April 17, 2025 • 32 mins
Joanna Moncrieff is a British psychiatrist, author and researcher who is a prominent and controversial voice in the research of depression.
Her 2002 study ‘The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence’ concluded that there was no link between serotonin and depression, debunking the mainstream medical belief in antidepressants.
Moncrieff, whose research has drawn criticism from ‘Big pharma’ and support from fringe figures on the right, speaks to Krishnan Guru-Murthy in the latest episode of Ways to Change the World.
Produced by Silvia Maresca, Ka Yee Mak and Tom Gordon-Martin.
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Episode Transcript
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(00:00):
Hello, and welcome to Ways to Change the World.
I'm Christian Guru Murthy, and this is the podcast in which we
talk to extraordinary people about the big ideas in their
lives and the events that have helped shape them.
My guest this week is Joanna Moncrief.
Now, Joanna is a psychiatrist and is perhaps the leading
skeptical voice in the use of antidepressants to treat
depression. She has written widely and she's
(00:22):
appeared on a lot of media. And she's a controversial
figure. And her latest book is called
Chemically Imbalanced. The Making and Unmaking of the
Serotonin Myth. Joanna, how would you change the
world? I would radically demedicalize
our understanding and treatment of mental health problems.
(00:42):
I think that understanding things like depression, anxiety,
ADHD, etcetera as if they are medical problems that arise from
the brain is harmful to the individuals themselves.
I don't think it leads to good outcomes and I think it's
harmful to society because it distracts our attention from
what is actually making people unhappy and stressed in the 1st
(01:03):
place. And so I would relocate help for
people with mental health problems out of medical
facilities, out of GP surgeries,probably to somewhere like
social services where they wouldn't be treated for a, for
their diagnosis, for their label, but actually helped to
deal with the problems that had made them unhappy or anxious or
(01:23):
stressed in the 1st so. You're not talking about just
replacing drugs with therapy, you're talking about tackling
the underlying causes of depression.
Yes, absolutely. I mean, I do think therapy is
helpful for some people in some situations, but I don't think
it's a panacea. And I think the main problem is
that we think of people who are depressed as having this thing
(01:45):
called depression and we treat the depression rather than
helping the individual with their individual difficulties.
I mean, there are between 8 and 9 million people, we think,
being treated for depression with antidepressants in Britain
at the moment. And it's thought to be a growing
diagnosis post pandemic, big increase in mental health
(02:05):
treatment. And what you're saying is
there's nothing biologically wrong?
Yes, I am saying that we haven'tfound evidence that there is a
biological process that causes this condition, if we want to
call it, call it a condition. What is the serotonin myth that
you think you're correcting? One of the biological theories
(02:27):
of depression that was proposed several decades back now was the
idea that depression is due to adeficiency of certain brain
chemicals. And serotonin was one of the
brain chemicals that was suggested to be relevant in
depression in particular. So this was is referred to as
the serotonin theory of depression.
It was articulated by medical researchers back in the 1960s.
(02:51):
There was a big project to try and detect abnormalities and
serotonin and other brain chemicals that were proposed in
the 1970s and 80s. They didn't find anything.
The theory sort of fell out of favour in the 1980s, but then it
was recruited by the Pharmaceutical industry when
they released the SSRIs in the late 1980s and early 1990s to
(03:16):
help to market that range of drugs.
And that's when this idea that depression is caused by a
chemical imbalance became reallywidely known by the general
public and, you know, featured in advertisements and on
pharmaceutical website industry websites and that sort of thing.
That is not an that is, you know, used now for depression or
(03:40):
for prescribing SSRIs. But you're saying that's still a
common misunderstanding. Well, I I think that question
has to be if, if, if antidepressants are not
correcting A serotonin deficiency or some other
chemical imbalance as they were initially said to be doing, then
what are they doing? That's a slightly different
(04:01):
question. I mean, what I'm what I'm trying
to tackle and to get get answers.
What you think is wrong with theway things are prescribed at the
moment is do you think, do you think people who go on to
antidepressants still think thatthis is the reason?
And what's your evidence for that?
I think there's an assumption bythe medical profession as well
as by patients that antidepressants work by
(04:22):
targeting some underlying biological abnormality, and yet
that has not been demonstrated. And there is another way that
antidepressants work which is not presented to patients and
not widely acknowledged. So I mean are you saying that
SSR is are a bit like alcohol? Absolutely.
They change the way you feel. Absolutely.
Antidepressants are mind altering brain and mind altering
(04:44):
drugs like alcohol, like cannabis, etcetera.
That doesn't mean that the effects that they produce are
exactly the same as the effects that alcohol produces, but in
principle they do the same thing.
They change our mental states quite subtly in the case of of
many antidepressants, but nevertheless they do produce
these changes, particularly thischaracteristic emotional
(05:04):
numbing. Isn't there something bigger
here, though, about our whole approach to medicine, which is
that too many people think that scientists really understand how
medicines work? You know, we've, we've got very
used to just taking pills to make things better.
And the truth is that a lot of it is just trial and error.
(05:26):
We don't really know. Yeah, I, I, I think we, I do
think we put far too much faith.We.
Didn't know how penicillin worked for decades.
I think we put too much, can puttoo much faith in, in medical
pronouncements or the pronouncements of, of, of
medical research or neurosciencefindings and, and those can be
over interpreted. But I think that taking
(05:50):
something, for example, for pain, people often cite the fact
that we don't know exactly how paracetamol works is different
from taking something that is changing your mental state, like
alcohol, as you say, and therefore changing your thoughts
and feelings by changing, changing your brain chemistry.
We do that like you say, we do it with alcohol.
(06:12):
We recognise that, you know, if you take a lot of alcohol,
you'll probably temporarily feelbetter, feel less depressed or
less anxious, but we don't regard that as a sensible long
term solution to feeling, you know, to feeling low or, or
fearful or something like that. And so I, you know, I think that
(06:33):
that that way that antidepressants are working,
that those effects that they have need to be clearly
explained to people so that theycan make properly informed
decisions about whether they want to take brain and mind
altering substances to address their emotional problems.
So you think there is no use forantidepressants, is that right?
(06:54):
So, so I think that the the evidence base for
antidepressants shows that they are probably not very not
beneficial. They are minimally different
from a placebo. And that difference is probably
explained by the fact that people in these randomised
control trials who are meant to not know whether they get the
(07:15):
placebo or the antidepressant probably do know in a lot of
cases. And that gives them an amplified
that gives the people who are taking the antidepressant an
amplified placebo effect. So I think that's probably what
explains the small difference between antidepressants and
placebo, but it's very small and.
