Of all the themes that weave in and out of my life, the most common is loss. We are all bound for loss to become more prevalent as we get older—I suppose that’s the agreement we sign in exchange for living a long life—but for people who experience it early in life, grief is a persistent, melancholic hum.

It was once described to me as a live sphere caught in a box. The box stays the same size, but the sphere grows and shrinks and moves. When the sphere hits the sides of the box, it sends a shock through the edges so strong, the box and the sphere become one.

Once the sphere is created, it never goes away. But it can become so small relative to the box that it feels like it’s dissolved into the ethers. There’s no telling how long the sphere will stay swollen, or what instance will cause the sphere to morph. The death of a child, I imagine, makes for the most inelastic sphere.

Still, the greatest grips of grief come from the tiniest of moments. A hair caught in a comb. The empty space where his books used to be. A whiff of eucalyptus. The emotion that arises is not quite sadness, not quite nostalgia. It is yearning. A deep ache for what never was or will never will be.

Grief transcends death because of this yearning. All loss and all endings come with what if. Divorce and separation, the transition out of childhood, a career ending injury. It all illuminates an impossible timeline, forever nourishing the sphere, which is why ranking grief on a hierarchy of suffering is a futile game. Every subsequent loss builds on the one that came before, the grief of today’s end feeding on yesterday.

Psychiatry has now decided that grief lasting more than six months for a child and twelve months for an adult can be classified as mental illness, known as prolonged grief disorder. Advocates of the new addition to the Diagnostic and Statistical Manual of Mental Disorders (DSM) say that this new classification will help people incapacitated by grief get treatment, likely on their insurance’s dime. Critics argue that it’s just another way for pharmaceutical companies to make money, and that psychiatrists will over diagnose and unnecessarily medicate people for normal human emotion.

I’m sure the truth is somewhere in between, but what I know for sure is that grief waits for you. It is an enduring, compounding, and often surprising price we pay for love. Perhaps it is the most noble emotion of all.

After a marathon few months, I’m headed into a much needed hiatus from all things work. Until then, I wanted to leave you with a selection of books to help you mentally settle into these unsettling times. I ingest the wise words of others during troubled times always helps me re-center.

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I recommend this book all the time, including in recent issues of HIAS. If you are depressed or have a depressed family member, this is the one book I’d recommend over all others.

“There was a mystery haunting award-winning investigative journalist Johann Hari. He was thirty-nine years old, and almost every year he had been alive, depression and anxiety had increased in Britain and across the Western world. Why?

He had a very personal reason to ask this question. When he was a teenager, he had gone to his doctor and explained that he felt like pain was leaking out of him, and he couldn’t control it or understand it. Some of the solutions his doctor offered had given him some relief-but he remained in deep pain.

So, as an adult, he went on a forty-thousand-mile journey across the world to interview the leading experts about what causes depression and anxiety, and what solves them. He learned there is scientific evidence for nine different causes of depression and anxiety-and that this knowledge leads to a very different set of solutions: ones that offer real hope.”

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Biology of Belief was one of the first books to bring the world of epigenetics and the power of thought to the mainstream.

“The implications of this research radically change our understanding of life, showing that genes and DNA do not control our biology; instead, DNA is controlled by signals from outside the cell, including the energetic messages emanating from our positive and negative thoughts.

This profoundly hopeful synthesis of the latest and best research in cell biology and quantum physics has been hailed as a major breakthrough, showing that our bodies can be changed as we retrain our thinking.”

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“Do antidepressants work? Of course — everyone knows it. Like his colleagues, Irving Kirsch, a researcher and clinical psychologist, for years referred patients to psychiatrists to have their depression treated with drugs before deciding to investigate for himself just how effective the drugs actually were. Over the course of the past fifteen years, however, Kirsch’s research — a thorough analysis of decades of Food and Drug Administration data — has demonstrated that what everyone knew about antidepressants was wrong. Instead of treating depression with drugs, we’ve been treating it with suggestion.

The Emperor’s New Drugs makes an overwhelming case that what had seemed a cornerstone of psychiatric treatment is little more than a faulty consensus. But Kirsch does more than just criticize: he offers a path society can follow so that we stop popping pills and start proper treatment for depression.”

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“In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades?

Interwoven with Whitaker’s groundbreaking analysis of the merits of psychiatric medications are the personal stories of children and adults swept up in this epidemic. As Anatomy of an Epidemic reveals, other societies have begun to alter their use of psychiatric medications and are now reporting much improved outcomes . . . so why can’t such change happen here in the United States? Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?”

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This book has changed the way I approach decision making and helped understand what is truly essential, as opposed to a shiny distraction.

“Essentialism is more than a time-management strategy or a productivity technique. It is a systematic discipline for discerning what is absolutely essential, then eliminating everything that is not, so we can make the highest possible contribution toward the things that really matter.

By forcing us to apply more selective criteria for what is Essential, the disciplined pursuit of less empowers us to reclaim control of our own choices about where to spend our precious time and energy—instead of giving others the implicit permission to choose for us.”

