395. Is depression just a chemical imbalance?

The idea that depression is caused by a “chemical imbalance” is one of the most widely accepted explanations in modern mental health ... but is it actually true? In this bonus episode, we unpack where the chemical imbalance theory came from, how it became the dominant narrative around depression, and why many researchers today believe the story is far more complicated. Including: The academic and applied history of this theory What research says about antidepressants vs placebo Why the “low serotonin” explanation may be too simple The psychological and social drivers of depression Why meaning, connection, and environment matter for mental health Why depression treatment often works best when it’s multi-layered Happy listening! Watch on Netflix http://netflix.com/thepsychologyofyour20s Follow Jemma on Instagram: @jemmasbeg https://www.instagram.com/jemmasbeg/?hl=en# Follow the podcast on Instagram: @thatpsychologypodcast https://www.instagram.com/thatpsychologypodcast/?hl=en# Subscribe on Substack: @thepsychologyofyour20s https://substack.com/@thepsychologyofyour20s For business: [email protected] mailto:[email protected] The Psychology of your 20s is not a substitute for professional mental health help. If you are struggling, distressed or require personalised advice, please reach out to your doctor or a licensed psychologist. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Jemma Sbeg?

  This is an iHeart Podcast. Guaranteed Human.

• 0:04Speaker 01

  Cash Flow Crunch. OnDeck's small business line of credit gives your business immediate access to funds, up to $200,000, right when you need it. Cover seasonal dips, manage payroll, restock inventory, or tackle unexpected expenses without missing a beat. With flexible draws, transparent pricing, and control over repayment, get funded quickly and confidently. Apply today at ondeck.com. Funds could be available as soon as tomorrow. Depending on certain loan attributes, your business loan may be issued by OnDeck or Celtic Bank. OnDeck does not lend in North Dakota. All loans and amounts subject to lender approval.

• 0:34Jemma Sbeg?

  This episode is sponsored by Gymshark. Gymshark has spent over 14 years obsessing over gym clothing and the people who wear it. And let me just say, I think we all know, they are very, very good at what they do. No, seriously, their stuff is so good. Their everyday seamless collection is light, it's soft, it's stretchy. All of their stuff just looks good on, and it's made for people who love to exercise, whatever exercise that is. Lifting, cardio, Pilates, running around campus, maybe just doing errands. Discover Gymshark and find your new favorite gym clothing at gymshark.com.

• 1:11Jemma Sbeg?

  Hey, question. Are you an Extra Care member at CVS? Because there is literally no reason not to be. It's super easy to join and members instantly get extra big deals on things you buy most. I mean, this is stuff you're already buying. Things like snacks, personal care products, all of it. And after you join, the savings just show up. Deals refresh every two weeks, but they don't last long. Head to your local CVS or open the CVS app, look for extra big deals, and start saving today. No one's journey is the same. That's why Delta SkyMiles moves with you. Whether it's earning

• 1:50Jemma Sbeg?

  miles from coffee runs, to flights, to redeeming for vacations your way, or even unlocking exclusive experiences, a SkyMiles membership fits into your lifestyle, letting you do more of what makes you, you. It's more than travel. It's the membership that flies, dines, streams, rides, and arrives with you. Because when you have a membership, that's as unique as you are, there's no telling where your journey will take you next. You know that feeling when your skin just needs a tall drink of water? That's what Clinique Moisture Surge 100 Hour Moisturizer is for. Moisture Surge 100 Hour Moisturizer absorbs instantly and hydrates for 100 hours for plump, glowing skin.

• 2:35Jemma Sbeg?

  That's right, 100 hours. It is a lightweight, oil-free gel cream, safe for sensitive skin. It's allergy-tested and fragrance-free. I use this all the time. It makes my skin feel so fresh and plump and glowy. Even under makeup, I still see an amazing difference. It never leaves my skin oily or tacky. Try Clinique Moisture Surge 100 Hour today at clinique.com. Feels like moisture surge.

• 3:11Jemma Sbeg?

  Hello, everybody. I'm Jemma Sbeg and welcome back to the Psychology of Your 20s, the podcast where we talk through the biggest changes, moments and transitions of our 20s and what they mean for our psychology.