Just to be clear on that, I meanthe evidence is that that there
is a there is an improved outcome for people on
(07:37):
antidepressants isn't? There there is a there's a
slightly better. Than if you're just on a
placebo. It's slightly better.
Yes. And and your hypothesis is that
people somehow know, I mean, what's that based on?
So there are trials where peoplehave asked, people asked the
participants to guess whether they're taking the
antidepressant or the placebo. In most of those, not all, but
(07:58):
in most of those people can guess more accurately than would
be predicted by chance what they're taking.
And then we also know from some studies that what you guess
you're taking has really quite astrong impact on outcome.
It can improve your depression scores by quite a bit more than
than the difference between the drug and the placebo.
(08:18):
Isn't there a bit of a problem with with surmising that because
people are correctly guessing that they're on the drug rather
than the placebo, that the, the drug doesn't work?
You know, they, they, they are probably guessing that because
they're feeling better. Yeah, absolutely.
So, so that's been proposed by people.
The trouble is it's also been shown in negative trials where
(08:40):
there's no difference between the drug and placebo that people
who guess they're on the the active drug do better than
people who guess they're on the placebo, regardless of what
they're actually taking. But I mean the.
The I suppose the the summary position for you is that you you
don't think that the the medicaltrial outcome, which shows that
people are better off taking antidepressants than not, is
(09:02):
sufficiently good for it to be scientifically sound.
I, I don't think that it justifies the mass prescribing
of antidepressants, but another really important point is that
we, we've assumed that what antidepressants are doing is
correcting some underlying biological process that leads to
the symptoms of depression. We don't have evidence of that
that's large. That was the, the paper that I
(09:24):
did on the serotonin hypothesis was what sparked me writing the
book. And, and there's another,
another way that antidepressantsmight be working or might be
having their effects when peopletake them for depression.
And that is that they are, they're, you know, they're not
inert. They are drugs that change our
normal brain chemistry and by doing so change our normal
(09:49):
mental states, our normal feelings, thought, thought
processes, etcetera. They're not massively strong
drugs in this respect, most of the antidepressants that we use
nowadays, but they do induce feelings of emotional numbing.
They numb people's positive and negative emotions and they have
been shown to do this in volunteers as well as people
(10:11):
with depression. And of course, if you if you
give people with depression a drug that numbs them a bit, that
may be what's reducing their depression scores compared to
placebo, as well as this amplified placebo effect.
So I'm not saying that. So, you know, it's possible that
it might be that effect too. But, but I think that the
(10:32):
decisions that people make aboutwhether they want to take a drug
for depression, if it's presented to them as something
that changes their normal brain chemistry in their normal mental
states will be different from ifit's presented to them as
something that's going to targetand correct some underlying
abnormality. Because one of the criticisms
(10:54):
around your, your work is that you're, you created a straw man,
you know, an imaginary myth, which is the, you know, this
explanation around brain chemistry.
When, if you go on the NHS website or if you look up any of
the charity websites, they're pretty clear.
You know, they, they don't, you know, they don't actually say
that. They don't say there's a problem
with your serotonin. Therefore, go on one of the many
(11:18):
common antidepressants that people know about.
South So lots and lots of medical websites have told
people that there's a problem intheir brain chemistry.
Historically they have started to correct that over the last
few years, some and some have corrected it since we published
the the paper on serotonin and depression.
But The thing is, if if you if you don't tell people this other
(11:38):
explanation that these drugs arealtering your brain chemistry
and thereby altering your normalmental states, then people will
assume. I think particularly after all
the promotion that's come from the Pharmaceutical industry
persuading people that depression was a chemical
imbalance, that the drugs are targeting some underlying
abnormality. So I so.
(11:59):
They're being fixed. So I think, yeah, yes, exactly.
So I think that unless people are explicitly told that no, we
don't have evidence that this iswhat the drugs are doing, then
that's what they will assume that they are doing.
I mean, at at the moment antidepressants are doled out
very, very easily by GPS who arenot psychiatrists.
(12:19):
How? How have we got into that
situation? Well, that's a really good
question. I think we've, I, I think there
are a number of factors. I mean, the first is that the
Pharmaceutical industry has promoted antidepressants very
heavily since, since the releaseof SSRIs in the early 1990s.
So, you know, there's GPS and psychiatrists have been deluged
(12:41):
with advertising and promotionalmaterial.
So that's one of the reasons, I think that another reason is
that doctors want to be able to help people.
And you know, what does a doctorusually do?
They they give you a pill, they give you a prescription.
And, and psychiatrists in particular want to feel that
(13:02):
they have a medical solution fora common mental health complaint
that is depression. And people themselves have have,
you know, of course, the idea that you could get rid of, you
know, of, of, of really troubling feelings with a pill
is appealing. And so so people have also been
persuaded by by that message that originally came from the
(13:24):
Pharmaceutical industry because actually prior to the
pharmaceutical industry's reallystrong campaigns of the 1990s,
people were reluctant to take medication for depression.
And they did. Because it was really scary
medication, lithium and that kind of.
Thing well, it was partly because the benzodiazepines were
so widely prescribed at that time and it was becoming clear
(13:45):
that they were dependence inducing.
So it was partly because of fears about dependence, but also
also people I think just felt that actually dealing with
emotional problems with with drugs wasn't wasn't the right
route and that depression was something that was a reaction to
life circumstances and so there should be other ways to deal
with it. I mean, patients ask for SSRIs,
(14:09):
don't they? You know, people, they don't,
they don't go to the doctor and say, can I, you know, what can I
do? They'll say, I think I need to
take antidepressants. What should doctors be doing in
that situation? So I, I think there are some
patients that that come to doctors like that, but I think
there are also many patients that come to doctors and I'm not
sure really whether they should be taking a drug or not.
(14:30):
And so I do think that the encounter with a doctor is an
opportunity to de medicalise thesituation and try and suggest
other approaches to people. And I'm sure that lots of
doctors do do that. Of course, you know, often
people are coming to their doctors at a time of crisis and
wanting something to be done andthe doctor doesn't want to send
people away without anything. So there are all these pressures
(14:53):
I think that do. And our mental health services
are on their knees anyway, so, so queues, you know, queues for
treatment are extremely. Long and and GPS are trying to
deal with a lot of distress thatthat mental health services
won't take on. Yes, absolutely, yeah.
So there is, there is always going to be a temptation to say,
OK, we'll try this. There is, I mean, we do have a
national therapy service now in the UK and we're, you know,
(15:14):
unique to, to have one. I think in, in the world, one of
the few countries in the world that has that.
So there are other options. But you know, I know therapy
doesn't necessarily start immediately, but people can be
referred for therapy straight away.
