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Mental Health: Serotonin is Only Part of the Story

Bethany Butzer's picture

mental  health

When I was on antidepressants, my doctor told me a story that many doctors around the world tell their patients every day: “Taking antidepressants is like a diabetic taking insulin. The insulin helps the diabetic with their problem, so why stop taking it? If you have a chemical imbalance in your brain and the antidepressants are helping to regulate that, then often it doesn’t make sense to stop taking the medication.” The problem with this story is that in many cases, it’s false.

Equating mental illness with physical illness is both premature and misleading. Don’t get me wrong, I do believe that physical and chemical factors are involved in mental illness to some extent and for some people, but I also believe that treating mental illness in the same way that we treat diabetes or high cholesterol causes us to draw many false parallels between mental and physical disorders.

On the one hand, equating mental and physical illness is beneficial in that it helps relieve some of the stigma associated with taking antidepressants. Bringing anxiety and depression into the body, as opposed to thinking it’s “all in your head,” provides a sense of normalcy. In the same way that uncle Joe takes his heart medication every day to stay alive, you take your brain medicine every day to stay sane.

The downside to this explanation is that attributing anxiety and depression to a chemical imbalance is horribly disempowering. Instead of feeling like you have any say in the matter, you throw in the towel and decide there’s nothing you can do about your mental health because it’s all chemical. So you stop going to therapy, you stay in your dysfunctional relationship, or you forego that yoga class. You tell yourself there’s no point bothering with any alternative approaches because there’s nothing you can do to change your brain. Unfortunately, this point of view closes the door on a huge number of resources that could be beneficial to your well-being.

Believe me, I know how this feels.

There’s a lot of mental illness in my family, and I figured that taking antidepressants forever was simply my fate. Some doctors even told me that, based on my history, it was likely that I would have to take antidepressants indefinitely. So for years I resigned myself to the fact that I would have to take antidepressants for the rest of my life.

I was wrong. And I truly believe that many people who fall victim to this story are also wrong.

I wholeheartedly agree with Joseph Glenmullen, M.D., author of Prozac Backlash, who states that in all likelihood, 75% of the people who are currently taking antidepressants can significantly reduce their dose or stop taking antidepressants completely (with the help of their doctor and other lifestyle changes).

I think it’s also crucial to point out that the whole “serotonin deficiency” idea is still much more of a hypothesis than a fact. As Dr. Glenmullen points out in his books Prozac Backlash and The Antidepressant Solution, a serotonin deficiency for depression has not been conclusively found. In fact, most of the tests that have examined the serotonin deficiency hypothesis have been done on rat brains that have been mashed to bits and placed in test tubes. These test tube studies do show that SSRI-type antidepressants raise serotonin levels. However, extrapolating the results from blenderized rat brains to living human brains is shady at best (and pseudoscience at worst). This is almost equivalent to saying that someone whose headache goes away when they take a Tylenol has a Tylenol deficiency.

It’s actually impossible to measure serotonin levels in living humans with much accuracy. This is why when you go to the doctor with depressive symptoms they don’t send you for a serotonin blood test. Blood levels of serotonin are not very useful, since the blood in our arm is far removed from our brain, and 95% of the serotonin in the body is in our stomach and other tissues. Plus, serotonin is involved in many other things besides mood, such as appetite and sex, which is why antidepressants have various side effects.

This is one of the key ways that anxiety and depression are different from physical illness: you can’t do a blood test for mental disorders. In other words, the way that we diagnose mental disorders is completely subjective. The Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, is what psychiatrists and psychologists use to diagnose mental illness. This book is made up of endless lists of symptoms that were compiled by experts in various areas. Many of these diagnoses are still hotly debated, and the subjectivity of the DSM is captured perfectly by the fact that as recently as the 1980s homosexuality was listed as a mental disorder. 

Even if, somewhere down the line, it were unequivocally proven that people with anxiety and depression have a chemical imbalance, this wouldn’t necessarily prove that this imbalance is the cause of the problem. To illustrate this fact, Dr. Glenmullen uses the example of someone who is robbed at gunpoint. If this person was tested afterwards, they would have all sorts of stress hormones and chemicals racing through their body. But these hormones and chemicals would be the result of the psychological trauma, not the cause.

As Dr. Glenmullen notes in Prozac Backlash:

The truth of the matter is: No one has anything but the vaguest idea of the chemical effects of these drugs on the living human brain.

In fact, regulatory agencies in Ireland and other countries have forced pharmaceutical companies to stop claiming that antidepressants correct a serotonin imbalance in their marketing of these drugs.