• 3:30Jemma Sbeg?

  Hello, everybody. Welcome back to the show. Welcome back to the podcast. It is so great to have you here back for another episode. Today, I have a bonus episode for you guys. And if you are new around here, let me tell you about our bonus episodes. So our bonus episodes are our little shorter, sharper, more focused episodes that we do on a singular term, a singular theory, a singular idea that you may have heard thrown around to do with psychology, to do with mental health, something that gets a lot of traction mainly online, but perhaps you never see properly discussed. This is like my chance to just dive into the research for you guys and for myself.

• 4:15Jemma Sbeg?

  And today we have a significant one. We are talking about the theory that depression is just a chemical imbalance. Is that really true? Or is it a little bit too? Simple. A lot of how we approach depression, think about depression, is based on this biological model, but there are definitely parts of it that are no longer accurate and that we know are no longer accurate as we kind of gain, yeah, more medical understanding. So that is what we are going to talk about today. A quick disclaimer, please do not take this as medical advice.

• 4:57Jemma Sbeg?

  A lot of our discussion today does have implications for things like antidepressants. I'm on antidepressants. I literally just took mine like five minutes ago. They helped me. I will continue to stay on them and I do believe they work. Um, you know, some articles that we're gonna cite today are skeptical of that. But as always, you know, what works for you might not work for everyone. If you are on antidepressants, if you are considering it, always talk to your doctor before starting or stopping this kind of medication. Just wanna put that in here because, yeah, you know, this discussion does have some big implications for that and I don't want anybody to be making rash decisions around thirty minutes of audio.

• 5:42Jemma Sbeg?

  So with that being said, let's get into it, starting with what do we actually mean by depression is a chemical imbalance? This is widely believed to be a li- to be quite an outdated description actually these days and yet it is still used all the time. But when people say this, what they actually mean is the idea that depression happens because your brain doesn't have enough of certain neurotransmitters, especially serotonin. And therefore, increasing the balance or the level of that neurotransmitter will correct the deficiency and will eliminate depression.

• 6:24Jemma Sbeg?

  Neurotransmitters, just for a very quick biological refresh, are the brain's chemical messengers. Your brain cells, your neurons, they don't actually touch each other directly. They communicate across these tiny gaps to stop electrical signals from interrupting each other. And the things that pass through those gaps and pass on messages are your neurotransmitters. So they influence everything from mood to motivation, sleep, appetite, attention, stress response, everything that is going on in your body at any given moment. As I've mentioned, one transmitter you will hear constantly in these conversations is serotonin. Serotonin is a chemical messenger involved in so many processes.

• 7:09Jemma Sbeg?

  I think a lot of people just think of it as the happiness drug or the happiness chemical. But it affects everything from mood to sleep to appetite to emotional regulation. Those things have a correlation with happiness, which is why, yeah, it all gets. Yeah, it's why it gets that simplistic definition of like, this is the happy chemical. Or dopamine often gets cited as that as well for the same reasons. So this is how the biological story of depression came to be. Serotonin controls mood. Mood controls happiness. Depressed people are unhappy. Therefore, working in reverse, someone who is unhappy and with a low mood

• 7:52Jemma Sbeg?

  must have disturbances in serotonin. Therefore artificially changing or influencing serotonin availability will improve depression because this is, at the end of the day, just a biological shortage problem. When did this theory actually first come to be? Because I feel like now it's just taken for granted. I was literally like, my dad says this all the time, like it's just a chemical imbalance. Um, we just take it for granted, whether it is correct or not. To understand this, you have to look back to the fifties and sixties when there was this huge medical push to basically create a drug for every condition.

• 8:33Jemma Sbeg?

  And doctors started noticing during this process, kind of by accident, that certain drugs developed for completely different reasons were affecting mood. Drugs for like wart treatment, drugs for epilepsy, drugs for hair growth, just like anything you can think of. They started noticing that it was also changing how people felt. There was a really notable review paper from this man called Shinder Kraut in nineteen sixty five, who was kind of the first one to be like. Hey, maybe this is saying something. Maybe some depressions could be linked to a deficiency in certain chemicals.

