A patient we'll call David came for a consultation seeking help regarding a mood disorder. Variously diagnosed as depression or anxiety - or both, it had plagued him for most of his adulthood. To a large degree, his emotions seemed tied up with his work life. As a middle aged professional who ran his own small firm, he placed a great deal of pressure on himself to perform up to his own high standards and easily fell into despair about what he perceived as his professional inadequacies.
David had sought out the assistance of therapists but talking through his problems did little to alleviate the problem. He had gone on and off antidepressants several times as well. They would work to a certain degree, dampening the extreme moods and make it easier to function on a day-to-day basis.
His therapist assured him that he would have to take medication for the rest of his life because his brain just didn't make enough serotonin, the neurotransmitter that has long been linked to happiness and a sense of wellbeing. But for David, these medications that acted on serotonin levels in his brain - the selective serotonin reuptake inhibitors or SSRIs - really did not make him happy nor provide him with a sense of wellbeing. They acted more like a buffer, distancing him from his emotions but did little to fundamentally change his thoughts and feelings. It was this sense that a pharmacological approach really did not resolve his inner turmoil that brought him to homeopathy.
It is interesting that well into the 21st century, many professionals in the mental health field still hold onto the belief that depression is simply a deficit of this particular chemical. The idea first gained currency in the 1960s, but even George Ashcroft, the Scottish scientist who first put forth the idea, jettisoned it after a number of years because his follow-up research showed it to be incorrect. He came to understand that low levels of serotonin were "probably a measure of functional activity of the systems and not a cause"1. In other words, it may accompany depression, but didn't produce it.
Many others have weighed in with similar opinions on the subject. In 'Blaming the Brain', the neuroscientis Elliot Valenstein wrote in 1998: “Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims."2 The editor of the Psychiatric Times wrote in 2011 that, “In truth, the “chemical imbalance” notion was always a kind of urban legend - never a theory seriously propounded by well-informed psychiatrists.”3
The more interesting question is what gives this notion its legs. Why do people like David's therapist still suggest to patients that serotonin deficiency is at the root of their problems? The answer, more than likely is two-fold.
First, it is a simplistic concept easy to understand and easy to convey. This is always the attraction of reductionist thinking. Take a complex and usually multi-factorial phenomenon like depression that can manifest in so many ways in different people, and reduce it to 'it's your serotonin'.
Even the concept that serotonin is a mood enhancer is simplistic. One doesn't have to go much past the first paragraph of its Wikipedia entry to understand how complex the action of serotonin in the human body actually is. "It has a popular image as a contributor to feelings of well-being and happiness, though its actual biological function is complex and multifaceted, modulating cognition, reward, learning, memory, and numerous physiological processes.4
This may also explain why so many adverse reactions and side effects are associated with SSRI's. It has been widely known for decades that they can produce akathisia - a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs - and which, in certain individuals, can produce "homicidal akathisia", that is, violent impulses towards oneself or others.5
The second reason is that having successfully developed SSRIs which diminish the reabsorption of serotonin in the 1980's, the pharmaceutical industry began to aggressively market them along with the theory that gave their use credence even though it was no longer generally accepted in the scientific community.
Fortunately, David suffered no side-effects from his medication. Nonetheless, he wanted to find a way to do more than tone down the volume of the ongoing self-criticism and sense of inadequacy that controlled his life. Decision-making was agonizing, paralyzing him with self-doubt about making the wrong choice. And, if a decision didn't turn out well or as anticipated, he would be filled with inwardly directed rage.
David did his utmost to please his clients and would be devastated if he sensed that their expectations were not met. Yet, he also disparaged himself for being so obsequious to them and not standing up for himself.
Initially, I prescribed the homeopathic medicine Aurum metallicum for David. Prepared from a dilution of gold, it is well known in the treatment of depression, especially with suicidal ideation. More to the point, 'Aurum personalities' have a high degree of responsibility, demand a tremendous amount of themselves and are shattered when they don't meet their own expectations.
Unfortunately, the remedy really did not help David to any significant degree. I tried another similar remedy, this time the gold salt Aurum-arsenicosum. It too did nothing.
Much to his credit, David remained committed to the treatment over this period of time which gave me the opportunity to re-evaluate his case. Researching the homeopathic literature, I came across a very similar case published in a book not coincidentally entitled "Prozac-Free".6 The authors described a man who was highly self-critical, a constant second guesser, filled with low self-esteem and highly indecisive. And they too had first prescribed Aurum metallicum with little results.
Ultimately, the remedy that did prove effective in that case - and subsequently in David's - was a homeopathic preparation of Cadmium sulphate.
His reaction was immediate and dramatic. "After all this time, everything has suddenly changed. I feel a profound difference. I'm reconnected to my life and it all makes sense to me." The critical voice had receded and David was now appreciating his own talents and worth.
A study of Cadmium sulphuratum provides a fascinating insight into the nature and evolution of homeopathic medicines. Dating back nearly two centuries, it proved to be highly effective in treating yellow fever, cholera and inflammation of the digestive tract. It also has a reputation for the treatment of gastric cancer where there is burning pain, uncontrollable vomiting and fever. Patients needing this remedy exhibit extreme exhaustion, physical coldness and weakness.
In the early literature, information about the mental state, if mentioned at all, is quite sparse. There is a mention of a 'horror of solitude and work', irritability and an apprehension when approached by anyone. It has only been in more recent times that this has been fleshed out. As the authors of Prozac Free write, it is characterized as a medicine for "depressed, discouraged individuals who feel stuck... who suffer from such tremendous self-doubt and reproach. Though their ideals may be high and they may be quite capable, they never feel that way."7
It's been quite a few months since that initial dose of Cadmium sulphuratum and David has maintained a continued sense of well-being and self-assuredness. As for his serotonin levels, that is difficult to say.
1. L McHenry, Ethical issues in psychopharmacology, J Med Ethics . 2006 Jul; 32(7): 405–410.
2. January 29, 2012 <https://www.madinamerica.com/author/leolacasse/>
5. https://articles.mercola.com/sites/articles/archive/2012/01/07/antidepressants-trigger- violent-behavior.aspx
6. Judyth Reichenberg-Ullman and Bob Ullman, Prozac-Free: Homeopathic Medicine for Depression, Anxiety and other Mental and Emotional Problems (Prima Publishing, 1999)