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Biological beliefs about depression can prolong antidepressant use.

Seeing depression as a brain defect reduces agency and optimism.

Viewing depression as a meaningful signal can support better outcomes.

One of the strangest things about depression is that what one believes about its nature and causes can help—or hinder—healing.

Depression is different from, say, hypothyroidism. It doesn’t matter quite so much what you believe about hypothyroidism: If you take your medication, you will keep symptoms under control.

Depression works differently. Do I think of my depression as caused by a chemical imbalance in my brain? Or a reasonable response to adversity? Or a message from the depths of my soul that I should change my life?

Over the last decade, an emerging body of evidence has shown that one’s beliefs about depression are not neutral. They shape treatment outcomes in surprising ways.

How biological beliefs undermine recovery

Most notably, the belief that depression stems from a chemical imbalance in one's brain can hinder treatment in at least three ways:

Biological beliefs can give rise to “prognostic pessimism.” Some form the idea that, if depression is a biological condition, it’s unlikely to change—it’s just part of “who I am.”

Biological beliefs can create the impression that medication is the only useful form of treatment, thereby limiting treatment options.

Biological beliefs can create a sense of a lack of agency, or what psychologists call an external locus of control. This is the idea that I’m helpless to change my depression on my own; I need a doctor to “fix” me.

These beliefs can perpetuate depression by limiting the treatments we pursue and creating a sense of hopelessness about them.

Unfortunately, biological beliefs about........

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