The Myth of Biological Depression

In the Introduction to his book Rethinking Depression (New World Library 2012, p. 3, italics his) California-licensed family therapist Eric Maisel, Ph.D., says this:

One of the goals of this book is to help you remove the word depression from your vocabulary and, as a result, from your life.  If depression were an actual disease, illness, or disorder you wouldn't be able to rid yourself of it just by removing it from your vocabulary.  But since it isn't a disease, illness, or disorder, you can dispense with it right this second.  What I would love for you to say is "I can't be depressed because there is no disease of depression!"

Similarly, in her book A Straight Talking Introduction to Psychiatric Drugs (PCCS Books, Ross-on-Wye 2009, p. 65), Joanna Moncrieff, M.B.B.S., M.Sc., MFRCPsych, M.D., Senior Lecturer in Mental Health Sciences at the University College, London, says this:

...it is important to say here that the term "depression" as currently used is misleading.  ...  there is no scientific evidence to support the idea that there are particular features of the brain that give rise to the particular feeling of depression.

      Unhappiness or "depression" alleged to be the result of bio­logical abnormality is called "bio­logi­cal" or "endogenous" or "clinical" depres­sion.  In her book The Broken Brain: The Bio­logical Revo­lu­tion in Psychiatry, University of Iowa psychi­a­try professor Nancy Andreasen, M.D., Ph.D., says "The older term endogenous implies that the de­pres­sion 'grows from within' or is biologically caused, with the implication that unfortunate and painful events such as losing a job or lover cannot be consid­ered con­trib­uting causes" (Harper & Row 1984, p. 203).  Similar­ly, in 1984 in the Chicago Tribune newspaper columnist Joan Beck alleged: "depressive disorders are basical­ly bio­chemical—and not caused by events or environ­mental cir­cum­stances or personal relation­ships" (July 30, 1984, Sec. 1, p. 16).  A July 2013 Readers Digest article (pp. 132-133) says "For the past 50 years, the conventional wisdom among many psychiatrists was that depression was caused by a brain-chemical imbalance such as low levels of the feel-good hormone serotonin."
      The concept of biological or endogenous de­pression is im­por­tant to psychiatry for two reasons.  First, it is the most common supposed mental illness.  As Victor I. Reus, M.D., wrote in 1988: "The history of the diagnosis and treatment of melancholia could serve as a history of psychia­try itself" (appear­ing in: H. H. Goldman, editor, Review of General Psychiatry, 2nd Edition, Appleton & Lange 1988, p. 332).  Second, all of psychiatry's biological "treat­ments" for depression—whether it is drugs, electro­shock, or psychosurgery—are based on the idea that the unhappiness we call depression can be caused by a biological malfunction in the brain rather than life experi­ence.  The erroneous belief in biologi­cal causation justifies the otherwise unjustifi­able use of biological thera­pies, primarily "antidepressant" drugs and electro­convulsive "therapy" (see Psychiatry's Electro­convulsive Shock Treatment—A Crime Against Humanity).  The biological thera­pies for this nonexistent "disease" of depression and other so-called mental illnesses also in theory justify the exis­tence of psy­chiatry as a medi­cal specialty distinguishable from psycholo­gy, social work, and coun­sel­ling.