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A more practical application of epigenetics (whereas Biology of Belief focuses on the science), It Didn’t Start With You explores how the traumas suffered by your family have a direct affect on you.

“The latest scientific research, now making headlines, supports what many have long intuited—that traumatic experience can be passed down through generations. It Didn’t Start with You builds on the work of leading experts in post-traumatic stress, including Mount Sinai School of Medicine neuroscientist Rachel Yehuda and psychiatrist Bessel van der Kolk, author of The Body Keeps the Score.”

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The Power of Now was the final piece in my puzzle of healing. I read it when I was in Prague, in January of 2017, and felt the shift occur as I read the book. It is one of those books that will be over the head of those who aren’t ready, but for those who are, it is transformational.

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I believe this book should be required reading. It is astounding—for those who are ready to receive its message.

“At the age of sixteen, Edith Eger was sent to Auschwitz. Hours after her parents were killed, Nazi officer Dr. Josef Mengele, forced Edie to dance for his amusement and her survival. Edie was pulled from a pile of corpses when the American troops liberated the camps in 1945.

Edie spent decades struggling with flashbacks and survivor’s guilt, determined to stay silent and hide from the past. Thirty-five years after the war ended, she returned to Auschwitz and was finally able to fully heal and forgive the one person she’d been unable to forgive—herself.”

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“‘Believing that something is wrong with us is a deep and tenacious suffering,’ says Tara Brach at the start of this illuminating book. This suffering emerges in crippling self-judgments and conflicts in our relationships, in addictions and perfectionism, in loneliness and overwork—all the forces that keep our lives constricted and unfulfilled. Radical Acceptance offers a path to freedom, including the day-to-day practical guidance developed over Dr. Brach’s twenty years of work with therapy clients and Buddhist students.”

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Money is one of the great causes of mental anguish, and yet few people are willing to pick up a book and learn how to get out of debt, invest, and change the invisible scripts that run your monetary life. Whether you don’t think you have the income to save an extra $50/month or you don’t know what to do with your riches, I Will Teach You To Be Rich is as educational as it is entertaining.

In 2018, after thirty-two years of relishing in perfect eyesight, a routine optometry appointment indicated that it was time for me to get glasses. My first question was, “What about contacts?”

For as long as I can remember, I’ve had strong reactions to tactile sensations. Mostly, I don’t like it. I pull away from touch, get little nauseated around pockmarked surfaces, and am picky about fabrics. The wrong type of sweater doesn’t just make me itchy, it makes me irate.

When the glasses hammer came down, I hoped that contacts or laser eye surgery would keep me from having glasses touch my face. But my eyes don’t tolerate contacts well, and I’m not a candidate for LASIK or PRK (something about odd shaped corneas.) Bespectacled I became, begrudgingly.

It was all manageable enough until covid hit and masks became the norm. I’ve loathed those pieces of scratchy cloth from the moment they arrived, not because of their (bizarre) association with political peacocking and righteous indignation, but because of the fury that rises with in me from having so much stuff on my face. The masks could be made of silk and I’d still want to burn every one of them.

Of course, they aren’t always optional—at least not where I live. I’ve gone through dozens of styles of masks, desperate to find one that doesn’t make me want to jump out of my skin when I have to put it on. The ‘ole surgical standbys are the least rage-inducing, especially if they’re black or white. (The blue ones make everywhere feel like a hospital.)

Overall, it’s been frustrating to step into anger every time I go somewhere with a mask requirement. Because there’s so much emotion swirling around the pandemic in the first place, I always assumed the irritation that arrived was connected to spending the last two years living in what can only be described as a clusterfuck.

But a few weeks ago, in a startling example of delayed logic, I had an epiphany: take off the damn glasses. My eyesight is strong enough that I can make my way through the world without specs. I may not recognize you in a crowd 100 feet away, but I can still make out the fuzzy brands of crackers on a grocery store shelf. When I simply removed the glasses obstacle, my anger evaporated.

For two years I’ve been hearing people say, “I don’t even notice the mask anymore,” to which I resisted the urge to punch them in the face. Now, I leave my glasses in the car peruse retail stores in peace. It’s been a revelation, I tell you. Such a simple solution, too.

It’s not always the destructive choices that that contribute to melancholy or anger. Sometimes, it’s a basic assumption you’ve learned to take as truth. In my case, the assumption was that my glasses were an extension of my body, always on me unless I was sleeping or showering. Because of that benign assumption, it never occurred to me that taking them off might actually beneficial. As a result, I spent almost two years fighting daily anger over something I was in control of all along.

My challenge to you, and a journaling prompt for those of you so inclined: Examine your life and look for opportunities to take off the metaphorical glasses. How might this contribute to inner overall peace and happiness?

Over the past few months, I’ve been undergoing a series of extensive and thorough medical tests to get to the bottom of some physical issues I’ve been struggling with for years. Since well before these tests began, I’ve intuitively known two things to be true: something is inside me isn’t right but that whatever it is, it is treatable.

