Out Of Balance

What's out of balance and by how much?

In the 1970s when brain chemistry began to emerge as a science within a science, a new condition and its diagnosis became popular. This was / is the state of “chemical imbalance”, applied to many persons whose behavior seemed to be out of the bounds of normal.

Slightly later, and not surprisingly, discoveries were made of pharmaceutical agents which purported to restore a condition of chemical normalcy within the brains of those affected.

The more we learn about brain micro-function, the more we have to wonder how it is that anyone anywhere could possibly ever be “normal.” There are many ways things can go sour under the influence of foods, drugs (legally prescribed or smuggled across the border), infections, physical or emotional trauma, and more, including just getting through life. “Normal” has to occupy a wide area on and under the bell curve of human behavior.

Brain chemistry is going on within cells, where things like serotonin and dopamine are produced, and between cells at the synapses, where these substances are used. They are used in the course of one cell’s communication with others, but they must then be neutralized because too much communicating isn’t a good thing. Or is it? Some experience suggests otherwise.

Neurotransmitters like serotonin are really enablers for another process which generates a teeny electrical current within a receptor nerve cell. This process is the rapid entry of sodium ions into the receptor neuron, resulting in a change in the electrical charge of the cell. Once this has taken place, serotonin has to be swept up and taken back where it came from, the terminal of the message-sending cell. So, what now?

Some pretty smart people discovered that human depression might be associated with low levels of serotonin and proceeded to develop drugs (the selective serotonin re-uptake inhibitors, or SSRIs) which keep the chemical in play at the synapse for longer periods. Then they found out that the drugs did indeed help to relieve symptoms of depression, and we saw our first book on the market, “Give Your Life To Prozac!” (Publication occurred in about the same length of time it takes serotonin to cross from one neuron to another.)

Enterprising psychiatrists as well as general physicians began using SSRIs like Prozac and Zoloft to treat patients of all ages and with a variety of symptoms, from phobias and depression to anxiety and sleep disorders. (This strengthens the adage, “When your only tool is a hammer, everything looks like a nail.”) And, as might be expected, in response to widespread use came the first reports of increased suicide rates, uncontrollable rage, disturbance of sexual function, and other relatively undesirable symptoms. If we didn’t have a chemical imbalance before, we surely had it now.

Two things are egregiously overused. The first is the diagnosis, “chemical imbalance”, and the second is SSRIs. The diagnosis is a lazy one, and requires only a prescription (also lazy behavior) rather than a search for a cause and a possible non-pharmacologic cure. Often, that's cognitive / behavioral therapy, which is a whole 'nother issue.

(Note: An excellent illustrated discussion of neurotransmitters can be found at this website from Columbia University. Don't worry - you won't get spammed by these people, whose goal, like ours, is dissemination of knowledge about science.)