What If Depression Isn’t a Chemical Imbalance?
Sadness, stress, and struggle: when did being human become a disorder?
A Raffle and a Big Blue Book 📖
A few months ago, I went to an internship fair for my counseling program.
One of the tables featured a chatty man hosting a raffle, and I felt obliged to sign up (as one often does). I didn’t think much about it.
The prize? Nothing other than the Diagnostic and Statistical Manual of Mental Disorders—the infamous “DSM.”
A few weeks later…I got an email: Congratulations, you won the raffle!
…Yay??
Soon after, it arrived on my doorstep.
The DSM is massive. It's considered "the Bible" for psychiatrists because it catalogs every mental disorder perceived to be in existence. The big blue book sat on my shelf for months, collecting dust and silently demanding attention.
Finally, I decided to do some digging. What’s really inside this thing? What does it mean for me and my work as a counselor?
What I found shocked me…
And completely transformed everything I thought I knew about mental health.
The Grief Exception
In the DSM, there used to be a "grief exception,” meaning that the authors created one singular loophole for Major Depressive Disorder (MDD).
The exception stated that if you recently lost a loved one and are experiencing symptoms of grief—depressed mood, decreased interest in pleasure, feelings of worthlessness—you wouldn't be diagnosed with depression
The exception existed for the grieving, and the grieving only.
By making this exception, the authors of the DSM acknowledged that life events and environment factors could play a role in causing someone feelings of persistent sadness or distress.
But if there was one exception, couldn't there two?
Three?
More?
Loss of a loved one is devastating. But so is losing a job. Or a family member going to prison. Or a divorce. Or being diagnosed with cancer. Or surviving a car accident.
Do you understand what I'm getting at?
And HERE'S THE KICKER:
That grief exclusion? It was removed.
What This Means
Today, there are zero exceptions in the DSM that prevent a diagnosis of MDD or an anxiety disorder due to a negative life event like the ones I listed above.
If your symptoms meet the diagnostic criteria for MDD or an anxiety disorder, you can be diagnosed. This diagnosis also means that you are declared clinically unwell and can be prescribed very powerful psychiatric drugs 💊 (Without necessarily addressing the life circumstances that led to your distress in the first place.)
The removal of the grief exception represents a big problem in how mental health is conceptualized—and it's not the only troubling aspect of modern psychiatry.
Psychiatry Has Pathologized Normal Human Suffering.
The life events I described above are inherently and predictably distressing. Feeling symptoms similar to depression in response to painful, difficult situations is expected. It's human. 🧬
For the most part, all humans —even you and I—would be affected in similar ways.
Yet.
Instead of offering societal or structural support, the solution becomes an individual medical diagnosis—which often leads to psychiatric drugs.
A person is then given sometimes-harmful medication for a potentially-long period of time without acknowledging their situational distress which could naturally improve with time, support, or lifestyle changes.
(Human resilience is extraordinary.)
The Truth About the Chemical Imbalance Myth 🧪
For decades, we have been told that depression stems from a chemical imbalance in the brain—a serotonin deficiency that can be corrected with some pills.
Like many, I assumed solid scientific evidence supported this widely accepted theory.
But this was never proven.
Not then.
Not now.
As Johann Hari explains in his eye-opening Lost Connections, the idea that depression is a chemical imbalance is "an accident of history"—the result of "scientists initially misreading what they were seeing, and then drug companies selling that misperception to the world to cash in."
Decades of research have been reviewed by meta-analyses and have found no significant evidence that low serotonin levels cause depression.
Yet millions of people have been prescribed SSRIs under this assumption.
So…What Actually Causes Depression?
Now, I know that was a lot. It got a bit heated.
You might be wondering: If depression isn’t just a chemical imbalance, what is it?
The truth: humans are complex.
We are shaped by biological, psychological, social, and spiritual factors. Depression often has roots in disconnection—from meaning, from purpose, from nature, from respect, from values, from a hope-filled, from each other.
The Good News
I'd like to end on a hopeful note:
Not everyone in the mental health field subscribes to the (very) outdated chemical imbalance model.
Especially counselors.
In my classes, we're trained to see the whole person. My professors do a great job of emphasizing the bio-psycho-social-spiritual model of mental health and wellbeing.
They recognize that our experiences, lifestyles, diet, culture, beliefs, and environment all interact to make us who we are.
Experiencing depression is a normal human response to abnormal life experiences. It's adaptive. It's our brain's way of telling us something. 🧠
So I’ll leave you with this:
Maybe,
just maybe,
you're not broken.
Maybe,
your suffering isn't a disorder
—it's a signal.
Thank you for reading 🫶🏻
With love and health,
Sophie
I remember when I was studying clinical psychology 10+ years ago and back then the DSM seemed like the book of all books…and how much things have changed in the meantime