And yet, all my interactions with the American medical system thus far have led me to dead ends. Despite my history of extended international travel, few tests were run, with doctors dismissing my hunches because by most metrics, I’m a functioning individual. Instead, they assumed inconclusive diagnoses like IBS, lupus, stress, age. The solution was to relax! Drink more water! Eat more fiber! One doctor even suggested an antidepressant to help with gut issues, to which I smirked, raised an eyebrow, and resisted the urge to hand over a draft of my book along with my absurd $100 copay.

In September, after five years of this song and dance, the right professionals appeared at the right time. Instead of looking at each one of my issues in a vacuum, as if each symptom existed independently from the rest, my team analyzed my lab results and lifestyle from the perspective of an interconnected organism.

A saliva test, for example, indicated high cortisol (stress) levels but nonexistent estrogen and progesterone (sex hormone) levels. Looked at independently, the answer is hormone therapy that lowers cortisol and raises estrogen and progesterone. Simple, right?

Nope. A urine analysis revealed nearly nonexistent levels of metabolized cortisol, and a blood test showed signs of kidney dysfunction. Therefore, it’s not that my body produces too much cortisol, it’s that it can’t process it, which is a totally different problem that would not be fixed by lowering cortisol through drugs.

Still, this wasn’t the root of my complicaitons. My poor cortisol production was a symptom of a greater issue we discovered: a raging bacterial infection and parasitic presence, likely picked up while I was traipsing around the globe back in 2016. The constant stress of the infection increases cortisol production (and therefore lowers sex hormones because evolutionarily, it was unadvisable for our ancestors to focus on baby-making during stressors like famine or tribal war.) But because my gut is renting out space to unwelcome squatters, it’s not absorbing nutrients or electrolytes. Thus, I’m dehydrated no matter what I drink, which explains the kidney dysfunction, and the kidney dysfunction leads us right back to….poor cortisol processing! Hallelujah! Answers!

Why am I telling you this?

Two reasons. First, my gut bug story is a reminder to follow your intuition when it comes to your health. Half a dozen doctors dismissed my complaints, for years. I get it. They’re trained to look for extremes and to fit people into boxes of symptoms because that’s how we bill insurance companies. But the only person who knows you, is you. If you’re not a hypochondriac and you think something is off, follow that thread. Either you don’t find anything and you can breathe easy, or you turn out to be right.

Second, in going through this process, I was struck by how a whole-body approach to physical health is so similar to successful treatment of mental health. In both cases, few professionals actually look at comprehensive systems. An internist analyzes the gut and an endocrinologist analyzes the hormones, but at no point does either specialist talk to the other. The same is true for our approach to mental health. If you meet the criteria for depression, a psychiatrist gives you a diagnosis and a prescription slip. If you’re lucky, you work with someone who lets you talk a little bit about your wounds and your stressors for forty-five minutes, once a month.

While a series of lab tests were able to diagnose my root physical issues (the rent’s about to skyrocket, gut bugs), it’s rare to find people who are willing to dig around for root issues in their psyche. This work requires radical acceptance, ferocious commitment, and an unrelenting belief that it is possible to heal. It will ask someone to face their deepest shame, make extreme changes to their life, and to prioritize this work above all else. It requires financial commitment. It often gets worse before it gets better. It is hard. But it is also how we heal, how we build the strength to support a beautiful life.

I will be spending the next six months on a strict diet & supplementation schedule to evict the unwanted tenants living in my belly. What if you also spent the next six months committed to your physical and/or mental health? What if you went all in and committed to addressing the issues you know, intuitively, are bubbling inside your mind or body? What if you trusted that the work would pay off? What might your new life be like?

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Thank you everyone for your support over the past few months. I’ve spent the time in monk-mode, putting the last serious edits into my memoir, MAY CAUSE SIDE EFFECTS (Central Recovery Press, June 2022).

The work paid off. Johann Hari, award-winning journalist and author of the international bestseller Lost Connections: Uncovering the Real Causes of Depression and Unexpected Solutionssaid my book is “a heart-rending and tender memoir that will start conversations we urgently need to have.” Lost Connections is arguably the best book on depression and depression recovery in the world, and I am honored to have Johann endorse my work.

MAY CAUSE SIDE EFFECTS is available for preorder. If you can, please consider ordering from your local independent bookstore. Not only does it support local business, but bestseller lists rank orders from independent bookstores higher than orders from Amazon.

Barnes & Nobles | Amazon | Indiebound | The Writer’s Block

Because so many people reach out to me with questions about depression, antidepressants, and recovery, I decided to make those questions part of my blog repertoire.

If you would like to Ask Brooke a question, you can do so here.

Today’s question is from a reporter at HerCampus who asked:

My father died when I was in high school, so I spent much of my college experience “grieving” his death. I say “grieving” because at that point, I was medicated up to my eyeballs on psychiatric drugs given to me to inhibit the grieving process. The decision to medicate me as a response to grief has had long term consequences on my life (it’s what my book is about), so this is a topic that sits deep in my heart.

There are two key aspects to processing grief, especially as a young person whose mind isn’t fully developed. The first, and arguably most important, is to understand that the response to grief is not necessarily aligned or timed with the trauma itself. 

