The False Promise of Antidepressants | Dr. Joanna Moncrieff

[RUSH TRANSCRIPT BELOW] Dr. Joanna Moncrieff is a British psychiatrist and author of “Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth.” She challenges the long-held belief that depression is caused by a lack of the hormone serotonin.

“The serotonin myth … was first put out there in the 1960s, then picked up by the pharmaceutical industry in the 1990s and widely propagated by them as part of their campaign to sell SSRIs, their new generation of antidepressants,” she said.

Contrary to what many people still believe, there’s no evidence that depression is caused by a lack of serotonin in the brain, Moncrieff said.

“A few years ago, we published what’s called an umbrella review, a sort of meta review of all the different areas of research that have looked at this. … And we show that there is no consistent or convincing evidence in any of these areas of research for any association between serotonin and depression. So hence, the idea is a myth,” she said.

In our interview, she explains how this narrative took hold and how it reshaped modern psychiatry.

So what causes depression if not a lack of serotonin? Dr. Moncrieff, who is a professor of critical and social psychiatry at University College London, regards depression as “meaningful human reactions to the circumstances of life now, and that is indeed how people used to think about them.”

It’s not a biological disease, she said, but a normal reaction that anyone may experience at times throughout life.

“It’s not something that we naturally just get over in a couple of weeks. It can take weeks and months of grieving, even for a short-term relationship that’s finished.”

To label deep sadness as a pathological medical condition that needs to be fixed with drugs is the wrong approach and precludes seeing a person “who is suffering, who is going through a period of difficulty and trying to work out what that is and how we can support them with it,” Moncrieff said.

Views expressed in this video are opinions of the host and the guest, and do not necessarily reflect the views of The Epoch Times.

RUSH TRANSCRIPT

Jan Jekielek:

Joanna Moncrieff, such a pleasure to have you on American Thought Leaders.

Joanna Moncrieff:

Pleasure to be here.

Mr. Jekielek:

Your book is titled Chemically Imbalanced, and in the book, you talk about a serotonin myth. What exactly is that?

Ms. Moncrieff:

So the serotonin myth is the idea that depression is caused by a lack of serotonin in the brain. It’s an idea that was first put out there in the 1960s, then picked up by the pharmaceutical industry in the 1990s, widely propagated by them as part of their campaign to sell SSRIs [selective serotonin reuptake inhibitors] their new generation of antidepressants. And it was always and still is officially a theory, a theory about the possible origins of depression. But it was promoted so strongly and often in very categorical terms that people have come to believe that it is an established scientific fact that depression is caused by a lack of serotonin in the brain.

A set of colleagues and I set out to look at the evidence for whether this is the case or not a few years ago, and we published what’s called an umbrella review, a sort of meta-review of all the different areas of research that have looked at this in 2022. And we showed that there is no consistent or convincing evidence in any of these areas of research for any association between serotonin and depression. So hence, the idea is a myth.

Mr. Jekielek:

It’s kind of shocking to hear that. I mean, most of us assume that this is just true, basically that there’s some sort of imbalance, some sort of problem in the brain that these drugs actually fix. But you’re saying that that’s not the case.

Ms. Moncrieff:

That’s not the case. So we showed that the evidence on serotonin and depression doesn’t stack up. There are numerous other theories about possible biological mechanisms that might underpin depression; they have not been proven either. And in fact, for most of those, there’s very much less research than there is on the links between serotonin and depression.

But you’re right to say that there is an assumption, both within much of the medical profession and, I think, in the general public now, because of the promotion of this idea, that depression must be caused by some underlying biological mechanism, and maybe we just haven’t found it yet.

But actually, we didn’t always think like that. We’ve had our minds deliberately changed, deliberately shaped on this issue. So when the pharmaceutical industry started these promotional campaigns in the early 1990s, they were associated with disease awareness campaigns that were run by medical organizations, often with funding from pharmaceutical companies. And I looked at the archives of one of these campaigns when I was writing the book.

This was the Defeat Depression Campaign that was conducted in the United Kingdom. And the aims of that campaign were to persuade people that depression is a medical condition and that you should go to your doctor and get antidepressant treatment to treat it. They did some market research before they launched the campaign, and they asked people what they think depression is caused by, and one of the options they gave to people is it’s caused by a chemical imbalance or some sort of biological abnormality in the brain.

The vast majority of people didn’t think that depression was caused by those things; they thought depression was caused by unemployment, divorce, having been abused as a child, adverse life events, in other words. And they also thought that treating depression with a drug would just numb someone’s emotions and wasn’t a sensible idea and might lead to people becoming dependent on the drug.

