Open Letter to This Morning
Dear This Morning producers,
We, the undersigned, are writing this letter to voice our concerns about your segment aired on Monday, 11th October, “The truth about antidepressants – What you need to know?”, which featured Dr. Ellie Cannon as an expert on the topic. While we applaud the programme for taking the initiative to educate its viewers on matters relating to the dramatic increase in use of antidepressant drugs in the UK, we were disheartened to find misleading information — and in some cases, actual falsehoods — being presented in the segment regarding how SSRIs work and how their safety was characterised. We address four key areas below.
The ‘chemical imbalance’/ serotonin deficit hypothesis
Dr. Cannon stated that Antidepressants are, “medications that increase hormone levels in the brain… they increase those hormone levels so that you can function again.” She goes on to say, “if somebody who didn’t have depression took them, they wouldn’t do anything.”
The ‘chemical imbalance’ hypothesis of depression (and similar explanations for other diagnoses) expressed above has long since been abandoned. In fact, prominent psychiatrists have publicly stated that they believe it to always have been a “myth.” (1)
There is no evidence for the existence of lower levels (or ‘imbalances’) of serotonin or any other neurotransmitter in people diagnosed with depression, anxiety or any other disorder she mentions.
There is no evidence that increased levels of serotonin cause people diagnosed with such disorders to “function.” It is unknown how SSRIs and other antidepressants produce benefits for those who do experience such benefits.
Moreover, at best only 20 out of 100 people taking antidepressants will benefit to a greater extent than those taking a placebo or doing nothing. (2)
The claim that SSRIs would “do nothing” to a person not diagnosed with such a disorder is false. On the contrary, the neurochemical effect and potential for adverse effects would remain the same for anyone who took them. (3)
Downplaying the ‘side-effects’
Dr. Cannon states: “That’s one of the myths — that they make you feel like a zombie, stop you feeling happy, they stunt everything, they don’t. What they stop is the bad feelings, the bad thoughts, whether it’s depression, whether it’s anxiety.”
While Dr. Cannon to her credit does mention ‘side effects’ at different points, she very explicitly dismisses one of the most common side-effects, found in over 50% of people who take SSRIs — emotional numbing and apathy (4) — which was clearly the target of Mr. Schofield’s question.
Sexual dysfunction, which affects 50% or more of those taking antidepressants (5), and insomnia (30%-50%) (6) are other adverse effects of antidepressants that occur so frequently that it is hard to understand a lack of reference in any fair discussion of the drugs.
It is hard to square these effects with the implication that one is able to live one’s “best life” under drug treatment. At the very least, an adverse experience is as common as a good experience on antidepressants.
Denying the problem of dependence
Dr Cannon told the audience that antidepressants “are not addictive.” While antidepressants do not fit the medico-legal definition of “addictive drugs,” they do cause physical dependence just as other drugs that affect the central nervous system do, such as stimulants and opioids. Because of this, people’s brains adapt to them and they become difficult, or even impossible, to stop.
As a result, antidepressants cause withdrawal syndrome —which can be severe and debilitating— in about 40-50% of those who attempt to go off the drugs (7). For some, this can last years, putting jobs, relationships and lives at risk. The Royal College of Psychiatrists now recommends that patients are warned of the possibility of severe and long lasting withdrawal effects when they are considering starting these drugs. (8)
Long-term use of antidepressants
Dr. Cannon: “there was a study that was reported in the Times that showed that people who stay on antidepressants long term actually do better. So, perhaps we do need to think of them like a chronic medication. Where you stay on them as maintenance, a bit like you do with your asthma inhaler. Rather than coming on and off. You’re better because you’re on the medication.”
The recent study that Dr. Cannon refers to has been widely criticised for not distinguishing between withdrawal symptoms and relapse.
Other studies of long-term treatment have similar problems and overall evidence does not confirm that antidepressants have beneficial long-term effects. (9)
There are in fact legitimate concerns that for a large proportion of users antidepressants might be largely ineffective or even harmful. (10)
Taken together, a picture emerges that is, we suggest, deeply problematic. The issues involved unfortunately go far beyond the particular segment in question, however. As the undersigned and many others can attest, it is very common for medical professionals to use similarly incomplete and misleading explanations, at times including false information, to encourage people to take antidepressants. It is incumbent on medical professionals— at this time especially— to be giving accurate, balanced information and advice in the media to re-establish trust in their profession. At the very least, this should include recognition of the widespread over-prescribing of antidepressants — as reported by the All Party Parliamentary Group for Prescribed Drug Dependence this week. (11)
With this in mind, we ask that This Morning make a positive commitment to have the information contained in this letter represented and aired on the programme in some form. We would be happy to discuss the form this might take, and to recommend speakers.
