Psychiatrist and author of Psychotherapy of Character:
The Play of Consciousness in the Theater of the Brain

No, It’s not the Neurotransmitters, Depression is not a biological disease caused by an imbalance of serotonin


The theory that depression is a biological disease, caused by an imbalance of serotonin and the other neurotransmitters is invalid. It is a house of cards promoted by Big Pharma and its influence peddling in academic psychiatry. It has been completely accepted by the American Psychiatric Association with its DSM_5 and the culture at large. And the treatment for ‘clinical depression’ is promoted to be antidepressants. Beyond recognizing that this theory is untrue, it is incumbent to present a valid understanding of depression, the brain, and consciousness and the appropriate treatment.

The pharmaceutical industry has been exposed having been engaged in study suppression, falsification, strategic marketing, and financial incentives. Sales of antidepressants in 2011 was 11 billion dollars. Ben Goldacre is his illuminating Ted lecture, “What doctors don’t know about the drugs they prescribe” addressed the issue of study suppression. A fifteen year review of antidepressant studies showed that 50% of the 76 studies were positive and 50% were negative. All of the positive studies were published and all but three of the negative studies were suppressed and not published. In 2004 approximately half of all studies that weren’t already suppressed by the pharmaceutical industry concluded that antidepressants are not significantly more effective than placebo alone. And two thirds of studies for children given antidepressants show the same.  Even the standard for the positive studies by which effectiveness is scientifically accepted is that if  antidepressants work 40% of the time and Placebos work 30% of the time, it is deemed to be an effective drug. This means that the antidepressants apparently work 10% of the time. So much for this evidence based theory. In real science, the exception proves the rule. For a theory to be correct it has to be correct 100% of the time. I will not go into the negative effects of these drugs here – in addition to not being efficacious there are considerable side effects, habituation, drug tolerance and addiction. [See the download “Do No Harm”, the Appendix of my book.]

The real cause of depression, and all the rest of psychiatric symptoms, follows from the way one’s unique consciousness is formed in the brain all through development from embryonic life to age twenty. Our developmental experience is mapped in the limbic-cortex as incredibly complex circuits of neuronal maps that reflect the impacts of love, respect, deprivation, and abuse as digested by one’s unique temperament. These brain maps generate human consciousness – which is organized in as a drama in the theater of the brain with a cast of personas, feeling relationships between them, scenarios, plots, set designs and landscapes. The internal play is the consummate creation of the human genome. Once established, beginning at age three, the representational play operates via top down cortical processing, and is the invisible prism through which we live our lives.

Serotonin and the other neurotransmitters operate in the synapses of our limbic cortical maps connecting the trillions of neurons that create the mappings that form our plays. Serotonin has no life of its own. It is merely a brain mechanism that serves the neuronal organization of consciousness, the play itself. The way the limbic-cortical brain maps our experience reflects the actuality of our experience. If our character play is too damaged by deprivation and abuse, it generates an invisible sadomasochistic play that is filled with attack and humiliation, endless war. Consequently the activated internal play is one of continuous internal fighting between personas. As such it feeds on the serotonin supply on an ongoing basis. It is inevitable that the supply will be overtaxed. This is not the result of a serotonin problem. It is built in from a damaged characterological play. It is not a question of ‘if’, but only ‘when’ serotonin will be overused and depression will appear.

Depression is the signal that there are problematic fault lines in one’s characterological play. It does not mean there is a neurotransmitter problem. It means there is an internal play problem. If one feeds more serotonin into the system, one actually feeds and builds the internal war which only worsens the situation. In fact, the antidepressants actually harden people and makes them unconflicted about selfishness, which can be experienced as feeling better. But the real problem is the damaging problematic play. This is what needs to addressed and healed rather than fueled.

The treatment is the psychotherapy of character. Psychotherapy operates in exactly the same way as our plays were created in the first place. In therapy, one mourns one’s problematic experience within the boundaries and emotional holding relationship with the therapist. A patient digests and relinquishes his old play, and then writes a new play that is not sadomasochistic. Symptoms disappear all by themselves as the old play, where serotonin was being over consumed, is no longer activated. In its place, a new play, grounded in authenticity and love is established and activated. The brain is dynamic and responds to psychotherapy in its characteristic way. Studies have repeatedly shown than that the brain changes from psychotherapy. How can that be if symptoms are a serotonin disease?

For a theory to be valid, it has to conform to the actual brain-body in its development and organization. It has to correspond to the actualities of the human genome as it orchestrates morphogenesis into the mature adult brain-body. Likewise, in order for an understanding of the operations of the brain-body to be meaningful, it has to be consonant with actualities of human life and struggle. There has never been any evidence for the neurotransmitter disease model. On the other hand, I propose a model that is consonant to the realities of human life and development. It is a unified field theory that encompasses dreams, myths, art, human character, religion, and beliefs.

Robert A. Berezin, MD is the author of Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain


14 Responses to No, It’s not the Neurotransmitters, Depression is not a biological disease caused by an imbalance of serotonin

  • Layla says:

    Super interesting!! I am a Movemet Based and Somatic therapist, body worked and Actress and always made this theory mine, always sensed that all our emotional and psychological issies where comming from old patterns, from old memories storaged in our bodies that we need to release in order to “writte a new story” please let me know how can I get more information and if there is any conference given by the Author. Thanks

  • I am not giving conferences at this time, just working and writing. I hope you will read my book, “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”. Let me know if it fits with your work and your thinking.

