Doctors Won't Tell You This! - Dark Truth About Antidepressants & How Big Pharma Fooled Everyone

1. RCDr. Rangan Chatterjee0:00

   If there is no evidence to support the chemical imbalance theory of depression and a serotonin deficiency, why is it that so many people think that there is? And why are so many people on these drugs?

2. JMJoanna Moncrieff0:15

   So that's, that's a very good question, and the answer primarily is because of the efforts of the pharmaceutical industry in the-- from the 1990s onwards. So the chemical imbalance theory of depression was first constructed in the 1960s by psychiatrists and researchers who were, um, who were experimenting with various drug treatments for depression and trying to come up with a justification for, for using drug treatment in this situation. But it wasn't an enormously well-known or popular theory at that time. There was a big project set up to test whether there were any differences in people's brain chemicals, people who had depression versus people who didn't in the 1980s. That didn't come up with anything. So, you know, the theory wasn't really getting anywhere. But then in the 1990s when the pharmaceutical industry wanted to promote their new range of drugs for emotional problems, that is the SSRIs, they picked up this theory and widely promoted it. And so there were massive, um, advertising campaigns that, that told people that depression was caused by a chemical imbalance, or sometimes they'd say it might be caused by a chemical imbalance. But this was repeated so many times that basically people became convinced it was true.

3. RCDr. Rangan Chatterjee1:35

   Yeah. This idea that depression is caused by a chemical imbalance, I think that idea has become so widespread that it's now taken as fact.

4. JMJoanna Moncrieff1:49

   Absolutely. Absolutely, yes.

5. RCDr. Rangan Chatterjee1:50

   It's not just, "Oh, that's a theory."

6. JMJoanna Moncrieff1:52

   Yeah. Yeah.

7. RCDr. Rangan Chatterjee1:52

   I think the general public-

8. JMJoanna Moncrieff1:54

   Yeah

9. RCDr. Rangan Chatterjee1:54

   ... or much of the general public believe this to be true. And so your work for many years, including your brand-new book, Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth, I think is really helpful, not only for the public, but also for professionals like me, other medical professionals who potentially have felt intuitively there's something not quite right here. But I think what you've done is give people the evidence for that.

10. JMJoanna Moncrieff2:23

    Yeah, absolutely.

11. RCDr. Rangan Chatterjee2:23

    Or I should say the lack of evidence for that.

12. JMJoanna Moncrieff2:25

    Yeah, yeah. So this is exactly why we set out to do the serotonin review because I became aware that most of the general public think that the link between serotonin and depression is an established fact. They think it's, it's pr- proven. They don't realize that it's a speculation, a theory that, you know, that there may be a bit of evidence for and a bit of evidence against. So that's why I thought, right, we need to look at the evidence properly, set it out, get it published, and, and see what it says. And, and I think, as you say, that actually a lot of clinicians had been persuaded that maybe this was true too, even though there was, you know, there was no convincing body of evidence ever put together to say, you know, "Yes, this is definitively the case."

13. RCDr. Rangan Chatterjee3:10

    Yeah. It's interesting. In one of your chapters of this book, you write about your appearance on, I think, This Morning, the UK television show, to talk about this, and the resident GP said on that segment, "Well, why does it matter?" Right? "Why does it matter? We know that they work. It doesn't really matter why they work." Now, it was quite shocking for me to read that, to go, it doesn't really matter why they work. Hold on a minute. There are a ton of side effects-

14. JMJoanna Moncrieff3:38

    Yeah, yeah

15. RCDr. Rangan Chatterjee3:38

    ... to these drugs, right? So if the whole principle on- upon which they're prescribed is built on sand, we kinda need to know about it, right?

16. JMJoanna Moncrieff3:50

    Absolutely.

17. RCDr. Rangan Chatterjee3:50

    So what is your take on that?

18. JMJoanna Moncrieff3:51

    Yeah.

19. RCDr. Rangan Chatterjee3:51

    And what are-- for, for anyone who's listening who perhaps is on an antidepressant at the moment or an SSRI, selective serotonin reuptake inhibitor, what are some of the signs that might indicate they're having some problems on them?

