My brain chemicals are out of whack!

I don’t know about you but I’ve never understood what is meant by the phrase “chemical imbalance.” Pharmaceutical companies use the term as a means of describing depression. It gives the condition a medical-sounding cause, which of course requires a medical-sounding treatment (such as the pill they happen to sell).

Before I go any further, I want to state that antidepressants are an excellent treatment for both depression and anxiety. I am not anti-medication in any way. However, just because pills that alter brain chemistry can be helpful in many cases (miraculous in some, useless in some, and helpful in a large percentage of people) doesn’t mean these conditions are caused when some disease process has thrown brain chemistry out of balance.

Depression is not an illness in the classic sense. The best way to understand it is to see it as a mood state. A depressed mood is what we see in individuals but it is only a description of what they are feeling. It says nothing about why.

Depressed moods can be caused by purely physical processes (for example, post-partum depression or the depression we often see in a person suffering from a bipolar disorder). But they can also be caused by events such as the loss of a loved one, a failed relationship or a bankruptcy. Personality plays a major role in how we handle these challenges. Some people seem to weather them far better than others.

Personality can also make life as a whole more challenging for some people. For example, if you have very high standards toward yourself, you will likely live a life of frequent disappointment.

To be technical, personality is found in the brain and the brain runs on chemicals. This means that every mood reflects a change in chemicals. But it doesn’t mean the brain is not functioning well. A normally working brain will be affected by major events. And personality, while fairly stable, will nevertheless slowly morph through lifetime experiences. To say we get depressed when we are chemically imbalanced is tautological gibberish.

I suppose one day we may be able to completely understand how attitudes and personality traits develop in the brain. This would pave the way for total mind-control but I suspect this would a) be centuries away and b) pose some minor ethical challenges.

For now, we only have the ability to influence the brain through two means. Medically, we can alter Serotonin function and have a positive impact on moods in a broad way. And psychologically, we can help people understand patterns of behaviour and work on altering attitudes and perspectives. Neither of these means are perfect but such is our current understanding of brain chemistry.

I wrote a column on the issue as my last one before vacation. There was a delay in publication but it finally appeared on August 13. Here it is:

I’m chemically imbalanced
(Source: Déséquilibre chimique. Journal Métro, August 13, 2013)
(Voir plus bas pour la version Française)

If I am to believe pharmaceutical companies an awful lot of us are walking around with chemical imbalances in our brains. Imagine that. It’s a wonder any of us can function.

In an effort to market antidepressant medication drug companies often describe depression or anxiety as chemical imbalances that can be readjusted with their amazing products. If only it were that simple.

I often encourage, and even insist at times, that my clients get prescriptions for antidepressants. They have changed the lives of many of my clients. However, not everyone responds to them and many people spend years dealing with changes of doses or trying various combinations to no avail. This is because a) their symptoms are not caused by imbalances, and b) medication does not always help fix what’s wrong.

It’s all chemical
Some people are indeed more vulnerable to depression, or other psychological problems, because of a combination of their biological make-ups, their upbringing, and what they are currently experiencing. But to say they are chemically imbalanced makes little sense. Everything that happens in our brains is mediated by biochemical changes. My moods, my attitudes, my self-esteem, even the simple act of remembering what I had for breakfast are things my brain does through chemical means.

While biochemical factors can often play a role in many cases of depression, brains are also affected by current events and by long-standing experiences. Financial difficulties, for example, can weigh heavily on some people and contribute to depressed mood even if their brain chemistries are functioning normally.

It’s all life
Since my mood is in my brain, and events affect mood, then it also means that events change my brain chemistry. If I become depressed after the death of loved one, you would be able to see changes in my brain through a scan. But you would also see signs on my face. It doesn’t take high-tech equipment to see tears. Proper treatment, whether pharmaceutical or psychological, can alter those signs.

Medication is an important and valid treatment option but not because chemical imbalances are at the source of most problems. Life events, combined with the way we live them through our individual personalities, will continue to affect mood. By increasing the function of Serotonin in our brains, medication can reduce depressive and anxious symptoms, but it cannot completely rebalance lives.

That being said, I’m now off to balance my own brain chemistry by taking a little time off. See you in September.

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Voici la version Française

Je souffre d’un déséquilibre chimique

À en croire les sociétés pharmaceutiques, beaucoup d’entre nous traversent la vie avec un déséquilibre chimique au cerveau. À ce compte-là, c’est étonnant que nous puissions fonctionner!

En vue de commercialiser les antidépresseurs, les fabricants décrivent souvent la dépression ou l’anxiété comme des déséquilibres chimiques qui peuvent être résorbés grâce à leurs merveilleux produits. Si seulement c’était aussi simple…

J’incite souvent mes clients, et parfois avec insistance, à obtenir une ordonnance d’antidépresseurs. Ces médicaments ont changé la vie de bien des gens. Cependant, les réactions diffèrent d’une personne à  une autre, et plusieurs passent des années à chercher le bon dosage, mais en vain. C’est parce que : a) leurs symptômes ne sont pas causés par un déséquilibre; et b) un médicament ne règle pas toujours ce qui ne va pas.

C’est chimique
Certains sont plus vulnérables à la dépression ou à d’autres troubles, en raison d’une combinaison de constitution biologique, d’éducation et de ce qu’ils vivent à ce moment. Mais, dire qu’ils souffrent d’un déséquilibre chimique n’est pas logique. Tout ce qui se passe dans le cerveau est soumis à des changements biochimiques. Les humeurs, les attitudes, l’estime de soi, et le simple fait de se rappeler ce qu’on a mangé pour déjeuner sont des choses que le cerveau accomplit par des moyens chimiques.

Les facteurs biochimiques jouent un rôle dans bien des cas de dépression, mais le cerveau est aussi affecté par les événements courants et les expériences à long terme. Ainsi, les soucis financiers peuvent être un lourd fardeau pour certains et mener à une humeur dépressive, même si le fonctionnement chimique du cerveau est tout à fait normal.

C’est la vie
Comme l’humeur prend sa source dans le cerveau, et que les événements influent sur l’humeur, cela signifie que les événements modifient la chimie du cerveau. Si j’étais déprimé après le décès d’un être cher, vous pourriez observer les changements dans mon cerveau par imagerie médicale. Mais vous pourriez aussi en voir les signes sur mon visage. Ça ne prend pas de l’équipement de haute technologie pour voir des larmes. Un bon traitement, pharmaceutique ou psychologique, peut atténuer ces signes.

La médication est une option importante et valable, mais ce n’est pas parce que des déséquilibres chimiques sont à la source de la plupart des problèmes. Les événements de la vie, alliés à la façon dont nous les vivons en fonction de notre personnalité, continueront d’influencer notre humeur. En augmentant le taux de sérotonine dans notre cerveau, les médicaments peuvent atténuer les symptômes de dépression et d’anxiété, mais ils ne peuvent pas rééquilibrer complètement nos vies.

Cela dit, je pars rééquilibrer la chimie de mon cerveau en prenant un peu de vacances. Je vous reparle en septembre!

Tagged as antidepressants, Anxiety, chemical-imbalance, Depression, SSRI.

Posted in Depression, Mental health.

Posted on 06 Aug 2013