• 9:15Jemma Sbeg?

  And he concluded this based on his study of animals alone. Because back then, this theory was quite an experimental one that he was doing. And also, that's normally the the first stage of of any theory that wants to have like pharmaceutical implications. Like you test on animals. But at that time, like I said, it was not controversial. It was just different. It was just a different idea. And so it led researchers to focus on one group of neurotransmitters in particular called monoamines. Monoamine, monoamines, I should say plural, is just a class of neurotransmitters that include things like serotonin, like norepinephrine and like dopamine.

• 10:00Jemma Sbeg?

  And they concentrated on all those as kind of one in a way. This became the monoamine hypothesis. You probably, you may have heard about this, but it was basically the earliest biological theory of depression. Depression is because of a disruption in chemical messenger systems. Fast forward over a decade, I guess a decade, yeah, a decade. In nineteen seventy five, the first like big, big paper came out about a drug called fluoxetine, which is still on the market today. And worked by, it works still by increasing serotonin in the brain of rats, of people,

• 10:44Jemma Sbeg?

  by preventing the reuptake of serotonin. So basically, how our brain cleans up and gets rid of serotonin that's sitting in the synapse. That's like the simple way of putting it. This drug became so popular, so popular almost instantly.

• 11:06Jemma Sbeg?

  Probably because like the other treatments for depression at that time were not amazing. They weren't that great. Um, yeah, they just weren't, they weren't great. So Prozac, fluoxetine, just like hit the market running. And also started being kind of like, um, that recommended for heaps of other things. So like, yes, major depressive disorder, but then also OCD, panic disorder, um, eating disorders as well, anything that people believed came down to mood and our attempts to, or inability to regulate our mood or regulate things that, you know,

• 11:48Jemma Sbeg?

  and any behaviours that we use to try and regulate our mood that were becoming problematic or whatever. Like they basically just were like, this is the one, you just, you grab, you, you get on this and you're gonna be feeling so much better. So this is when the public narrative became that simplified version of depression is just a chemical imbalance. Because now there was this drug, this like, this cure that could just, in their words, like eliminate all those dark, bad thoughts, like those dark, bad feelings that people felt a lot of shame towards, that I guess also were, yeah, really impairing people. It all came down to this really simple equation.

• 12:31Jemma Sbeg?

  There isn't enough of this one thing in your brain, we increase it, you will feel better. And that's really reassuring to a lot of people. And it's easy to deliver, like in a healthcare perspective, you know, if you're a GP, if you're a doctor, if you're a psychologist, psychiatrist, whatever, and you've got a short amount of time with a patient, you've got a waiting room full of people who are really struggling. This, this idea that you can give somebody this tablet and that's going to make them feel better, um, is a great one and is one that people really wanna hang on to, obviously. A two thousand and five paper from researchers in the US actually later analyzed as well how

• 13:12Jemma Sbeg?

  the antidepressants were marketed to the American public when they first came out and they argued that a lot of these campaigns really pushed the use of a- antidepressants by basically again using this chemical imbalance message and that marketing was really significant in how a whole generation and the generation after that of people, including you and me, started thinking of this, of this condition, started thinking of depression. So it wasn't plucked out of thin air, as I said, like it all came down to the, the first really promising treatment pathway

• 13:54Jemma Sbeg?

  and why that treatment pathway seemed to work. And the thing is, there are literally thousands of randomized trials that show antidepressants do work. They do work. They beat a placebo on average. But the problem is, it is not the miracle drug that people think it is, at least not for everyone. And the effects aren't as dramatic as maybe we've been led to believe. If we kind of average out everybody's response, and this is where the skepticism around depression is just a chemical imbalance comes in. Basically, a drug is a great safety net. It is life changing,

• 14:37Jemma Sbeg?

  but depression is a three, four, five headed monster. And taking medication only cuts off one of those heads. So our healthcare system does need to be providing more than what a biological approach would suggest. You've probably heard of this. There has been a major push recently around this prominent theory that the reason SSRIs work is basically because they are a placebo. The biological model is not correct. It's just the idea that people are doing something for their mental health that improves their mental health. I don't personally believe that, um.

