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Do Antidepressants Cause a “Chemical Imbalance?” Likely.

I’m not sure when pharmaceutical companies started marketing that a “chemical imbalance” is the cause of depression. Either way, this is a great marketing ploy that really gets people to believe that if they are feeling “depressed,” it must be a result of a natural chemical imbalance. In reality, most people do not likely have major problems with levels of various neurotransmitters.

However, the most popular way to treat depression is the quick fix method – taking a “drug” before trying other alternatives. What most drugs do (SSRI’s) is prevent the reuptake of the neurotransmitter “serotonin.” The neurotransmitter serotonin is involved in influencing: sleep, aggression, impulsivity, mood, and anxiety levels. When serotonin levels increase, it may make some people drowsy and result in feelings of pleasant relaxation.

Although SSRI’s work for awhile, most people either develop a tolerance and come off of them OR they cannot cope with the detrimental side effects. When a person withdraws from an SSRI, a new problem is created – a “chemical imbalance.” Serotonin levels do not dramatically get restored overnight – it can take months to correct the imbalance that was created by SSRI’s.

How Antidepressants Cause A Chemical Imbalance

It is pretty logical that taking antidepressants can create an increased imbalance of neurotransmitters in the brain. Most people believe that SSRI’s only affect serotonin, but other evidence has pointed to the fact that certain drugs may indirectly influence levels of other neurotransmitters and hormones.

1. The person takes an antidepressant – A person begins treatment by taking an antidepressant medication. Typically the person will stay on this drug for a period of at least 90 days (3 months). Over this timeframe, the person’s brain will have changed from one that is drug free, to one that depends on the drug-induced changes in serotonin activity.

2. The antidepressant increases serotonin – The antidepressant increases the amount of serotonin at the synapses in the brain. The brain reacts by making the individual feel a boosted mood, less anxious, and typically more relaxed. Eventually the brain will become sensitized to receiving the drug and essentially change by becoming tolerant and adapted to the drug that it has been receiving.

3. The drug loses effectiveness – After treatment for a long term, the drug will eventually either: lose effectiveness or stop working. The loss of effectiveness is because your physiology has been altered from when you originally started the drug. Various changes in brain activity, hormone levels, and neurotransmitter levels have resulted in the drug “pooping out.”

4. Doctors have to up the dose – When this happens, a person usually panics and goes to their doctor or psychiatrist and asks what they can do. Most professionals will merely throw more of the antidepressant formula at the person – increasing the dose. The increased dosage may work, but it will be temporary once again. Sometimes the increased dose doesn’t even work and/or results in debilitating side effects. Many times people switch drugs to another SSRI and find that another drug doesn’t work either – this is a result of the serotonin system being altered by the first medication.

5. Inevitable withdrawal – Eventually the individual that was on an SSRI is going to have to withdraw from it. If conducted “cold turkey” the symptoms experienced will be extremely severe because the brain has become reliant upon the drug for functioning. If a gradual “taper” is conducted, the person is still going to experience an SSRI-induced chemical imbalance.

6. Chemical imbalance is created – Not only will the serotonin level be significantly lower than before the individual started the medication, a new problem is created: an SSRI-induced chemical imbalance. Really the only way to feel the way you did “pre-SSRI” is to play the waiting game. Your physiology (e.g. hormones, neurotransmitters, etc.) must be reset to homeostasis – which can take awhile (months and/or years).

7. Brain attempts to restore homeostasis – The reason some people experience “withdrawal symptoms” or “post-acute withdrawal” symptoms upon discontinuation from an antidepressant is because their entire physiology is out of balance. As your physiology attempts to restore itself to homeostasis, you encounter many unpleasant states of consciousness and may experience: mood swings, anxiety, depersonalization, etc.

8. Brain functioning changes – The way the person operates and functions has now changed. They are literally a different person than before. In some cases, people are able to actually find peace after a year or two of being antidepressant-free. This is in part due to the fact that taking the antidepressant and withdrawing shook up the person’s reality enough for them to make much needed lifestyle changes. However, some people are not lucky enough to experience any sort of recovery and may even experience deeper depression than before.

9. Hooked on SSRI’s for life? – Some people are on antidepressants for life, especially after they quit their first one. Quitting one antidepressant can result in very low levels of serotonin, to the point that a person keeps trying other SSRI’s to find relief. The newly created chemical imbalance actually created a significantly more severe depression than the person originally had “pre-SSRI.” This newly created chemical imbalance is actually resistant to most forms of treatment because the person’s serotonin system hasn’t had time to correct itself. Throwing more SSRI’s at the problem may provide temporary relief, but is not a long term solution.

