Brooke Shields recently received an advocacy award from the Hope for Depression Research Foundation in Manhattan. At the event, she spoke about her experience with postpartum depression and about the stigma of mental illness.
People magazine covered the event here. Of interest to me was this bit about her treatment for depression:
"Shields was prescribed medication, though she stopping taking it one point, thinking she didn't need them. 'That was the week I almost did not resist driving my car straight into a wall on the side of the freeway,' she told the crowd. 'My baby was in the back seat and that even pissed me off because I thought she's even ruining this for me. I just wanted to drive into the wall and my friend stayed on the phone with me and made me safely get home.'
She later called her doctor to ask for more help, and was eventually diagnosed with a chemical imbalance. 'I learned what was going on inside my body and what was going on inside my brain,' she said. 'I learned I wasn't doing anything wrong to feel that way. That it was actually out of my control.'
Two things.
One, I don't thinkPeople magazinegot it right when they wrote that Brooke Shields was diagnosed with a chemical imbalance. People don't get diagnosed with a chemical imbalance. It's not like there's a test given inyour physician's office, like swabbing your throat or having you pee on a stick or something, that tells you whether your neurotransmitters are messed up.
Shields would have beendiagnosed with postpartum depression, which has, as far as we know at this moment, several causes including one or more genetic, biological and environmental factors. As Dr. John Grohol at Psych Central has often stated:
"Sorry, mental disorders such as depression and bipolar disorder are not simply 'brain illnesses,' without any significant psychological or social components that must also be treated. They are complex disorders that involve genes, biology, personality, social development, environment, relationships, and a whole lot more in most people. Buying into the simplistic and discredited model of 'brain chemical imbalance' isn’t something that’s beneficial for research or public advocacy or policy."
Does this mean the serotinin or dopamine in your brain aren't involved somehow with your postpartum depression? No. Does this mean that there isn't some or even a major portion of the illness you're experiencing that is indeed out of your control? No. Does this mean it's your fault if your illness isn't biochemical? No. But it does mean it's way too simplistic to say you simply have a "chemical imbalance".
This Just In: I checked two MDs who are specialists in perinatal mood and anxiety disordersthis afternoon just to make sure I'm not makingthisup and theysaidwhat I've written iscorrect. There are no consistently identified biomarkers for depression.There is a test that can be done of cerebrospinal fluid apparently, but it is invasive and not necessarily diagnostic.
In fact, that kind of terminology sometimes frustrates mebecause in some way I feel itadds to the stigma of mental illness. Rather than as an evidence-based, medically acceptable diagnosis, I think the term "chemical imbalance" is often used by the media as a sugarcoated, societally acceptable way ofreferring todepression or postpartum depression. We can't just say we have a mental illness, because that's too hard to prove, supposedly? Can't be seen on an X-ray? Too hard for people to believe? But if we use the phrase "chemical imbalance" thenthat's acceptable? That makes it all okay? I don't know why we have to wordsmith the truth. I hope somedaythat stating you have a mental illness like postpartum depression won't require any sort of PR spin.
Now that I got that off my chest, the second thing I wanted to point out is this: I'm glad to see thatShields spoke so openly about something I hear about quite a lot from moms –this idea of deciding you should be your own doctor and quit your meds whenever you feel like you don't need them. Bad idea. You can see what can happen when you do that, as described by Brooke in the quote above. Whatever form of treatment you are undergoing, talk with yourhealthcare providerabout whether you should end it, and when and how you should go about doing that. It's for your own good.
Actually, from my recent visit to a neuro-psychiatrist, there IS a test they can do to check your neurotransmitters. It was a 24-hour saliva collection done at timed intervals. That was the whole point of that test. I don't know much about it (because I admittedly didn't really ask questions, I just went with it) but I can request more information the next time I go back if you'd like.
