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The term ''chemical imbalance'' is used in consumer literature and websites for ), and in Advertising in the United States after the Deregulation of Pharmaceutical advertising. It is not used in scientific literature as it does not reflect current knowledge. A criticism of the use of this lay explanation is that explaining mental illness in terms of 'chemical imbalance' implicates a chemical solution. For example, insufficient availability of Insulin in Type I Diabetes is treated with insulin. By Analogy , it then appears that the appropriate treatment for insufficient (imbalanced) neurotransmitter levels is a chemical that fixes this balance. However, unlike Type I diabetes, other treatments are available for mental illness, and medication is often most effective when supplemented with other treatments. CHEMICAL IMBALANCES Changes in levels of Neurotransmitter s and other Neural level phenomena are hypothesised to be the underlying Psychopathology for certain mental illnesses, notably Clinical Depression and Schizophrenia . Clinical depression In Initially, relatively simple changes in the level of these neurotransmitters were thought to be found in individuals with depression. However, advanced findings began to fine tune the more simple explanations. For example, certain Drugs used to treat depression were found to change the levels of neurotransmitters for several days, but then return to normal, well before any effect was observed on the depressive episode. Such findings implicate more complex mechanisms, such as changes in neurotransmitter production, transmission, re-uptake, and Neural sensitivity. With respect to causality, a number of environmental factors have been suggested. Further information: Causes Of Depression Other disorders In addition to depression, changes in levels of neurotransmitters have also been implicated in Anxiety disorders, Bipolar Disorder (manic depressive disorder), Schizophrenia , and Parkinson's Disease . As well as changes in Serotonin and Norepinephrine , Dopamine systems have also been considered. So, while all biology is essentially chemical in nature, rather than being caused by simple chemical imbalances, mental illness is now widely recognized to be caused by complex and, in many cases, as-yet unknown factors. According to Jaelline Jaffe and Jeanne Segal : ::"''The misconception the {Link without Title} commercials foster is that the brain somehow develops a chemical imbalance and the result is depression, occurring in a single directional process. In fact, the relationship between brain chemistry and experience is a two-directional phenomenon: Life experience affects brain chemistry at least as much as brain chemistry affects life experience. The 'chemical imbalance' hypothesis is not wrong. It's just not entirely correct.''" Use of drugs to correct Psychiatric Drugs influence levels of neurotransmitters in the brain, and perhaps underlie the genesis of the term 'chemical imbalance theory'. Most people believe that the psychiatric drugs, such as antidepressants, 'correct,' or move towards average levels, the levels of neurotransmitters in the brain. However, rather than restoring 'normal' levels, these drugs frequently attempt to compensate for changes in sensitivity to or production of neurotransmitters, with newer drugs acting in a relatively isolated part of the brain (although some drugs act on a larger scale). Another perspective is that drugs, when they work, are providing a ''non-specific psychological effect that is useful,'' rather than correcting a chemical imbalance. For example, SSRIs, according to one author, provide a "well whatever" emotional reaction to experiences. Hence their usefulness not only in depression but panic disorder, obsessive compulsive disorder, generalized anxiety disorder, body dysmorphic disorder, social phobias and many other supposedly specific disorders. The common mechanism is a decrease in overwhelming emotions induced by the medication. Indeed research shows that in lab animals SSRIs decrease "stress induced vocalizations" (in normal ''not chemically imbalanced!'' guinea pig and rat pups)[http://jpet.aspetjournals.org/cgi/reprint/308/2/474.pdf][http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7919948&dopt=Citation]. Stress induced vocalizations are the normal reaction of pups to being removed from their mothers. Similar signs of stress in normal adult animals and their decrease through the use of SSRI's has been demonstrated.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12600706&itool=iconabstr&query_hl=2&itool=pubmed_docsum] It should be noted that one of the ''problems'' with SSRIs can be a reduction in emotional responsiveness beyond what can be described as symptoms. In other words what is good about SSRIs is what is bad about them. For an interesting discussion of these issues see "A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances." [http://www.geocities.com/ss06470/index.htm] Limitations on the use of medications Most disorders treated with medication have a hypothesised neural mechanism, but it is important to note that chemical imbalances are not believed to explain all psychiatric differences, nor are medications used to treat all neurological or psychiatric issues. CONTROVERSY Critics contend that psychiatric drugs, intended to alter Neurochemical processes by manipulating neurotransmitter levels, are not always