• 15:15Jemma Sbeg?

  Yeah, my thoughts about this are complicated. Let's just get into the evidence. So this theory really took the world by storm with the publication of this big paper in two thousand and eleven. That seemed to conclude that in most cases, I think their estimate was like in eighty percent of cases. What people are experiencing when their symptoms get better by taking an SSRI is purely the belief that, again, this medication is doing something. That belief influences our perception of reality and that perception and belief is what makes us feel better. This study again was massive. It did look at so many people.

• 15:55Jemma Sbeg?

  But a follow up, or I guess one, a prior review showed that it's probably a little bit different. It is not that this many people are reacting to a placebo effect. It's that the real benefit comes and the real benefit can be seen based on severity first. So basically, this FDA review found that an SSRI offers more noticeable benefits for people with more severe depression, who are more likely to have a larger biological component compared to people with milder presentations, who may still have a biological component, but perhaps their depression is coming down to other things.

• 16:40Jemma Sbeg?

  And for them, a placebo and an SSRI, you know, the fake version and the real version might impact behavior and impact how they feel in similar ways. They also found that the reason why this is the case is because an SSRI isn't always acting directly on our mood. It's affecting things that are going to impact mood down the line. So another trial from two thousand and nineteen. Shows this really well. It looked at cetrolene, cetrolene for depressive symptoms. And it found that in the first six weeks, like in under six weeks,

• 17:22Jemma Sbeg?

  if somebody was like, I feel amazing, it probably wasn't because of a biological, of an immediate biological impact on serotonin levels. It was more so because it affected how they were able to sleep. It affected a sense of control over the depressive symptoms. It affected energy levels. It affected, yeah, their mindset, especially in that, in that first part. What this is really coming down to, like, the placebo effect, let's be real, is probably real for some people. Like, it probably is real, but not for everyone. And it's not just the placebo effect that's having an impact.

• 18:04Jemma Sbeg?

  That is one part of perhaps some people's experience with SSRIs. But it's also the fact that even if this drug doesn't act directly on happiness or directly on mood, it does act on all these other things that do make people feel better. And that if you have, and I hate to say like, I hate to say mild depression, but that's kind of the clinical term. If you have mild depression, right, those things may be contributing more to your hopelessness and your sadness and your depressed state um than we think. And so taking those out and influencing them is what's making us feel better. Let's discuss this a little bit more because I do have a problem with this theory. I have a big problem.

• 18:49Jemma Sbeg?

  Um, whether a drug is a placebo or not, obviously it is important because you don't want to put people on medications that are gonna do, that could impact them in other ways if they literally aren't impacting the primary symptom. But what I will say is that if it works for people who otherwise feel hopeless, is that really a bad thing? You know, thoughts are powerful. Taking a medication that impacts your ability to deal with your thoughts by providing you with a control mechanism is powerful. It's just another version of, of all these thought therapies, of all the ways that we try and change people's thoughts to change their coping. B, my other imp, like, issue with the placebo theory is that

• 19:34Jemma Sbeg?

  You cannot take a theory as big and large as the biological theory of depression. A theory that supports one of the first and only lines of treatment for millions of millions of people who are suffering. You cannot take that theory, tear it apart and not offer another one. I think that is deeply callous and unethical. And this is my opinion. I think people are so quick to wanna make a headline, to wanna disprove a theory under the guise of helping people. And it actually leaves them feeling worse, right? There has been this whole push recently, and it's it's a valid push, right? To be like, is the biological theory correct? Like, is medication even really doing anything for people?

• 20:19Jemma Sbeg?

  Like, what are we wasting our time on? And people are really quick to be like, it's not, this is my final conclusion. It's it's just a placebo, rip it to shreds. And it's like, so what what else are you offering people? And don't say exercise, don't say diet. Like, what else are you offering people with treatment resistant depression? Or what else are you offering people who

• 20:42Jemma Sbeg?

  who have our own S R S R I's, find them to be life-saving? And now we're like, so do I not take this and go back to the way I was before? Like, I think that's I think that's a really hard call to make. The same goes with people online. Like, now that this placebo theory has really gained legs, it's become a lot more prominent, a lot more accepted. People are now using it as a way to kind of shame people for health decisions. Um, I made this post the other day, no, not the other day, a couple of months ago, about how going on Lexapro in my twenties was life-changing, and it is. And there was this woman all up in arms in my comment section, being like, science has completely disproved this.