It it will start within a few weeks.
The the basic level of the of the NHS talking therapy service
that's available. But therapy often doesn't work,
(15:35):
does it? You know, people try it and it
just doesn't help. No, not not always, but but I
don't think that antidepressantshelp either.
Well, that that's the problem though, isn't it?
Because billions of people are taking them and presumably a lot
of them feel that they are beinghelped.
You know that it's working and they don't know why, and they
(15:56):
don't really care why. They just know that it's making
them feel better. Otherwise they wouldn't carry on
taking them, yes. Which is why we need to look at
the randomised control trials and, and, and try and understand
the results of those and recognise that actually most of
the effect of the antidepressantis a placebo effect.
And a placebo effect, of course is about, is about having some
(16:18):
hope that you will get better. It's not just about being, you
know, being duped that you're, you know, taking something that
doesn't really work it, it is the hope that people get.
The trouble is that that I thinkantidepressants are giving
people false hope. And a lot of people may feel
better initially, but actually there will come a point when
they realise that the antidepressant isn't working
anymore or they've still got problems.
(16:40):
And then they can often feel even worse because they feel, oh
gosh, you know, I've, I've had the treatment that's supposed to
work. It's not working for me.
I must be a, you know, a really specially severe case.
You know, what on earth am I going to do?
And that can put people in an even worse place.
Even if it was, let's say it's 75% placebo, why does that
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matter if it's not harming them?Because it's reaffirming this
idea that the problem is in yourbrain and that you need a drug
to fix it. And we know that people who have
that idea actually have worse outcomes than people who don't
have that idea, who think that depression is, is a reaction
that that, that you know, to circumstances.
(17:23):
And people who view depression in that way have a stronger
belief that they can do something to to help themselves
and affect their circumstances. But I mean, why do you think
it's better to tell somebody that the problem isn't your
brain, the problem is your mind,which is an even more amorphous,
difficult thing to try and understand, and nobody really
understands it. You know that that really can
(17:43):
feel hopeless, can't it? I suppose it gives people more
agency. If you you know, if you locate
the problem in the brain, then you need a medical biological
intervention to deal with it. If it's if it's to do with you
and your life and your circumstances, then there are
there are ways to change those. But a lot of people don't feel
(18:04):
they can change their circumstances.
That's often the cause of depression.
Yes, yes, it is and, and, and, and some people are in, in
circumstances that are very difficult to change.
I still don't think we have evidence that antidepressants
help in that situation and some.So you don't think the evidence
that so many people are taking it for so long is evidence that
(18:25):
they are helpful? I think it's evidence that
they're unhelpful. You know, just explain that they
haven't. Well, people.
Because I think most people say,well, look, you've got 8 or 9
million people taking it. They're taking it for a long
time. Most of them will say, well,
they think they're feeling better as a result, which is why
they carry on going back for repeat prescriptions and carry
on taking the drugs. Isn't that effectively a massive
clinical trial? So, So what happens is people
(18:48):
take antidepressants for a bit, maybe, maybe think that they are
doing a bit better. And often when people start an
antidepressant, I should say that you know, that they're at
their lowest point, they feel they've got to do something
about it. They go and see their doctor and
then they feel they have done something.
So there's all those sort of factors operating that I think
can help people improve when they first go on to an
(19:09):
antidepressant. But so, so people will take an
antidepressant, feel a bit better, think that the
antidepressant has helped them come off it.
And then the next time that theyget into difficulties, they will
assume that that they need a drug again.
So they'll go back to their doctor, they'll get back onto
the antidepressant. They might stay on it a bit
(19:29):
longer this time. And when they try and come off
it, they might experience some withdrawal symptoms, which can
include anxiety, low mood, changeable mood, tearfulness.
So often people will think that they're getting depressed again
and have and, and put themselvesback onto the drug and not
realise that what they were going through is withdrawal.
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And so people end up on taking these drugs for long periods of
time. I think that's, I think that's
evidence first of all that they're not working, but also
that people are becoming dependent on them and finding it
difficult to get off them. But I mean, again, like, you
know, the, the, the retort to that for a lot of people is
going to be, well, it whatever works, you know, and if that
works and gives me some sort of instant relief in a way that
(20:15):
talking therapies don't because they're very hidden this, what's
wrong with that? You know, I can, I can see your
sort of your, your principled objection to it.
But I, you know, practically we're in a world where the NHS
health services are not good enough to cope with the demand.
(20:36):
I mean, I suppose I'm saying it doesn't work.
I mean, there's not, there aren't a lot of studies on the
long term outcome of long term use of antidepressants.
But the ones that there are don't suggest that people who
are taking these drugs long termare doing better than people who
aren't. And we know that there are lots
of what we might call side effects or adverse effects of
antidepressants that I think areprobably going to be reducing
(20:58):
the quality of life of people who are taking them long term.
They include things like lethargy, insomnia, difficulty
concentrating, sexual dysfunction, which is, which is
widely recognised. And then of course these
problems with with trying to getoff the drugs if, if people want
(21:19):
to try and come off them. A lot of people do experience
withdrawal symptoms. For some people these can be
severe and really debilitating and can go on for long periods
of time. And the sexual dysfunction can
also persist for some people after they've come off the
medication. This is something that's just
come to light over the last few years, really.
So why do you think there are somany more cases of mental health
(21:42):
crises being reported now and people saying that they are
depressed? So good question and I'm, I
don't have all the answers. I mean, first of all, we've been
the public have been educated for decades now that that, you
know, negative emotions and medical problems and they should
go and see their doctors about them.
So I think it's partly that and that education has come from
(22:04):
medical institutions, but also been sponsored by the
Pharmaceutical industry partly. And, and I think I think it's
also to do with factors in society.
We've become a very competitive society, I think increasingly so
over the last few decades. I think that's particularly
affected young people so that people are constantly, you know,
(22:25):
comparing themselves to other people and worried that they're
not living up to standards that,you know, can lead to
demoralisation. If people feel that they're not
succeeding as they should be, itcan lead to anxiety and stress,
clearly. And, and for many people, life
has got, of course, we've got a cost of living crisis, you know,
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so life has become financially more difficult, employment has
become less secure and precarious Housing, of course,
is a, is a huge problem. So there are lots and lots of
social factors that I think giverise to stress among adults and
and younger people. And do you, do you think people
want the diagnosis? You know, do people like being
(23:09):
told, yes, you you've got depression and you need to be
treated? I think some people have have
come to believe that that they have a medical problem and that
a medical label would be helpfulfor them, whether it's
depression or anxiety or ADHD or, or various other labels that
people come come to their doctors thinking that they might
(23:31):
have. Nowadays, of course, social
media is playing a role in that.People, you know, look on social
media at people doing videos saying I've got this, I've got
that and think, oh, you know, yes, that might be me.