In the end, I think that current research suggests that serotonin probably does have some sort of an effect on our mood. But the mechanisms by which this occurs are far from well understood. The human brain and the neurotransmitters within it are extremely complex, and it’s enormously premature for scientists and pharmaceutical companies to be acting like they have it all figured out.

Many years from now, medical professionals are probably going to look back at this point in history and be amazed at how easily we jumped onto the bandwagon that anxiety and depression are caused by a shortage in one or two neurotransmitters. I think our acceptance of this idea reflects our longing and desire for a simple solution. After all, if mental illness was just like diabetes or heart disease, we could provide fast relief for a lot of people who are suffering.

Unfortunately, mental illness isn’t this simple.

I’m always very careful to let people know that I’m not completely against the use of antidepressants. If antidepressants work for you and help you get over a tough period in your life, then so be it. However I strongly encourage anyone suffering from anxiety or depression to always keep an open mind and investigate the many alternatives to antidepressants – even if you’ve been told that you probably have a chemical imbalance.

We need to stop giving our power away based on explanations that haven’t been scientifically proven. Reclaim your power and know that the totality of who you are is far more than the effects of one or two brain chemicals.

Know that your mental health is in your hands, not your head.

Bethany Butzer, Ph.D. is an author, speaker, researcher and yoga teacher who provides inspirational products and services that help people manage their stress and mood. Bethany suffered from anxiety and depression in her early 20s, and she's made it her mission to motivate others to achieve their highest level of mental fitness.

Bethany's book, The Antidepressant Antidote, chronicles her personal struggles with anxiety, depression and a dependence on antidepressant medication. She also shares how she finally managed to get off the medication for good.

Bethany truly believes that everyone is meant to enjoy optimum mental health. All of the products and services that she offers, from her writing, speaking engagements and research projects to her yoga classes for anxiety and stress, are geared toward making the world a better place by nourishing and honoring our mental wellness. www.bethanybutzer.com


poo's picture

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Carol's picture

Reduction of dosage

I realize what I am sharing is anecdotal, but I also know anecdotes can be like metaphors to help up better understand.
I was diagnosed with clinical depression about 10 years ago.... I was sick. My MD prescribed an anti-depressant and therapy. The meds gave me the energy to do the incredibly hard, but ultimately rewarding work of therapy.
I am now a practicing yogini and yoga teacher. From within my deepest sense of knowing, I know that without the meds and therapy, I would probably not be here. I also know that adding yoga to my daily routine has allowed me to reduce the dosage of the meds I take.
I am reluctant to think in either/ors... for me the combination of Western traditional medical practices and complimentary medical practices has brought me to a place of understanding and self acceptance I never expected to achieve.

Bethany Butzer's picture

Thank-you for sharing

Thank-you for sharing Christina! I wholeheartedly agree that antidepressants are necessary in some cases and that neurotransmitters like serotonin are involved in anxiety and depression. However I also believe that people aren't often made aware of alternatives to antidepressants, which is unfortunate. I do believe that, even when people suffer from a chemical imbalance, there are still aspects of their mental health that are "in their hands." I appreciate you sharing your thoughts, as this helps open up the conversation around this issue.

I also encourage you to check out Lissa's recent blog "1 in 5 Americans Takes a Psychiatric Drug": http://www.owningpink.com/blogs/owning-pink/1-5-americans-takes-psychiat...

Much love,


Christina's picture

Saying that mental health is

Saying that mental health is "in your hands" is also misleading and potentially dangerous and stigmatizing. It's great that you were able to stop taking your medication, but it doesn't mean that 90% or even 50% of people on antidepressants would be better off without them or have the ability to control their brains.

A lot of people do not have scientific or medical backgrounds, and when they read a post like this - which claims that the literature on depression is nothing more than looking at mashed up rat brains in test tubes, they may accept it as gospel. That is misleading and unfair to the variety of ways and techniques in which depression and other mental disorders have been studied.

It is CERTAINLY true that our actions contribute to the way that ALL of our body systems function. Just as an individual with Type 2 Diabetes should not take his medication without also understanding the diet and exercise component of care, a person with anxiety and depression should be cognizant of various ways they can proactively help to control their systems.

The brain is complex, and we have not yet found a meaningful way to measure potential pathophysiology in the average patient, but that does not mean the brain is exempt from suboptimal functioning that can benefit form modern medicine.

Christina's picture

*systems = symptoms

*systems = symptoms

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