• 21:26Jemma Sbeg?

  Science says that like, these drugs aren't doing anything for you. That's why I would never take them. And when I asked her, what would you suggest instead? She gave me some really pathetic answers and it annoyed me so freaking much. Actually, it made me really mad. Why come here, come in here to my page, into my life in a way, interrogate my health choices, rip them apart, introduce a sense of hopelessness about the thing that has helped me? And then walk out like you've helped me without providing me with an alternative, without understanding my situation. Like, that is cruel. That is cruel. And I think when we go to tear apart the chemical imbalance biological model, we do have to think about

• 22:11Jemma Sbeg?

  that impact. So let's talk about that a little bit more after this short break.

• 22:21Speaker 01

  Cash Flow Crunch. OnDeck's small business line of credit gives your business immediate access to funds up to $200,000 right when you need it. Cover seasonal dips, manage payroll, restock inventory, or tackle unexpected expenses without missing a beat. With flexible draws, transparent pricing, and control over repayment, get funded quickly and confidently. Apply today at ondeck.com. Funds could be available as soon as tomorrow. Depending on certain loan attributes, your business loan may be issued by OnDeck or Celtic Bank. OnDeck does not lend in North Dakota. All loans and amounts subject to lender approval.

• 22:51Jemma Sbeg?

  This episode is sponsored by Gymshark. Gymshark has spent over 14 years obsessing over gym clothing and the people who wear it. And let me just say, I think we all know, they are very, very good at what they do. No, seriously, their stuff is so good. Their everyday seamless collection is light, it's soft, it's stretchy. All of their stuff just looks good on, and it's made for people who love to exercise, whatever exercise that is. Lifting, cardio, Pilates, running around campus, maybe just doing errands. Discover Gymshark and find your new favorite gym clothing at gymshark.com.

• 23:28Jemma Sbeg?

  I've been really trying to prioritize my health in a realistic way this year, and something that has kept me really motivated is my Whoop. I am such a data person, which is why I love Whoop, because I can genuinely see why my body feels differently depending on the day, why I'm running differently, why I'm maybe less focused. Whoop effortlessly tracks my sleep, it tracks my strain, my recovery, my stress, and most importantly, my overall health. And it just gives me all that data and all those patterns, so I can make better decisions, which includes knowing when to go easy and knowing when to go hard. New members can try Whoop with a 30-day free trial before committing to a membership. That's join.whoop.com/psychology for your free month of Whoop.

• 24:13Jemma Sbeg?

  No two journeys look alike. That's why Sky Miles is designed to move with you wherever life takes you. Fly, it flies with you on new adventures, family getaways, business trips and the moments that matter most. Earn, it earns alongside your everyday life. It dines with you on special nights out, it streams alongside your favorite entertainment, rides through your daily routines and helps turn everyday moments into something more. Redeem, it helps you redeem for what's next. From spontaneous weekend escapes to the trip that you have been dreaming about, to upgrading your next trip to a premium cabin experience. The miles you've earned along the way can help take you further. Access, and it unlocks access to exclusive, one of a kind experiences and opportunities

• 24:58Jemma Sbeg?

  that make membership feel rewarding long before takeoff and long after landing. Because Sky Miles is more than a travel program, it is a membership that moves with you. Fly farther, earn every day, redeem your way and access more. Because when your membership is as unique as you are, there's no telling where your next journey will take you. Once the chemical imbalance rhetoric became the dominant story, it not only changed like scientific research headlines, it also changed how people understood themselves, how families responded to diagnosis, how the healthcare system treated depression, and that has been really, really positive.

• 25:38Jemma Sbeg?

