Note from the Author: Special thanks to Laura Hendrickson, M.D. and former psychiatrist for her help with this article.
Often counselees are told by their doctors that they have a “chemical imbalance.” Their underlying diagnosis may be depression or bipolar disorder. Those diagnosed as “bipolar” are, many times, told they are like the diabetics who must have insulin. They must take a mood-stabilizer medication and possibly an antidepressant to keep the chemicals in their brain in proper balance. Those diagnosed as “depressed” are frequently told they, too, have a disease of a chemical imbalance in their brain which the medicine will correct.
Is this correct? Let me explain why I believe it is not.
In the brain there are chemicals called neurotransmitters. These neurotransmitters (dopamine, norepinephrine, and serotonin) are like tiny chemical bridges that allow electrical activity to move from cell to cell in the brain. Electrical activity shows that a brain is alive or can show seizure activity. What the electrical activity is not is the person’s thoughts. Actually, scientists do not know how a person thinks a thought.
What doctors do know is that the antidepressants change the balance of the neurotransmitters in the brain. Actually they change the balance to extremely abnormal levels. It is also known that the antidepressants will, for most patients, lift their mood. What is not known, however, is how (by what pharmacological means) that the depressive mood is altered. It is theorized that the patient’s mood is lifted because the medicine changes the balance of the chemicals. Therefore, it is assumed that the depression is caused by a neurotransmitter “chemical” imbalance.
It may seem odd to pastors and other non-medical people that doctors would give a medicine when they don’t clearly understand how it works, but that is common in medicine. For instance, it was probably 100 years before doctors discovered how aspirin reduced fever, but they gave aspirin anyway because they knew it worked.
It also may seem odd that doctors are sometimes so quick to diagnose someone as having a chemical imbalance instead of sending them to their pastor or a counselor to learn to control their thoughts, to correct their emotions, or respond better to difficult circumstances. The reason so many doctors do this is they are taught in medical school to view people as if the physical body is all there is. In other words, people are sophisticated physical organisms, so if they are depressed, they must be victims of a physical disease. Doctors tend to look at things through their “medical model.” So, when a patient experiences painful emotions, these are thought to be due to a physical cause, such as (they theorize), a “chemical imbalance,” instead of coming from the inner man (the heart, soul, or mind).
It is important to remember that doctors give antidepressants because they work for some people not because they really know how or what is really causing almost all depression. In fact, they cannot test a patient for neurotransmitter levels in their brain without doing a biopsy of their brain which, of course, they don’t do.
Biblical Counselors and the Field of Medicine
Biblical counselors should have great respect for doctors and the training they have had. However, we ought to acknowledge that the “practice of medicine” is, to a certain extent, an educated guessing game. Therefore, we must be careful not to be intimidated into taking medications which may unnecessarily mask symptoms that we should be dealing with biblically. Also, these medicines may cause difficult and sometimes permanent side effects including, for some people, extreme difficulty withdrawing from the medication.
Side effects of antidepressant withdrawal are crying spells, worsened mood, low energy, trouble concentrating or sleeping, suicidal thoughts, anxiety, panic attacks, irritability, impulsivity, aggressiveness, self-harm, confusion, memory problems, hallucinations, flu-like aches and pain, fever, sweats, nausea, vomiting, abdominal pain, spinning feeling, unsteady gait, headache, tremor, numbness, tingling, electric zap-like sensations in the brain or body, ringing in the ears, drooling, slurred speech, muscle cramps, uncontrollable twitching of the mouth.[i] Certainly not every patient experiences all the withdrawal symptoms to their full extent, but research has shown that “as many as 78 percent of patients have withdrawal reactions when they stop their antidepressants, depending on the particular drug.”[ii]
There are legitimate physical causes for depression such as hypothyroidism or side effects to medications such as steroids or some high blood pressure medicine. Those can be and should be treated medically. However, the vast majority of depressed patients are diagnosed as having a chemical imbalance, told dogmatically that they have a disease, and must take medicine to treat it so that they can either get well or, at least, remain stable. This is simply not true. Neither is it the biblical method for learning how to manage our emotions.
For those pastors and counselors who have counselees already on antidepressants and desiring to get off, I highly recommend that you (and possibly the counselee) read The Antidepressant Solution by Dr. Joseph Glenmullen (Free Press Publishers, 2005). It is important to warn the counselee who desires to come off his medication, not to take himself off of them without consulting with his doctor first. A person who does not heed this warning runs a great risk of having severe rebound symptoms (and possibly of being placed on an additional psychiatric medication!). Therefore, his doctor needs to guide him in a safe process. For those not already on antidepressants, they should be encouraged to seek help from their pastor or a biblical counselor who will give them hope from the Lord and help them learn to cope with their problems in a way that gives God glory and will ultimately give them peace of mind.
If asked, most doctors will admit that the chemical imbalance diagnosis is their “best guess” and that the medicines do have unpleasant to even severe side effects to say nothing of the withdrawal effects. “In fact, leading psychiatrists such as Dr. David Healy don’t even believe in the “chemical imbalance” theory any more. Now researchers agree that whatever antidepressants do, they do not correct an imbalance.”[iii]
When Jeremiah was depressed, he remembered certain things about God’s perfections and it gave him hope:
“This I recall to my mind, therefore I have hope. The LORD’s lovingkindnesses indeed never cease, for His compassions never fail. They are new every morning; great is Your faithfulness. The LORD is my portion,” says my soul, “therefore I have hope in Him” (Lamentations 3:21-24).
The true believer’s hope is in the Lord. Christians are to be controlled by the Holy Spirit whose fruit is love, joy, and peace instead of controlled by a mood altering medication. The chemical imbalance theory of depression is not true. What is true is that depression is a very real and miserable emotion. Your counselees who struggle with depression need help and hope that honors God and enables them to give Him glory.[iv]
Why are you in despair, O my soul? And why have you become disturbed within me? Hope in God, for I shall yet praise Him, The help of my countenance, and my God” (Psalm 42:11).
Join the Conversation
What is your perspective/conviction regarding “chemical imbalance”?
BCC Staff Note: The BCC, as a true coalition, has a diversity of perspectives on biblical counseling and the complex body/soul relationship. We recommend several resources for further study. Chapter 28 of Christ-Centered Biblical Counseling addresses this issue. We also recommend Dr. Charles’ Hodges book, Good Mood Bad Mood. Additionally, yesterday’s post at the BCC by Pastor Dave Dunham, Counseling People Struggling with Obsessions and Compulsions reflects on these complex body/soul issues.
[i]Glenmullen, Joseph. The Antidepressant Solution (New York, New York: Free Press, 2005), p.135.
[iii]Doctor Laura Hendrickson (former Psychiatrist and MD) in e-mail correspondence with Martha Peace, June 2005.
[iv]For a biblical counselor in your area look on the www.biblicalcounseling.com web site under “find a counselor.”