So this is how most people thought back in the late 1980s and early 1990s, and the pharmaceutical industry set out very deliberately, I believe, to change people’s minds and to persuade people instead that depression is a biological condition and needs a biological remedy, i.e. the drugs that they were promoting.

Mr. Jekielek:

So this is just a conspiracy to sell drugs?

Ms. Moncrieff:

This was a marketing campaign, yes. It was aided and abetted by the medical profession who, as I mentioned, had first come up with this idea actually back in the 1960s, and parts of the psychiatric profession were very keen to believe that the conditions they were treating were biological diseases the same as other doctors were dealing with, and very keen to believe that they had sophisticated targeted treatments with which to treat these conditions. So it was an idea that had been around in the ether, but it wasn’t an idea that was accepted by the majority of the population or the media until the pharmaceutical industry got in there and started to promote it.

Mr. Jekielek:

So that’s super interesting. I think you’re saying that there was a desire in the medical profession to actually believe that. Is that what you’re saying? saying?

Ms. Moncrieff:

Yes absolutely. And there still is. And I’ve called it, in some of my writing, I’ve called it wishful thinking. You know, the doctors and psychiatrists want to believe that the conditions they treat are proper medical diseases and that the treatments they have are proper medical treatments that work like cancer drugs to target the underlying mechanism that produces the symptoms of depression or anxiety, or whatever it is. They don’t want to think that they’re using chemical pacifiers or just numbing people out in some way.

Mr. Jekielek:

So what do you think these conditions are?

Ms. Moncrieff:

I think that we need to think about emotions differently and we need to see them as meaningful human reactions to the circumstances of life now. And that is indeed how people used to think about them. Now that doesn’t mean that people are always aware of what they’re reacting to. Sometimes people can be unhappy or anxious and not be quite aware of what it is they’re responding to. But usually there is a reason that can eventually be identified or pinpointed. And it’s also not to say that everyone is the same and that everyone, you know, would react to the same situation in the same way.

Of course, we all have different biology and different brains. Our unique biology is part of what makes us who we are, part of what shapes our personality. So understanding emotions as reactions to circumstances doesn’t necessarily mean that biology is completely irrelevant or not involved, but we need to understand them at the level of the human being, not at the level of the brain.

Mr. Jekielek:

Before we continue, tell me a little bit about your background, your work, and how you got interested in all this.

Ms. Moncrieff:

So I’m a psychiatrist, and I was always skeptical of the idea that psychiatric problems were exactly the same as the rest of medicine, that having depression was the same as having pneumonia. That seemed to me to be a very odd way to think. So I read authors who were critical of psychiatry when I was still in medical school, people like Thomas Szasz and R.D. Laing.

And then when I started doing my psychiatric training, I became very interested in drug treatment, partly because of the complete disjunction between what I saw in the old hospitals and the old mental hospitals that I used to work in and what was in the textbooks. In the textbooks, we were being told we had these amazing new drugs, they were curing people, they were restoring people back to normal lives and normal functioning, and that’s why we were able to close down the hospitals.

In reality, I saw hospitals where there were wards full of people who were zombified, would be one way of describing it, heavily sedated, shuffling around, often had sort of tremors and obvious side effects from the medication they were receiving, and who were not being discharged to normal life, who were being placed in other supported residential facilities.

Mr. Jekielek:

So at this point, you’re practicing, or you’re still in school? Or I’m just trying to understand the evolution of your thinking here and actually the evolution of your career.

Ms. Moncrieff:

Yes. So at this point, I’m a junior psychiatrist working in hospitals, doing what I’m told to do by the senior psychiatrists and trying to sort of square that with my views and my conscience. And then I get some research positions that enable me to do some research and, in particular, to look at some of the literature on drug treatment in more detail. And that leads me to investigate the literature on antidepressants vs. placebo.

Now, one of the more senior psychiatrists I worked with said to me once, I was saying to him, look, we’re giving all these people antidepressants. Some of them seem to get a bit better, but some of them don’t. They’re probably getting better because, you know, they’ve got a new job or they’ve sorted out their relationship problems. I’m not sure that I see any obvious benefit of these antidepressants, and he said to me, oh no, they’re just active placebos. Go and read this study published in the British Journal of Psychiatry.

As it happened, I went off and read this study, and it was a description of some studies that had been done in the 1960s that compared antidepressants to what was called an active placebo, which was basically a drug that was not thought to be an antidepressant but mimicked some of  the side effects of antidepressants. Those studies showed no difference between antidepressants and the active placebo, and that was a real light bulb moment for me.