So I think that's playing a role.
I think people are desperately looking for explanations.
And I think that's a reflection of people of, of feelings of
(23:52):
insecurity. People feel that they're, you
know, not not performing at the level that that that is expected
by someone. I mean, it it, it does feel a
little bit, I've been listening to you.
It feels a little bit like you are basically saying it's all in
your head in a sort of academic Y kind of way.
So I'm saying that there are real problems out there in
(24:12):
society that that make people feel stressed and anxious and
unhappy, and we need to address those problems.
And I think actually the people who are saying it's in your
brain are the people who that are making it less likely that
we're going to resolve the problems that are making people
unhappy and distressed and anxious in the first place.
(24:33):
How realistic is it then, do youthink, to try and treat 89
million people a different way? How you know?
It would be tremendously intensive, wouldn't it, for the
NHS? Well, we have radically changed
the way that we treat back pain.For example, we used to tell
people to go to bed and, and rest up and take time off work.
And now the advice is, you know,to, to keep active and take
(24:57):
gentle exercise. And the number of people off
sick for back pain has plummeted.
So I think that we can make large changes in medicine
actually. And I think that we, we could
take a different approach to, todepression and anxiety and an
emotional, emotional problems. In fact, it's already started.
We have, there's, there's socialprescribing now in general
(25:21):
practices, social prescribers who try and link people up with
local social groups and institutions that might help
them and support them with, you know, loneliness and, and
financial hardships and other problems that may be leading to
mental health problems or indeedphysical health problems.
So, so we've we've actually havemade a start I and what I'm
(25:43):
saying is I think we need to take that further.
I think we need to actually locate that sort of help outside
of the NHS do. You think it means retraining
GPS? I think we need to support GPS
to be able to divert people awayfrom away from antidepressants,
away from medical solutions intointo social ones.
(26:04):
Do you think GPS are too influenced by the Pharmaceutical
industry and the literature thatthey're constantly sent?
I, I can't speak for GPS specifically, but I know that
the medical profession as a whole is influenced by, by
Pharmaceutical industry advertising.
You know, I go to conferences and there are, you know,
pharmaceutical companies with stands up everywhere and handing
out leaflets and things like that.
(26:25):
It's actually better than it wasa couple of decades ago, I would
say. But but the influence is still
there. What kind of reaction have you
had then over the years to your work?
I mean, you are, you're controversial, you're constantly
criticised. I think doctors, but
particularly psychiatrists, are very reluctant to admit that
(26:46):
their drugs are not targeting underlying biological processes,
underlying mechanisms that that produce symptoms or disorders,
because they want to think that these drugs are more
sophisticated than they are. They've been psychiatrists who I
think want to shut down the debate about about the serotonin
(27:07):
theory of depression, about the biological origins of, of
depression and the fact that there isn't really convincing
evidence for them in order to maintain this, what I would say
a misleading view that antidepressants and other drugs
work in this in this targeted and sophisticated way, I mean.
You you're also taking on big pharma.
(27:28):
You know how? How do they respond?
Well, I, I haven't had any sort of personal, personal contact
with big Pharma. I mean, actually I think big
pharma have largely moved on from antidepressants and now the
drugs that are being marketed are mainly drugs for ADHD.
So, so they probably, they probably don't care that much
(27:49):
actually. Is that your next crusade?
It might be. I mean, why have you spent so
much time on this? Because this has been many years
you've been, you've been making this argument.
Yes. So because antidepressants,
antidepressants are by far and away the most commonly used
psychiatric drug. Because this idea that
depression is caused by chemicalimbalance was widely believed by
(28:12):
most of the general public to have been established.
Even though most of the people in the profession knew that it
hadn't really been established and the research was actually
the research based was actually quite weak.
And because I believe that that that subscribing to this view
that depression is a chemical imbalance is not helpful to
(28:32):
people, there's. Going to be a lot of people
listening who are on antidepressants.
What should they do? So I think that people should,
if, if they want to question if they want to rethink being on
antidepressants, if they want tothink about the possibility of
coming off them, do some reading, discuss it with friends
(28:53):
and and family. And then go and see their their
doctors and make a plan to come off their antidepressants slowly
and carefully and at the right time.
So don't read your book and juststop.
No, don't read my book and throwthe drugs in the in the bin,
because it's very important to say that might make the
withdrawal process a lot worse. What?
What sort of things would happen?
(29:13):
So withdrawal symptoms can be quite severe for for some people
and and prolonged and it seems that if you come down much more
slowly, that's going to make them milder and less likely to
be prolonged and. And in terms of the evidence
base for talking therapies and other therapies, how good is
(29:33):
that? You know, because what you've
done is sort of undermined the the evidence base for
antidepressants. You know, the question is how
good are the alternatives? So the evidence is that talking
therapies are as good as antidepressants.
So so. Not very good at all.
They don't work. So, so I, I think that this idea
(29:58):
that we're treating a disease isone of the problems and, and so
it's very unlikely that there'llbe something that just works in,
in that sort of medical sense. And therefore I think we need to
see talking therapies as something that might be useful
for some people in certain situations, but not in others.
It's. Quite a bleak outlook you're
(30:18):
offering, isn't it? In some ways, because you're,
you're basically saying there are some people who are
depressed who are just going to be depressed.
No, I'm really not saying that. And I don't think it's a bleak
outlook. Most people will get better than
depression anyways. You lost your parents as a child
and you've had a terrible life as a result.
There isn't going to be any social group that the GP can
send you to or talking therapy that's going to help you with
(30:41):
that. But, but giving people
antidepressants is giving them false hope because, because we
really don't have evidence that it might be numbing the pain.
It might be numbing the pain, but it's, it's, it's not, it's
not providing a very satisfactory solution to the
problem. I would suggest.
And, and I think it's really important to say most people
recover from depression spontaneously without
(31:04):
antidepressants. And I think that giving
antidepressants to people is actually making that less
lightly, certainly less lightly in the long run.
So even even though it may be a difficult message at the
beginning to say actually we don't have a drug that's going
to solve the situation in the long term, I think it's actually
a much more hopeful message thatyou actually have the resources
(31:24):
in yourself to deal with this problem.
I mean that that's really interesting if that's true, that
most people just feel better spontaneously.
So that the best advice to a family or friend who comes to
you saying they're feeling terrible is you will feel
better. Is is to stick it out and maybe
you need some support and some care in the in the meantime and
(31:47):
and to try and work out what it's a response to and change
that if it's possible. Joanna Moncrief, thank you very
much indeed. Thank you.
