People who think their depression or anxiety is the result of a chemical imbalance tend to use antidepressants for much longer periods of time than people who think their condition is a reaction to life events. These people are less likely to try to stop taking their medication, even if their ongoing symptoms are mild. A study detailing these patterns was published in the Journal of Affective Disorders.
Since the 1990s, pharmaceutical marketing and educational campaigns have heavily promoted the idea that depression is a biological disease. Many of these campaigns specifically argued that mental distress was caused by a lack of serotonin in the brain. This medical explanation was originally intended to reduce social stigma and encourage people to seek professional help. Over the past few decades, prescriptions for depression and anxiety have skyrocketed in both the US and UK.
Currently, long-term prescriptions are the main driver of the significant increase in continued use of antidepressants. Millions of people in the UK take these drugs, and at any given time half of them have been on them for more than two years. In the United States, nearly half of patients taking antidepressants have been on them for more than 5 years. Although medical guidelines recommend continued treatment for some people, health experts estimate that a large proportion of long-term users may be taking the drug unnecessarily.
Modern research no longer supports the original biological theory of depression. A recent systematic review of the scientific literature found no consistent evidence linking depression and abnormal serotonin levels. Despite this change in scientific understanding, public perception is still heavily influenced by old marketing messages. Recent survey data shows that up to 80 percent of the population in Western countries supports the chemical imbalance theory.
Molly Griffin-Williams, a researcher at University College London, along with psychiatrist Joanna Moncrief and others, wanted to investigate how these deeply held biological beliefs affect patients today. Researchers wondered if believing that mental illness is a physical defect in the brain might change how individuals approach recovery. The researchers specifically wanted to know whether patients would be more reluctant to stop taking the drug in this light.
To explore this question, the research team designed a cross-sectional survey of adults attending public psychotherapy services in the UK. This national program provides free counseling and support to people with common mental health issues such as depression, generalized anxiety disorder, and post-traumatic stress disorder. The team contacted patients who agreed to approach the study and confirmed their eligibility. A total of 497 people who were currently taking or had previously taken antidepressants completed the online survey.
The study asked participants to choose the statement that best represented their understanding of their original state. Options included biological explanations, such as brain disease or chemical imbalances, and environmental explanations, such as reactions to life problems. Another question asked participants how they saw the medication working. Here they can indicate whether they believe the drug corrects low serotonin, acts as a temporary aid, or acts as a bridge to facilitate treatment.
The researchers also extracted data from patients’ medical records to collect objective measures of their mental health. They looked at participants’ starting scores on standard clinical questionnaires used to assess depression and anxiety. These tools, known as the Patient Health Questionnaire and the Generalized Anxiety Disorder Assessment, numerically assess the distress of symptoms. By comparing these scores, the team could see whether the different beliefs were simply a byproduct of the patient’s actual degree of illness.
Survey responses revealed mixed patient perspectives. Approximately 57 percent of respondents endorsed at least one statement attributing their condition or need for medication to a biological cause. At the same time, approximately 66 percent of participants believed their mental health struggles were a reaction to difficult life events. This overlap suggests that many people have mixed views of emotional distress, accepting both medical and environmental explanations.
When researchers looked at drug-taking habits, a clear pattern of behavior emerged. Those who held biological beliefs about their mental health used antidepressants for a median of 12 months. In contrast, patients who did not support a biological explanation used the drug for a median of only 6 months.
The views held by patients also corresponded to different attitudes about the effectiveness of drugs. Those in the biological belief group were more likely to report that the medication improved their symptoms. They were also much more likely to express an inability to cope with daily life without antidepressants.
This psychological dependence led to a decreased willingness to discontinue treatment. Only about 58 percent of people with biological beliefs had ever tried to stop taking their medication. In the group lacking these beliefs, almost 68 percent of patients were planning to stop taking antidepressants.
The team checked clinical assessment scores to ensure that these differences were not caused by the severity of the underlying disease. They found no differences in initial depression or anxiety scores between the two belief groups. Patients with a biological view are not objectively worse off than other patients. This means that long-term use is linked to the patient’s view rather than the medical condition.
The researchers also assessed how these beliefs interacted with drug withdrawal. Patients who try to stop taking antidepressants often experience discontinuation syndrome, which includes dizziness, electric shock sensations in the brain, and emotional instability. In this study, among people who attempted to quit smoking, holding biological beliefs was not associated with experiencing more severe withdrawal symptoms. However, long-term use of the drug could lead to worse withdrawal effects in the future.
The research team acknowledged that their methodology had some limitations. Because this study was cross-sectional, we only captured a snapshot of participants at one point in time. This design does not allow us to prove that biological beliefs directly cause long-term use in patients. It is quite possible that the daily habit of taking pills gradually forms a person’s way of thinking, reinforcing the idea that he is suffering from a permanent chemical deficiency.
Patient samples also present limitations on how universally applicable these findings are. Participants were recruited from public psychotherapy services, indicating that they were already open to non-medical forms of mental health intervention. This particular demographic may be naturally more inclined to treat their symptoms as a response to personal stress compared to broader drug users. Furthermore, the assessment of withdrawal symptoms is based on retrospective self-report and may include memory inaccuracies.
Going forward, researchers suggest that changing the way health professionals talk about mental health could improve outcomes for patients. Preventing unnecessary long-term dependence is a major public health priority, as long-term drug use leads to worsening withdrawal symptoms. Future studies should test whether explicitly educating patients about the lack of evidence of chemical imbalances can help them safely discontinue their medications. If doctors avoid viewing depression as a permanent biological defect, patients may be more likely to forget their prescriptions after recovering from a difficult period in their lives.
The study, “Beliefs about the biological nature of mental disorders and how they influence antidepressant use and withdrawal,” was authored by Molly Griffin Williams, Mark Horowitz, James Davis, and Joanna Moncrief.