Hours after my father died, I went to see the Rocky Horror Picture Show and laughed with my friends. The adults around me were perplexed, and I remember feeling like I “shouldn’t” be happy (cue the shame) even though I was happy to be there.

Now, as a 35-year old, I understand their confusion. But as a teenager, I didn’t get what it meant to lose a parent. It was kind of like the first day of calculus. I had a vague notion that it was going to be hard, but because I didn’t understand any of it on the first day of school, the looming difficulty didn’t mean anything to me. It took time for me to understand enough about calculus to even have the vocabulary to describe how difficult it was, just like it took months for me to show any sort of outward grief from losing my father. But by then, I’d been sent to a psychiatrist because I wasn’t “grieving properly.”

What actually happened was that I was in shock from the trauma and slow to release emotion. I wasn’t aware that trauma and emotion can be separated by weeks, months, or years, so everyone (including me) thought I was “doing okay.” When the emotion finally did come out, I blamed it on the circumstance at the time, thinking that because I’d been “doing okay” so far, my emotions were unrelated to grief.

This is tricky because grief is often mistaken for a psychiatric illness, which leads to misdiagnosis and overmedication. Over the years, the Diagnostic and Statistical Manual of Mental Disorders has changed its criteria for distinguishing between major depressive disorder and grief. The third edition of the DSM, which governed the psychiatric industry from 1980 to 1994, gave patients one year of bereavement leeway before they could officially be diagnosed with a mental disorder. The fourth edition of the DSM slashed the timeframe down to two months. And the DSM-V, published in 2013, eliminated it entirely. Rather, if you’re not “over” a in a few weeks, you can be officially diagnosed with a mental illness—an unconscionable change, in my opinion.

It’s also important for young people to understand that grieving includes joy. Grief is not necessarily a blanket of blurry darkness in which no levity can get through. It comes in waves, which means there are pockets of time to feel joy. Fully feeling that joy or happiness is just as important as feeling the loss. Joy reminds us that we are alive and that we have something to live for. It honors the person or experience that’s been lost.

Had I known that back when I went to the Rocky Horror Picture Show, I may not have stepped into the shame of experiencing joy during grief. I may not have learned to view the world through a nihilist, depressed lens. I may never have been medicated for a mental illness I don’t know if I ever really had.

What I know for sure is that when I got off all the antidepressants, after 15 years, the grief I’d medicated away for so long was still there. I had to process it, a decade and a half later, which was much more destructive than it would have been had I let it unfold naturally.

Grief will always wait for you. It can be delayed but not avoided. Embrace it when it comes. Process it. Know that by feeling it you are transforming it into light and love.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

One of the most underrated and useful techniques in creating a steady life is to understand the purpose of priority. And yet, like most things in our hustle harder society, “priority” is a word that only comes up around work. We instinctively know that when it comes to our job, there are certain things that are more important than others. We’re okay with letting busy work fall to the wayside when a deadline is looming, but when it comes to our personal life, prioritization is often replaced with the phrase, “I don’t have time.”

As in, “I don’t have time to work out” or “I don’t have time to cook” or “I don’t have time to write that novel.”

This is, to be frank, bullshit. You do have time to work out. You do have time to cook. You do have time to write that novel. It’s just that none of this is your priority. You are not choosing to build these activities into your day, and therefore it doesn’t get done.

Whenever I point this out to people who complain about not getting around to one thing or another, I’m always shocked by how defensive they become. When it comes to things we “should” be doing, we have a nasty habit of defending our own choices in order to rationalize our lack of action. We let the excuses fly, as if not working out or not cooking is somehow an attack on our character.

But if we shift our mindset from “I don’t have time” to “it’s not my priority,” we relieve ourselves of the guilt that comes with not accomplishing a task. Working out simply isn’t a priority. Cooking is not a priority. Writing a novel is not a priority.

And it’s okay.

As long as you’re being honest with yourself about why you choose to spend your time the way you do, it doesn’t matter if you never step foot in a gym or put pen to paper.

This blog is my priority every Monday morning. Objectively, the few hours of dedicated writing are probably better spent on paid work, pitching editors, or trying to build a better following so my book gets bought. But, even though it won’t be winning a Pulitzer and I’m not influencing millions of people with my words, I like starting my week with a low-stakes task that keeps me writing and reflecting. And I know that if I don’t do it on Monday morning before I get bogged down with other jobs, it won’t get done. So I prioritize it first.

What frustration would melt away if you acknowledge that all the things you “don’t have time to do” are simply not your priority right now? How might your life be more enjoyable if you stop beating yourself up for everything you’re not doing? And what might happen if you shift your priorities toward what you really want?

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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“Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” – Victor Frankl

In a recent interview with Tim Ferriss, author and business strategist Greg McKeown talked about a concept he called, “The Lighter Path.”

The Lighter Path, in essence, is the ability to cultivate a spirit of hope and ease even in the most difficult of times. Its antithesis is not the darker path, but the heavier path; the path that creates more chaos, more hurt, more work.