Thank you for joining us on Waysto Change the World.
You can watch all of these interviews on the Channel 4 News
YouTube channel. Our producer is Sylvia Maresca.
Until next time, bye bye.
Hello, and welcome to Ways to Change the World.
I'm Christian Guru Murthy, and this is the podcast in which we
talk to extraordinary people about the big ideas in their
lives and the events that have helped shape them.
My guest this week is Joanna Moncrief.
Now, Joanna is a psychiatrist and is perhaps the leading
skeptical voice in the use of antidepressants to treat
depression. She has written widely and she's
(00:22):
appeared on a lot of media. And she's a controversial
figure. And her latest book is called
Chemically Imbalanced. The Making and Unmaking of the
Serotonin Myth. Joanna, how would you change the
world? I would radically demedicalize
our understanding and treatment of mental health problems.
(00:42):
I think that understanding things like depression, anxiety,
ADHD, etcetera as if they are medical problems that arise from
the brain is harmful to the individuals themselves.
I don't think it leads to good outcomes and I think it's
harmful to society because it distracts our attention from
what is actually making people unhappy and stressed in the 1st
(01:03):
place. And so I would relocate help for
people with mental health problems out of medical
facilities, out of GP surgeries,probably to somewhere like
social services where they wouldn't be treated for a, for
their diagnosis, for their label, but actually helped to
deal with the problems that had made them unhappy or anxious or
(01:23):
stressed in the 1st so. You're not talking about just
replacing drugs with therapy, you're talking about tackling
the underlying causes of depression.
Yes, absolutely. I mean, I do think therapy is
helpful for some people in some situations, but I don't think
it's a panacea. And I think the main problem is
that we think of people who are depressed as having this thing
(01:45):
called depression and we treat the depression rather than
helping the individual with their individual difficulties.
I mean, there are between 8 and 9 million people, we think,
being treated for depression with antidepressants in Britain
at the moment. And it's thought to be a growing
diagnosis post pandemic, big increase in mental health
(02:05):
treatment. And what you're saying is
there's nothing biologically wrong?
Yes, I am saying that we haven'tfound evidence that there is a
biological process that causes this condition, if we want to
call it, call it a condition. What is the serotonin myth that
you think you're correcting? One of the biological theories
(02:27):
of depression that was proposed several decades back now was the
idea that depression is due to adeficiency of certain brain
chemicals. And serotonin was one of the
brain chemicals that was suggested to be relevant in
depression in particular. So this was is referred to as
the serotonin theory of depression.
It was articulated by medical researchers back in the 1960s.
(02:51):
There was a big project to try and detect abnormalities and
serotonin and other brain chemicals that were proposed in
the 1970s and 80s. They didn't find anything.
The theory sort of fell out of favour in the 1980s, but then it
was recruited by the Pharmaceutical industry when
they released the SSRIs in the late 1980s and early 1990s to
(03:16):
help to market that range of drugs.
And that's when this idea that depression is caused by a
chemical imbalance became reallywidely known by the general
public and, you know, featured in advertisements and on
pharmaceutical website industry websites and that sort of thing.
That is not an that is, you know, used now for depression or
(03:40):
for prescribing SSRIs. But you're saying that's still a
common misunderstanding. Well, I I think that question
has to be if, if, if antidepressants are not
correcting A serotonin deficiency or some other
chemical imbalance as they were initially said to be doing, then
what are they doing? That's a slightly different
(04:01):
question. I mean, what I'm what I'm trying
to tackle and to get get answers.
What you think is wrong with theway things are prescribed at the
moment is do you think, do you think people who go on to
antidepressants still think thatthis is the reason?
And what's your evidence for that?
I think there's an assumption bythe medical profession as well
as by patients that antidepressants work by
(04:22):
targeting some underlying biological abnormality, and yet
that has not been demonstrated. And there is another way that
antidepressants work which is not presented to patients and
not widely acknowledged. So I mean are you saying that
SSR is are a bit like alcohol? Absolutely.
They change the way you feel. Absolutely.
Antidepressants are mind altering brain and mind altering
(04:44):
drugs like alcohol, like cannabis, etcetera.
That doesn't mean that the effects that they produce are
exactly the same as the effects that alcohol produces, but in
principle they do the same thing.
They change our mental states quite subtly in the case of of
many antidepressants, but nevertheless they do produce
these changes, particularly thischaracteristic emotional
(05:04):
numbing. Isn't there something bigger
here, though, about our whole approach to medicine, which is
that too many people think that scientists really understand how
medicines work? You know, we've, we've got very
used to just taking pills to make things better.
And the truth is that a lot of it is just trial and error.
(05:26):
We don't really know. Yeah, I, I, I think we, I do
think we put far too much faith.We.
Didn't know how penicillin worked for decades.
I think we put too much, can puttoo much faith in, in medical
pronouncements or the pronouncements of, of, of
medical research or neurosciencefindings and, and those can be
over interpreted. But I think that taking
(05:50):
something, for example, for pain, people often cite the fact
that we don't know exactly how paracetamol works is different
from taking something that is changing your mental state, like
alcohol, as you say, and therefore changing your thoughts
and feelings by changing, changing your brain chemistry.
We do that like you say, we do it with alcohol.
(06:12):
We recognise that, you know, if you take a lot of alcohol,
you'll probably temporarily feelbetter, feel less depressed or
less anxious, but we don't regard that as a sensible long
term solution to feeling, you know, to feeling low or, or
fearful or something like that. And so I, you know, I think that
(06:33):
that that way that antidepressants are working,
that those effects that they have need to be clearly
explained to people so that theycan make properly informed
decisions about whether they want to take brain and mind
altering substances to address their emotional problems.
So you think there is no use forantidepressants, is that right?
(06:54):
So, so I think that the the evidence base for
antidepressants shows that they are probably not very not
beneficial. They are minimally different
from a placebo. And that difference is probably
explained by the fact that people in these randomised
control trials who are meant to not know whether they get the
(07:15):
placebo or the antidepressant probably do know in a lot of
cases. And that gives them an amplified
that gives the people who are taking the antidepressant an
amplified placebo effect. So I think that's probably what
explains the small difference between antidepressants and
placebo, but it's very small and.
Just to be clear on that, I meanthe evidence is that that there
is a there is an improved outcome for people on
(07:37):
antidepressants isn't? There there is a there's a
slightly better. Than if you're just on a
placebo. It's slightly better.
Yes. And and your hypothesis is that
people somehow know, I mean, what's that based on?