10. Treatment-resistant depression – Many people will develop treatment-resistant depression as a result of the chemical imbalance that is created from using an SSRI for an extended period of time. Most individuals that withdraw from these drugs don’t realize that the withdrawal process alone is likely going to make them extremely depressed. During the withdrawal, depression may be unbearable, but it is important to fight through it. If you end up constantly switching medications, your brain will never have time to recover and restore the neurotransmitters that were used up by the SSRI. In some cases this “chemical imbalance” is resistant to all forms of treatment because the individual has abnormal serotonin functioning and/or levels. It takes time for this to heal – sometimes a very long term.

Antidepressants vs. Illicit Drugs to Treat Depression

The major difference between antidepressants and illicit drugs is that antidepressants have been found to be relatively “safe” in the eyes of the FDA for the treatment of depression. Additionally they have been studied and found to be effective for treating symptoms of depression. Trials were conducted and each drug went through an extensive period of rigorous trials to make sure that they could be tolerated by people.

Antidepressants take awhile to achieve “effectiveness” in many people, but most people end up responding to one drug. When they achieve the antidepressant effect from the drug that they are taking, it feels good. Life feels better and the person can now function. The reason antidepressants are not controlled substances is because they really cannot be abused due to gradual build up and potential of severe side effects.

Illicit drugs on the other hand have not been studied for treating depression or approved by the FDA. However, most people will find that when they get “high” off of a drug that temporarily increases neurotransmitters, they feel pretty good. The difference between illicit drugs and antidepressants is that with illicit drugs, the antidepressant effects are short lived and a person will build up a tolerance and “crash.”

In the event of a crash from illicit drugs, a person’s brain is trying to restore itself to a state of functional homeostasis. The neurotransmitters and brain activity was thrown off by the drug, and most people experience symptoms to go along with it. When it comes to antidepressants, the withdrawal process can also leave the brain in a state of chemical imbalance.

It is the newly created imbalance in neurotransmitter levels that causes people to suddenly become even more depressed than when they first started an SSRI. The problem is that the person experiencing the increase in depression believes now that they have always had a chemical imbalance and that their brain eventually would have become severely depressed on its own.

In reality, when you prevent the reuptake of serotonin in the brain for long periods of time, the person is likely going to have abnormally low levels of serotonin for an extended time when they first quit taking the drug. Before you use an antidepressant, there is no way to know the levels of your neurotransmitters and whether your “serotonin is low.” Professionals just say that “low serotonin” can cause depression because people respond well to SSRIs.

This just means that for some people, preventing reuptake of serotonin can reduce depression – it doesn’t indicate that the person had abnormally low serotonin before starting an SSRI. What will cause abnormally low serotonin is staying on an SSRI for an extended period of time and withdrawing. It will take your brain awhile to reestablish normal levels of neurotransmitters during withdrawal.

Factors that influence neurotransmitter levels

There are plenty of factors that influence neurotransmitter levels besides that of antidepressants. You should not merely get on an antidepressant unless you have changed all aspects of your life to reflect a picture of health. If you are not: eating a fairly healthy diet, socializing, getting plenty of exercise, etc. – you are likely going to feel depressed.

  1. Genetics – Most people with optimal neurotransmitters have favorable genetics that support good mental health. People that are extroverted tend to have dispositions against developing depression, anxiety, and mood disorders.
  2. Diet – If you are not eating a balanced diet with plenty of protein, carbohydrates, fruits, and vegetables – this could be your problem. Most people with depression are typically not getting adequate protein in their diets. Unfortunately a majority of people don’t think to make dietary changes to determine if it would improve their mood before going on an SSRI.
  3. Exercise – Do you even exercise? Plenty of people claim to have tried “exercising,” but they haven’t seriously exercised. Consistent aerobic exercise has been found to boost mood by elevating endorphins and releasing pleasurable neurotransmitters in the brain. (Read: Psychological benefits of exercise).
  4. Environment – What type of environment are you in? People that are in an abusive, dangerous environment have different brain activity than someone in a calm, peaceful environment. This is why kids that are bullied on a daily basis become depressed – they are having a tough time with their environment.
  5. Activities – The activities you engage in on a daily basis can influence your neurotransmitters. If you constantly isolate yourself from society and avoid people, you are going to have less connections to help you cope with social situations.
  6. Drugs – If you use other drugs such as: alcohol, caffeine, nicotine, marijuana, etc. – this can influence levels of neurotransmitters. Have you ever felt depressed or lethargic a night after drinking? This is a result of your physiology trying to restore functioning after enduring the alcohol exposure.
  7. Beliefs / Thoughts – Something as simple as thinking positively can change a person’s outlook and mental functioning. The reason cognitive behavioral therapy (CBT) works just as well as antidepressant drugs for depression is because it targets faulty thinking. By changing the way you think, you are creating thoughts that support a better mood.

