This is the first time, outside of my coursework in neuroscience, that I've encountered someone questioning the chemical imbalance hypothesis. Despite a complete lack of evidence, the field of psychology mostly remains split on it. As many psychologists believe it as disbelieve it (this was true, at least, fifteen years ago - no telling how the numbers split now).
One thing I wish people understood about depression and medication is that it takes roughly 6-18 months to figure out someone's medication and dose. Interestingly, even severe, lifethreatening depression typically resolves itself in 6-18 months. This resolution can happen even without external intervention. And so it's worth questioning, as someone in the bouts of depression, if you're feeling better because you and your doctor figured out your medication or because you simply feel better.
The fact that most medication that deals with mood disorders is addictive complicates this further, since one of the primarily side effects of withdrawal is depression. Thus and so, medicine meant to help us through a temporary difficult patch in life can become a lifelong dependence.
That's not to say that medication has no place in treatment, but that sometimes the cure is simply time and growing resilience.
You get it! You're spot-on. It's true that medications work well in acute cases short term, but I'm one of those people who will (likely) be on psychotropic meds for the rest of my life. At this point, my body is just in homeostasis. I never change them. This is my normal. I say this for anyone who thinks that to be 'recovered' you have to be off meds, which I mistakenly believed. Not so. As Edward says so well, they weren't tested long-term and we now know that the body becomes dependent on them. Thank you, Edward, for reading and for such a smart response.
That’s fascinating. I know from reading Astral Codex Ten that SSRIs do work for a lot of people, but that’s clearly just treating the symptoms, rather than the cause. There’s so much we don’t know about mental health and how the brain works, I don’t think it’s surprising depression or anxiety remain such a mystery to us. Sarah’s message is an optimistic one though, that one can make a full recovery. Really recommend her Cured Substack on this topic!
Definitely! SSRIs certainly are helpful and I wouldn't advise someone to stop taking their medication because they read a comment on the internet (talk to your doctors, people).
But SSRIs are also addictive. Understanding that is, I think, an important part of mental health and depression. If you stop taking your medication cold turkey, you WILL get depressed. Maybe even severely depressed. This is a symptom of withdrawal and will likely pass once you've successfully weened from the medication.
Having said that, depression can be quite dangerous so you should come up with some sort of plan or program for discontinuing your medication, if you even want to stop taking it.
This was a great post. It also made me think of this- as a reader, I tend to think what I read in a book as somehow verified or true. But, often, it’s just what is known or believed at that time or even just a point of view. It speaks to the ephemeral side of book content, something that I don’t hear about as often.
I listened and read along--this is wonderful. Not only is the story here one that means a lot to me on its own, but the way it fits into this new space, 'The Books that Made Us' is also perfect. Just excellent.
I also just subscribed to Writers at Work--the welcome email mentions we could email you; do you have a preferred address for that? Or just reply to that welcome email?
Haven't read this post yet, will this afternoon, but just wanted to say I love "Darkness Visible," I've read it a couple different times during rough patches in my life.
I've had this post flagged in my inbox for days. The title Darkness Invisible: A Memoir of Madness burned itself into my retina and I knew I had to read Sarah's essay, just needed to save it for when I had proper attention and presence. What a powerful, and hopeful, reflection on the journey of depression. As with all adversity, it often runs its course. Or shape-shifts with time as we draw meaning and purpose into our experiences so that when it strikes again, we have a little padding built around the blows.
Very well-written piece. Echoing others that this is the first time I’s heard that the chemical imbalance hypothesis might not be right. It is so entrenched that I never even thought to question it, I just accepted it as medical fact. So I really appreciate you bringing that misconception to light. It’s interesting, because the idea that depression isn’t a chemical imbalance makes the diagnosis feel less determinative, in that depending on the person and what they’re struggling with, medication might not be the only or even the best option.
Also, love that you are serializing your memoir on Substack. I’m working on my own memoir and have toyed with the idea of doing that if I can’t find a good fit with a traditional publishing house--would love to hear more about your experience!
It's been a fascinating experience. Don't think about serializing if a traditional publisher doesn't take it. Think about doing it before you and your agent even go out with it. I'll go through all this during the workshop, but I'm serializing 'Cured' (the sequel to my first memoir, Pathological, which came out from HarperCollins) with my agent and editor.
And you're not alone in terms of the chemical imbalance theory--80% of Americans still believe it's true. I'm not anti-medication, but pharma did an excellent job of perpetuating the myth.