So there are trials where peoplehave asked, people asked the
participants to guess whether they're taking the
antidepressant or the placebo. In most of those, not all, but
(07:58):
in most of those people can guess more accurately than would
be predicted by chance what they're taking.
And then we also know from some studies that what you guess
you're taking has really quite astrong impact on outcome.
It can improve your depression scores by quite a bit more than
than the difference between the drug and the placebo.
(08:18):
Isn't there a bit of a problem with with surmising that because
people are correctly guessing that they're on the drug rather
than the placebo, that the, the drug doesn't work?
You know, they, they, they are probably guessing that because
they're feeling better. Yeah, absolutely.
So, so that's been proposed by people.
The trouble is it's also been shown in negative trials where
(08:40):
there's no difference between the drug and placebo that people
who guess they're on the the active drug do better than
people who guess they're on the placebo, regardless of what
they're actually taking. But I mean the.
The I suppose the the summary position for you is that you you
don't think that the the medicaltrial outcome, which shows that
people are better off taking antidepressants than not, is
(09:02):
sufficiently good for it to be scientifically sound.
I, I don't think that it justifies the mass prescribing
of antidepressants, but another really important point is that
we, we've assumed that what antidepressants are doing is
correcting some underlying biological process that leads to
the symptoms of depression. We don't have evidence of that
that's large. That was the, the paper that I
(09:24):
did on the serotonin hypothesis was what sparked me writing the
book. And, and there's another,
another way that antidepressantsmight be working or might be
having their effects when peopletake them for depression.
And that is that they are, they're, you know, they're not
inert. They are drugs that change our
normal brain chemistry and by doing so change our normal
(09:49):
mental states, our normal feelings, thought, thought
processes, etcetera. They're not massively strong
drugs in this respect, most of the antidepressants that we use
nowadays, but they do induce feelings of emotional numbing.
They numb people's positive and negative emotions and they have
been shown to do this in volunteers as well as people
(10:11):
with depression. And of course, if you if you
give people with depression a drug that numbs them a bit, that
may be what's reducing their depression scores compared to
placebo, as well as this amplified placebo effect.
So I'm not saying that. So, you know, it's possible that
it might be that effect too. But, but I think that the
(10:32):
decisions that people make aboutwhether they want to take a drug
for depression, if it's presented to them as something
that changes their normal brain chemistry in their normal mental
states will be different from ifit's presented to them as
something that's going to targetand correct some underlying
abnormality. Because one of the criticisms
(10:54):
around your, your work is that you're, you created a straw man,
you know, an imaginary myth, which is the, you know, this
explanation around brain chemistry.
When, if you go on the NHS website or if you look up any of
the charity websites, they're pretty clear.
You know, they, they don't, you know, they don't actually say
that. They don't say there's a problem
with your serotonin. Therefore, go on one of the many
(11:18):
common antidepressants that people know about.
South So lots and lots of medical websites have told
people that there's a problem intheir brain chemistry.
Historically they have started to correct that over the last
few years, some and some have corrected it since we published
the the paper on serotonin and depression.
But The thing is, if if you if you don't tell people this other
(11:38):
explanation that these drugs arealtering your brain chemistry
and thereby altering your normalmental states, then people will
assume. I think particularly after all
the promotion that's come from the Pharmaceutical industry
persuading people that depression was a chemical
imbalance, that the drugs are targeting some underlying
abnormality. So I so.
(11:59):
They're being fixed. So I think, yeah, yes, exactly.
So I think that unless people are explicitly told that no, we
don't have evidence that this iswhat the drugs are doing, then
that's what they will assume that they are doing.
I mean, at at the moment antidepressants are doled out
very, very easily by GPS who arenot psychiatrists.
(12:19):
How? How have we got into that
situation? Well, that's a really good
question. I think we've, I, I think there
are a number of factors. I mean, the first is that the
Pharmaceutical industry has promoted antidepressants very
heavily since, since the releaseof SSRIs in the early 1990s.
So, you know, there's GPS and psychiatrists have been deluged
(12:41):
with advertising and promotionalmaterial.
So that's one of the reasons, I think that another reason is
that doctors want to be able to help people.
And you know, what does a doctorusually do?
They they give you a pill, they give you a prescription.
And, and psychiatrists in particular want to feel that
(13:02):
they have a medical solution fora common mental health complaint
that is depression. And people themselves have have,
you know, of course, the idea that you could get rid of, you
know, of, of, of really troubling feelings with a pill
is appealing. And so so people have also been
persuaded by by that message that originally came from the
(13:24):
Pharmaceutical industry because actually prior to the
pharmaceutical industry's reallystrong campaigns of the 1990s,
people were reluctant to take medication for depression.
And they did. Because it was really scary
medication, lithium and that kind of.
Thing well, it was partly because the benzodiazepines were
so widely prescribed at that time and it was becoming clear
(13:45):
that they were dependence inducing.
So it was partly because of fears about dependence, but also
also people I think just felt that actually dealing with
emotional problems with with drugs wasn't wasn't the right
route and that depression was something that was a reaction to
life circumstances and so there should be other ways to deal
with it. I mean, patients ask for SSRIs,
(14:09):
don't they? You know, people, they don't,
they don't go to the doctor and say, can I, you know, what can I
do? They'll say, I think I need to
take antidepressants. What should doctors be doing in
that situation? So I, I think there are some
patients that that come to doctors like that, but I think
there are also many patients that come to doctors and I'm not
sure really whether they should be taking a drug or not.
(14:30):
And so I do think that the encounter with a doctor is an
opportunity to de medicalise thesituation and try and suggest
other approaches to people. And I'm sure that lots of
doctors do do that. Of course, you know, often
people are coming to their doctors at a time of crisis and
wanting something to be done andthe doctor doesn't want to send
people away without anything. So there are all these pressures
(14:53):
I think that do. And our mental health services
are on their knees anyway, so, so queues, you know, queues for
treatment are extremely. Long and and GPS are trying to
deal with a lot of distress thatthat mental health services
won't take on. Yes, absolutely, yeah.
So there is, there is always going to be a temptation to say,
OK, we'll try this. There is, I mean, we do have a
national therapy service now in the UK and we're, you know,
(15:14):
unique to, to have one. I think in, in the world, one of
the few countries in the world that has that.
So there are other options. But you know, I know therapy
doesn't necessarily start immediately, but people can be
referred for therapy straight away.
It it will start within a few weeks.
The the basic level of the of the NHS talking therapy service
that's available. But therapy often doesn't work,
(15:35):
does it? You know, people try it and it
just doesn't help. No, not not always, but but I
don't think that antidepressantshelp either.
Well, that that's the problem though, isn't it?