Antidepressants: Should Be A Last Resort

I understand that people use antidepressants with success. I know that there are plenty of individuals that really have tried everything and who make no excuses. There are tons of honorable people that have been to mental “hell and back” and need an antidepressant drug to help them cope with reality. Some people just have just inherited bad genetics or genetics that contribute to them behaving in a certain way.

People that cannot cope with their reality need some support and/or outside help. Individuals with depression usually don’t try to become depressed. They end up depressed because their brain isn’t allowing them to enjoy life or reality. Usually they have tried many things to improve their situation and have come to the conclusion that nothing will help.

When someone reaches the point of considering suicide because they know they will never be able to: enjoy life and/or contribute to society, then an antidepressant should be utilized. These drugs can help patch the depression and help an individual realize what it’s like to “feel good” in life. Although this is a “drugged” feeling and certainly not what a normal person feels like, it may be just what a person needs to feel better and function.

With that said, the person on an antidepressant will likely have to withdraw from it eventually. The withdrawal process is not going to be easy, because when stopping, a new chemical imbalance will be created. Thus, for awhile, a person may actually need an antidepressant just to feel “normal.” This is because previous treatments with antidepressants have created a new chemical imbalance.

Final thoughts: Drugs are never a permanent solution to mental illness, but they are one of the only tools people have to deal with their depression. Depression can be very debilitating and lead a person to committing suicide. If a person is able to find relief on a medication to the point that they can actually enjoy life, the antidepressant treatment is well worth it.

However, a lot of people don’t realize that these medications can actually create a new problem – that of a chemical imbalance. Since the person taking it may lack perspective as to how they felt “pre-SSRI” treatment, they may just assume that they have organically developed treatment resistant-depression, when in reality it was caused by the treatment.

Always understand that with any drug that makes a person feel good and “happier” – they may experience a comedown and withdrawal that in some cases is equal to or greater in proportion to the level of happiness that was experienced while on the drug.  The irony is that the drugs marketed to treat a “chemical imbalance” can actually create a chemical imbalance in individuals where there was never one to begin with.

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{ 19 comments… add one }
  • wendi September 2, 2014, 4:29 pm

    What a great article. It does leave me wondering about the long term effects of other drugs in regards to a chemical imbalance once stopping the drug. I took darvon for RLS (low dose every evening for many years). After I stopped it, (it’s been a year and a half), I’m still somewhat depressed, really unmotivated and fatigued, however, I made substantial life changes so my body could recover. Do you have recovery stories of the brain coming back into balance after long term drug use that effects neurotransmitters.?

  • Christine December 19, 2014, 4:34 pm

    I can attest first hand to how complex this is when you have withdrawn from snri’s or ssri’s and can’t figure out if you need to go back on. There seems to be a huge lack of actual data on this. How to tell whether it’s your body still adjusting to the lack of the drugs, or the depression returning? How long is a good amount of time to wait? These questions are not clear to me.

  • Gretchen December 22, 2014, 6:23 am

    Thank you for this interesting article. Unfortunately it was what I was fearing. I have been on SSRI’s for almost 20 years and I still have mental health issues. I wish I never took them to begin with!! :( feeling hopeless

    • GLOOM December 22, 2014, 9:23 pm

      The good news is that your brain is not permanently “stuck” in this imbalance. If given proper time and nourishment, it can successfully recover and change for the better.

    • Elizabeth May 4, 2015, 5:18 pm

      Gretchen, you’re not hopeless! I had taken them for over ten years and am off now! If they take time to change your brain then it takes time for organic methods to change things too (exercise, therapy, reading, omega-3s, vitamin b12, ect.) your brain never stops working/developing and creating new cells until you’re dead! Keep educating yourself. Your story can help so many!

  • Carla Poole March 30, 2015, 2:11 am

    Thank you, thank you for this great information! I feel awful on these antidepressant and I thought I needed to have more. Thank you again!

