Did you know that nearly one in five UK adults – and almost one in four women – are currently taking antidepressants? Yet according to my guest this week, the fundamental theory behind these prescriptions may be built on remarkably shaky ground.
Joanna Moncrieff is Professor of Critical and Social Psychiatry at University College London, a consultant psychiatrist for the NHS, and the author of the groundbreaking book, Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth.
In our thought-provoking conversation, Joanna explains how the widely accepted belief that depression is caused by a chemical imbalance or serotonin deficiency has little scientific evidence to support it. This theory, which became popularised in the 1990s through pharmaceutical industry marketing, has fundamentally changed how we view our emotions and mental health.
Joanna and I discuss:
- Why the difference between antidepressants and placebos in clinical trials is just two points on a 54-point depression scale – a minimal difference that may not be clinically significant
- How the diagnosis of depression itself is subjective and based on criteria that Joanna describes as “completely made up”, rather than objective biological markers
- The concerning side effects of SSRIs that are often underreported – including emotional numbness, sexual dysfunction that can persist even after stopping medication, and in some cases, an increase in suicidal thoughts
- How pharmaceutical marketing campaigns in the 1990s fundamentally changed our cultural understanding of depression from a natural human response to life circumstances to a “chemical imbalance” requiring medication
- Why withdrawal from antidepressants can be extremely challenging, particularly at lower doses, and why reducing medication requires careful, gradual reduction that many doctors aren’t trained to manage
- Whether visiting your GP should be your first option when experiencing a low mood, and how alternatives like exercise, mindfulness and addressing underlying life issues might be more effective
Throughout the episode, Joanna encourages us to view our emotional responses as meaningful signals rather than medical disorders that need chemical correction. She believes we’ve been disempowering people by teaching them that negative emotions represent a deficiency rather than a natural human experience that can guide us toward necessary life changes.
This conversation isn’t about telling anyone what to do with their current medication, but providing information to make truly informed decisions. If you or someone you know has ever taken antidepressants or been diagnosed with depression, this episode offers a perspective that could fundamentally change how you view mental health treatment in the future.