McKeown developed this idea after his bubbly, chatty 14-year-old daughter, Eve, began to turn morose and awkward. Her personality change was originally written off as typical teenage behavior, but after Eve failed a basic physical therapy test, she was taken to a neurologist. Despite a battery of inconclusive tests, her condition worsened to the point where Eve could no longer talk or write her own name.

“Everything came back negative, sort of good news, but bad news because you’d have no idea what’s going on,” McKeown said. “And she is fully on the way to becoming comatose and then dying in a coma…this is the stuff that agony is made of, right?”

McKeown realized that despite his daughter’s grim condition, he had two choices: he could take the lighter path and make this already awful situation easier on himself and his family, or, he could take the heavier path and make it more even more difficult.

In a crisis or as a response to trauma, the heavier path is tempting and easy to fall into. It starts with complaining or trying to solve the problem through sheer effort. Focusing all that energy on one person or problem can take the air out of the room for everyone else, leading to destroyed marriages and families.

“All of these things weren’t just hypothetical,” McKeown said. “They were right there. There was that opportunity.”

The lighter path, though, creates a space of trust and hope. While it “doesn’t feel super light,” it is lighter than the heavier path. And in times of crisis, we need all the help we can get.

McKeown said, “We would get around the piano and we would sing. We would read together at night. We would do the small and simple and even enjoyable things. And so, what was at times agonizing, but could have been seriously worse, even, was actually punctuated with joy.”

Despite never getting a formal diagnosis, Eve McKeown fully recovered. Though her story creates a poignant container to explore the idea behind light and heavy paths, it’s important to note that we don’t need a crisis to choose the lighter path.

Take a moment and think about the topography of your life. Are there any burdens, grudges, or transgressions you haven’t forgiven? Are you in a constant state of anger and defensiveness over the injustices of the world? Is there clutter, literal or figurative, that simply makes life harder?

All of this leads to a life lived on the heavier path. To become aware of the heaviness and to consciously choose to rewrite the stories around this heaviness—that is the work. That is your job. And it isn’t all or nothing. Removing even 20% of your psychic drag could have a huge impact on your life.

Start small. Maybe it’s saying “no” to a draining project, smoothing things out with an old friend who voted for the other guy, or pausing before you write a knee-jerk text message that’s sure to cause more chaos.

Simply ask yourself, before you make a choice, “Does this have to be difficult?”

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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During my decade and a half of deep depression, my mother often said to me, “Honey, you can choose not to be depressed.”

To which I responded, seething, “Depression isn’t a choice. Why would I choose this? I can’t just turn it on and off.”

And then I’d huff out of the room and stew in twisted satisfaction, my depression a badge of honor. I didn’t believe that depression was a choice, but I did believe that enduring my depression made me stronger than everyone who wasn’t persisting through darkness.

Today, I cringe at my own response. Here was a woman who, after being widowed at 47, survived breast cancer, underwent open-heart surgery, kept a business with 40 employees afloat during the recession, and did it all while raising an only child who spent those years huffing out of the room. My mother had every reason to fall into a hole of depression, and yet she never succumbed. That’s real strength. Some people might look at the difference between my mother and me as a difference in “brain chemistry.” Rather, one of us was “wired” to go off the depression deep end while the other was not.

I don’t buy it. Not only because the chemical imbalance theory has been debunked over and over and over and over and over again, but because in looking at how my mother and I processed the traumas of our individual lives, she chose to exercise the muscle of it-can-happen-to-anyone resilience while I exercised the muscle of moral elitism. Rather, I repeatedly chose to feed my inherent belief that I was special and therefore, tragic.

Part of this was age. I was 15 when my father died, arguably the most self-involved age in existence. And while I’d love to say that my lugubrious swim in the seas of melancholy was unconscious, the reality is that I knew exactly what I was doing. I liked the pity. I liked the attention. I liked the freedom of loss. No one expects much of the grieving, and I was happy to be left alone.

Had I shed this narrative once I graduated high school, perhaps I could have started to build the muscle of resilience. Instead, I doubled down on moral elitism, working that muscle from all angles until I was left with nothing but suicidal thoughts. It was never a choice to To Be or Not To Be Depressed, but the culmination of fifteen years of small choices that atrophied my resilience.

That is the choice my mother was talking about all those years ago. Depression is a beast that rips the reigns from your hands and drags you along for the ride. But it ebbs and flows, leaving pockets of opportunity where it’s up to you to find the strength to pick up those reigns and right yourself back on course.

No, there isn’t an on-off switch. But there is the single choice to commit to making thousands of little choices, building more and more resilience and awareness. Like a muscle, it gets stronger over time. And just like building muscle, it starts slow. One little choice. One little change. One little life.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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This is the last installment of Debunking the Chemical Imbalance Theory of Depression.
The previous installments can be found here: Part I | Part II | Part III | Part IV

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With social media at the forefront of 21st-century communication, there is a tendency for non-experts to argue with one another via evidence-based research. Having an opinion is dangerous when a single Tweet can get you fired, but making a statement that begins, “Studies show that…” cushions whatever belief follows.