  • Brian April 30, 2015, 4:13 pm

    I have been off of antidepressants for one year and have not been able to recover. I now have worse depression than I ever had before taking the drugs, I have chronic digestive problems, nerve damage to my legs and feet and arms, and am thinking of suicide frequently. These drugs ruined my body and my life.

    • Carrie August 20, 2015, 2:52 am

      Brian, don’t give up. It took me two years. I am not my old self, but the agony is over. I think it was brain damage. I know they say we can’t feel our brains, but in my lifetime they said brains can’t grow new neurons. They can. Anyway, it felt like my brain was freezing and burning. Coconut oil seemed to let me turn a corner near the 2-year mark. I’m still not not functional–I would sit in one place all day if I could. But the mental anguish (dread, regret, doom) that came after a somewhat psychotic SNRI withdrawal is gone. What were you on?

  • Carrie August 20, 2015, 2:47 am

    Brian, it gets better. It took two years for me to stop feeling like you do. Now I am lethargic and stupid, but the deep dark hellish inhumane despair of post-antidepressant brain damage faded. I honestly think coconut oil did the trick after two weeks of putting two tablespoons in my coffee in the morning. (They are testing it at USFlorida for Alzheimer’s so it must do something).

  • Jennifer June 7, 2016, 5:58 am

    Thank you for this honest article, I wish I had read something like this years ago before I ever took an SSRI. I went on Zoloft for mild, mostly situational anxiety. At first I thought it was a miracle, I felt wonderful for about 2 weeks, then over time, a kind of depression set in, something I’d never experienced before.

    It didn’t occur to me it was the pills because they are called antidepressants. Eventually I sort of leveled out, but from that point I was experiencing a kind of low level depression, like I was sort of numb. They no longer did much for my anxiety either, but I couldn’t stop taking them because extreme withdrawal symptoms would kick in after a few days, so I was stuck on antidepressants for 13 years until I found out you are supposed to taper, which I did over 2 months.

    But even that was much too fast and now I’ve been in protracted withdrawal for over 3 years and one of the symptoms I now have is depression, which I never had before starting on the drug. I actually have a whole heap of symptoms I never had before, my whole body has been affected, my life ruined and there is no cure or treatment apart from time. Don’t ever start on these poisons unless your life depends on it because eventually they will ruin your life.

  • Keith June 25, 2016, 1:13 pm

    So the imbalance these medications allegedly fix, creates an imbalance when you stop make things worse. #Money #Greed #Suffer

  • Brendan July 14, 2016, 8:23 am

    Really good to find an article like this. I took paroxetine for 5 years and tapered off 5 months ago. I feel like my brain has been changed. I am extremely slow, can’t grasp concepts or conversation, have much worse social and general anxiety than before meds, and depression. It feels like there is just something missing from my brain and it’s not firing at all.

    It does feel like brain damage, but it is so hard to explain to anyone. I really don’t want to return to meds and regain that numb, alternate reality where everything is fine, because I know eventually I’ll have to return to the real world and deal with this again. So I am trying everything I can to get out of this state without meds, feels like it’s going to take a very long amount of time to ever start feeling okay again or normalish.

    Please consider everything else before beginning SSRI’s.

  • Thomas August 16, 2016, 4:02 pm

    Hello… so how do you explain that some people don’t experience withdrawal?

    • GLOOM August 16, 2016, 10:56 pm

      I think the lack of a said “withdrawal” can be chalked up to a few things, including:

      1. Immediate transition: Most who report fewer withdrawal symptoms tend to immediately transition to another medication, multiple medications, and/or supplements – each of which target similar neurotransmitter systems… This essentially masks the imbalance induced by the prior medication or makes it more manageable. If I were to switch from Paxil to Prozac immediately, I may notice some discontinuation effects, but they’d probably be less severe than if I stopped Paxil cold turkey.

      2. Tapering: Slow downward titration of dosing over an extended duration may also reduce likelihood of a perceived “withdrawal”…

      3. Genes: Specifically CYP2D6. While taking certain ADs, patients may not feel anything if they are ultrarapid metabolizers… This is because the plasma levels are not high enough to deliver any effect – the med is metabolized too quickly. For this reason, when they discontinue usage, they don’t feel much different than when they used it. It is also possible that “genes” or gene complexes promote quicker transition to neurochemical homeostasis, and if you happen to have those genes, you experience a shorter and/or less significant withdrawal (or protracted AD-induced chemical imbalance).

      4. Belief: Being told “there’s no such thing as a withdrawal,” can have profound implications, leading patients to believe that what they experience is NOT withdrawal. Instead, the patient may simply report a worsening of his/her “condition” characterized by new symptoms without knowing there’s such thing as withdrawal.