  For a lot of people, the chemical imbalance framing made depression finally feel legitimate. If you grew up with a societal narrative that mental health was superfluous, it was an indulgent thing to pay attention to, then hearing that, you know, depression has links to our literal brain chemistry can be immensely validating and it brings a sense of relief by knowing you are actually unwell in a physical sense. It also reduces this like age old sense of blame, that depression is something that you can choose, you can snap out of it. This model helped people realize that that is not the case. You cannot go into your brain and change chemical messaging.

• 26:23Jemma Sbeg?

  Like that's not something that you're able to do, you were born this way, this is just who you are. So on a human level, like this story, this chemical imbalance story. Gave people a bridge, gave people a language for suffering and for their condition that others could understand. And it also made medication and it made treatment feel less scary. It brought a lot of people out of the dark, a lot of people out of the, you know, the, the hiding spaces of shame and said, we can help you. We can help you. This isn't your fault. And that has reduced stigma greatly. It's been an incredibly positive thing. There are some trade offs though.

• 27:05Jemma Sbeg?

  As much as I don't like the placebo idea, I also think the purely biological, um, I don't know, I don't wanna say mindset, approach, belief, hypothesis is also incorrect. And the reason I think it's problematic is because it's reduced a very huge, complex condition into a single simplistic explanation, which actually shrink and it continues to shrink down the magnitude of people's experience with it. In a way, it confuses what the treatment changes with what caused the problem in the first place. SSRIs change serotonin signaling, that's true. But saying SSRIs affect serotonin because serotonin is the

• 27:51Jemma Sbeg?

  reason that you are depressed is not entirely accurate. Just in the same way as paracetamol helps a headache, but it's not a lack of paracetamol that causes the headache is also true. It might be, you know, you need paracetamol, you have a headache because you're ill, because you didn't drink enough water, because you're hungover. The paracetamol still helps. The origin of the symptom isn't the lack of paracetamol. The same way the origin of, of symptoms may not be just a lack of serotonin. A lot of treatments work by compensating for symptoms rather than getting down to the, the underlying issue. And there are a lot of people who are depressed.

• 28:35Jemma Sbeg?

  Not because of brain chemistry or because brain chemistry and then a bunch of other stuff on top of that. But it's not just this biological thing. It's an interplay of grief, trauma, loneliness, burnout, chronic stress, poverty, discrimination, life events, you know, a relationship that floored them, a life without rest, a job hunting process that's been really terrible. The chemical imbalance story can sometimes make those factors feel irrelevant. And say like, oh, if we get you on this antidepressant, you will feel better.

• 29:14Jemma Sbeg?

  And sometimes that's why they don't work, because they cannot fix what lives outside the bloodstream. Medication can definitely reduce symptoms, mood, anxiety, agitation, sleep, appetite, concentration, those sort of things. But it doesn't actually repair financial pressures, caregiving pressures, academic stress, workplace drama, loneliness, disconnection, an unhappy, unsafe relationship, a life that feels meaningless, people treating you badly in society. How can we claim that a tablet can fix all of that and call it a day?

• 29:54Jemma Sbeg?

  We can't. It literally, it just can't. It can help you with coping. It doesn't change what physically surrounds you. You know, sometimes depression is a signal that something isn't working in your life.

• 30:09Jemma Sbeg?

  And it cannot reduce those physical circumstances if those are the cause. And I say if because yes, the biological model is valid on some front. But when we talk about another theory that probably makes more sense, right? That theory that I was waiting for people to offer.

• 30:28Jemma Sbeg?

  I would say a social and development theory mixed with a biological theory is probably more accurate. You know, this, like, the interpersonal model, cognitive models, which say that our, you know, the conditions that we have are shaped by our risk over time and by our internal and external environment over time. So, yes, we have a biological vulnerability, but then include the fact that you were hurt as a child, then you had inconsistent parenting, then you had, you experienced violence or you were cheated on, then you couldn't find a job, then you really struggled at uni, at work, then you felt purposeless on top of all of that, plus you're broke again, like,

• 31:12Jemma Sbeg?

  that's not just biology. You cannot medicate your way out of structural stress. We need to be focusing on that as well. And we also need to be focusing on even further research that talks about how a lot of people in modern day society lack a sense of purpose, the way that they used to really have in what they were doing, in how they were living, in their free time. There was a twenty twenty three meta-analysis that found greater purpose in life is significantly associated with lower depression and anxiety levels. Having a sense that, like, you mean something is incredibly influential in how we feel. And I think in today's age, like, it's harder to feel like you actually do mean something.

