Chemical Imbalance - Criticisms

Criticisms

According to critics, the chemical imbalance hypothesis has been overpromoted and continues to be advanced as factual by pharmaceutical companies. They believe the general population and many journalists have accepted this hypothesis into their understanding of mental illness uncritically. They have pointed to the lack of an established chemical balance (without which, they claim, the notion of an "imbalance" is meaningless). Certain pharmaceutical companies such as Pfizer continue to promote drugs like Zoloft with advertisements asserting that mental illness may be due to chemical imbalances in the brain, and that their drugs work to "correct" this imbalance. Most academics believe that the advertisements are oversimplified and don't fully explain what is happening.

Chemical imbalance theories do not presume individual laboratory tests be obtained from a patient at the time of prescription, such as one would expect in the analogy to physical medicine. For example, someone suffering from schizophrenia is not given haloperidol on the basis of a laboratory test which shows that his or her dopamine level is too high.

Chemical imbalance theories distinguish between "side" and "main" drug effects in recording the response to the drug. "Side" effects are considered to be simple, direct, predictable, allowable effects which are merely "physical" but do include often flattened affect and memory, emotive and cognitive effects. These drug effects may then be cited capriciously as further evidence to confirm the diagnosis as correct, confusing cause and effect.

When "improvement" is measured in industry research studies, attention is given only to the "main" effect—typically a complex, indirect, interpersonal, perceptual, cultural change, thereby confusing cause with coincidence. In chemical imbalance theories, there are no effectiveness measures using standard social networks and associated tests before and after drug administration.

Chemical imbalance theories predominate in "streamline" public sector medicine for lower social class and homeless persons, where drugs constitute the only form of treatment. There is much wishful thinking in attribution of drug effect, particularly in cases like schizophrenia, where there no longer exists a patient control group available.

One criticism while not outright rejecting the theory is that it has been scientifically proven that things other than drugs can influence brain chemistry. Exercise releases endorphins. Even our own thoughts change our brain chemistry. These natural methods of changing brain chemicals are claimed by critics to be preferable to drugs since drugs have side effects. Furthermore, some psychiatric drugs might alter the mind by disabling moods and emotions not just in circumstances where they're a problem but in circumstances where they're appropriate or even beneficial as well while natural ways to change brain chemistry can be used as needed.

There is also criticism that Chemical Imbalance theory does not take into account that there are feedback mechanisms in all neurotransmitter pathways. These feedback mechanisms are present in all mammals, and likely all forms of life utilizing neurons, and are absolutely required for information processing to function properly. Publications on chemical imbalance theory often do not properly follow the scientific method, and often gather data on changes to neurotransmitter systems in patients who are taking, or have taken, psychotropic medication. This skews data by confusing the cause of the illness with feedback mechanisms potentiated by psychotropic drugs. Limited publications on changes detected in neurotransmitters pathways in psychotropic drug naive patients have not been reproducible. The primary neurotransmitter feedback mechanisms currently studied are:

• Receptor deletion (uncoupling),
• Receptor addition (supersensitivity),
• increase or decrease of neurotransmitter metabolism (manufacture),
• increase or decrease of neurotransmitter release,
• increase or decrease of reuptake (removal process from the synaptic cleft),
• increase or decrease of enzymatic breakdown of neurotransmitters (for monoamines like Dopamine, Serotonin, and Norepinephrine - this is done by the Monoamine Oxidase enzyme)

Receptor deletion and Receptor addition are implicated in causing psychiatric and physiological symptoms of dependence and withdrawal from psychotropic drugs. As feedback mechanisms also evolved to overcome the effect of molecules from eternal sources that interfere with receptors (and thereby interfere with information processing) through a variety of means, treatment with psychotropic drugs should produce 'withdrawal' like symptoms with long or even short term use of an unchanged dose (this is called dependence), thus the chemical imbalance theory is under attack due to published evidence on how feedback mechanisms respond to drugs - rather than a lack of evidence on changes in neurotransmitters in patients with mental illness. To date, all studied psychotropic drugs potentiate feedback mechanisms, some feedback mechanisms of which have been implicated in causing the same symptoms of the illness the drugs are approved to treat. It is currently understood that feedback mechanisms can lose their original reference point in some patients with some drugs (usually in long term treatment), meaning that a drug with the exact opposite effect is needed to repair the feedback mechanisms to end otherwise permanent drug withdrawal symptoms. The only class of drugs that had been studied in this manner are benzodiazepines, for treatment of 'protracted withdrawal syndrome' using a GABA agonist.