Millions of people have been wrongly told depression stems from low levels of happy hormones in the brain, according to Professor Joanna Moncrieff, a psychiatrist at University College London. Professor Moncrieff asserts that the narrative given to generations of patients regarding a chemical imbalance is false, and these medications do not function by rectifying a verified neural defect.
Serotonin and Depression: Examining the Evidence Gap
Professor Moncrieff led a major review that brought together research examining possible links between the happy hormone serotonin and depression. According to Professor Moncrieff, none of those areas provided convincing or consistent evidence of a link between low serotonin and depression. Record numbers of people now take these medications, with more than nine million people in England—around one in five adults—prescribed antidepressants.
Following the discovery by researchers in the 1960s that antidepressants modified brain chemicals, the chemical-imbalance hypothesis came to light. Scientists questioned whether the drugs might work by correcting an underlying abnormality. This explanation gained widespread recognition during the rollout of selective serotonin reuptake inhibitors, commonly known as SSRIs, throughout the late 1980s and 1990s. Nerve cells are prevented from reabsorbing serotonin by SSRIs, thereby increasing the amount of this chemical present in the brain. However, Professor Moncrieff states this does not by itself show that people with depression had too little serotonin beforehand.
How Antidepressants Alter Brain Chemistry
Professor Moncrieff argues that antidepressants relieve distress by numbing people’s emotions. According to the psychiatrist, the drugs dull happiness, excitement, love, and sexual feelings alongside sadness and anxiety. She insists that antidepressants are not simply dummy pills, noting they are active drugs that change the normal state of brain chemistry.
These assertions are presented in an upcoming interview for the Care Visions Talks podcast—produced by the residential childcare organization Care Visions—which is slated for launch this autumn. The assertion also forms the core of a major new edition of Professor Moncrieff’s book, Chemically Imbalanced, published later this month. Professor Moncrieff stated that the way the drugs are marketed is not supported by evidence.
Medicalizing Emotions and Alternative Treatments
Professor Moncrieff is calling for a revolution in mental health treatment with a greater focus on why an individual is distressed. According to the University College London professor, depression is almost always a reaction to things happening in people’s lives, although genes and biology can influence individual vulnerability. She expressed hope that people will realize the huge experiment in medicalizing emotions and life difficulties is a mistake.
Highlighted side effects linked to the drugs include sexual dysfunction, weight gain, fatigue, sleep problems, and withdrawal symptoms. Some patients who stop treatment experience dizziness, severe anxiety, and brain zaps, with a minority reporting severe problems lasting months or years. Professor Moncrieff expressed particular concern about young people, noting that antidepressants have not been shown to reduce suicide and could slightly increase suicidal thoughts and self-harm among young users.
Dividing Views Within Psychiatry
Professor Moncrieff’s conclusions are fiercely disputed by other experts in the field. While numerous psychiatrists concur that depression cannot simply be reduced to a serotonin deficit, they contend this does not invalidate the efficacy of antidepressants or suggest biology has no role in the condition. A landmark Lancet analysis found all 21 antidepressants studied were more effective than dummy pills for adults with major depressive disorder during severe episodes. Authors of the Lancet analysis stated the results provided evidence that antidepressants work, although average benefits were generally modest and varied between drugs.
Detractors have likewise criticized Professor Moncrieff’s evaluation of serotonin, contending that her methodologies and findings were overstated and that serotonin might still play a part through more intricate mechanisms associated with serotonin concentration. Furthermore, patients frequently report that antidepressants transformed or saved their lives. Unless a patient opts for them after receiving comprehensive details regarding potential adverse reactions and alternative choices, NHS guidelines dictate that antidepressants ought to be proposed as an initial intervention strictly for more severe cases of depression. The drugs are not recommended for treating depression in under-18s, although they may be used alongside another treatment.
Did You Know?
Professor Moncrieff serves as an expert adviser to the Beyond Pills All-Party Parliamentary Group, which campaigns to stop UK healthcare from over-relying on prescription medications.
Frequently Asked Questions
Do antidepressants work by fixing a chemical imbalance?
According to Professor Joanna Moncrieff, the chemical imbalance theory is a myth, and studies have not established that depression is caused by a serotonin deficiency. However, other psychiatrists and a landmark Lancet analysis argue the drugs are effective through mechanisms that may involve more complex biological processes.
What are the common side effects of antidepressants?
What does NHS guidance say about prescribing antidepressants?
NHS guidance states antidepressants should generally be offered as a first-line treatment only for more severe depression, and they are not recommended as a standalone treatment for under-18s.
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