Replacing the Myth of the Chemical Imbalance: The Brain as Ecosystem (with thanks to John McManamy)

I've been spending a lot of time on John McManamy's Depression and Bipolar Web recently.  In addition to having a lot of critically important advice for folks living with mood disorders, he's a really smart guy who gets into the science, and his writing is often pretty funny.

A few years ago, he wrote an article about the need to replace the "chemical imbalance" myth with something that has, you know, some actual validity.  You remember the chemical imbalance theory, right?  It's the one that tells you that you're depressed because of a "serotonin imbalance", or that you have ADHD because you don't have "enough" dopamine.  It was a working theory that seemed to have some explanatory value, and it provided a simple metaphor that patients could understand.  (It also provided a simple metaphor that drug companies could use to market their medications directly to the public, but that's a rant for another day.)

In an article entitled Systems in Collapse, McManamy proposes that we think of the brain not as some sort of soup, to which pungent oregano can be added to enhance the flavor of the tomatoes and to balance the sweetness of the basil, but as a complex ecosystem.  Neurotransmitters are just one of many actors in this ecosystem.  There are also the various regions of the brain, and the ways in which these interact.  There's also the question of what neurotransmitters do once they get inside your cells.  As you can see, it's much more complicated than "not having enough" serotonin.

So let's pretend the brain is a fish tank.  A fish tank is a closed ecosystem, where the inputs are what the owner of the tank decides they are, so it's already an oversimplified version of your brain.  But it's simple enough to work with, so I'm going with it.

The ecosystem of a fish tank, like a brain, needs to be kept in equilibrium.  To help keep my brain in equilibrium, I'm taking lamictal to control my mood.  The going theory is that it's a glutamate inhibitor, and that by limiting the amount of glutamate (an excitatory chemical) brain cell death is prevented.  In the fish tank metaphor, maybe lamictal is an algae-eater, preventing the depletion of oxygen in the tank.

But oxygen levels aren't all about algae, they're about surface area and aeration.  And a fish tank isn't just about oxygen levels.  To be successful, the water in the fish tank needs to be kept at the right temperature, and it needs to be cleaned and filtered.  The type of gravel, aquarium plants, lighting, and positioning will matter to the tank's equilibrium.  Finally, the fish themselves need to be the right size for the tank, and they need to be compatible species.

If the tank manager gets all of this right, the tank will pretty much keep itself at equilibrium.  Equilibrium means happy fish.  If the tank manager gets even one of these things wrong, the fish might die.  Dead fish are not happy fish.

Likewise, my brain isn't just about glutamate and the prevention of cell death.  There are other neurotransmitters besides glutamate -- there's dopamine, serotonin, norepinephrine, and plenty of others.  These interact within the cells and between the cells, mediating the flow of information between different regions of my brain.  If I stay too depressed for too long, parts of my brain might even shrink and atrophy, making it even more difficult for them to do their jobs.

With all that going on, it's no wonder that a single pill can never be sufficient to manage a mood disorder.

Every experience you have changes your brain.  Yes, you read that correctly.  What you learned in fifth grade science class, how alcohol KILLS BRAIN CELLS!  and brain cells NEVER GROW BACK!!! is just plain wrong.  Every experience you have either reinforces existing neural pathways, or creates new ones.  Pretty cool, huh?

Knowing this, it's seems obvious that managing a mood disorder requires a healthy lifestyle in order to be kept in healthy equilibrium.  Exercise changes your brain for the better.  So does eating right.  And getting enough sleep.  And minimizing stress.  Maybe you need to throw in a sun lamp if you cycle seasonally.  A mindfulness practice also helps.  Pleasurable activities are also required.

Each of these things is a component in your brain's ecosystem whether you attend to them or not.  Failing to exercise, or eating lots of junk food, impairs your brain's ability to keep itself in balance.  If you do everything right, except for getting enough sleep, your brain's ecosystem will collapse.

One of the most frustrating things about having a mood disorder (and in my case, one that's exacerbated by ADHD) is the amount of work it takes to manage it.  When you're in the depths of depression, it can be agonizingly difficult to get up and eat something, let alone prepare a healthy meal for yourself.  If you're barely able to get out of bed the thought of exercise may be overwhelming.  And how can you get a decent night's sleep if your mood disorder is giving you insomnia?

The answer I found is to institute these changes when things are relatively stable in your life.  I did this a few years ago, at a time when my relationship and my finances were good, and when my mood disorder appeared to be in remission (ha!).  Fortunately, by the time I had my crisis last winter, eating right and exercising had become ingrained habits.  Between my ADHD and my mood problems, I needed to build myself a healthy brain ecosystem that would support me when things got bad.

By doing so, I ensured that my crisis wasn't as bad as it could have been, and that coming out of it would be so much easier.

Talk to me, folks.  How do you keep your own brain's ecosystem in balance?