“Doctor, I have a neurochemical imbalance.”
I hear this often from my patients. It is a powerful statement, raising contradicting emotions. Some people are relieved. They think, “I have a medical illness which medication can solve. It’s not my fault. I’m not weak, lazy or just making it up. I’ll take medication and feel all better, exactly like the time I had pneumonia and took antibiotics.” Others are enraged and think, “I know there’s a psychological reason for my depression. I want to understand it and do something about it. If it’s just a neurochemical imbalance, there’s nothing I can do. It’s out of my control. It’s just a drug company scheme. I feel like a lab rat and there’s no way to know what kind of side effects I’ll have in the future.”
“Mmm…,” I say (because I’m a psychiatrist), “Well… it’s neither this or that. This is not a perfect analogy, but think of moving your arm. When you move your arm, the levels of neurotransmitters in your neurons change. These are the chemicals you say are not balanced in your body. They are the way neurons communicate with each other – instead of words, they use neurotransmitters. When you want to move your arm, neurons pass on the message and the levels change. Hypothetically, you could have taken a drug that would change levels of neurotransmitters in neurons leading to your arm, thereby making it move. It doesn’t mean you can’t do it on your own. The same with depression. There are studies that show that psychotherapy has the same effect on neurotransmitter levels as medication.”
Disorders of the mind are much more complicated than regular medical illness. Placing depression in the same category as pneumonia has its advantages and disadvantages. On the one hand, exactly like having pneumonia, it is not the patient’s fault. On the other hand, depression is so much more complicated than pneumonia that we cannot say, “Just take medication and we promise it’ll go away.”
For some people, medication is the right way to go, for others, psychotherapy, and for some, both. If you are depressed or anxious, I hope that understanding that “neurochemical imbalance” is not something you can’t comprehend or something that is out of reach, but is just a way that your mind communicates with your body, something that can change with either medication or psychotherapy (and sometimes even on its own), will help you make the right treatment choice for you.