I thought, oh yes, of course, all these placebo-controlled trials where you use a dummy tablet that has no effect are not really measuring the full placebo effect of taking an actual drug that makes you feel a bit different, that gives you some side effects, or just maybe makes you feel as if you’re in a slightly different mental state.

And of course, if you’re in one of these trials and you think you’ve got the real drug because you’re feeling a little bit different or you’ve got a dry mouth or you’re feeling a bit sick, you’re going to have a stronger placebo effect because you think you’ve got the real thing. You’ve been told that you’re in this trial to try out this brilliant new treatment that we’ve got for depression.

And so most people in that situation want the real drug and will get a boost if they think that’s what they’ve got. And I think that’s what accounts for what is actually a very small difference between antidepressants and placebo in the clinical trials that are conducted of them.

Mr. Jekielek:

So what happened with this study? I mean, have people been trying to replicate it? I mean, I haven’t been studying this area for that long, but I know quite a number of psychiatrists who are deeply committed to helping people, which one would hope would be the case with most psychiatrists, actually. And you’re describing a study here that’s basically saying there’s no difference between placebo and SSRIs with a whole bunch of side effects. It kind of suggests an industry that doesn’t have this type of care in mind. I mean, how did we get here?

Ms. Moncrieff:

Yes. And not only that, not only do we have these studies that show no difference between antidepressants and placebo, which are quite old, so, you know, could maybe be dismissed because they were all done back in the 60s. Some of them are quite small with various limitations. But the majority of data from placebo-controlled trials show very small differences between an antidepressant and a placebo, so small that they would not qualify as actually being a clinically meaningful difference. And we’ve known that at least since 1998, when a psychologist called Irving Kirsch published a book called The Emperor’s New Drugs, in which he was saying, look, we’re giving people all these drugs, but they don’t actually do anything.

So why has psychiatry not taken this seriously, not taken this on board, not said, oh dear, you know, maybe we should stop giving out these drugs that are having minimal, if any, beneficial effects and yet are, you know, causing side effects, making people dependent, giving some people really severe withdrawal problems, causing sexual dysfunction, making people have falls and bleeds, and causing fetal malformations and all the other things that antidepressants do?

So instead of doing that, instead of questioning why we were prescribing these drugs so widely and trying to rein in the prescribing, researchers, leading psychiatric researchers, found ways to present the evidence that made it look a little bit better. So they did things—well, first of all, they ignored the fact that there was this problem with the placebo effect and that people could probably work out whether they were getting the real drug or not. Then they presented the data in a different way.

Instead of presenting the actual data that is collected from people, which consists of scores on depression rating scales, they presented it differently. Now there are lots of questions, you know, so questions about whether a depression rating scale really measures depression. You know, measuring depression is not like measuring blood pressure.

But just putting those aside for a minute, the actual data show very small differences on these depression rating scale scores between the placebo and the antidepressant groups in these trials. But if you draw a line through the data and you say people who get above this score will count as responders, and people who get below this score will count as non-responders, that massively inflates the difference because if you draw the line in the right place, you can make it look as if you’ve got a big difference.

Whereas, the data you’re using is still the data that actually shows this very small difference between antidepressants and placebo. Just to quantify that difference, the most commonly used depression rating scale is called the Hamilton Depression Rating Scale [HAM-D]. It has a maximum score of 52 points, and the difference between an antidepressant and a placebo on average across all the clinical trials is two points—two points on a 52-point scale.

That doesn’t sound as if it’s really important. It sounds trivial. But if you categorize people in this way, then you can get up to about a 30 percent difference. between people taking an antidepressant and people taking a placebo, but based on the same data. So that’s one way that the data has basically been massaged to make it look better. Another way is that negative results are often not published or buried in small print, while more positive ones that are sort of just found by chance are highlighted. Yes, so that’s how we end up in this situation.

Why does that happen? Why is the profession so keen to present antidepressants in this light, is the follow-on question to that, isn’t it? I think the answer to that is that this idea that depression is a biological condition, that it is rectified by targeted and sophisticated drug treatment, has become central to the profession’s identity. It enables the psychiatric profession to present itself as a branch of the medical profession and to say, look, we’re just the same as other doctors, and to paper over the very obvious differences that there are between emotional and behavioral problems and lung cancer or liver disease or whatever it is.

Mr. Jekielek:

So you’re reminding me of something you said once, that psychiatry is a system of social control, not a system of healing, which really one would hope would be the case. Explain to me what you meant here.