Because billions of people are taking them and presumably a lot
of them feel that they are beinghelped.
You know that it's working and they don't know why, and they
(15:56):
don't really care why. They just know that it's making
them feel better. Otherwise they wouldn't carry on
taking them, yes. Which is why we need to look at
the randomised control trials and, and, and try and understand
the results of those and recognise that actually most of
the effect of the antidepressantis a placebo effect.
And a placebo effect, of course is about, is about having some
(16:18):
hope that you will get better. It's not just about being, you
know, being duped that you're, you know, taking something that
doesn't really work it, it is the hope that people get.
The trouble is that that I thinkantidepressants are giving
people false hope. And a lot of people may feel
better initially, but actually there will come a point when
they realise that the antidepressant isn't working
anymore or they've still got problems.
(16:40):
And then they can often feel even worse because they feel, oh
gosh, you know, I've, I've had the treatment that's supposed to
work. It's not working for me.
I must be a, you know, a really specially severe case.
You know, what on earth am I going to do?
And that can put people in an even worse place.
Even if it was, let's say it's 75% placebo, why does that
(17:01):
matter if it's not harming them?Because it's reaffirming this
idea that the problem is in yourbrain and that you need a drug
to fix it. And we know that people who have
that idea actually have worse outcomes than people who don't
have that idea, who think that depression is, is a reaction
that that, that you know, to circumstances.
(17:23):
And people who view depression in that way have a stronger
belief that they can do something to to help themselves
and affect their circumstances. But I mean, why do you think
it's better to tell somebody that the problem isn't your
brain, the problem is your mind,which is an even more amorphous,
difficult thing to try and understand, and nobody really
understands it. You know that that really can
(17:43):
feel hopeless, can't it? I suppose it gives people more
agency. If you you know, if you locate
the problem in the brain, then you need a medical biological
intervention to deal with it. If it's if it's to do with you
and your life and your circumstances, then there are
there are ways to change those. But a lot of people don't feel
(18:04):
they can change their circumstances.
That's often the cause of depression.
Yes, yes, it is and, and, and, and some people are in, in
circumstances that are very difficult to change.
I still don't think we have evidence that antidepressants
help in that situation and some.So you don't think the evidence
that so many people are taking it for so long is evidence that
(18:25):
they are helpful? I think it's evidence that
they're unhelpful. You know, just explain that they
haven't. Well, people.
Because I think most people say,well, look, you've got 8 or 9
million people taking it. They're taking it for a long
time. Most of them will say, well,
they think they're feeling better as a result, which is why
they carry on going back for repeat prescriptions and carry
on taking the drugs. Isn't that effectively a massive
clinical trial? So, So what happens is people
(18:48):
take antidepressants for a bit, maybe, maybe think that they are
doing a bit better. And often when people start an
antidepressant, I should say that you know, that they're at
their lowest point, they feel they've got to do something
about it. They go and see their doctor and
then they feel they have done something.
So there's all those sort of factors operating that I think
can help people improve when they first go on to an
(19:09):
antidepressant. But so, so people will take an
antidepressant, feel a bit better, think that the
antidepressant has helped them come off it.
And then the next time that theyget into difficulties, they will
assume that that they need a drug again.
So they'll go back to their doctor, they'll get back onto
the antidepressant. They might stay on it a bit
(19:29):
longer this time. And when they try and come off
it, they might experience some withdrawal symptoms, which can
include anxiety, low mood, changeable mood, tearfulness.
So often people will think that they're getting depressed again
and have and, and put themselvesback onto the drug and not
realise that what they were going through is withdrawal.
(19:50):
And so people end up on taking these drugs for long periods of
time. I think that's, I think that's
evidence first of all that they're not working, but also
that people are becoming dependent on them and finding it
difficult to get off them. But I mean, again, like, you
know, the, the, the retort to that for a lot of people is
going to be, well, it whatever works, you know, and if that
works and gives me some sort of instant relief in a way that
(20:15):
talking therapies don't because they're very hidden this, what's
wrong with that? You know, I can, I can see your
sort of your, your principled objection to it.
But I, you know, practically we're in a world where the NHS
health services are not good enough to cope with the demand.
(20:36):
I mean, I suppose I'm saying it doesn't work.
I mean, there's not, there aren't a lot of studies on the
long term outcome of long term use of antidepressants.
But the ones that there are don't suggest that people who
are taking these drugs long termare doing better than people who
aren't. And we know that there are lots
of what we might call side effects or adverse effects of
antidepressants that I think areprobably going to be reducing
(20:58):
the quality of life of people who are taking them long term.
They include things like lethargy, insomnia, difficulty
concentrating, sexual dysfunction, which is, which is
widely recognised. And then of course these
problems with with trying to getoff the drugs if, if people want
(21:19):
to try and come off them. A lot of people do experience
withdrawal symptoms. For some people these can be
severe and really debilitating and can go on for long periods
of time. And the sexual dysfunction can
also persist for some people after they've come off the
medication. This is something that's just
come to light over the last few years, really.
So why do you think there are somany more cases of mental health
(21:42):
crises being reported now and people saying that they are
depressed? So good question and I'm, I
don't have all the answers. I mean, first of all, we've been
the public have been educated for decades now that that, you
know, negative emotions and medical problems and they should
go and see their doctors about them.
So I think it's partly that and that education has come from
(22:04):
medical institutions, but also been sponsored by the
Pharmaceutical industry partly. And, and I think I think it's
also to do with factors in society.
We've become a very competitive society, I think increasingly so
over the last few decades. I think that's particularly
affected young people so that people are constantly, you know,
(22:25):
comparing themselves to other people and worried that they're
not living up to standards that,you know, can lead to
demoralisation. If people feel that they're not
succeeding as they should be, itcan lead to anxiety and stress,
clearly. And, and for many people, life
has got, of course, we've got a cost of living crisis, you know,
(22:46):
so life has become financially more difficult, employment has
become less secure and precarious Housing, of course,
is a, is a huge problem. So there are lots and lots of
social factors that I think giverise to stress among adults and
and younger people. And do you, do you think people
want the diagnosis? You know, do people like being
(23:09):
told, yes, you you've got depression and you need to be
treated? I think some people have have
come to believe that that they have a medical problem and that
a medical label would be helpfulfor them, whether it's
depression or anxiety or ADHD or, or various other labels that
people come come to their doctors thinking that they might
(23:31):
have. Nowadays, of course, social
media is playing a role in that.People, you know, look on social
media at people doing videos saying I've got this, I've got
that and think, oh, you know, yes, that might be me.
So I think that's playing a role.
I think people are desperately looking for explanations.