We look forward to hearing your response at your earliest convenience,
Sincerely, the undersigned:
Professor Joanna Moncrieff — Consultant psychiatrist (North East London NHS foundation Trust) and Professor of Critical and Social Psychiatry, Division of Psychiatry, University College London.
Adele Framer — Patient advocate and founder of survivingantidepressants.org
James Barnes — Psychotherapist
Harriet Vogl — Psychologist
Professor John Read — Professor of Clinical Psychology, University of East London; Chair, International Institute of Psychiatric Drug Withdrawal.
Professor Peter Kinderman — Professor of Clinical Psychology, University of Liverpool
Lucy Johnstone — Consultant clinical psychologist
Jo Watson — Psychotherapist & Activist
Anne Guy — Psychotherapist
Dr Mark Horowitz — Clinical Research Fellow in Psychiatry, University College London and North East London NHS Foundation Trust.
John Drummond —Expert by experience (parent and carer)
Dr. James Davies — Reader in Medical Anthropology and Psychology, University of Roehampton London.
Fiona French — Patient advocate & campaigner
Anne Cooke — Consultant Clinical Psychologist
Dr Jessica Taylor — Chartered Psychologist & Director of VictimFocus
Professor Martin Milton — Professor of Counselling Psychology
Dr Eoin Galavan — Clinical and Counselling Psychologist
Duncan Double — Retired consultant psychiatrist
James Moore — Patient Advocate and Campaigner
Jen Kilyon — Chair U.K. Soteria Network
Professor Sinead McGilloway — Professor of Family and Community Mental Health
Jay Beichman PhD MBACP(SnrAccred)
Hannah Istead — Clinical/Community Psychologist
Sara Tai — Consultant Clinical Psychologist & Senior Lecturer at the University of Manchester.
(2) InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361016/]
(3) Jakobsen, J. C., Katakam, K. K., Schou, A., Hellmuth, S. G., Stallknecht, S. E., Leth-Møller, K., Iversen, M., Banke, M. B., Petersen, I. J., Klingenberg, S. L., Krogh, J., Ebert, S. E., Timm, A., Lindschou, J., & Gluud, C. (2017). Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis. BMC Psychiatry, 17(1), 58. https://doi.org/10.1186/s12888-016-1173-2
(4) Goodwin, G. M., Price, J., De Bodinat, C., & Laredo, J. (2017). Emotional blunting with antidepressant treatments: A survey among depressed patients. Journal of Affective Disorders, 221, 31–35. https://doi.org/10.1016/j.jad.2017.05.048
(5) Montejo, et al., SALSEX Working Study Group. (2019). A Real-World Study on Antidepressant-Associated Sexual Dysfunction in 2144 Outpatients: The SALSEX I Study. Archives of Sexual Behavior, 48(3), 923–933. https://doi.org/10.1007/s10508-018-1365-6
(6) Wichniak, A., Wierzbicka, A., & Jernajczyk, W. (2012). Sleep and Antidepressant Treatment. Current Pharmaceutical Design, 18(36), 5802–5817. https://doi.org/10.2174/138161212803523608
(7) Davies. J., & Reed, J. (2019) A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, S0306460318308347. https://doi.org/10.1016/j.addbeh.2018.08.027
Jauhar, S., & Hayes, J. (2019). The war on antidepressants: What we can, and can’t conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read. Addictive Behaviors, 97, 122–125. https://doi.org/10.1016/j.addbeh.2019.01.025
(9) Lewis, et al. (2021). Maintenance or Discontinuation of Antidepressants in Primary Care. New England Journal of Medicine, 385(14), 1257–1267. https://doi.org/10.1056/NEJMoa2106356
Hangartner, M. P. (2020). How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding, Therapeutic advances in psychopharmacology, 10: 2045125320921694. https://doi.org/10.1177/2045125320921694
(10) Hangartner, M. P. (2020). How effective are antidepressants for depression over the long term? A critical review of relapse prevention trials and the issue of withdrawal confounding, Therapeutic advances in psychopharmacology, 10: 2045125320921694. https://doi.org/10.1177/2045125320921694