a separate issue,” he said.[32] [Emphasis added]

This smacks of more theories consumers are expected to believe—no-one knows how antidepressants “work,” but take them anyway.

CCHR has always stipulated no one should suddenly stop taking the drugs because of serious withdrawal effects and should withdraw only under medical supervision.

Dr. Moncrieff says that telling patients their behavior is the result of a chemical imbalance conveys “the message that we are powerless to change ourselves or our situations. When things go wrong, it persuades us we need a pill to put them right. This approach may appeal to some people, and I am in no way disparaging those who chose to follow it. But it is important that everyone knows how little evidence there is to support it.”[33]

In fact, the SSRI “miracle pills” are now acknowledged as being no more effective than a placebo. Studies show a 29-46% failure rate with antidepressants.[34]

Yet, in tracking their usage in the U.S., CCHR provides statistics on its clearinghouse website and resource, www.cchrint.org. Take, for example, three of the top selling antidepressants:

• The number of Americans of all ages taking Prozac (including its generic version, fluoxetine) in the United States increased 27% between 2006 (4,451,617) and 2020 (5,655,422).[35]
• Lexapro (including its generic version, escitalopram) usage increased 37% 2006 (5,957,349) and 2020 (8,170,580)[36]
• For Zoloft (including its generic version, sertraline) there was a 61.6% increase between 2006 (5,843,138) and 2020 (9,447,275).[37]

The website also includes a page with expert quotes dismissing the chemical imbalance theory as false.

It is not surprising given the level of dishonesty in this chemical imbalance scam that the World Health Organization and UN Human Rights agencies have criticized the failure of the biological model relied upon in the mental health field. On July 6^th, 2020, Dr. Dainius Pūras, a psychiatrist and the UN Special Rapporteur on the Right to Health, addressed the UN Human Rights Council and advised that that the dominance of the biomedical model has resulted in an overuse of medicalization and institutionalization. He warned against the exaggerated benefits of psychotropic medications and highlighted that their effectiveness is not comparable to other medicines that are essential for certain physical conditions, such as for example, antibiotics for bacterial infections. Further, “there are no biological markers for mental health conditions.”[38]

In February 2022, the UN Human Rights Commissioner reported that there is an overreliance on mental health drugs which are a “significant obstacle to the realization of the right to health.”[39]

The chemical imbalance lie has been one of the most significant obstacles.

References:

[1] Joanna Moncrieff, Ruth E. Cooper, Tom Stockmann, Simone Amendola, Michael P. Hengartner and Mark A. Horowitz, “The serotonin theory of depression: a systematic umbrella review of the evidence,” Molecular Psychiatry, 20 July 2022, https://www.nature.com/articles/s41380-022-01661-0

[2] https://www.prnewswire.com/in/news-releases/antidepressant-drugs-market-size-to-reach-usd-21-004-8-million-by-2030-at-cagr-3-0-valuates-reports-839380083.html; “A $15 billion hustle? Expert says pill-prescribing psychiatrists KNEW that depression isn’t caused by low serotonin levels – as landmark study shows that pricy drugs do little to help mental health,” Daily Mail, 21 July 2022, https://www.dailymail.co.uk/news/article-11035903/Expert-says-psychiatrists-KNOW-theory-low-serotonin-levels-cause-depression-incomplete.html

[2a] “Mental Health Watchdog forced to say ‘I told you’ about depression chemical imbalance,” The European Times, 24 July 2022, https://www.europeantimes.news/2022/07/mental-health-watchdog-forced-to-say-i-told-you-about-chemical-imbalance/

[3] Op. cit., Daily Mail, 21 July 2022

[4] Melissa Braddock, “Prozac: Purpose Antidepressant,” Chemical & Engineering News, 20 June 2005, https://cen.acs.org/articles/83/i25/Prozac.html

[5] “How do antidepressants trigger fear and anxiety?” Science News, 24 Aug. 2016, https://www.sciencedaily.com/releases/2016/08/160824135045.htm

[6] Op. cit., Molecular Psychiatry, 20 July 2022

[7] Jacqui Wise “‘No convincing evidence’ that depression is caused by low serotonin levels, say study authors,” BMH, 2022, https://www.bmj.com/content/378/bmj.o1808

[8] Christopher Lane, Ph.D., “A Decisive Blow to the Serotonin Hypothesis of Depression: An exhaustive new review debunks the ‘chemical imbalance’ theory of depression,” Psychology Today, 19 July 2022, https://www.psychologytoday.com/us/blog/side-effects/202207/decisive-blow-the-serotonin-hypothesis-depression

[9] “Depression is probably not caused by a chemical imbalance in the brain – new study,” The Conversation, 21 July 2022, https://theconversation.com/depression-is-probably-not-caused-by-a-chemical-imbalance-in-the-brain-new-study-186672; https://www.psychiatry.org/patients-families/depression/what-is-depression

[10] Op. cit., Daily Mail, 21 July 2022

[11] Ang B., Horowitz M. & Moncrieff J., “Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the academic literature,” SSM – Mental Health (2022), https://discovery.ucl.ac.uk/id/eprint/10147405/

[12] Ibid.

