Two years ago, a piece argued that depression isn’t simply about chemical imbalances. In no equivocal terms, it stated that depression’s link to being this kind of an imbalance is a lie. This report, of course, is not the only one. Another piece in the Harvard medical journal reiterates the same point.
Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It’s believed that several of these forces interact to bring on depression.Harvard Health Publishing
Both reports suggest that yes, chemicals are involved in the process of being depressed, but that comes later.
First come several other factors like trauma, stressful surroundings, emotional triggers and so on and so forth. Depression simply does not exist in isolation or a vacuum and is not the first step, several factors lead to it, claim the reports.
If depression indeed is a chemical imbalance, the next logical step is to take a pill that counterbalances it and voila! You’re cured. Not so easy. People sometimes take pills for years without being recovered.
To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.Harvard Health Publishing
This also goes to explain why two people with similar symptoms of depression might respond entirely differently to the same medication. Additionally, there is no concrete or definite data on the direct link of antidepressants to mental health and depression. Consequently, we don’t know for sure what Prozac, one of the most widely used medication used for depression in the US, is really doing to a depressed person.
Depression: A Complex Illness
Dr Achal Bhagat, Senior Consultant Psychiatrist and Psychotherapist at Apollo Hospital, comments on this and says that depression is a complex illness which cannot be explained in definite terms.
There are a number of factors that may increase its chances. These include abuse, certain medicines, interpersonal conflict, death or a loss, genetics, major events - both positive and negative, serious illnesses and substance abuse (nearly 30 percent people with substance abuse problems also have major or clinical depression).Dr Achal Bhagat
So, what is the role of medication and hormones in all this?
Depression and Hormones
According to Dr Bhagat, there are two hormones that have primarily been associated with depression - serotonin and cortisol.
The commonest explanation is an imbalance of serotonin. This is supported by imaging studies where it has been found that the size of the hippocampus (a part of the brain) in those with depression is relatively smaller than those who do not have depression. The serotonin receptors in smaller hippocampus are also low. Some people have also proposed that cortisol levels are higher in those with depression and this may lead to shrinking of the hippocampus.Dr Achal Bhagat
Can This Hormonal Imbalance be Treated with Medication?
Following the thought expressed in the studies which don’t see depression as linked to chemical imbalances, Reshma Valliappan, a mental health activist who has been very vocal in the past about her struggle with schizophrenia, agrees that medication doesn’t help deal with mental disorders.
How does she look at depression at depression and its links with medication?
Many of us know for certain that once medication is given, we are also suggested therapy. It is in that room, that I uncover the layers of causes to my said disorder and this mostly points to a dysfunctional upbringing of some sort. I’ve had many therapists and counsellors who have worked with those like myself and we’ve all uncovered areas of parenting that messed us up.Reshma Valliappan
However, in her case even therapy hasn’t been the solution. Reshma adds that different experts seem to have different views which impede her recovery.
The politics in the practice here contradicts each other where the practitioner who is prescribing these medications only look at a possible imbalance that needs to be fixed. Yet in the same school of practice - a different practitioner is suggesting that we’ve had bad experiences and require family therapy to enable us confront our past issues. Practitioners tend to override each other on our expense and unfortunately we are caught in the chaos of their practice being more important than our actualities.Reshma Valliappan
How Does Reshma Look at Her Depression?
Reshma has lived with depression since 1995 and has a non-traditional approach to it. It should be noted that this is a very personal approach and should not be looked at as medical advice. Each person’s treatment differs and only a trained medical professional can guide you with that.
For Reshma, emotions often become overwhelming to the point of leaving her unable to function or in her own words:
The minute my body faces a ‘crash on energy’, I notice how I am overwhelmed by the simplest of emotions and situations and fall into weeping spells, fatigue and the lack of interest to do anything in life.Reshma Valliappan
She adds her life experiences have a huge role to play in her depression, but pinpointing them helps her find a solution which she didn’t otherwise find in medication.
As a human, I am bound to get affected by them (life experiences). Where my expectations and what I want is not met, I also observe a slow dip in me which further builds up into a ball of depression... I’ve noticed unrealistic expectations with myself, owing to the lifestyle I lead, and often it can make it difficult to know where and when must I stop and simply let go of what I can’t achieve. When I can pinpoint these reasons and see how they are affecting or even causing my depression, it makes me feel that I do have control over what is happening with me and that there are solutions I can find.Reshma Valliappan
Depression - a Quicksand of Uncertainty
With depression, as both Dr Bhagat and Reshma suggest, we have only scraped a little of the tip of the iceberg. While data and research continues to remain sketchy on what really works, both people FIT reached out to are in disagreement about what truly works when it comes to mental illness.
Dr Bhagat comments about the potency of antidepressants in treating severe depression, Reshma feels that it reduces her agency and gives her a pessimistic view of her illness when we reduce it to chemicals. In fact, she’s not the only one in feeling this manner. According to this study, reducing depression to simply a chemical imbalance gives a very bleak perspective of the illness to the one suffering with it.
If someone were to merely tell me it’s a chemical imbalance, it suggests that there is nothing I can ever do to help myself. It kills any hope one can have to help oneself. It puts help in a material process instead which also depends on my bank account, thereby adding more struggle to my pain.Reshma Valliappan
On the other hand, Dr Bhagat points out the role of antidepressants in addressing this very chemical imbalance. In fact, they have been proven to perform better than placebo, he further says.
Severe depression responds well to treatment with anti depressants which seem to have a long term neurotrophic impact on neurons. The two main meta analysis of many studies on effectivity of antidepressants conclude that antidepressants do work well in severe depression. A recent study which brought together the information regarding 1,00,000 patients concluded the antidepressants work significantly better than placebo.Dr Achal Bhagat
Yet, he adds:
It does not mean that psychotherapy does not work for depression. However the availability of trained psychotherapists in a country like India is limited. Where access to therapy is available, a combination of both medicines and psychotherapy works well.
Anything related to the mind is still overwhelming beyond comprehension. While people located at different points of the spectrum would disagree on several aspects, we can all agree that there definitely isn’t any one single way to address or treat depression.
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