CAUTION: If you are taking antidepressants or any other psychiatric medication, do not stop or adjust your dosage without first consulting a qualified healthcare professional. Coming off these medications without proper guidance can lead to serious withdrawal symptoms. Always seek professional advice before making changes to your treatment.
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, 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 remarkably small 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 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 changes in our lives.
This conversation isn't about telling anyone what to do with their current medication, but rather 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.
I hope you enjoy listening.
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Actionable Insights
1. View Emotions as Meaningful Signals
Encourage viewing emotional responses as meaningful signals rather than medical disorders that need chemical correction, as they are natural human experiences and reflections of values.
2. Reflect on Mood Signals
If struggling with mood, reflect on what the mood is signaling (e.g., work, relationship issues) and make changes; if unable to identify, consider psychotherapy, exercise, mindfulness, good diet, and discuss feelings with loved ones.
3. Prioritize Lifestyle Pillars
Improve mood and well-being by focusing on the four pillars of health: food, movement, sleep, and relaxation, making adjustments in these areas to regain a sense of agency.
4. Explore Non-Drug Alternatives
Explore exercise, mindfulness, and addressing underlying life issues as potentially more effective alternatives than drugs for low mood symptoms.
5. Seek Varied Mood Support
If experiencing low moods, consider seeking help from a life coach, psychologist, or other non-medical professionals, especially if your doctor primarily focuses on diagnosis and drug treatment.
6. Foster Patient Agency
Doctors should foster a sense of agency and autonomy in patients, avoiding over-labeling that suggests dependence on medication for improvement.
7. Recognize Natural Mood Improvement
Understand that depression often improves naturally over time, and there are self-help strategies that can contribute to recovery, rather than solely relying on medication.
8. Doctors Offer Non-Drug Alternatives
Doctors should guide patients towards alternative depression management strategies, such as exercise, mindfulness, problem-solving therapy, or CBT, as recommended by NICE guidelines, before prescribing antidepressants.
9. Evaluate Antidepressant Side Effects
Before taking antidepressants, carefully evaluate potential negative changes like emotional blunting, lethargy, sexual dysfunction, and increased suicidal thoughts, as these are significant considerations.
10. Shorten Antidepressant Use
If you must take antidepressants, aim to take them for the shortest possible time to minimize the risk and severity of serious adverse effects like dependence and persistent sexual dysfunction.
11. Taper Antidepressants Slowly
If considering stopping antidepressants, taper them slowly and carefully, especially if you’ve been on them for a long time, to minimize severe and protracted withdrawal symptoms.
12. Utilize Deprescribing Guidelines
If your doctor is unfamiliar with antidepressant withdrawal, refer them to resources like the Royal College of Psychiatrists’ ‘Stopping Antidepressants’ information or the detailed Maudsley Deprescribing Guidelines.