But research is rigged from the start. It’s an open secret in the academic community, but little known by the rest of us. There are predatory journals that profit off of bad science or outright fiction, but because the journals and websites look official, people confuse them for legitimate science. There’s also the fact that Big Pharma funds its own trials (that are used as the basis for FDA approval) which creates an obvious conflict of interest. And don’t forget about medical ghostwriting, where pharmaceutical reps actually write the content of published articles but slap a (paid) doctor’s name on it. Then there’s the replication crisis, in which the results of research can’t be replicated, which indicates that the results are likely false.

Of course, there’s also all the legitimate, ethical research that does exist but has to survive within the chaos. Can you tell the difference? Are you sure about that? And if you can spot the good from the bad, what about all the research that was never published in the first place? Is a lie by omission still a lie?

This question is at the heart of publication bias, arguably the most troubling aspect of the current state of drug research. Publication bias is what happens when the outcome of a study determines whether or not it gets published or distributed. For example, a researcher could conduct 10 studies claiming that a new drug lowers blood pressure. Let’s say that in four of the trials, blood pressure levels didn’t change. In four other trials, blood pressure levels actually increased. But in two trials, blood pressure levels decreased.

Though 8 of 10 trials did not have the intended outcome, there is nothing in the bylaws that state that the researchers have to publicize that information. Instead, they can focus their publication efforts on the two trials that did show a positive reduction in blood pressure and use those results to get their drug approved by the FDA—even though their own research showed that the drug flopped 80% of the time.

This graveyard of failed or abandoned studies means that doctors don’t have complete information for the drugs they’re prescribing. This is a big reason why I don’t like it when people lump all doctors in a box when it comes to prescribed harm. They can do their research and think that they are acting in an ethical way, but they are being misled just like the rest of us.

How bad is it? Let’s take a look.

In 2015, researcher Erick. H Turner used the Freedom of Information Act to gather all the trials on antidepressants that were approved by the FDA over a 15-year period. Keep in mind that this isn’t all the trials ever conducted, just the ones used to get marketing authorization. Any unsubmitted trials, whether failed or abandoned, are known only to the researchers. Only the results of trials submitted to the FDA are available through the Freedom of Information Act.

There were 74 trials submitted to the FDA; 38 showed that the antidepressants had a positive effect (compared to a placebo and/or a competitor), and 36 showed either no effect or a negative effect. Essentially, it’s a coin toss.

Turner then cross-referenced these studies with peer-reviewed journals to see which ones were actually published for public consumption. Of the 74 original trials, 37 of the positive studies were published whereas only 3 of the negative trials were published.

Rather, from the FDA’s perspective, these drugs had some sort of positive impact 51% of the time. From the public’s perspective, if we’re basing this off of research doctors and patients can access, these drugs are effective 92.5% of the time.

In the words of Ben Goldacre, Senior Clinical Research Fellow at the Centre for Evidence-Based Medicine at the University of Oxford, “If I tossed a coin a hundred times, and I’m allowed to withhold from you the answers half the time, then I can convince you that I have a coin with two heads.”

And that’s why pharmaceutical companies to legally allowed to advertise that antidepressants like Pristiq are “proven to treat depression” and “thought to work by affecting the levels of two chemicals in the brain, serotonin and norepinephrine.” It doesn’t matter that we know it’s not the whole story, because manufacturers aren’t forced to report all their trials.

Unfortunately, there’s no real answer to any of this. Doing your own research is fabulous, but know that the research is incomplete. At some point, you have to reach inside yourself and calibrate your own inner compass.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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Part I—The History of Chemical Imbalance Theory
Part II—The Flaws of Chemical Imbalance Theory
Part III—Pharmaceutical Advertising & Chemical Imbalance Theory

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At this point in our journey, you’re probably coming around to the idea that the chemical imbalance theory is flawed at best and an outright lie at worst. Although it’s been disproven over and over again and that patients who think a chemical imbalance is the cause of their depression actually have worse treatment outcomes, pharmaceutical advertisements and lifestyle and health websites continue to push the narrative.

The chemical imbalance theory is unique in that it scratches a specific itch for pharmaceutical companies, doctors, and patients. Pharmaceutical companies need the chemical imbalance theory to peddle their product. They can’t manufacture a pill to erase the lingering, emotional effects of childhood trauma or an unfulfilling life, but they can produce a “biological answer” to a “biological problem.” Someone prone to blood clots takes an anticoagulant. Someone prone to depression takes an antidepressant. The language lends itself to storytelling; the patient a damsel in distress, the drug a regal prince.

This myth wouldn’t survive, however, if people weren’t buying it. It’s easy to understand why people flock to the pharmacy. When people are in pain, they need help. Immediately. Unraveling the emotional ball of knotted yarn is a long and messy process made longer and messier by a bungled healthcare system, a cultural inability to tolerate discomfort, and a social system that doesn’t support people through drastic life changes. A $30 bottle of generic venlafaxine and the assumption that it’s all gone wrong thanks to a chemical imbalance is much easier to swallow.