Ms. Moncrieff:

It’s a system of social control in two slightly different ways, I would suggest. One of the most fundamental functions of the psychiatric system is to manage people whose behavior is really disturbed and irrational, so irrational that they can’t be managed in the criminal system. People whose behavior is disturbing to other people may be antisocial and may occasionally be dangerous to other people. So psychiatrists have been authorized by governments, by states, to lock people up if necessary who are in that condition and to forcibly change that behavior by giving people drugs or in other ways. So that’s one way in which it is a system of social control.

The psychiatric system is trying to present that as being a medical activity, that we’re not locking people up who are just behaving in inconvenient or disturbing ways; what we’re doing is treating biological diseases. One of the reasons that psychiatrists present it that way is that it makes them feel better, but I think as a society we accept that interpretation because it makes us feel more comfortable, because there’s something uncomfortable about the idea that there are some sorts of behavior we really don’t want to tolerate, and yet those behaviors don’t fit neatly into our democratic judicial procedures.

There’s another way in which psychiatry is involved in social control, though, and that is by labeling people’s understandable discontent with the way that things are as pathology. And instead of listening to people and saying, I can understand why you might be unhappy, you know, given the circumstances you’re in, given the fact that you’re struggling with your financial situation and your relationships, and that you had a terrible childhood.

Instead of saying all that, which of course then leads us on to the next point, it leads us on to thinking about how we might change society and change people’s circumstances so that they don’t get depressed. Instead of saying that, psychiatrists come in, they say, okay, you’ve got clinical depression, you’ve got this condition, this medical condition, and we’re going to give you a treatment for that. We’re going to tweak you so that you don’t feel this anymore. You’re not reacting to this in the same way. And so that is social control to the extent that it is silencing voices who are articulating the problems with our society and articulating their distress at certain aspects of their circumstances.

Mr. Jekielek:

Okay, so here’s the thing. Let’s use perhaps a typical example. I imagine this happens countless times. A young boy breaks up with his girlfriend, can’t handle it because she was such an important part of his life. He feels bad. Some friends notice that he’s having a rough time, that he’s not getting over it. So he goes to seek help. He goes to see a psychiatrist.

And so it would be in this kind of circumstance where you could either, for example, go to some kind of talk therapy or talk to a professional or maybe, I don’t know, seek some other kind of therapy. But it’s very common, apparently, for people to prescribe or for medical professionals to prescribe SSRIs in this kind of situation. Is that what you’re saying?

Ms. Moncrieff:

Yes, absolutely. I still practice clinically and the majority of people I see are struggling with relationship difficulties and job difficulties. There are a lot of young people who are very anxious about going out into the world and trying to find a job and a career and financial problems and all sorts of things. Now, of course, we’re all different and some people will react more extremely to a situation that other people would just wash over them. But I also think that we expect people to bounce back too quickly.

I think there are a lot of things that, you know, a relationship breakup, for example, is a good example. It happens all the time to everyone, but that doesn’t make it any less painful when it happens. And it’s not something that we naturally just, you know, get over in a couple of weeks. It can take weeks and months of grieving, even for, you know, a short-term relationship that’s finished.

And so we are taking these situations, labeling them as medical, pathological medical conditions that need to be rectified in some way and treated, rather than seeing a person who is suffering, who is going through a period of difficulty, trying to work out what that is and how we can support them with it.

Mr. Jekielek:

So the thing that strikes me in this situation is that a person, I think, typically needs to go through some kind of process to deal with this kind of situation and that the drug itself might actually prevent that process. So in a sense, being on the drug might have the opposite result of the desired outcome, perhaps.

Ms. Moncrieff:

Yes, absolutely. So many of the drugs that are prescribed for mental health problems, and in particular, antidepressants, one of the characteristic mental alterations that they produce, and this is in anyone, not just someone who’s depressed or anxious, is they numb people’s emotions. And they don’t just numb negative emotions; they numb positive emotions too.

So people might say things like, I did feel a bit less depressed or a bit less stressed or anxious, but I don’t feel happy anymore. I don’t get any pleasure, you know, listening to music anymore. And if you’re in that numb state, I think it can be difficult to process whatever it is that’s happened to you that, you know, that’s led you to go and see the doctor and get on this prescription in the first place. And do you know what?

When I was training, psychotherapists would not treat people who were taking long-term medication for that reason because they felt, you know, part of the point of psychotherapy was to help people to process their emotions, to understand what had led to them and how to manage them. And if they’re just being numbed by a drug, you’re not going to be able to do that, or it’s going to be at least a less efficient process.

