“Depression is not caused by a chemical imbalance in the brain, and it is not cured by medication. Depression may not even be an illness at all. Often, it can be a normal reaction to abnormal situations. Poverty, unemployment, and the loss of loved ones can make people depressed, and these social and situational causes of depression cannot be changed by drugs.”

“Depression, we are told over and over again, is a brain disease, a chemical imbalance that can be adjusted by antidepressant medication. In an informational brochure issued to inform the public about depression, the US National Institute for Mental Health tells people that 'depressive illnesses are disorders of the brain' and adds that 'important neurotransmitters - chemicals that brain cells use to communicate - appear to be out of balance'. This view is so widespread that it was even proffered by the editors of PLoS [Public Library of Science] Medicine in their summary that accompanied our article. 'Depression,' they wrote, 'is a serious medical illness caused by imbalances in the brain chemicals that regulate mood', and they went on to say that antidepressants are supposed to work by correcting these imbalances.The editors wrote their comment on chemical imbalances as if it were an established fact, and this is also how it is presented by drug companies. Actually, it is not. Instead, even its proponents have to admit that it is a controversial hypothesis that has not yet been proven. Not only is the chemical-imbalance hypothesis unproven, but I will argue that it is about as close as a theory gets in science to being dis-proven by the evidence.”

“Not only are poor, unemployed, less will-educated and non-white people more likely to become depressed, but they are also least likely to benefit from treatment by either antidepressants or psychotherapy. That is why combating depression requires more than merely providing effective treatment for those who are already suffering from it. We also need the change the social conditions - such a racism, unemployment, poverty, unaffordable housing, and lack of adequate education - that put people at increased risk of becoming depressed.”

“Depression is a serious problem, but drugs are not the answer. In the long run, psychotherapy is both cheaper and more effective, even for very serious levels of depression. Physical exercise and self-help books based on CBT can also be useful, either alone or in combination with therapy. Reducing social and economic inequality would also reduce the incidence of depression.”

“For people who are depressed, and especially for those who do not receive enough benefit from medication of for whom the side effects of antidepressants are troubling, the fact that placebos can duplicate much of the effects of antidepressants should be taken as good news. It means that there are other ways of alleviating depression. As we have seen, treatments like psychotherapy and physical exercise are at least as effective as antidepressant drugs and more effective than placebos. In particular, CBT has been shown to lower the risk of relapsing into depression for years after treatment has ended, making it particularly cost effective.”

“The results of decades of neurotransmitter-depletion studies point to one inescapable conclusion: low levels or serotonin, norepinephrine or dopamine do not cause depression. here is how the authors of the most complete meta-analysis of serotonin-depletion studies summarized the data: "Although previously the monoamine systems were considered to be responsible for the development of major depressive disorder (MDD), the available evidence to date does not support a direct causal relationship with MDD. There is no simple direct correlation of serotonin or norepinephrine levels in the brain and mood.' In other words, after a half-century of research, the chemical-imbalance hypothesis as promulgated by the drug companies that manufacture SSRIs and other antidepressants is not only with clear and consistent support, but has been disproved by experimental evidence.”

“When people recover from depression via psychotherapy, their attributions about recovery are likely to be different than those of people who have been treated with medication. Psychotherapy is a learning experience. Improvement is not produced by an external substance, but by changes within the person. It is like learning to read, write or ride a bicycle. Once you have learned, the skills stays with you. People no not become illiterate after they graduate from school, and if they get rusty at riding a bicycle, the skill can be acquired with relatively little practice. Furthermore, part of what a person might learn in therapy is to expect downturns in mood and to interpret them as a normal part of their life, rather than as an indication of an underlying disorder. This understanding, along with the skills that the person has learned for coping with negative moods and situations, can help to prevent a depressive relapse.”