      Many professional and lay people today think depression can be caused by "chemical imbalance" in the brain even though no chemi­cal imbalance theories of depression have been verified.  As psychiatry professor Thomas S. Szasz, M.D., said in 2006, "There is no evidence for a chemical imbalance causing mental illness, but that does not impair the doctrine's scientific standing or popularity" ("Mental Illness as a Brain Disease: A Brief History Lesson", szasz.com).  Psychiatry professor Nancy Andreasen discusses some of the chemical imbalance theories of depression in her book The Broken Brain.
      One of the theories she describes is the belief that "de­press­ion" (what I think should be called simply unhappiness or severe unhappi­ness) is the result of neuroendocrine abnormalities indicat­ed by excessive cortisol in the blood.  The test for this  is called the dexa­metha­sone‑suppression test or DST.  The theory behind this test and the claims of its useful­ness were found to be mis­taken, how­ever, because, in Dr. Andreasen's words, "so many patients with well‑defined depressive illness have normal DSTs" (pp. 180‑182).   An article in the July 1984 Harvard Medical School Health Letter reached a similar conclusion.  The article, titled "Diagnos­ing Depres­sion: How Good is the 'DST'?", report­ed that "For every three office patients with an abnor­mal DST, only one is likely to have true depres­sion. ... [And] a large fraction of people who are de­pressed by other criteria will still have normal results on the DST" (p. 5).  Similarly, in an article in the Novem­ber 1983 Archives of Internal Medi­cine three physi­cians concluded that "Data from studies cur­rent­ly avail­able do not support the use of the dexa­metha­sone ST [Suppression Test]" (Martin F. Shapiro, M.D., et al., "Biases in the Laboratory Diagnosis of Depres­sion in Medical Practice", Vol. 143, p. 2085).  In 1993 in her book If It Runs In Your Family: Depression, Connie S. Chan, Ph.D., acknowledges that "There is still no valid biological test for depression" (Bantam Books, p. 106).  Despite its having been discredited, some biologi­cally orient­ed psychi­atrists are (appar­ently) so eager for biologi­cal explanations for people's unhap­pi­ness or "depres­sion" that they continue to use the DST anyway.  For example, in his book The Good News About Depression, pub­lished in 1986, psychia­trist Mark S. Gold, M.D., says he continues to use the DST.  In that book Dr. Gold claims the DST is "highly touted as the diag­nostic test for biologic depres­sion" (Bantam, p. 155, emphasis in original).
      In The Broken Brain, Dr. Andreasen also describes what she calls "the most widely accepted theory about the cause of depression...the 'cate­cholamine hypothesis.'"  She emphasizes that "the catecholamine hypothesis is theory rather than fact" (p. 231).  She says "This hypothesis suggests that patients suffering from depression have a deficit of norepi­nephrine in the brain" (p. 183), norepineph­rine being one of the "major catechol­amine systems" in the brain (pp. 231‑232). One way the catechol­amine hypothesis is evaluated is by studying one of the breakdown products of norepi­nephrine, called MHPG, in urine.  People with so‑called depressive illness "tended to have lower MHPG" (p. 234).  The prob­lem with this theory, according to Dr. Andrea­sen, is that "not all patients with depression have low MHPG" (Id).  She according­ly concludes that this cate­cholamine hypothesis "has not yet ex­plained the mechanism causing depression" (p. 184).
      Another theory is that severe unhappiness ("depression") is caused by lowered levels or abnor­mal use of another brain chemi­cal, seroto­nin.  A panel of experts assem­bled by the U.S. Congress Office of Technology Assessment reported the following in 1992 (The Biology of Mental Disor­ders, U.S. Gov't Printing Office, pp. 82 & 84):