This is such an important topic. My son, whose fascination with psychology stems from harrowing personal experience during his teen years, showed me this TED Talk about studying brain scans to understand and eventually diagnose brain illnesses. Given the hit or miss nature of mental illness diagnosis (that's how it feels on the receiving end), this is fascinating and . . . maybe even hopeful? The promise of medication is built on a whole lot of assumptions, but when he was in deep crisis, anti-psychotic meds worked wonders. https://youtu.be/esPRsT-lmw8
This was such a great essay. I know it’s been said at least twice already, but this is the first time I’ve read that the chemical imbalance theory isn’t true. As someone who doesn’t live in a country belonging to the “developed” West, I can say that our medicine is a little bit outdated, so many psychologists and psychiatrists I’ve talked to believe in this theory and prescribe treatment accordingly. Moreover, many treatment options with low or even absolutely zero experimental results, like neurofeedback or theta healing, are in vogue here.
I have a family member who’s been taking meds for depression, based in this chemical imbalance theory, and while they do think the meds made a difference, they stopped taking them after about a year. As you and others pointed out, I don’t know if my family member feels better as a result of the meds or just of the passage of time.
This is a very sensitive topic, and as I get older, I come to realize that medicine in general is less of an exact science and more of a game of trial-and-error, of luck even, both in terms of the effectiveness of treatment on a given patient, as well as in terms of choosing the right doctor. My wife’s gone to no fewer than five dentists in the last few months, and they all have given her different diagnoses! How is this possible, I might have thought when I was a teenager, but now I’m not really surprised anymore.
Thank you for reading! I love the dentist analogy. And your note made me think (again) that there's nothing wrong with trial-and-error given we know so little about the brain and the mind; what's wrong is the biopsychiatrists and other mental health professionals who either pretend or think it's otherwise and make the rest of us believe it too.
I read a great book on this a few years ago called Lost Connections where the author argues that part of the upswing on depression and anxiety is due to 9 lost connections with things that give our life fulfilment and meaning. Things like friendships, purpose, nature, and stuff like that. Was very interesting read, think at least part of it must be true. Though I do believe that some people have the misfortune of being more prone to suffering from these afflictions, whether due to genetics or what I don’t know.
Great post.
This is the first time, outside of my coursework in neuroscience, that I've encountered someone questioning the chemical imbalance hypothesis. Despite a complete lack of evidence, the field of psychology mostly remains split on it. As many psychologists believe it as disbelieve it (this was true, at least, fifteen years ago - no telling how the numbers split now).
One thing I wish people understood about depression and medication is that it takes roughly 6-18 months to figure out someone's medication and dose. Interestingly, even severe, lifethreatening depression typically resolves itself in 6-18 months. This resolution can happen even without external intervention. And so it's worth questioning, as someone in the bouts of depression, if you're feeling better because you and your doctor figured out your medication or because you simply feel better.
The fact that most medication that deals with mood disorders is addictive complicates this further, since one of the primarily side effects of withdrawal is depression. Thus and so, medicine meant to help us through a temporary difficult patch in life can become a lifelong dependence.
That's not to say that medication has no place in treatment, but that sometimes the cure is simply time and growing resilience.
You get it! You're spot-on. It's true that medications work well in acute cases short term, but I'm one of those people who will (likely) be on psychotropic meds for the rest of my life. At this point, my body is just in homeostasis. I never change them. This is my normal. I say this for anyone who thinks that to be 'recovered' you have to be off meds, which I mistakenly believed. Not so. As Edward says so well, they weren't tested long-term and we now know that the body becomes dependent on them. Thank you, Edward, for reading and for such a smart response.
That’s fascinating. I know from reading Astral Codex Ten that SSRIs do work for a lot of people, but that’s clearly just treating the symptoms, rather than the cause. There’s so much we don’t know about mental health and how the brain works, I don’t think it’s surprising depression or anxiety remain such a mystery to us. Sarah’s message is an optimistic one though, that one can make a full recovery. Really recommend her Cured Substack on this topic!
Definitely! SSRIs certainly are helpful and I wouldn't advise someone to stop taking their medication because they read a comment on the internet (talk to your doctors, people).
But SSRIs are also addictive. Understanding that is, I think, an important part of mental health and depression. If you stop taking your medication cold turkey, you WILL get depressed. Maybe even severely depressed. This is a symptom of withdrawal and will likely pass once you've successfully weened from the medication.
Having said that, depression can be quite dangerous so you should come up with some sort of plan or program for discontinuing your medication, if you even want to stop taking it.
This was a great post. It also made me think of this- as a reader, I tend to think what I read in a book as somehow verified or true. But, often, it’s just what is known or believed at that time or even just a point of view. It speaks to the ephemeral side of book content, something that I don’t hear about as often.
I wrote a piece in Poets and Writers about The Fact Checked Memoir on this very topic: https://www.pw.org/content/the_fully_factchecked_memoir_backing_up_facts_standing_behind_truth
Will check it out
Yes, I certainly believed it!
Yes I know exactly what you mean! It’s important to remember that just because a book is published doesn’t mean it’s 100% accurate
I listened and read along--this is wonderful. Not only is the story here one that means a lot to me on its own, but the way it fits into this new space, 'The Books that Made Us' is also perfect. Just excellent.
Thank you. I hoped it would set a good standard for The Books That Made Us, such a great Substack.