And I think that's a reflection of people of, of feelings of
(23:52):
insecurity. People feel that they're, you
know, not not performing at the level that that that is expected
by someone. I mean, it it, it does feel a
little bit, I've been listening to you.
It feels a little bit like you are basically saying it's all in
your head in a sort of academic Y kind of way.
So I'm saying that there are real problems out there in
(24:12):
society that that make people feel stressed and anxious and
unhappy, and we need to address those problems.
And I think actually the people who are saying it's in your
brain are the people who that are making it less likely that
we're going to resolve the problems that are making people
unhappy and distressed and anxious in the first place.
(24:33):
How realistic is it then, do youthink, to try and treat 89
million people a different way? How you know?
It would be tremendously intensive, wouldn't it, for the
NHS? Well, we have radically changed
the way that we treat back pain.For example, we used to tell
people to go to bed and, and rest up and take time off work.
And now the advice is, you know,to, to keep active and take
(24:57):
gentle exercise. And the number of people off
sick for back pain has plummeted.
So I think that we can make large changes in medicine
actually. And I think that we, we could
take a different approach to, todepression and anxiety and an
emotional, emotional problems. In fact, it's already started.
We have, there's, there's socialprescribing now in general
(25:21):
practices, social prescribers who try and link people up with
local social groups and institutions that might help
them and support them with, you know, loneliness and, and
financial hardships and other problems that may be leading to
mental health problems or indeedphysical health problems.
So, so we've we've actually havemade a start I and what I'm
(25:43):
saying is I think we need to take that further.
I think we need to actually locate that sort of help outside
of the NHS do. You think it means retraining
GPS? I think we need to support GPS
to be able to divert people awayfrom away from antidepressants,
away from medical solutions intointo social ones.
(26:04):
Do you think GPS are too influenced by the Pharmaceutical
industry and the literature thatthey're constantly sent?
I, I can't speak for GPS specifically, but I know that
the medical profession as a whole is influenced by, by
Pharmaceutical industry advertising.
You know, I go to conferences and there are, you know,
pharmaceutical companies with stands up everywhere and handing
out leaflets and things like that.
(26:25):
It's actually better than it wasa couple of decades ago, I would
say. But but the influence is still
there. What kind of reaction have you
had then over the years to your work?
I mean, you are, you're controversial, you're constantly
criticised. I think doctors, but
particularly psychiatrists, are very reluctant to admit that
(26:46):
their drugs are not targeting underlying biological processes,
underlying mechanisms that that produce symptoms or disorders,
because they want to think that these drugs are more
sophisticated than they are. They've been psychiatrists who I
think want to shut down the debate about about the serotonin
(27:07):
theory of depression, about the biological origins of, of
depression and the fact that there isn't really convincing
evidence for them in order to maintain this, what I would say
a misleading view that antidepressants and other drugs
work in this in this targeted and sophisticated way, I mean.
You you're also taking on big pharma.
(27:28):
You know how? How do they respond?
Well, I, I haven't had any sort of personal, personal contact
with big Pharma. I mean, actually I think big
pharma have largely moved on from antidepressants and now the
drugs that are being marketed are mainly drugs for ADHD.
So, so they probably, they probably don't care that much
(27:49):
actually. Is that your next crusade?
It might be. I mean, why have you spent so
much time on this? Because this has been many years
you've been, you've been making this argument.
Yes. So because antidepressants,
antidepressants are by far and away the most commonly used
psychiatric drug. Because this idea that
depression is caused by chemicalimbalance was widely believed by
(28:12):
most of the general public to have been established.
Even though most of the people in the profession knew that it
hadn't really been established and the research was actually
the research based was actually quite weak.
And because I believe that that that subscribing to this view
that depression is a chemical imbalance is not helpful to
(28:32):
people, there's. Going to be a lot of people
listening who are on antidepressants.
What should they do? So I think that people should,
if, if they want to question if they want to rethink being on
antidepressants, if they want tothink about the possibility of
coming off them, do some reading, discuss it with friends
(28:53):
and and family. And then go and see their their
doctors and make a plan to come off their antidepressants slowly
and carefully and at the right time.
So don't read your book and juststop.
No, don't read my book and throwthe drugs in the in the bin,
because it's very important to say that might make the
withdrawal process a lot worse. What?
What sort of things would happen?
(29:13):
So withdrawal symptoms can be quite severe for for some people
and and prolonged and it seems that if you come down much more
slowly, that's going to make them milder and less likely to
be prolonged and. And in terms of the evidence
base for talking therapies and other therapies, how good is
(29:33):
that? You know, because what you've
done is sort of undermined the the evidence base for
antidepressants. You know, the question is how
good are the alternatives? So the evidence is that talking
therapies are as good as antidepressants.
So so. Not very good at all.
They don't work. So, so I, I think that this idea
(29:58):
that we're treating a disease isone of the problems and, and so
it's very unlikely that there'llbe something that just works in,
in that sort of medical sense. And therefore I think we need to
see talking therapies as something that might be useful
for some people in certain situations, but not in others.
It's. Quite a bleak outlook you're
(30:18):
offering, isn't it? In some ways, because you're,
you're basically saying there are some people who are
depressed who are just going to be depressed.
No, I'm really not saying that. And I don't think it's a bleak
outlook. Most people will get better than
depression anyways. You lost your parents as a child
and you've had a terrible life as a result.
There isn't going to be any social group that the GP can
send you to or talking therapy that's going to help you with
(30:41):
that. But, but giving people
antidepressants is giving them false hope because, because we
really don't have evidence that it might be numbing the pain.
It might be numbing the pain, but it's, it's, it's not, it's
not providing a very satisfactory solution to the
problem. I would suggest.
And, and I think it's really important to say most people
recover from depression spontaneously without
(31:04):
antidepressants. And I think that giving
antidepressants to people is actually making that less
lightly, certainly less lightly in the long run.
So even even though it may be a difficult message at the
beginning to say actually we don't have a drug that's going
to solve the situation in the long term, I think it's actually
a much more hopeful message thatyou actually have the resources
(31:24):
in yourself to deal with this problem.
I mean that that's really interesting if that's true, that
most people just feel better spontaneously.
So that the best advice to a family or friend who comes to
you saying they're feeling terrible is you will feel
better. Is is to stick it out and maybe
you need some support and some care in the in the meantime and
(31:47):
and to try and work out what it's a response to and change
that if it's possible. Joanna Moncrief, thank you very
much indeed. Thank you.
Thank you for joining us on Waysto Change the World.
You can watch all of these interviews on the Channel 4 News
YouTube channel. Our producer is Sylvia Maresca.
Until next time, bye bye.
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