Chemical Imbalance is a Myth (Sort of)

What type of depressed are you?

After high school, my depression became increasingly worse. So bad that for the first time, thoughts of self-harm would intrude during my community college classes and in other quiet places. The depression had come in waves since I was around 14, but this time it paired with an eating disorder and a loss of structure. I’ve found that it comes in waves for most people — my mom’s waves were timed accordingly to when she forgot to take her Prozac, and my sister’s waves were kept in the privacy of her own apartment.

After months of exhausting self-maintenance — exercising, interacting with others, checking my email, showering, getting out of bed every day — I still wanted to die. “I want to die” has a different tone to it now from years of using it sarcastically after a social mishap. When I told my friends I wanted to die, most of the time they replied, “yeah, me too.”

I never wanted to go on medication. Medication was for people who were too lazy to take care of themselves properly. But I figured if my options came down to popping some antidepressants or killing myself, I might as well give it a shot.

When I met with my doctor, she didn’t question me when I told her I was depressed. She only asked what type of depressed I was. I explained that I wasn’t sad, I was just indifferent. Not a single thing was worth giving a shit about. She scribbled “300 mg of Wellbutrin” on her prescription pad.

When I got home, I finally felt enough to sob into my hands on my living room floor at my mom’s feet. She cried too — she forgot to take her Prozac that day.

“Honey, this will just help break the cycle. There’s a chemical imbalance and medication corrects that. You’re vulnerable because I have it and your grandma has it and most women in our family have it.”

This actually made me feel better. It wasn’t my fault.

What soothed me about my condition was the biology behind it all. It was out of my control, my brain was doing this to me. So, like any hyper-analytical, recovering depressive, I bought a used textbook on neurobiology and listened to every free lecture I could find. Maybe, if I understood what was happening I could figure out how to approach it.

Run for Your Life, Tax Day is Coming

When a zebra is running from a lion, it releases adrenaline and glucocorticoids that tell the body to get going. Its blood pressure and heart rate will rise, it’s immune system will kick on high and it will increase muscle tone. Almost everything else that isn’t dire to those few minutes — digestion, reproduction, growth — will be suppressed. Humans have the incredible ability to do this exact same thing by thinking about their 30-year mortgage.

It seems like we should be well enough evolved to recognize the difference between being mauled by a bear and tax day — but we aren’t. Our abstract threats and fears are just as real as any physical danger. The abstractness forms in the part of our brain called the cortex. This relatively new part of our brain is responsible for critical, rational thinking. Other parts of our brain can’t hold abstract ideas, they focus on carrying out the physical functions of the body. The cortex is the one that whispers to them the horrors of the world and convinces them to react.

There was a theory for a long time that your stress response would run out of ammunition if the danger persisted long enough. We now know that’s not true — the stress response will not stop until the danger is gone. Your body will fight at the expense of every other mechanism, which results in failures of physical functions. Major depressives have this internal battle happening 24/7. The common symptoms of depression — lethargy, lack of appetite, strange sleep patterns, a decreased libido — are a result of this.

Without the cortex, all of this havoc would never have been set in motion.

Occam’s solution? Cut it out.

And that’s what they did. It’s called a bilateral cingulotomy, a severing of the pathway between the cortex and the rest of the brain. They actually still do this in extreme cases, and it works. But when you take away the ability to formulate abstract sadness, you take away abstract pleasure as well.

So they tried a different route — manipulating neurotransmitters.

Breaking the Cycle

This is where the “chemical imbalance” rumour started. It’s not entirely wrong, it’s just misleading. The truth is, we don’t have a golden ratio of serotonin, dopamine, and norepinephrine. All we know is that these neurotransmitters have something to do with our pleasure pathways. We know that these neurotransmitters have a connection to physical symptoms; they still live within the realm of biology.

But I’m not comfortable with succumbing to my pre-determined biology forever. At first, I needed to condemn biology as the sole proprietor of my misery; but after a while, I needed to regain some control. Human biology isn’t a fully enclosed system. We interact and are influenced by our environment like any other animal. To put this in a painfully rudimentary way — hormones and neurotransmitters may act on their own in some sense, but to say that the environment has no effect on those processes is going too far.

I live in Detroit, and while I adore my University and the city, living in the Midwest can be brutal. For 6 months out of the year, we are allotted roughly 7 hours of dim, grey sunlight a day. Sitting on nightstands, vanities, desks, and windowsills of my friend’s apartments are Seasonal Affective Disorder (SAD) lights — little flat lamps that mimic the rays of the sun. From October to March, every morning when I wake up, I swallow a tablet of Vitamin D and bask in 10,000 luxe of blue wavelength light. Would I be happier in these 6 months if I moved to Arizona? Or Florida? Well — probably not Florida, but I could see Arizona doing me some good. Packing up to escape the winter is not a cure, but several changes in the environment could elicit noticeable improvement.

University housing does not allow pets. But every so often, the rusty elevator doors would peel open to reveal a dog — to which I would spend the entire elevator ride sitting on the floor and letting him or her lick my face. I miss having a dog. Come to find out, getting approval for a “therapy pet” is just as easy as it was getting approval for a med card (when weed was still outlawed). After a quick Google search, “can a dog cure my depression”, I found that dogs can provide structure, companionship, and encourage exercise. Again, not a cure-all, but a change in environment that may help.

I’m sure that some people have fulfilling careers, lovely childhood memories, a dog, and a family that they adore, but are still depressed; these people probably turn to the wide world of antidepressants for help. For others, changes in their environment may make all the difference in the world, which commonly leads to a condescending view of people who choose to medicate. Some have tried every antidepressant in every dosage, and they didn’t receive relief until they accepted Jesus into their heart. Other paths to recovery seem reasonably straightforward — drug addicts must stop taking drugs, diabetics must take insulin, etc. The path to recovery with depression is individualized and confusing and so, so, very long. But I truly believe that there is an answer out there for everyone, and don’t listen to the ones who promise that they have the answer for you. Above all, depression is a path to self-actualization.

Take What You Need

I relied on pathology to find the courage to admit that something was wrong with me. Robert Sapolsky and other neuroscientists held my hand through YouTube and offered a sort of specialized support. Medication helped me crawl away from the cycle just enough to find the energy to do something, anything about it. And what could I do about it? A lot of small things — write every day, go for walks, cook a real dinner, make tea and read at night. A more significant change in environment would most likely have a more significant impact, but I belong here for at least 4 more years, and these small alterations are enough to get by.

The point I really want to drive home here is to take what you need. If you need to focus on the biology to feel removed from it, that’s okay. If you need to examine your environment and manipulate it so you feel some control, do that. Maybe you need a combination of both, one after another. For me, I needed to blame my brain, then blame myself. We don’t have the scientific means to definitively know why we’re depressed, the ratio of our neurotransmitters at any given moment, exactly how much the weather affects us, or where the depression gene resides in us — if it does at all.

I found an old journal entry of mine on the matter -

“I don’t believe being thrown in the downward spiral every so often is completely worthless. The honest to God truth is we were born, against our will, into this world that has no answers. We will never have all the answers, and the uncertainty of ourselves and our setting in the universe is horrific. After all, we are born with a complex rationale that allows us to ask questions, so living in a world with few answers is saddening. This perspective is easily forgotten about though, especially when you’re on meds. Take the time to be grateful for your ability to tend to your own garden and glimpse into grimness. It gives you a full experience.”