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.
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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.”
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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)
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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.
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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.
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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)
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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)
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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.
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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.
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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.
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Denying the problem of dependence
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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.
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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)
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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.”
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The recent study that Dr. Cannon refers to has been widely criticised for not distinguishing between withdrawal symptoms and relapse.
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Other studies of long-term treatment have similar problems and overall evidence does not confirm that antidepressants have beneficial long-term effects. (9)
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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.
References
(1) https://www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again
(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
(8) https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps04_19—antidepressants-and-depression.pdf?sfvrsn=ddea9473_5
(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
(11) http://cepuk.org/2021/10/19/500m-wasted-each-year-in-england-on-dependency-forming-medicines%EF%BB%BF
“Dr Ellie: I mean, I feel like I prescribe them very often. I think they are within the top 10 of the most prescribed drugs from a GP. They’ve certainly been more common in the last couple of years. We talk about mental illness and much more. The pandemic obviously has significantly affected people.” mmm so it is a chemical imbalance or is it the pandemic… or maybe ‘talking about it more’? Anyhooo… perhaps it is chronic, so let’s prescribe them chronically. Un fricking believable.
I admire the restraint of the signatories to the open letter.
For the sake of clarity – here is a transcript of the ITV This Morning Interview, together with the ITV Intro:
ITV This morning: Monday 11 October 2021 10:54ap
As a new study reveals that 56% of people would be likely to relapse within a year of starting antidepressants, could the answer be to make them a more long term medication for patients?
Maybe, says Dr Ellie Cannon, who joins us to unpack the myths surrounding antidepressants, and reveal how they work.
TRANSCRIPT – Interview
Dr Ellie Cannon – ITV This Morning 11 Oct 2021 – with Philip Schofield & Holly Wells
Philip: With NHS figures showing that more than 20 million prescriptions for antidepressants were given in just three months last year. Dr Ellie is here to explain more. Good morning. How would you class an antidepressant? What are they?
Dr Ellie: Well, they’re medications that increase hormone levels in the brain so specifically a hormone called serotonin. They’re not really happy pills, so people shouldn’t really call them that …so because if somebody who didn’t have depression took them they wouldn’t do anything. But if you have depression, or anxiety or OCD are quite a lot of the different mental illnesses. They increase those hormone levels so you can function.
Philip: Do they all do that and do they all work they all work the same way?
Dr Ellie: The most commonly prescribed in the UK are called SSRIs. And one of those S’s is for serotonin. They are the most common, people will have heard of sertraline, citalopram, fluoxetine, there are some others, other ones like mirtazapine which are slightly different, but they’re the most modern and that’s what we prescribe most often.
Holly: And so we’re just saying that there’s a 6% increase between October and December 2020. How common are they? How many people are using them? Do you think?
Dr Ellie: I mean, I feel like I prescribe them very often. I think they are within the top 10 of the most prescribed drugs from a GP. They’ve certainly been more common in the last couple of years. We talk about mental illness and much more. The pandemic obviously has significantly affected people. We don’t have the access to mental health services that we should so often we’re almost left to, we have to, give an antidepressant because there isn’t anything else so they are incredibly common. I think.
Philip: So do you think there’s a stigma surrounding them?
Dr Ellie: I do think there’s a stigma. So I actually take antidepressants, I’m a doctor, I’m functioning. I have very bad anxiety but I take antidepressants which are licenced for anxiety and they really help me, they help me live my best life. They totally take away the physical symptoms that I have of anxiety. And I feel that people don’t admit that often enough. People would often be surprised maybe to hear that a doctor takes them and there are a lot of people who are taking these medications and I think we need to start thinking about them just like we think about diabetes medication or blood pressure pills.
Holly: Yeah, I think the more people that you speak about it, the more it normalises for sure so yeah, thank you.
Philip: Is there… there are people who say, you know, I don’t want to take those because they’re gonna make me like a zombie. They’re going to put me to sleep. And do they do that?
Dr Ellie: Well, I certainly don’t feel like a zombie. There are side effects like with all medications and one of them can be that they make people tired. So if that happens to you you take them in the evening. But no, I think that’s one of the myths that they make people like a zombie. They stop you feeling happy. They stunt everything – they don’t. What they actually stop is the bad feelings and bad thoughts, whether it’s depression, whether it’s anxiety. Of course there are side effects, and you should always talk about that with your doctor. But actually, I really think they help if you have a condition. They help people to live, how they want to live.
Holly: But this isn’t a quick fix, or is it?
Dr Ellie: No, it’s really not and actually, people really need to know that it takes weeks sometimes to get used to taking an antidepressant. People can feel worse before they feel better. The first two or three weeks on an antidepressant can actually be worse, which is really hard if you’re already feeling quite dreadful. So it can take a good five or six weeks for them actually to be effective. There’s definitely not a quick fix. And if you are started on them we expect you to be on them for at least six months.
Holly: Okay.
Philip: So does it depend on whether or not your life gets better your mood gets better if you .. if you see yourself .. oh actually, hold on a second, things are beginning to look better for me. I can come off them now.
Dr Ellie: Well, it’s interesting because there was a study last week that was reported in the Times that showed actually people who stay on antidepressants long term actually do better and actually coming off them going back on them coming off and going back on is actually is not a good idea. 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. Because I always see that with patients making the mistake of thinking oh, I’m better now. I’ll stop – Well you’re better because you’re on the medication!
Holly: And when you do stop, if you get to that point where you and your GP have discussed it and you feel like it’s the right thing, you have to be careful there because you can’t just stop taking them one day.
Dr Ellie: No, you can’t. Antidepressants are not addictive. I should say that because people think that they are, they’re not addictive. But if you come off them too fast it can make you feel quite strange It can make you feel a bit sort of dopey, a bit confused. It affects your memories, you have to come down off them very slowly and reduce the dose over weeks actually.
Philip: with the help of your doctor
Dr Ellie: with the help of your doctor.
Philip: You would expect that the people who would say actually right, I said okay, now I feel fine because that’s the benefit of the antidepressants, which take a long time to kick in. So, then they kick in over a period of time you think I’m okay now and you stop and you realise that in fact it was the antidepressants for what making you feel okay,
Dr Ellie: exactly.
Philip: And you wouldn’t see that for a few weeks.
Dr Ellie: Exactly right. So that’s why it’s actually this long term idea that is probably more beneficial.
Holly: So if somebody is watching this now they’re thinking, Oh, I think this might benefit me actually. What should they do?
Dr Ellie: So be in touch with your with your GP talk to them about it. There are many ways of treating mental illnesses, there’s also therapy there’s also lifestyle options. But for a lot of people, tablets are a good idea and can work really well. Not for everybody. Speak to your GP talk to them. They will assess whether or not you need them whether you would benefit and think about it they really shouldn’t have the stigma that they do.
Philip: Don’t be embarrassed and don’t be ashamed.
Dr Ellie: No don’t
Philip and Holly: Thank you.
Thank you. Discussion of, greater awareness of, and understanding of antidepressant induced AKATHISIA and its vulnerability to misdiagnosis as Serious Mental Illness is also required.
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