      5. Lack of self-awareness: Let’s face it, not everyone is adequately self-aware to pick up on changes that occur when they use and discontinue various substances. They may notice slight differences, but their awareness is clouded and self-perception. There are individuals who report zero withdrawal from potent psychostimulants, yet if we objectively measured their cognitive function after discontinuation – noticeable impairment may linger for months as a result of a chemical void/imbalance associated with psychostimulant usage that will require time for recovery.

      To be clear, this article isn’t implying that the only “imbalanced” neurochemistry occurs is through antidepressant usage. It’s likely that many users of ADs exhibited substantial neurochemical irregularities prior to AD usage. That said, it makes logical sense that long-term, daily antidepressant administration alters neurochemistry/connectivity, in such a way, that additional imbalances emerge during treatment, as well as after discontinuation – possibly leaving a person even more “imbalanced” than they once were.

      • Thomas August 21, 2016, 4:06 pm

        Thanks for answering. I must say, anyhow you’re very quick to neglect the easiest and most logical answer: that a person was bad-the drug helped (somehow) – and went back to bad when the drug was discontinued. That should be the first alternative to take into account by logical reasoning but the net is full of people blaming anything else than the individual. Human nature in a nutshell. P.S. I’m not advocating for pills, I really wish there was another solution to mental problems.

        • GLOOM August 23, 2016, 1:45 am

          Agree with your perspective… (there are likely many other possibilities as well). That said, I think that if we analyzed neural activity prior to treatment with a psychiatric drug (e.g. connectivity, chemistry, activation, etc.), then compared it to post-treatment activity – neural differences would emerge that are unrelated to the original “disordered activity.”

          Many of these differences (e.g. receptor downregulation) are likely attributable to drug-induced neural changes, as well as the brain attempting to reestablish homeostasis after receiving regular medication for an extended duration. Perhaps some of these changes aren’t severe enough for certain individuals to notice withdrawal symptoms.

          However, it’s also possible that severe neuropsychiatric disorders impair self-awareness/memory/etc. to such an extent that, following discontinuation of a medication, users don’t realize they’re experiencing a medley of withdrawal symptoms with the simultaneous return of their original “disordered activity.” As a result, some people just assume that their original condition is back and/or somehow became more severe with symptomatic oddities that they never experienced prior to the start of their treatment (even though these are related to the drug-induced neural changes).

          Then again, another (potential possibility) is that the drug-induced chemical imbalance that occurs post-treatment (somehow) favorable, leading a subset of persons to feel “better” than pre-treatment or while on the drug. Although this is likely an anomaly, perhaps for a rare percentage of individuals, the process of reversion to homeostasis (after discontinuation) somehow elicits a functional/favorable state of consciousness – hence reporting no disconcerting “withdrawal symptoms.”

  • Julia September 24, 2016, 9:55 pm

    I am so upset and frustrated because I feel all of these things, and I just wish that I could function like I used to before being taking those stupid drugs.

  • Suzie Russell September 25, 2016, 1:14 pm

    Very interesting article. I took high doses of Prozac through my twenties that ameliorated my bouts of suicidal depression, but didn’t stop them. Then 10 years ago I was put on a high dose of Venlafaxine and a low dose of lithium to boost it. Although I gained 35 pounds, and my brain slowed to a crawl, I wouldn’t swap these 10 years of freedom from the hellish torment of the deepest darkest depression for anything.

    I’m sure it’s damaged my brain, and might have caused my Chronic Fatigue Syndrome and Chronic Migraines. But nothing on earth could be worse than suicidal depression. Even if my medications stop working, and the depression comes back, at least – because of the anti-depressants – I have been here, and psychologically well to be a mother to my children. I think the short term benefit can be totally worth it. For a lot of us who have no option but to take anti-depressants, they truly are life-saving.

  • Vivian December 3, 2016, 2:28 am

    I had been on Zoloft for 16 yrs. Recently stopped them, about 7 months ago. It’s been a living nightmare. I feel like I am going nuts every so often and the depersonalization is scary. I have no one here, except my teenage son. My family is seeming to ignore me and watch me struggle from afar. I am so happy for blogs/posts like this, to reassure me I am not alone; and to continue my fight. I have been experiencing major acne, oily hair and my hormones all out of wack. I am in my late 30’s and feel like I am going through puberty. When I was a teen, never had acne or major hormone issues. Please tell me this will go away, that it will stop. I have no one else to turn to. Please.

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