We’ve all heard, and perhaps even relayed to others, the generally accepted wisdom that “depression is a chemical imbalance. It’s due to a lack of serotonin in your brain. You thus treat it chemically by taking SSRIs”. And yet, we’ve also seen our depressed clients not be magically cured by taking an antidepressant. Antidepressants do not make you “happy” and in general don’t have the affect our clients are hoping for.
If you’ve ever taken the time to look at the research on whether antidepressants even work, what you will find will shock you. 1 in 5 people actually become worse when they take them. For those that do report to feel better, the reason why they have improved seems to be entirely due to placebo. That’s right, the positive effect of antidepressants is due to placebo. Now, it’s shocking to me that something that causes so many negative side effects would be so widely prescribed (1 in 10 Americans) when factually speaking it doesn’t even work.
Let’s take a moment to examine this even further. SSRIs work by increasing the amount of serotonin in your brain. However, researchers now agree that serotonin is no longer believed to be the chemical of depression nor the chemical of happiness. This makes sense. If you want to know what serotonin feels like, just eat a carb-tastic meal. For me, that’s a big piece of shepard’s pie or whatever your comfort food of choice is. After you eat you’ll have a feeling of calm and contentment wash over you. That’s the serotonin. It’s certainly a pleasant feeling, but I wouldn’t describe it as “happiness” or the opposite of depression. Neither would your clients. And that’s why these medications don’t really work. By the way, they have not yet even found the happiness chemical.
What’s worse is that while they don’t really work, you are messing with people’s brains when a sugar pill would have the same positive effect. I don’t think messing with someone’s brain is something you should be doing unless you can really give a strong justification for it. You might think “I agree with you that these medications don’t really work, but what’s the harm of giving someone extra serotonin?” The problem is that our brain wants there to be a balance. When it gets artificially flooded with serotonin it responds by decreasing the other chemicals in your brain. Now you really have a chemical imbalance! This is why people can feel so “off” while they’re on these drugs.
I’ve been thinking that if there truly was a happiness chemical in our brain that they would have found it by now. What if happiness is not an “emotion” but rather a drive? It’s a drive for us to try to fulfill our needs and once those needs are filled, we get the “happiness reward” delivered by our brain. When we are not having our needs fulfilled, our brain creates this depressed feeling to try to motivate us to seek to fulfill our needs. It’s our body trying to tell us something and if we ignore it long enough it the depressed feeling eventually turns into full-blown depression. I came to this conclusion because this is something I’ve noticed with my clients. They are extremely deprived and depleted in their lives. But once I help them to make changes so that their needs and purpose is being fulfilled, the depression lifts. This is what makes me think happiness is a drive and that depression is not a “chemical imbalance”.
If happiness is a drive it is thus something we can create for ourselves by living a more purposeful and meaningful life, not something that can ever be brought about by taking a pill. Maybe when people do get that little placebo “boost” after taking the pill it’s because their brain is rewarding them for at least taking a step towards trying to satisfy those unfulfilled needs. However I would not expect such a boost to last if you still did not take steps towards improving your life afterwards. This may be why so many people report that their antidepressants stop working.
If it’s true that happiness is a drive, then I do not think that it will ever be possible to create a chemical treatment for depression that actually works. It would simply have no affect because it is not a chemical issue. If you are depressed because you’re struggling to pay the bills, your husband’s cheating on you, and the kids don’t respect you, you are going to stay depressed until that situation changes. No pill is going to stop that from being a depressing situation. If you are depressed, the best treatment is to create a life that is meaningful and purposeful and plays to your strengths instead of your weaknesses. As therapists, shouldn’t we be promoting this kind of treatment instead?