Besides, patients aren’t supposed to be the expert. They aren’t following the words of Dr. Thomas Insel, former Director of the National Institute of Mental Health, who explicitly stated in a 2007 Newsweek article that “a depressed brain is not necessarily underproducing [neurotransmitters.]” Instead, people are influenced by media (advertisements) and experts (doctors.) When both of these institutions are steering them towards a chemical “solution,” why shouldn’t they follow the advice? After all, isn’t “asking your doctor” the right thing to do?

But why are doctors, the experts who are supposed to rely on science, so willing to indulge the chemical imbalance myth when overwhelming, decades-long research does not support it?

The knee-jerk reaction is, of course, money baby! Though the days of outright paying doctors to prescribe specific, brand-name medications are long gone, physicians still receive kickbacks from pharmaceutical companies. It’s even considered public information and can be viewed on OpenPaymentsData.CMS.com. But with the plethora of generic psychiatric drugs available (and that the average per-physician payout, in 2015, was only $201), I don’t think money is the driving factor for psychiatric drug prescription.

A more robust hypothesis is that the chemical imbalance theory has helped destigmatize mental illness, enabling patients to “come out of the closet” with their depression. In theory, if people aren’t afraid to speak up about their private struggles, they are more likely to seek help. This hypothesis is further bolstered by the fact that insurance companies require a diagnosis before they will pay for treatment claims. Treatment for a “bag marriage” or “childhood sexual abuse” is not covered. But treatment for Generalized Anxiety Disorder or Major Depressive Disorder is fair game.

To be labeled with a psychiatric disorder implies that something abnormal has gone wrong in the body and that returning to a state of “normal” is the reasonable thing to do. The chemical imbalance theory fits this narrative and creates a simple way for doctors to explain a complex problem under the time and financial constraints dictated by health insurance. The line between truth and fantasy might be blurred, but if the patient is getting help, does it matter?

Given the 30% rise in suicide rates from 2000 to 20016 despite a 400% increase in antidepressant use and an overall decrease in mental health stigma, I’m going to say that yes, that line between truth and fantasy does matter.

But the blame can’t fall fully on the prescriber’s shoulders. Even the most well-read and researched of the bunch can only operate on the information they’re able to find.

And as it turns out, the game is rigged from the start.

Next week, we’ll dive into publication bias. Or rather, how the pharmaceutical industry legally sells you a two-headed coin.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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This is the third installment of an ongoing series debunking the chemical imbalance theory of depression. Part I examines the history of the theory while Part II examines its fatal flaws. Part III looks at the history of pharmaceutical advertising.

Antidepressants are a $26.25 billion dollar industry. If the industry as a whole was a person, it would be the 66th wealthiest individual on the planet. Zoloft, Lexapro, Xanax, Wellbutrin, Celexa, Prozac, Klonopin, Effexor, and Cymbalta all crack the top 50 most prescribed drugs in the United States, with Zoloft taking the 14th spot.

Pharmaceutical companies are also publicly traded, which means they’re incentivized to maximize profits for shareholders. And how do companies make more money? By increasing sales. And how do companies increase sales? Through advertising.

Medicine and prescription drugs are no exception. Prescription drugs, in this country, are a business. Full stop. The United States is one of only two countries in the world (New Zealand is the other) that allows direct-to-consumer (DTC) advertisement of pharmaceutical drugs. We simply cannot examine the rise of antidepressant use and the push behind the chemical imbalance theory without considering profit. As the saying goes, if you want the truth, follow the money.

At the turn of the 20th century, medications were classified either as “ethical drugs” listed by the American Medical Association (AMA) or “patent medications” that were mostly water with a little bit of alcohol, opium, or other mysterious ingredients thrown in. These patent medications were allowed to be advertised without regulation (and were therefore filled with false claims), yet they accounted for nearly half of newspaper revenue in the early 1900s.

In 1914 that The Federal Trade Commission (FTC) was created to crack down on false advertisements. Strangely, drug ads in medical journals were exempt from regulation. It wasn’t until 1938, after 105 people died from a drug that included antifreeze, that the FDA ruled that drugs have to be proven safe before marketing. But they also put the burden of determining whether or not the drug was safe on the drug manufacturer, rather than a third party.

It wasn’t until 1969, a few years after 10,000 babies were born with birth defects as a direct result of thalidomide poisoning from a drug used to treat morning sickness in pregnant women, that the FDA began to require that manufacturers provide information on side effects, contraindications, and effectiveness in drug advertisements. At the time, the majority of drug ads were in medical journals or aimed at physicians. DTC advertising only began in the late 70s and early 80s, when pharmaceutical companies cut out the middle man and began aiming advertisements directly at consumers.

Though there was a brief moratorium on DTC advertising in 1983 after a well-advertised arthritis drug made by Eli Lilly was pulled off the market due to adverse drug effects, the FDA declared in 1985 that drugs could be advertised directly to consumers as long as they met the same criteria as drugs advertised to physicians. All those side effects, contraindications, and risks needed to be included in the DTC ad. This declaration made it difficult to advertise on TV and radio because verbally listing all the side effects simply took up too much air time, so advertising shifted to print media, where disclaimers in small print could flourish.

