Joanna Moncrieff: “I’m Not Convinced Antidepressants Have Any Use”

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From The New Statesman: “Around one in eight adults in England – or 8.3 million people – is on antidepressants, a figure that has risen by over 20 per cent in the past five years. Many would say the medication has eased their suffering; Joanna Moncrieff, a professor of social psychiatry at University College London and an NHS psychiatrist, believes they have been sold a lie.

Her work made headlines last summer when she published a review in Molecular Psychiatry concluding there is ‘no evidence’ that depression is caused by low serotonin levels. Moncrieff had identified a gulf between professional and public understanding – around 80 per cent of people believe depression is caused by a chemical imbalance – but she also wanted to make a bigger and more controversial point about how antidepressants do, and don’t, work.

She argues that, given how little we know about ‘the biology of mental illness,’ there are no targeted, ‘disease’-specific drugs; antidepressants are closer in nature to alcohol. They do not rectify an underlying brain malfunction, but rather change how you think or feel. ‘Those changes are superimposed onto whatever someone is thinking and feeling at the time. We even have an expression for this with alcohol: we talk about “drowning your sorrows”,’ Moncrieff said, when we met in her spartan shared office at UCL. ‘If you recognise that’s what the drugs are doing, then it immediately becomes obvious they are not going to be a long-term solution and they might be harmful.’

Moncrieff is a leading figure in critical psychiatry, a movement that rejects mainstream psychiatrists’ medical approach to mental illness. Her books The Myth of the Chemical Cure (2007) and The Bitterest Pills (2013) argue that faulty science and corporate greed have led to psychopharmaceuticals being mis-sold and massively overprescribed, and are central texts in the movement.

When she sees her patients, she does sometimes prescribe drugs. In the short term, she finds sedatives can help those who are agitated and can’t sleep, and antipsychotics can be useful too. ‘But I’m not convinced that antidepressants have any use,’ Moncrieff told me.

She said clinical trials have shown the effectiveness of antidepressants over placebos is so small as to be clinically insignificant. Even this, she argued, can be explained by an enhanced placebo effect, since the side-effects from antidepressants (drowsiness, nausea, loss of libido) mean subjects can tell when they are in the treatment group. Most trials run for a few months, and can miss the longer-term aspects of antidepressant use, like withdrawal symptoms or the fact that depression often improves within six months without intervention.

Does she acknowledge that her views could seem dismissive to the millions who believe antidepressants help them? ‘Just because something’s painful and scary doesn’t mean you should keep information from people,’ she said. ‘Also, there’s nothing to be ashamed of if you had a placebo response… It’s not because people are gullible or stupid.’ She emphasised that anyone considering stopping antidepressants do so only with the support and guidance of a doctor.

. . . Moncrieff is used to strong criticism from colleagues, but says she’s seen a shift in recent years. A critic of the Covid vaccine mandates (she was sceptical of the trial data and opposed to coercive measures), she believes the pandemic created a new atmosphere of intolerance for scientists with heterodox views. ‘It became OK to cancel scientists. Scientists who weren’t toeing the line were attacked and vilified,’ she said. She noticed a similar climate in the wake of her serotonin study. ‘Some of the articles were putting forward the view that it’s off [limits] to criticise antidepressants, that this is an area of scientific debate that shouldn’t be allowed to be had,’ she said. ‘I think Covid enabled people to say that.’

Moncrieff has been a dissenter her entire career. As a student in the Nineties she felt greater affinity with earlier figures such as RD Laing and Thomas Szasz, who saw mental illness as a political and social construct, than with colleagues who believed that advances in brain science would yield new cures. While working for the Institute of Psychiatry in London she joined a reading group with like-minded peers – ‘We were all quite left-wing and a bit rebellious’ – that in 1999 merged with a group in Bradford to become the Critical Psychiatry Network. The network, of which Moncrieff is co-chair, now has over 400 members.

‘The pharmaceutical industry and the medical profession have coached the population for decades that there is a medical solution to various crises in life – and I think we need to uncage people because that’s simply not true,’ Moncrieff said. ‘We need to find more non-medical ways of supporting people through crises.’ Rather than viewing depression as an illness, she wants people to see it as a ‘mood state’: ‘Mood states are related to emotions, and moods and emotions are the way that human beings, which are complex, intelligent organisms, respond to events in their environment. Depression is by definition a reaction to a state that someone doesn’t want to be in, to something that’s gone wrong in someone’s life, or a stressful situation.’

Moncrieff’s critics point out that her views are popular with the American far right and Scientologists. ‘That’s life, isn’t it? Sometimes you share views on some things with people whose views on other things you don’t agree with,’ Moncrieff said. ‘Just because the Scientologists… have these views about mental health doesn’t mean I should drop them.’

Another group with whom her views resonate is the growing community of people who say they have been harmed by psychiatry and are agitating for change. Their perspective is more ‘powerful’ than hers, she said, and she was ‘hopeful’ for the future. ‘But,’ she added, ‘there needs to be a political move to demedicalise the whole mental health arena and that’s going to be very, very difficult.’”

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MITUK’s mission is to serve as a catalyst for fundamentally re-thinking theory and practice in the field of mental health in the UK, and promoting positive change. We believe that the current diagnostically-based paradigm of care has comprehensively failed, and that the future lies in non-medical alternatives which explicitly acknowledge the causal role of social and relational conflicts, abuses, adversities and injustices.