Prominent hypotheses concerning depression have focused on altered function of the group of neuro­transmitters called monoamines (i.e., norepi­neph­rine, epineph­rine, serotonin, dopamine), partic­ular­ly norepineph­rine (NE) and serotonin.  ...  studies of the NE [nor­epinephrine] autor­eceptor in depression have found no specific evidence of an abnormality to date.  Currently, no clear evidence links abnormal seroto­nin receptor activity in the brain to depres­sion.  ... the data currently avail­able do not provide consis­tent evidence either for altered neuro­transmit­ter levels or for disruption of normal receptor activity.

Even if it was shown there is some biolog­i­cal change or abnormali­ty "associat­ed" with de­pres­sion, the question would remain whether this is a cause or an effect of the "depres­sion".  A brain-scan study (using positron emission tomogra­phy or PET scans) found that simply asking normal people to imagine or recall a situa­tion that would make them feel very sad resulted in significant changes in blood flow in the brain (José V. Pardo, M.D., Ph.D., et al., "Neural Correlates of Self-Induced Dyspho­ria", American Journal of Psychi­a­try, May 1993, p. 713).  Other research will probably confirm it is emotions that cause biological changes in the brain rather than biological changes in the brain causing emotions.

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IN ALL OF HUMAN HISTORY THERE HAS NEVER BEEN EVEN ONE CASE IN WHICH IT WAS PROVED A PERSON FELT DEPRESSED BECAUSE OF A CHEMICAL IMBALANCE IN HIS OR HER BRAIN

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      One of the more popular theories of biolog­i­cally caused depression has been hypogly­ce­mia, which is low blood sugar.  In his book Fight­ing Depression, published in 1976, Harvey M. Ross, M.D., says "In my experience as an ortho­molecular psychiatrist, I find that many patients who complain of depression have hypo­glycemia (low blood sugar).  ...Because depres­sion is so common in those with hypoglycemia, any person who is depressed without a clear cut obvious cause for that depression should be suspected of having low blood sugar" (Larchmont Books, p. 76 & 93).  But in their book Do You Have A Depres­sive Illness?, published in 1988, psychia­trists Donald Klein, M.D., and Paul Wender, M.D., list hypogly­cemia in a section titled "Ill­nesses That Don't Cause Depres­sion" (Plume, p. 61).  The idea of hypoglyce­mia as a cause of depression was also rejected in the front page article of the November 1979 Har­vard Medical School Health Letter, titled "Hypo­glycemia—Fact or Fiction?".
      Another theory of a physical disease caus­ing psychological unhappiness or "depression" is hypo­thyroidism.  In her book Can Psycho­thera­pists Hurt You? psychologist Judi Striano, Ph.D., in­cludes a chapter titled "Is It Depression—Or An Underactive Thyroid?" (Professional Press 1988).  Similarly, three psychiatry professors in 1988 asserted "Frank hypo­thyroidism has long been known to cause depres­sion" (Alan I. Green, M.D., et al., The New Harvard Guide to Psy­chiatry, Harvard Univ. Press 1988, p. 135).  The theory here is that the thyroid gland, which is located in the neck, normally se­cretes hormones which reach the brain through the blood­stream necessary for a feeling of psychologi­cal well being and that if the thyroid produces too little of these hormones, the affected person can start feeling unhappy even if no prob­lems result from the endo­crine (gland) problem other than the unhappi­ness.  The American Medi­cal Association Encyclo­pe­dia of Medicine lists many symptoms of hypothy­roidism: "muscle weakness, cramps, a slow heart rate, dry and flaky skin, hair loss ... there may be weight gain" (Ran­dom House 1989, p. 563).  The Ency­clopedia does not list unhap­piness or "depres­sion" as one of the conse­quences of hypo­thyroidism.  But suppose you began to experi­ence "muscle weak­ness, cramps...dry and flaky skin, hair loss ... weight gain"?  How would this make you feel emotional­ly?—depressed, probably.  Just as hypo­thyroidism (hypo = low) is a thyroid gland that produces too little, hyperthyroid­ism is a thyroid glad that produces too much.  Therefore, if hypo­thyroid­ism causes depression, then it seems logical to assume hyperthyroidism has the opposite effect, that is, that it makes a person happy.  But this is not what happens.  As psychiatrist Mark S. Gold, M.D., points out in his book The Good News About Depres­sion: "Depression occurs in hyper­thyroid­ism, too" (p. 150).  What are the conse­quenc­es of hyperthy­roidism?: Dr. Gold lists abun­dant sweat­ing, fatigue, soft moist skin, heart palpita­tions, frequent bowel movements, muscular weak­ness, and protruding eyeballs.  So both hypo- and hyper- thyroidism cause physical problems in the body.  And both cause "depression".  This is only logical.  It is hard to feel anything but bad emo­tion­ally when your body doesn't feel well or work properly.  It has never been proved hypothyroidism affects mood other than through its effect on the victim's experi­ence of feeling physi­cally unhealthy.