• 31:57Jemma Sbeg?

  You know, it's harder to feel like you're gonna find a job that you really can give back in. It's hard to feel like you're going to make an impact when the world feels really terrible. So we do need to look more broadly. There's this really interesting book I read from Johann Hari called Lost Connections, and he looks at this idea. His central argument is because the story of a chemical imbalance is so simple and easy to understand, it's meant that we've underpaid attention to the ways that modern life disconnects us from what we as humans need. And he frames many of the drivers of depression and anxiety as basically different forms of disconnection, not just biological vulnerabilities.

• 32:41Jemma Sbeg?

  You know, we are disconnected from nature, we are disconnected from meaningful work, we are disconnected from people, from our communities, from a meaningful future. That is having a real life impact. With this perspective, I think depression gets the complexity it deserves, whilst also acknowledging how medication is a valuable part of that. If we do not also look outside of our own brains at the world we are living in and acknowledge how that is probably making us feel terrible, the blame does start to come back, right? It does start to feel like, as well, our depression becomes treatment resistant.

• 33:24Jemma Sbeg?

  Like, we are taking the medication, we are subscribing to the biological model, and, you know, it's not working. And so maybe I am to blame. Maybe this is a permanent state of being, maybe I'm a much harder case than anybody has ever seen before. When actually, it's just that people are looking at your case, or you are looking at your circumstances through a narrow lens, and other things, other levers in your life could be pulled, could be readjusted, so that you are happier. Like, I've definitely found this since moving to London. Like, my dosage of my antidepressant has stayed the same, but it looks like it's not working because I've become a lot sadder, and meaner, and shorter, and agitated, just

• 34:09Jemma Sbeg?

  because now I'm living in an environment that makes me feel less and less seen, and more and more, like, stressed out. Again, I don't want this to come through as though medication is the wrong thing to do, that's actually not what I think. But I do think it is a medical disservice to give someone a prescription to a drug that is really hard to come off of, that does change things, like your sex drive, like your weight, like your sleep, like your dreams, your energy, and not, maybe, just maybe, look at some other factors, and search for something else first.

• 34:49Jemma Sbeg?

  So what do we do with all this information? One of the main takeaways I want to leave you with is that depression is as unique as we are. It is a label for a cluster of symptoms. And people can end up in a depressed state through totally different pathways. Through grief, trauma, loneliness, illness, rumination, loss of meaning, chronic stress, often a mix of several, and then maybe also a biological component. That's why a one size fits all explanation never really works. There is an infinite number of combinations of biological and environmental and psychological factors that all come together to create this experience. That's why two people can go through the same thing, beyond the same medications even,

• 35:33Jemma Sbeg?

  have totally different outcomes. And why the neat explanation, any narrative that wants a simple phrase to explain this probably won't work. I think instead of hunting for the single cause that makes people depressed, the single cause that is easy to digest, we recognize how complex this is. We focus on reducing stress where possible, rebuilding protective connections to people, to purpose, to safety, to community, finding emotional outlets that work for us, increasing coping skills in children, finding play and joy, strengthening the parts of you that are vulnerable through therapy, through skills, through routine, and then allowing medication

• 36:16Jemma Sbeg?

  to remain as the sidekick, not the star of the show. And I think that that would allow people to just feel more seen. I think it would also allow people to just get better in a way that is more sustainable and holistic and meaningful. So there we go. That's how I'm going to wrap up the episode. I know I said at the start, like, this is going to be a short bonus episode. Obviously, that is not the case. I have a lot to say about this topic. And honestly, even as I'm wrapping up, I'm like, oh, I didn't even mention this. I didn't mention that. But yeah, I want to keep it short and sweet for you guys. I hope that this episode, even if you didn't agree with everything I said, I'm sure there's going to be some of you like, it just spurred conversation. Honestly.