20. JMJoanna Moncrieff4:06

    Yeah, so, so just to say first, um, the-- it was a very common reaction to when we first published the serotonin paper and also since I've published the book for psychiatrists and, and other leading doctors to say, "It doesn't matter. It doesn't matter how they work." And I think that is absolutely shocking. I think it matters a lot how they work, and it is absolutely essential that we discuss this with the public and, and so that people are able to evaluate what they might be doing to them if they're thinking about taking one of these drugs. So SSRIs, the idea was that they would work by correcting an underlying serotonin deficiency, and it turns out that actually the evidence for that is, is weak, inconsistent, and not compelling, and certainly not proven. Um, but they are dr- you know, they are drugs. They do change your, the normal state of your brain chemistry. They do modify our biology in some way. Um, and we know that they cause, you know, th- they, they change people's thinking and feeling processes. And s- and one of the common effects they have, for example, is that they cause a state of emotional numbing. So people often say that they can't, um, you know, they may not feel quite so sad anymore, but also they can't feel happy anymore, and they can't cry. And, and some people might welcome that effect, but some people, a lot of people report that it's actually quite unpleasant and-

21. RCDr. Rangan Chatterjee5:40

    Yeah

22. JMJoanna Moncrieff5:40

    ... and, you know, uh, they don't feel like themselves anymore when they're, when they're in that sort of state.

23. RCDr. Rangan Chatterjee5:46

    Yeah. It's interesting. As I was reading your book and, and diving into your work, Joanna, I reflected a lot on my own practice over the years as a medical doctor. And I've always believed that one of the most important things that a doctor can give a patient is a sense of agency and autonomy, and I feel that by overly labeling people and making them think that they can only get better if they're dependent on a medication which they can't then stop-I've always had a deep, I guess, an ethical issue with that. And I remember early in my days as a GP, there was one patient, I don't think I started an SSRI on her. I think she'd been started it by a colleague of mine. But she came in for her four weekly review, right? And she was a young lady, I think she was about 23 years old. And I remember her saying to me something to the effect of, "Well, yeah, I don't feel as low as I did four weeks ago, but I feel nothing anymore. I don't feel high. I don't feel joy. I feel nothing." So I always remember that so well. I thought, "That's really interesting. She's potentially having what you're calling this emotional numbness or emotional blunting." And I thought, "Well, how is that helpful?" Yeah, you could argue we've removed the really low moods, but if you can't experience pleasure or joy or hope or whatever it might be, I thought, "How is this helpful?"

24. JMJoanna Moncrieff7:20

    Yeah.

25. RCDr. Rangan Chatterjee7:20

    So that was, that's one case I really remember super, super well. Um, and the other case I remember really, really well is, without going into, into the young lady's history, I remember seeing someone and I thought, "Yeah, you know, these symptoms are consistent with what we get told we need to hit in order to make the diagnosis of depression" And I remember looking in the BNF, so for the people listening to the show all around the world, so the British National Formulary. So our kind of bible of, uh, drugs and the consequences, what the indications are, what the side effects are. And I remember looking through it, and I knew this anyway, but I was just looking through it, and although it's documented as a rare side effect, I was looking at it going, "Oh, there's an increased risk of suicidal ideation" And I thought, "This doesn't make any sense to me. I've got someone in front of me with low moods, and I'm potentially gonna be putting her on a drug that, yes, it might be a small risk, that may increase her risk of suicidal thoughts" And I thought, "This doesn't kinda make any sense." So any comments-

26. JMJoanna Moncrieff8:27

    Yeah, yeah

27. RCDr. Rangan Chatterjee8:27

    ... on what I've just said, Joanna?

28. JMJoanna Moncrieff8:28

    Yeah, yeah. No, absolutely. I mean, s- so it, it comes back to there being, you know, two very different ways of understanding what these drugs might be doing. And, and if you understand that they are correcting an underlying abnormality, an underlying deficiency, then it sounds like a good idea to take them. And you might take a small, you know, a small increased risk of something if you're correcting, you know, uh, an underlying biological disease that you have. But-

29. RCDr. Rangan Chatterjee8:56

    Yeah. So, so just on that.

30. JMJoanna Moncrieff8:57

    Yeah.

Episode duration: 1:49:26