The Chemical Imbalance Myth Is Still Being Sold to Patients

Why are patients still being told their depression or anxiety is caused by a chemical imbalance when the science doesn't support that simple explanation?

I’m going to say something that apparently still needs to be said: we need to stop telling people that they are depressed or anxious because their brain has a chemical imbalance that needs to be corrected with a psychiatric drug.

And yet, people are still hearing it.

They hear it from prescribers when they ask why they need an antidepressant every day. They hear that their brain “isn’t making enough serotonin” or that their “chemicals are out of balance.” It sounds scientific. It sounds definitive. It also makes taking a medication seem like the obvious solution. I say SHOW me the receipts and PROVE it. 

The scientific evidence doesn't support that neat little story. Researchers including Joanna Moncrieff and Mark Horowitz have examined the evidence behind the serotonin theory of depression and concluded that there is no good evidence that depression, is caused by low serotonin.

So why is this explanation still hanging around?

Because it is a hell of a lot easier to sell a pill when someone believes there is something chemically wrong with their brain. 

That was one of the biggest themes in our latest episode of The Gaslit Truth Podcast, where my co-host Dr. Teralyn and I sat down with writer and poetry therapist Ann Bracken. Ann's story is complicated, painful, and incredibly familiar. She watched her mother receive extensive psychiatric treatment, including dozens of ECT treatments and heavy medication. She vowed she would never go down that road herself. Then chronic headaches and emotional distress eventually pulled her into a medical system that offered antidepressants, benzodiazepines, opioids, and ultimately ECT.

And I kept coming back to one question: How did a headache turn into all of this?

That is the question I wish we asked more often in mental health. Not just, “What's wrong with your brain?” but, “What happened to you?” “What changed?” “What is your body trying to tell you?” “What are we missing?”

Emotional distress can absolutely show up physically. Pain is real. Anxiety is real. Depression is real. Pain and emotions are processed in the same area of the brain. Trauma can be profoundly physical. But acknowledging that doesn't mean we have to immediately turn someone's experience into a neurotransmitter problem.

Because once you accept the chemical imbalance explanation, the treatment path can become almost automatic. Take the medication. If you still feel bad, add something else. Can't sleep? Another medication. Anxiety? Another medication. Side effects? Another medication. Can't stop the original medication without feeling awful? Maybe you still “need” it.

And suddenly, instead of asking whether the treatment itself might be contributing to the problem, every new symptom becomes a reason for another intervention.

That's where informed consent gets really important.

Ann talked about being offered MS Contin and OxyContin for chronic headaches and being told not to cut a pill in half without really understanding why. Those details matter. Her providers knew the drugs were addictive. Informed consent isn't simply getting a prescription. It means understanding what you're taking, why you're taking it, what the potential benefits and risks are, what alternatives exist, and what can happen if you eventually want to stop.

Then there was ECT.

Ann described the fear and confusion surrounding the treatment and the memory problems that followed. From the patient's perspective, those memory gaps aren't some insignificant footnote in a treatment study. Your memories are your life.

We also talked about what Ann described as “psychic numbing.” And that phrase stuck with me because it raises a question we don't talk about nearly enough: What if a treatment reduces your suffering but also reduces your ability to fully experience your life?

What if you're less anxious, but you're also less excited? Less devastated, but also less connected? Less overwhelmed, but emotionally numb?

For some people, medication may absolutely be worth that tradeoff. For others, it may not be. The point is that patients should be allowed to understand the tradeoff and make that decision for themselves.

And that's what I appreciated most about Ann's story. It didn't end with “medication is bad.” It ended with agency.

She started paying attention. She questioned what was happening. She worked toward tapering her medications. She used poetry therapy, journaling, self-compassion, spiritual support, and reflection on the relationships in her life. She became curious about what her pain might actually be communicating.

I'm a therapist. I believe in treatment. I believe therapy can help. I believe psychiatric medication can be helpful for some people. But I also believe people deserve the whole story.

They deserve to know when a theory is just a theory. They deserve to know when the evidence doesn't support the explanation they've been given. They deserve honest conversations about benefits, risks, withdrawal, alternatives, and uncertainty.

Most importantly, they deserve to participate in decisions about their own bodies and minds.

Because a patient who believes their brain is broken is approaching treatment very differently from a patient who understands there are multiple possible explanations for what they're experiencing.

One is being handed an answer. The other is being invited into a conversation.

I'd rather have the conversation.

And that is exactly why Ann's story belongs on The Gaslit Truth Podcast.