I agree with you about how we need to get over the stigma of mental illness, but I actually think the phrase "chemical imbalance" may be a good step in the right direction. I remember when someone finally explained to me that part of what was wrong with my own very mentally ill mother (very depressive and probably borderline) was a "chemical imbalance," it helped me IMMENSELY. Learning about what happens inside a depressed brain was so helpful for me. It de-personalized it for me–she didn't want to be this way. She wasn't doing it on purpose. And it wasn't something she could just snap out of. And, in fact, something like medication COULD help because there was something concretely wrong– a physical imbalance in her brain. And when she did go on meds, the change felt almost miraculous to me ( of course, she also needed some major therapy which she never got, so plenty of issues continued, but not the intense depression that led to major bouts of rage. Those stopped almost immediately when the meds kicked in, and even though she never bcm the healthy mom I longed for, the meds improved her mood and, thus, my life SO much that I don't even want to imagine what might have happened if someone hadn't explained the physical part of depression first to her and then to me). The same was true for me when I went through ppd and finally got on meds. It helped to know that there was something actually going on physically that I had no control over. And, yes, there are so many other factors as well, as you say, but having spent years in therapy and having done all the right things and having none of them ultimately move me out of a suicidal depression, it was so helpful to realize that I did, in fact, have a "brain illness" in some ways and that I was going to need meds to treat the physical part of my illness. Of course mental illness is not just a physical thing, but for so long we've acted like it's a matter of the will, or just made up, or something that will go away if you just have enough faith, so a phrase like "chemical imbalance" is, to me, a short-hand way of saying, "Nope…not just something you can snap out of. Actually something physically going on in your body and brain." I think of ppd and other mental illnesses with a complex genesis as something akin to diabetes or heart disease–the kind of physical illnesses that are influenced by environment. Sure, there are a lot of factors that led to the develoipment of diabetes or heart disease (genetics, poor diet, poverty, second-hand smoke, etc.), but once the illness has developed–wherever it came from– there is an imbalance in the body that must be reckoned with (usually with meds) alongside other lifestyle changes that need to happen. Just my thoughts… 🙂
I'd be interested in hearing what the saliva test was testing for. The MDs I spoke to weren't aware of a saliva test that would check levels of neurotransmitters.
I get what you are saying and I really appreciate you sharing your experience. I have felt the same way in the past as you did when it came to others in my life who suffered mental illness. I do think the argument that mental illness is purely biologically-based makes it a lot easier for people to swallow and perhaps that's most important if it means getting people to reach out for help.
I guess what I would want people to know is, even if someone's mental illness isn't 100% due to a chemical imbalance, it doesn't mean that person chooses to be ill with a mental disorder of some kind, or that they can just snap out of it. Someone who has suffered a terrible childhood trauma, for instance, or was abused and has resulting adult depression or anxiety shouldn't be expected to just snap out of it regardless of how their neurotransmitters are working. All people with mental illness deserve compassion and effective professional help regardless of how they came to it.
I guess the other thing that worries me about the "chemical imbalance" concept is the idea that if we think what we have is only due to a chemical imbalance, we may believe all we need to do is take a medication to correct it. Perhaps that works for a portion of the people, but not all. If we look at mental illness as something more complex than simply a chemical imbalance, would people be more likely to accept that they may need to make changes in their lives and not just rely on a med? Like go to therapy. Exercise or get out in nature. Eat better. Work to build positive relationships with others. Learn coping skills. Breathe.
I have to wonder, would it turn out that the people who make multiple positive changes across their lives end up with a better long-term prognosis for their emotional health than someone who just takes a med?
And please don't get me wrong. Full disclosure, I have taken medication, and I do take a medication currently for my OCD. Plain and simple. Not ashamed. I just don't think psychiatric medication is the be all end all. It's not my savior. In my own personal situation it helps me no doubt, but other things help me as well. I find, and this is my own experience, that the more varied things I do to care for myself the better off I am.
We wouldn't tell someone who has diabetes to take insulin but not to change their diet and feel free to keep on smoking. (We also wouldn't tell them to change their diet and quit smoking but don't take insulin because meds are evil and big pharma just wants your money.)
It's all very complex, isn't it?
The tests I am aware of that impact mental health are the Adrenal Stress Index test and the The Female Hormone Panel, which is a dynamic mapping of the free fraction levels of Estradiol (E2) and Progesterone (P) throughout one cycle.; both from Diagnos-techs, Inc.
Neuroscience, Inc. provides testing for levels of epinephrine, noraepinephrine, dopamine, DOPAC, serotonin and one called 5 HIAA. They also test for taurine, GABA, glycene, PEA, histamine and creatine; all of which impact the nervous system.
Every woman is unique, just as the cause of PPD is different from one woman to another. For some women, medication is all that's needed (as in my case). For others, therapy is needed. For still others, a combination of medication and therapy. Generalizations, or a one-size-fits-all categorizations, simply don't work when it comes to PPD!