[13] https://www.youtube.com/watch?v=FxJomeak4V4

[14] Op. cit., SSM – Mental Health (2022)

[15] Dr. David Healy, Let Them Eat Prozac, (New York University Press, New York, 2004), p. 12

[16] https://www.reuters.com/article/us-serotonin/serotonin-levels-affect-brains-response-to-anger-idUSTRE78E6D420110915; https://www.news-medical.net/health/Serotonin-and-Aggression.aspx

[17] “Will $6.4 Million Verdict Open a New Mass Tort?” Lawyers Weekly, 9 July 2001, https://www.fitzgeraldlaw.com/paxil-maker-held-liable-in-murder-suicide

[18] CCHR’s report, Psychiatric Drugs Create Violence and Suicide, Los Angeles, 2018, p. 31, https://www.cchrint.org/pdfs/violence-report.pdf

[19] Op. cit., SSM – Mental Health (2022)

[20] Kelly Patricia O’Meara, Psyched Out: How Psychiatry Sells Mental Illness and Pushes Pills That Kill (Author House, 2006), pp. 47-48, citing Jonathan Leo, “The Biology of Mental Illness,” 2004

[21] People Magazine, 11 July 2005

[22] Interview of Dr. Mark Graff on CBS Studio 2, July 2005

[23] Op. cit., Psychology Today, 19 July 2022

[24] Ibid.

[25] https://www.cchrint.org/2010/04/15/from-psychobabble-to-biobabble-how-drug-money-has-come-to-dominate-psychiatry/, citing: Susan Perry, “From psychobabble to biobabble: How drug money has come to dominate psychiatry,” MinnPost, 15 Apr. 2010, https://www.minnpost.com/second-opinion/2010/04/psychobabble-biobabble-how-drug-money-has-come-dominate-psychiatry/

[26] https://www.psychiatrictimes.com/view/doctor-my-mood-disorder-due-chemical-imbalance

[27] Op. cit., SSM – Mental Health (2022)

[28] “Depression is probably not caused by a chemical imbalance in the brain – new study,” The Conversation, 21 July 2022, https://theconversation.com/depression-is-probably-not-caused-by-a-chemical-imbalance-in-the-brain-new-study-186672

[29] Christopher Lane, “Psychiatry’s Many Conflicts of Interest: A review of “Psychiatry Under the Influence,” Psychology Today, 13 Feb. 2016, https://www.psychologytoday.com/us/blog/side-effects/201602/psychiatrys-many-conflicts-interest

[30] Jeffrey R. Lacasse and Jonathan Leo, “Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse,” Florida State University Libraries, 2015

[31] https://cchr.org.au/melbourne-symposium-on-youth-mental-health-transition-into-adulthood-conflicts-of-interest-putting-millions-of-childrens-lives-at-risk

[32] Oliver Gordon, “How does depression work? Analysis finds it’s not caused by low serotonin,” ANC News, 22 July 2022, https://www.abc.net.au/news/2022-07-22/low-serotonin-reuptake-inhibitors-depression-review/101262660

[33] Joanne Moncrief, “The Chemical Imbalance Theory Of Depression: Still Promoted But Still Unfounded,” 1 May 2014, https://joannamoncrieff.com/2014/05/01/the-chemical-imbalance-theory-of-depression-still-promoted-but-still-unfounded/

[34] http://www.psychiatrictimes.com/major-depressive-disorder/treatment-resistant-depression

[35] https://www.cchrint.org/people-taking-prozac/

[36] https://www.cchrint.org/people-taking-lexapro/

[37] https://www.cchrint.org/people-taking-zoloft/

[38] “The world must change the way mental health challenges are addressed, UN expert says,” UN Human Rights Office of the High Commissioner, 6 July 2020, https://previous.ohchr.org/en/NewsEvents/Pages/DisplayNews.aspx?NewsID=26039&LangID=E

[39] Annual report of the UN High Commissioner for Human Rights and reports of the Office of the High Commissioner and the Secretary-General, 49th session, 28 Feb.–1 Apr. 2022