  • CJ says:

    That sounds right. Its definitely how I feel. I like that you point out the conflict- which is definitely what happens in my head- I want to be happy and successful, but then, no I dont, because the world is aweful and so am I so why bother? Problem is then how to rewire without years of therapy- because who can afford that, and what are the odds the therapist will be any good?

  • Manuel Montes de Oca says:

    Excellent work as well as the latest one about the theater of the brain. Almost poetic and very educational and right on the reasons why we can not be able to catch the biology of the mind.

  • David Rubin says:

    Curious if the statistics you mentioned ( A fifteen year review of antidepressant studies showed that 50% of the 76 studies were positive and 50% were negative) also applies to your application of treating depression. When you say “Studies have repeatedly shown than that the brain changes from psychotherapy.” and then ask the question: “How can that be if symptoms are a serotonin disease?” Couldn’t the answer be that not every treatment is appropriate for every person. Seems like the statement you make is very similar to the one that your critical of, that one size fits all.

    • David,
      I’ll address the “Seems like the statement you make is very similar to the one that your critical of, that one size fits all.” in my next post. Thank you for your comment.

  • Sarah Smith says:

    I found you on Mad in America and I love your views on the proper research/treatment approach for depression, first by dispelling the egregious misinformation floating out there. I really wish someone of your caliber would go the extra mile, however, by exposing the same myths about individuals who experience extreme states, including psychosis. My beautiful 24 year old daughter has been subjected to torture and human rights violations for the last five years. The only time she has ever been a danger to herself was when she had an adverse reaction going on or coming off a bad medicine. Her underlying childhood traumas have never been addressed but she has been isolated, restrained, stigmatized with a ‘brain disease’, institutionalized, incarcerated, and forcibly medicated. Why is it that professionals who are capable of finding the flaws in the treatment model for depression are not willing to look at the averse results of our treatment model for the ‘persistent severely mentally ill’ individuals? Have you looked at the incredible results of the Open Family Dialogue’ treatment for people with psychosis in Finland? Why can’t we employ more enlightened systems of care in this society. Why aren’t more doctors coming out to decry the forced medication or AOT that is being promoted in the Murphy Bill?

    • I’m sorry for your troubles. I would hope your daughter can find a good therapist. I do have two blogs on shcizophrenia, “Reflections on Geel – Schizophrenia is not a Medical Disease. Human beings with schizophrenia do best with care and respect.” and “The Secret World of Schizophrenia – The tragedy of a promise unfulfilled.” and more definitively chapter 10 of my book. Ultimately all of psychiatry is about human problems and need to be dealt with as such.
      Keep on fighting for her, you obviously are.

  • Bill Fisher says:

    Have you made it your mission to make depressed people more depressed? The science is clear that depression is a function of brain chemistry and a maladaptive state. The two can influence each other in both directions. You choose to blame it only on a maladaptive state. Perhaps the fact that the government shifting its research dollars to brain chemistry and away from psycotherapy has you fearing for your job so you choose to write books and get more attention by attacking Ketamine. I’m with you on anti-depressants-but let Ketamine have a chance before you blow it out of the water. Maybe talk to some people who have tried it like a good doctor should.

    • Rank Merida says:

      Dr. Berezin does not need to fear for his job. He can always switch to the side of APA where he can earn more and go to Big Pharma-funded vacations. Thankfully he won’t.

  • Riley says:

    There have been extremely promising results with “magic mushrooms”, do you think they should be considered an option?

    • Absolutely not. First of all, depression is not a biochemical ‘disease’ in the first place. Second to treat something by other pharnaceuticals is a complete fallacy. Never mind that mushrooms are hallucinogens and can make people psychotic.

  • Olia says:

    If depression is not a chemical imbalance disease than why do some prescription drugs cause depression as a side effect? A dose-response relationship has been observed: bigger dose causes worsening of depression simptomes. If depression is not a chemical imbalance disease than how can any drug cause it?

    • Theo Tsaousides, Ph.D. says:

      Any drug that crosses the blood-brain barrier is going to cause temporary changes in the brain’s biochemistry, and as a result in the physical, emotional, and mental state that a person experiences. Take street drugs, for instance. They can cause anything from euphoria to razor-sharp focus to death. The effect of the drug, however, is not evidence of etiology or causality. Giving someone a sedative or hypnotic will cause symptoms of somnolence, but that doesn’t mean that they suffer from insomnia and there is something wrong with their alertness networks. The fact that taking cocaine raises heart rate and blood pressure doesn’t imply that there is bradycardia or hypotension, or even worse, a dopamine deficiency.

      The brain is a battlefield of incessant biochemical imbalances. This is just how it works. This is how nerve impulses are generated and propagated. And any foreign substance in the brain is going to interfere with that clockwork imbalance and cause temporary (or with more prolonged exposure more permanent) symptoms.

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Robert Berezin, MD, psychiatrist and author of Psychotherapy of Character: The Play of Consciousness in the Theater of the Brain

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© 2013 by Robert Berezin, MD