      Some people think chemical imbalance related to hormonal changes must be a possible cause of "depression" because of the supposed biological causes of women's moods at different times of their menstrual cycles.  I don't find that argument con­vincing because I've known so many women whose mood and state of mind was consis­tently unaffected by her menstrual cycle.  Psycholo­gy pro­fessor David G. Myers, Ph.D., labels pre­menstrual syndrome (PMS) a myth in his book The Pursuit of Happiness (William Morrow & Co. 1992, pp. 84-85).  Of course, some women experience physical discom­fort due to men­struation.  Feeling lousy physically is enough to put anybody in a bad mood.
      Some people believe women experience undesir­able mood changes for biological reasons because of menopause.  However, a study by psy­chologists at University of Pittsburgh reported in 1990 found that "Menopause usually doesn't trigger stress or depres­sion in healthy women, and it even improves mental health for some".  Ac­cording to Rena Wing, one of the psychologists who did the study, "Everyone expects menopause to be a stress­ful event, but we didn't find any support for this myth" ("Meno­pausal stress may be a myth", USA Today, July 16, 1990, p. 1D).
      It is also widely believed that women go through a period of depression for biological rea­sons after giving birth to a child.  It's called post­partum depression.  In his book The Making of a Psychia­trist, Dr. David Viscott quotes Dr. George Maslow, a physi­cian doing an obstetrical residen­cy, making the following remark: "Come on, Viscott, do you really believe in postpartum depression?  I've seen maybe two in the last three years.  I think it's a lot of shit you guys [you psychiatrists] imag­ined to drum up business" (Pocket Books 1972, p. 88).  A woman who had given birth to eight (8) children, which in my opinion qualifies her as an expert on the subject of post­partum depression, told me what she called "post­partum blues" are real, but she attributed postpar­tum blues to psychological rather than physio­logical causes.  "I don't know about the physio­logi­cal causes", she said, but "so much of it is psycho­logical."  She said "You feel awful about your looks", because in our society a woman is "sup­posed" to be thin, and for at least a short time after giving birth a woman usually isn't.  She also said after childbirth a woman feels consider­able "physi­cal exhaustion".  Child­birth also is the begin­ning of new or increased parental obliga­tions, which if we are honest we must admit are quite burden­some.  The arrival of new or addi­tional parental obligations and the realization of the negative ways new or addition­al parenthood obligations will affect a woman's (or man's) life is an obvious non-biologi­cal explana­tion for postpartum depression.  It may not be until the actual birth of the child that parents realize how parenthood changes their lives for the worse, but a letter from a female friend of mine who at the time was only three months preg­nant with her first child illustrates that depres­sion associ­ated with childbirth may come long before the postpartum period: She said she was frequently break­ing down in tears because she thought with a child her life would never the same and that she would be a "prisoner" and wouldn't have time to do what she wanted in life.  A reason these psy­chologi­cal causes are often not candidly acknowl­edged and postpartum (or pre-partum) blues instead attribut­ed to unproven biolog­i­cal causes is our reluctance to admit the downside of parenthood.
      Another theory of biologically caused depres­sion is based on stroke damage in the left front region of the brain causing depression. What makes it seem possible this might be neuro­logically caused rather than being a reaction to the situation a person finds himself in because of having had a stroke is stroke damage in the right front of the brain alleged­ly causing "undue cheer­fulness."  However, a careful reading of books and articles about neurolo­gy for the most part doesn't support the allegation of undue cheerful­ness from right front brain damage.  Instead, what most neurologi­cal literature indicates sometimes results from right front stroke-related brain dam­age is anosagnosia, usually de­scribed as lack of concern or inability to know their own prob­lems, not happi­ness or cheer­fulness (e.g., neurology professor Oliver Sacks in The Man Who Mistook His Wife for a Hat and Other Clin­ical Tales, Harper & Row 1985, p. 5).
      Perhaps the most often heard argument is that antidepressant drugs wouldn't work if the cause of depression was not bio­logi­cal.  But antide­pressant drugs don't work.  As psychiatrist Peter Breggin, M.D., says in his book Talking Back to Prozac (St. Martin's Press 1994, p. 200), "there's no evidence that antide­pres­sants are especially effective".  Or as British psychiatrist Joanna Moncrieff writes in her book The Myth of the Chemical Cure—A Critique of Psychiatric Drug Treatment (Revised Edition, Palgrave Macmillan 2009, pp. 144 & 152)—

...contrary to current opinion, antidepressants are not superior to placebo even in the most severe forms of depression.   ... The idea that antidepressants have a specific action on a biological process is still cited as the main justification for the idea that depression is caused by a biochemical abnormality.  ...  However, the evidence reviewed above suggests that antidepressant drugs do not exert a specific effect in depression.