I also just subscribed to Writers at Work--the welcome email mentions we could email you; do you have a preferred address for that? Or just reply to that welcome email?
Wonderful! Either way! mssarahfay1516@gmail.com
Thank you!
Haven't read this post yet, will this afternoon, but just wanted to say I love "Darkness Visible," I've read it a couple different times during rough patches in my life.
I've had this post flagged in my inbox for days. The title Darkness Invisible: A Memoir of Madness burned itself into my retina and I knew I had to read Sarah's essay, just needed to save it for when I had proper attention and presence. What a powerful, and hopeful, reflection on the journey of depression. As with all adversity, it often runs its course. Or shape-shifts with time as we draw meaning and purpose into our experiences so that when it strikes again, we have a little padding built around the blows.
What a beautifully written comment. Would love you to guest post here at some point,
Kimberly!
Yes! Kimberly would be great!
I would love that! Thank you for suggesting it. I can't say I've ever publicly reviewed any of my favorite books but this could be a fun challenge. :)
First time for everything!
Challenge taken!
Very well-written piece. Echoing others that this is the first time I’s heard that the chemical imbalance hypothesis might not be right. It is so entrenched that I never even thought to question it, I just accepted it as medical fact. So I really appreciate you bringing that misconception to light. It’s interesting, because the idea that depression isn’t a chemical imbalance makes the diagnosis feel less determinative, in that depending on the person and what they’re struggling with, medication might not be the only or even the best option.
Also, love that you are serializing your memoir on Substack. I’m working on my own memoir and have toyed with the idea of doing that if I can’t find a good fit with a traditional publishing house--would love to hear more about your experience!
Thank you and yes! Come to the workshop! https://www.writersatwork.net/p/serialize-your-novel-or-memoir-on
It's been a fascinating experience. Don't think about serializing if a traditional publisher doesn't take it. Think about doing it before you and your agent even go out with it. I'll go through all this during the workshop, but I'm serializing 'Cured' (the sequel to my first memoir, Pathological, which came out from HarperCollins) with my agent and editor.
And you're not alone in terms of the chemical imbalance theory--80% of Americans still believe it's true. I'm not anti-medication, but pharma did an excellent job of perpetuating the myth.
Thanks for the link--I will check this out, sounds like an excellent workshop!
(I believe Sarah is actually running a workshop on serialising a memoir on here quite soon, if you check out her Writers at Work stack)
Great intel, thanks!!
This is such an important topic. My son, whose fascination with psychology stems from harrowing personal experience during his teen years, showed me this TED Talk about studying brain scans to understand and eventually diagnose brain illnesses. Given the hit or miss nature of mental illness diagnosis (that's how it feels on the receiving end), this is fascinating and . . . maybe even hopeful? The promise of medication is built on a whole lot of assumptions, but when he was in deep crisis, anti-psychotic meds worked wonders. https://youtu.be/esPRsT-lmw8
Fascinating video, thanks for sharing
Isn't it?
A beautiful post from Sarah, and I'm pleased to know a little more about William Styron. Thank you,
Thank you!
This was such a great essay. I know it’s been said at least twice already, but this is the first time I’ve read that the chemical imbalance theory isn’t true. As someone who doesn’t live in a country belonging to the “developed” West, I can say that our medicine is a little bit outdated, so many psychologists and psychiatrists I’ve talked to believe in this theory and prescribe treatment accordingly. Moreover, many treatment options with low or even absolutely zero experimental results, like neurofeedback or theta healing, are in vogue here.
I have a family member who’s been taking meds for depression, based in this chemical imbalance theory, and while they do think the meds made a difference, they stopped taking them after about a year. As you and others pointed out, I don’t know if my family member feels better as a result of the meds or just of the passage of time.
This is a very sensitive topic, and as I get older, I come to realize that medicine in general is less of an exact science and more of a game of trial-and-error, of luck even, both in terms of the effectiveness of treatment on a given patient, as well as in terms of choosing the right doctor. My wife’s gone to no fewer than five dentists in the last few months, and they all have given her different diagnoses! How is this possible, I might have thought when I was a teenager, but now I’m not really surprised anymore.
Thank you for reading! I love the dentist analogy. And your note made me think (again) that there's nothing wrong with trial-and-error given we know so little about the brain and the mind; what's wrong is the biopsychiatrists and other mental health professionals who either pretend or think it's otherwise and make the rest of us believe it too.
I read a great book on this a few years ago called Lost Connections where the author argues that part of the upswing on depression and anxiety is due to 9 lost connections with things that give our life fulfilment and meaning. Things like friendships, purpose, nature, and stuff like that. Was very interesting read, think at least part of it must be true. Though I do believe that some people have the misfortune of being more prone to suffering from these afflictions, whether due to genetics or what I don’t know.
Johann blurbed 'Pathological'! He's great. https://www.amazon.com/dp/0063068680?tag=authorweb-20