Exactly Ivy. Some may simply have a
chemical imbalance perhaps, though as I
said that's not a diagnosis. Some may have an underlying health condition like a
thyroid problem. Some may have personal
issues they need to deal with as well and
need more than just meds. Some may not need
meds at all. We are all so different.
The hormone panel, which is a good idea,
is not testing for neurotransmitters. It's
testing for thyroid problems, which can
cause symptoms that mimic PPD. It's always
good to make sure your doctor has checked
to make sure you don't have a condition like
thyroiditis that is causing your illness.
Yep, I agree with all you say in your response to my comment. I think the problem in general is how much we tend to compartmentalize and separate body/mind/spirt/emotion from one another as if that's even possible. I think the same goes for physical illnesses. It's rare that even bodily illnesses have just a simple and physical cause or cure. just like our emotions and minds get "sick" for a variety of reasons (some biological and some environmental), our bodies also get sick for a variety of reasons: often stress in our lives, or because of past trauma and abuse that has flooded our system with cortisol, which in turn, has shot our immune system and led to higher blood pressure which leads to heart-attacks, etc. And just like we talk about mental illness as a "chemical imbalance," we also talk about a heart-attack as if it's just a bodily disease isolated from our emotions and mental states, when in most cases it's not. In as much as the phrase "chemical imbalance" puts mental illness more on par with bodily illnesses, I appreciate it. But you're right that it's not enough. It can be dangerous. But I think talking about physical illness purely as having physical causes and cures is also dangerous. For example, many heart-attack victims simply take their meds and don't make the life-changes that need to happen for them to truly get better–exercise, better diet, and even therapy. I'd say that many people who suffer from heart-attacks need therapy as much as many of us with perinatal mood disorders in order to help them discover the patterns and stresses and perhaps traumas that have led to their bodies getting so stressed out and so sick. We'd never say that someone whose heart-attack was caused (in part) by stress from an awful and traumatic childhood doesn't deserve the best help possible–meds as well as help to resolve some of the psychological issues leading to increased stress and blood pressure. And we do the heart-attack victim no favors by ignoring the emotional and psychological factors leading to the heart attack. SO I guess I'd like to see us find a way to talk about sickness and wellness in general differently. I don't see a heart-attack as all that different from an acute bout of ppd, for example. Both are usually a result of a variety of systems–mental, spiritual, and physical–breaking down. Really recovering from either a heart-attack or a bout of ppd usually requires treating all of those systems, not just one. Certainly there are those who just need to treat one system, but that seems more rare than the norm to me.
Oh, and also, even if someone's depression is caused in large part by a traumatic childhood (as mine was), it doesn't mean that they aren't suffering from an "imbalance." The fact that they are depressed means, in part, that their neurotrasmitters aren't working properly–that something is wrong with their brain and their nervous system. Dan Siegel (a pediatric psychiatrist and nuerologist currently at UCLA Berkley, I believe) writes a lot about how our environments affect our brains, especially in childhood. As I'm sure you know, the stress caused by abuse and trauma actually cause physical changes in the brain and in the neural system that lead to all sorts of problems–everything from depression to a weaker immune system to higher blood pressure. Siegel says that the distinction between nature and nurture is kind of meaningless because the way we're raised and our environments (nurture) shapes our brains and our nervous systems so early, and our genetics (nature) shape our experience of our environments so much that it's largely impossible to separate the two. At any rate, the fact that abuse and trauma do cause physical changes in the brain and body means that even for those of us whose mental illness arises largely (or even entirely) from psychological stresses early in life, therapy is still often not enough. I'd done 7 years of therapy before I had ppd and was in therapy during the worst of my ppd, and it just didn't help my mood at all. It didn't significantly help with the depression or trauma. I didn't really start to recover until I took meds because my brain and my nervous system were so shot bcs of the stress of early abuse. Once the meds were able to start to correct the problems going on in my brain and nervous system, then therapy became effective. In many ways therapy has been invaluable for me. Just invaluable. But it just couldn't reach deep enough–couldn't get in to treat the "imbalances" in my brain that the abuse had led to. I suppose it's much like someone with high blood pressure who might be able to lower it some with changes in lifestyle and thinking patterns and diet alone, but ultimately need meds to help treat the imbalances in their bodies.