efficacious, not always safe, and not necessarily a scientifically sound method for improving Mental Health . The number of different chemicals in the brain and their unknown interactions limit understanding and increase the likelihood of unforeseen complications. Moreover, critics assert, the psychiatric establishment merely assumes patients who are diagnosed with a given mental illness always have a chemical imbalance in their Brain s, even though behavioral checklists, and not actual chemical measurements, are used to reach a diagnosis. Psychiatric diagnostic practices in the United States have come under criticism for over-reliance upon these behavioral checklists rather than thorough, whole-body medical testing. For example, in a Florida Psychiatric Hospital study from the 1980s , one hundred patients diagnosed with a mental illness were subsequently given a complete medical exam, after which it was discovered nearly half of the patients’ psychiatric problems were secondary manifestations of an undiagnosed medical problem, such as Hypothyroidism mimicking depression. {Link without Title} Most, if not all, hospitals in the United States currently require a medical exam be done on all patients admitted to an inpatient psychiatric unit. The author of the study, psychiatrist Mark Gold, remains a strong advocate that addiction and psychiatric disorders are rooted in complex chemical imbalances and that effective treatment is available for most correctly diagnosed psychiatric patients from various drug treatments -- an opinion that he shares with the majority of the medical community. Even when neurological and neurochemical differences are associated with certain behaviors, the practice of pathologizing these behaviours has been questioned by some activists and people who have been diagnosed with mental illnesses. Because neural mechanisms imply a physiological difference underlying mental illnesses, they appear to justify the use of medication in treatment. Critics argue that the legitimacy given to medication by neural mechanisms can lead to an over-reliance on medication. Similarly, the perceived efficacy of medication as a treatment implies an underlying neural mechanism. Critics also allege that pharmaceutical companies have a Conflict Of Interest when they fund research into biochemical mechanisms behind mental illness and the efficacy of medication at reducing behavior differences. Further controversy is engendered by the links between certain critics of psychiatry and the advocates and sells an alternative and expensive non-pharmacological treatment known as Dianetics . POPULAR CULTURE AND ADVERTISING The chemical imbalance theory, according to critics, is routinely presented as ‘fact’ so often it has become widely accepted as fact, despite having been challenged repeatedly. For example, Pfizer has heavily promoted its antidepressant drug, Zoloft , with ads asserting that mental illness may be due to a chemical imbalance in the brain, and that "Zoloft works to correct this imbalance." Without mentioning its own name, Eli Lilly urges viewers to seek treatment for depression, and to visit their website, DepressionHurts.com , because "Many researchers believe depression is caused by an imbalance of naturally occurring chemicals, serotonin and norepinephrine, in the brain and the body." DIAGNOSTIC UTILITY There are advanced imaging techniques such as Positron Emission Tomography (PET Scans) that can test for chemical imbalances. Changes in levels of Neurotransmitter Metabolites are detectable in Urine and Cerebrospinal Fluid and have been associated with certain mental illnesses, but are not sufficiently predictive for successful diagnosis. Thus, Psychiatric Diagnoses are usually made based on Algorithmic (DSM-IV) criteria outlined in Diagnostic manuals, primarily through reference to the Diagnostic And Statistical Manual Of Mental Disorders (DSM). In practice, psychiatric diagnoses rely upon a physician's judgments about a patient's medical history, clinical evaluation of Symptoms , and from patient response to psychiatric drugs. Pharmaceutical company literature continues to explain the operation of Psychoactive Drugs in terms of chemical imbalances, and restoring a chemical balance closer to 'normal'. The research underlying the mechanism by which the drugs are thought to work is typically justified by Clinical Trials demonstrating their efficacy. CAUTIONARY MEASURES An important consideration with regard to chemical intervention is the potential for relapsing into Depression or other psychiatric conditions when medication is discontinued abruptly or without medical supervision. Aside from Malnutrition , the only certain means of creating chemical imbalances in the brain is the use of Psychotropic chemicals, a category which includes both legal prescription drugs and illegal drugs like LSD or Cocaine . Side effects from psychotropic drugs can be significant. Great care must be taken to prevent severe Withdrawal symptoms after using psychotropic drugs. Neuroleptic drugs (typically used in the treatment of schizophrenia) are particularly dangerous to withdraw from quickly. Rebound psychosis is common and can leave a patient more unstable than they were prior to taking the neuroleptic in the first place. SEE ALSO Current neuroscience perspectives Critical perspectives EXTERNAL LINKS History
Current neuroscience theories
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