By David Joel Miller.
Low on Serotonin?
There has been a lot of talk about the way in which neurotransmitters affect the brain. Some of this has been helpful in understanding mental illness and some has not helped at all. On common expression has been that someone had a “chemical imbalance in the brain.” I wanted to talk about that and some other issues related to psychiatric medication in today’s blog. Please keep in mind that this is a highly simplified explanation. Remember I am a therapist and counselor, not a doctor so I need to find simple explanations for clients and myself without misleading them. If you have a background in biochemistry or research skip this blog now. If the doctor has told you to do or not do something please follow the doctor’s instructions or at the least talk with your doctor about these issues. The rest of you let me know if this helps explain things.
The expression chemical imbalance is a bit misleading. The frequent use of that expression has resulted in a lot of people coming in and asking to be tested to see if they have a chemical imbalance and if so what chemical do they need more of. They get quite upset when we say that we can’t do that kind of test. Here are some of the problems with that approach.
Thoughts in my brain and yours also, are carried from one nerve (brain) cell to another by chemicals. So when I think something, anything, my brain sends out chemicals to carry that message. Once the thought has come and gone the chemicals are broken down and reused or disposed of. So as fast as I can think something my brain chemistry is changing.
Now different brains may make, transport and use chemicals at varying rates but we all use chemicals to move thoughts. This is why talk therapies like Cognitive Behavior Therapy can help to change someone’s thinking which results in a change in their brain chemistry. Now medication can also help and research seems to show that doing both medication and therapy for your problems can result in changes that are more rapid and longer lasting than either treatment alone.
Most everyone has heard of anti-depressants. So they think that if I am short on a brain chemical I should be able to take a pill, replace the missing chemical and – presto – I am cured. Wish it was that simple. Let me give you one exaggerated example of how an antidepressant might work. The most well known and widely prescribed antidepressants right now are ones called SSRI. SSRI stands for Selective Serotonin Reuptake Inhibitors. This has resulted in a lot of people thinking that the reason they are depressed is a shortage of Serotonin. Let me try to explain how this works. You will need to unpack your imagination for this one.
I once drove a car that had a leaky radiator. At the time money was tight, still is a lot of the time but that is another story. So I kept putting water in the radiator. This is sort of like the way my brain might try to keep putting serotonin into use. But as fast as I filled the radiator the water kept leaking out. So my engine overheated. When I get low on Serotonin my brain overheats (not really don’t get the thermometer to check for depression) and then I get depressed.
So every few miles I had to find a place to stop and put water in the radiator and still it didn’t last long, kept overheating.
So this friend of mine tells me there is this thing you can get at the auto store that stops the radiator from leaking. I get some, put it in the radiator and the leak slows down. A second dose and the radiator stops leaking altogether, well almost stopped but at that point, I only have to put water in the radiator once a week, not every day. So it wasn’t the amount of that stop leak stuff that mattered. I didn’t need to fill the radiator up with it. It just helped me get more use out of the water I had already put in my radiator.
The SSRI works that way on our brains. It doesn’t put more serotonin in the brain but it slows down the leak so we get more miles or smiles out of the serotonin we already have.
Now, let’s say for illustration purposes here, I am bragging to my friend about what a great job that stops leak stuff did and he doesn’t believe me. So I do a demonstration. I get my trusty old shotgun out. Point it at the radiator and let it rip. Now the radiator starts to leak again. So out comes a can of stop up the radiator stuff and I pour it in. Only this time the stuff doesn’t work. The radiator keeps right on leaking.
This is exactly what happens to the brains of people who are on SSRI’s or other antidepressants and then they drink alcohol. Alcohol, remember, is a depressant substance. Why we so rarely call it a drug is beyond me, given that it causes more problems with abuse, dependence, and suicide than all the other drugs. But that is just the way it is.
So the point of this story is that the problem for most people is not that the brain is low on serotonin but that the things we do to our brains use up the serotonin way to fast. Good diet, plenty of sleep, avoiding drugs and alcohol can all help you produce more serotonin. So can changing your thinking because happy thoughts release more neurotransmitters into the brain. But calling this problem a chemical imbalance shouldn’t take away the responsibility to get our thinking and our living fixed.
Staying connected with David Joel Miller
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page or my Facebook author’s page, David Joel Miller. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.