• 37:00Jemma Sbeg?

  People in either camp stick to their guns very strongly. So it is this interesting thing where like the answer you go looking for is the one that you will probably find because there is actually a lot of evidence for both. But um you are still free to form your own opinion based on what works for you. Honestly, at the end of the day, whatever works for you, if a biological model really works for you. And that's like, it just is something to tell yourself. Honestly, who cares what the evidence is? Keep it up, keep that explanation going in your mind. You know, really, if that is the thing that's making you feel better, I really don't see a problem with that. So yeah, I hope you enjoyed the episode.

• 37:41Jemma Sbeg?

  Thank you as always to our researcher Libby Colbert for her assistance with this episode. If you do not know, you can actually go and watch full episodes of the podcast. Not this episode though, because this was a special bonus episode, but other episodes of the podcast in video format on Netflix. That's right, you can watch this show on Netflix. You can go there right now and check it out. You can prove me, prove me right, prove me wrong. Um also, you can follow us on Substack, you can follow us on Instagram if you want to connect in other ways. Um Instagram is a really great place to contribute to future episodes like this one. If that's something that you would like to do and also to give feedback to keep the conversation going.

• 38:25Jemma Sbeg?

  And yeah, to share your own lived experience. If this is something that you've been through, I always love hearing from you guys. I love hearing from the listeners, so I will hopefully see you over there. But until next time, be safe, be kind, be gentle to yourself and we will talk very, very soon.

• 38:48Jemma Sbeg?

  This episode is sponsored by Gymshark. Gymshark has spent over fourteen years obsessing over gym clothing and the people who wear it. And let me just say, I think we all know they are very, very good at what they do. No, seriously, their stuff is so good. Their everyday seamless collection is light, it's soft, it's stretchy. All of their stuff just looks good on and it's made for people who love to exercise, whatever exercise that is. Lifting cardio, Pilates, running around campus, maybe just doing errands. Discover Gymshark and find your new favorite gym clothing at gymshark.com.

• 39:25Jemma Sbeg?

  I've been approaching my health really differently this year. I used to be really focused on maximizing and doing more. And now I'm just realizing that if I listen to what my body needs, I perform way better. And that's why I am obsessed with my Whoop. Truly, you guys, you know I'm such a data and information-driven person. And I love opening my Whoop app and seeing how my sleep, my stress, my strain is correlating with my mood, with my running performance, with how I'm just feeling day to day. I'm not an elite athlete by any means, but I do really benefit. And I also just really enjoy knowing more about my body. And Whoop also gives me these actionable, personalized insights

• 40:08Jemma Sbeg?

  that have made me more intentional and meant that I make smarter decisions day to day about what I need, rather than just putting my foot on the gas and just going, going, going, going. New members can try Whoop with a 30-day free trial before committing to a membership. That's join.whoop.com/psychology for your free month of Whoop. Hi, this is Jemma Sbeg. Taking care of yourself doesn't have to mean completely changing your routine. Naturewise Vitamin D3 is an easy way to support immune, bone, and muscle health every single day. And because quality matters, Naturewise has one of the first NSF-certified Vitamin D3 currently on the market.

• 40:53Jemma Sbeg?

  Plus, it's non-GMO, gluten-free, and third-party tested. Visit naturewise.com to explore their Vitamin D3 options and find the one that's right for you. Naturewise.com. You know that feeling when your skin just needs a tall drink of water? That's what Clinique Moisture Surge 100-Hour Moisturizer is for. Moisture Surge 100-Hour Moisturizer absorbs instantly and hydrates for 100 hours for plump, glowing skin. That's right, 100 hours. It is a lightweight, oil-free gel cream, safe for sensitive skin. It's allergy-tested and fragrance-free. I use this all the time.

• 41:34Jemma Sbeg?

  It makes my skin feel so fresh and plump and glowy. Even under makeup, I still see an amazing difference. It never leaves my skin oily or tacky. Try Clinique Moisture Surge 100-Hour today at clinique.com. Feels like moisture surge. This is an iHeart Podcast. Guaranteed human.