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The “Chemical Imbalance” Explanation for Depression:
Origins, Lay Endorsement, and Clinical Implications
Christopher M. France
Cleveland State University
Paul H. Lysaker
Roudebush Veterans Affairs Medical Center, Indianapolis, and
Indiana University School of Medicine
Ryan P. Robinson
University of Akron
When a client asks whether her or his depression is caused by a chemical imbalance, how do you
respond? Depression is regularly depicted in popular media as resulting from a “chemical imbalance” and
this depiction raises a number of interesting questions for practicing clinicians. How accurate is the
chemical imbalance explanation for depression? How widely do laypersons agree with the explanation,
and how do they interpret the explanation? We discuss the origins, accuracy, and transmittal (e.g., via
direct-to-consumer advertising) of the chemical imbalance explanation for depression. We next present
results from a group case study examining lay endorsement and interpretation of the explanation. Finally,
we discuss clinical implications and present a short script for educating clients concerning “chemical
imbalances” in depression.
Keywords: chemical imbalance, depression, laypersons, direct-to-consumer advertising, monoamines
It is common in the United States for depression to be described
as resulting from a “chemical imbalance” (e.g., Valenstein, 1998).
As the potentially dominant cultural story of depression etiology,
the chemical imbalance explanation may exert a significant effect
on treatment-seeking behaviors as well as the structures that are
created and maintained for such treatment (e.g., Smith, 1999; also
see Rothman, 1971). As such, it appears important for mental
health professionals and other stakeholders (e.g., policymakers) to
understand lay beliefs concerning chemical imbalance explana-
tions for depression.
We do not dispute the possibility that neurotransmitters and
other brain chemicals play a significant role in the etiology of
depression. However, we are also concerned that the chemical
imbalance explanation may not reflect the full range of causes of
depression, may be given greater credence by both consumers and
practitioners than is supported by sound research, and/or may be
understood in an overly simplistic manner. Any unitary under-
standing of human suffering asserted in isolation of its nuances
may mislead those in need of treatment and confound self-
understanding, resulting in treatment-seeking strategies and out-
comes that are less than optimal for at least some clients.
The Development of Chemical Imbalance Explanations
for Depression
Modern chemical imbalance hypotheses of depression origi-
nated in the mid-20th century, spurred by important discoveries
such as the efficacy of chlorpromazine for psychosis; findings that
monoamines exist within the central nervous system (CNS) and act
as neurotransmitters; and an early understanding of monoamine
synthesis, storage, release, and deactivation. Such discoveries also
quickened the emergence of psychopharmacology as a discipline
and helped lead to the eventual widespread practice of using
prescription drugs to treat mental disorders also (e.g., Healy,
2001).
Iproniazid and Imipramine
The 1950s saw the appearance of the first antidepressant drugs
of the modern era, two being iproniazid and imipramine (Healy,
1997). Iproniazid’s initial importance was as an effective tubercu-
losis treatment, but it was also noted that some tubercular patients
CHRISTOPHER M. FRANCE received his PsyD in clinical psychology from
Wright State University. He is an assistant psychology professor at Cleve-
land State University and a licensed psychologist. His research interests
include cultural and personal conceptions of mental disorders and their
treatment.
PAUL H. LYSAKER received his PhD in clinical psychology from Kent State
University. He is a staff clinical psychologist at the Roudebush Veterans
Affairs Medical Center, Day Hospital 116H, and an assistant clinical
professor of psychology at the Indiana University School of Medicine,
Department of Psychiatry. His major areas of interest include vocational
rehabilitation, personal narratives, and recovery from severe mental illness.
RYAN P. ROBINSON received his MA in industrial organizational psychol-
ogy from the University of Akron, where he is also a doctoral candidate in
industrial organizational psychology. He is also a part-time lecturer at
Cleveland State University. His areas of interest include employee training
and development, affective reactions in the workplace, and research meth-
ods and statistics.
WE THANK Heather Dukes for assisting with background research and data
organization.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Chris-
topher M. France, Department of Psychology, Cleveland State University,
Chester Building 159, 2121 Euclid Avenue, Cleveland, OH 44115. E-mail:
c.m.france@csuohio.edu
Professional Psychology: Research and Practice Copyright 2007 by the American Psychological Association
2007, Vol. 38, No. 4, 411–420 0735-7028/07/$12.00 DOI: 10.1037/0735-7028.38.4.411
411
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