The 1990s ushered in the advertising era of “lifestyle” drugs for everything from erectile dysfunction to baldness to, you guessed it, depression. In 1997, with pressure from the pharmaceutical industry, the FDA drafted official television-friendly guidelines for drug advertisements (cue the speedy, may-cause-side-effects voiceover.) In the year after these regulations were drafted, DTC drug advertisement spending doubled from $1.1 billion in 1998 to $2.24 billion in 1999. By 2000, every $1 spent in drug advertising resulted in $4.20 in retail drug sales.

In 2015, the American Medical Association called for a complete ban on DTC drug advertisement due to anti-competitive behavior that allowed drug companies to manipulate drug prices for profit and then advertise the benefits of their inflated drugs to consumers. But the push to end DTC advertisements was shot down thanks to powerful drug lobbyists claiming that DTC advertisements provide patients with valuable information about their health and treatment options. By 2017, 72% of commercial breaks during the CBS Evening News contained drug ads.

In the next installment, I’ll examine how the advertising market has enabled pharmaceutical companies to prey on consumers by relying on the chemical imbalance theory as an easy explanation for depression.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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This is Part II of Debunking the Chemical Imbalance theory. Part I can be found here.

Psychiatry, like most hard sciences, suffers as research trickle down from laboratories to the mainstream. Take our friend from Part I, Harvard neuropsychopharmacologist Joseph Schildkraut, who said in 1965 that the chemical imbalance theory was “at best a reductionistic oversimplification of a very complex biological state.”

Though Schildkraut explicitly stated that there was no evidence to support or disprove the theory—which led to a generation of research that could not find a statistically notable link between biology and mental disorders—Schildkraut’s research was still cherry-picked by a verywellmind journalist for a January 2021 article entitled, “The Chemistry of Depression: What is the Biochemical Basis of Depression?”

The article gives the reader a general overview of how neurotransmitters work, the three neurotransmitters usually associated with depression (dopamine, norepinephrine, and serotonin), and the all familiar assumption that low levels of these chemicals may be associated with depression.

There are so many problems with this article that it would be impossible for me to unpack it all in one issue, so I’m going to focus on the most egregious statement and go from there: “Restoring the balance of brain chemicals could help alleviate symptoms—which is where the different classes of antidepressant medications may come in.”

For the sake of argument, let’s assume that an imbalance of “brain chemicals” is the cause of depression. How do we measure that imbalance in order to determine the amount and kind of antidepressants needed to restore the balance?

*crickets*

There is not, and never has been, a single test to measure the real-time amount of an individual’s “brain chemicals.” You cannot measure neurotransmitters in a blood test. You cannot measure neurotransmitters in an MRI or CT Scan. You can get an estimate of neurotransmitter levels by measuring something called biogenic amines in urine and spinal fluid. This test operates under the assumption that the results are an accurate depiction of what’s going on in the brain in real-time. This is a shaky assumption given that neurotransmitter levels literally change by the second and that up to 95% of serotonin is produced in the intestines.

There is also some research surrounding measuring neurotransmitter levels through PET scans, but like the biogenic amine test, it is at best, a snapshot in time that will never be relevant for 99.9% of patients.

If we don’t have any way to accurately measure neurotransmitter levels, then it stands to reason that we can’t know what is considered “balanced” in the first place, which is why the administration of psychiatric drugs is more of a guess than a science.

Knowing all this, a slew of questions emerge. If low levels of “brain chemicals” are responsible for depression, why is it that a drug filled with synthetic neurotransmitters can take more than a month to have an effect? And, if chemicals are the primary culprit, why do antidepressants only work for about 60% of patients? (Not to mention the fact that in the long run, talk therapy works as well as drug therapy, without the nasty side effects.)

Some people will argue that from a practical point of view, the validity of the chemical imbalance theory is irrelevant if the drugs help people. This argument would sit better with me if 1) pharmaceutical companies weren’t allowed to manipulate patients with misinformation based on a bunk theory. 2) Mainstream health websites like verywellmind didn’t continue to effectively mansplain the chemical cause of depression in exchange for website traffic. 3) If practitioners enforced short-term use of these drugs and 4) if practitioners actually knew how to take patients off these drugs safely and effectively.

But since none of those things are true, patients end up on a hamster wheel of drug-dependent diagnosis, spending their lives believing that their mental anguish is caused by a chemical imbalance that relieves them of actually addressing the problems and traumas in their lives that lead to depression.

In Part III, I’ll specifically focus on how pharmaceutical companies create billions of dollars in revenue by exploiting the chemical imbalance theory in order to market antidepressants to the general public.

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After 15 years of depression and antidepressants, my mission is to help people find hope in the name of healing. My memoir on the subject, MAY CAUSE SIDE EFFECTS, publishes on May 10, 2022. Pre-order it on Barnes & Nobles, Amazon, or wherever books are sold. For the most up-to-date announcements, subscribe to my newsletter HAPPINESS IS A SKILL.

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