Mr. Jekielek:

So something else just strikes me, something that has kind of become apparent over nearly a thousand interviews I’ve done on this program. And that’s that we seem to be a society that’s committed to pain reduction in a very extreme way. Like pain is a bad thing; we should ameliorate it at all costs. And we go to quite extreme lengths to actually do that. You know, almost valorizing pleasure or feeling good or feeling happy. I’m wondering if this isn’t feeding into the paradigm that you’re describing here.

Ms. Moncrieff:

Yes, I think it very much is, and I often get accused of, you know, forcing people to endure pain unnecessarily. You know, we have these drugs; they can make people feel better, why shouldn’t people take them? To which one of my answers is that actually, although antidepressants numb emotions and in theory that should, you know, that might relieve people’s acute distress. Actually, most people find that state of being numbed really quite unpleasant and don’t want to be in it.

And I think you’re also right that we have, that we’re giving a message out by, you know, through this very activity of saying, you know, go and see your doctor if you’re feeling down, get medication. That’s the answer. We are creating this completely unrealistic view of life as if it can all be, you know, sunshine and daisies and, you know, we’re never going to have to, we don’t have to face, you know, difficult problems and difficult times.

Mr. Jekielek:

And also the pursuit of a quick fix, or at least the promise of a quick fix, perhaps.

Ms. Moncrieff:

Yes. One of the reasons this whole idea that depression is caused by a serotonin deficiency or a chemical imbalance has become so popular is because it is this very simple idea that is associated with this very simple potential solution. You know, you can take a drug and it’ll put this problem right. And I think that is, you know, obviously really very appealing to people.

I guess if there was a drug that would just make us all feel great all the time, we’d all want to take it. But life’s not like that, is it? There is no free lunch. Any drug that’s going to make you feel great, from alcohol, from heroin, from cocaine, from all these substances that make you high, there’s a comedown and there’s a downside and lots of physical complications as well.

Mr. Jekielek:

So this is absolutely fascinating. Do you feel there’s any room for the use of drugs in a psychiatric scenario?

Ms. Moncrieff:

I do. I feel that some drugs are useful in some situations. We need to understand more about the ways that psychiatric drugs alter our normal mental states. And there are some psychiatric drugs that produce alterations that can be useful, I think, when people are, for example, acutely psychotic. So the drugs that we now call antipsychotics but used to be major tranquilizers, which are heavy-duty tranquilizers that slow down people’s thinking processes and damp down people’s emotions are not very nice drugs to take, but nevertheless when people are completely preoccupied by psychotic phenomena, you know, they’re completely paranoid, they’re hearing voices. When people are in that state, being dampened down by these drugs temporarily, I think, can be preferable to being in the psychotic state.

There are some people, I think, who have these symptoms long-term and actually benefit from long-term treatment with these drugs. Although for the majority of people, I would say that it’s preferable to keep the treatment short-term and to try to bring people off the drugs when the symptoms of the acute psychosis settle down. So that’s one example where I think we have drugs that can be useful in limited circumstances.

Benzodiazepine drugs, which are very effective at sedating, you know, making you feel sedated and calm and peaceful, and in sending people to sleep, I think can occasionally be useful, for example, in a situation where someone is getting into a manic episode and really just not sleeping at all. A manic episode is another example of where antipsychotics or other sedatives are useful just because people’s levels of physiological arousal are really high, so just to try to bring that down and help people to sleep and help people to get some peace can be helpful again temporarily because a manic episode is limited. People will come out of it in their own time.

So I do think there are these situations where psychiatric drugs can be useful. But I think the important thing is not presenting them as a sophisticated and targeted treatment that’s working to reverse some underlying mechanism. We haven’t found any underlying mechanisms for any type of mental disorder.

And all of the drugs that we are using are what we might call psychoactive drugs, drugs that change the normal state of the brain and therefore change our normal feelings, thoughts, behaviors, etc. And when we understand drugs like that, we can see that maybe sometimes some of these alterations might be useful for people, but also that it’s probably not a good thing to be chemically altering people’s brains, certainly not for long periods of time. Therefore, it’s something that we need to do cautiously and for as short a period as possible.

Mr. Jekielek:

A few years ago, a regular viewer of American Thought Leaders reached out to me and kind of persistently, about something, and I really didn’t tackle it right away because I was busy and, you know, sort of focused on other areas. But the person was pretty persistent. At one point, I delved into it. I really had no idea that these drugs are sexual inhibitors, and that’s a common side effect, but more so, in the context of PSSD [post SSRI sexual dysfunction], that these drugs can cause that sexual inhibition to be permanent in a pretty significant, small but pretty significant number of cases. Let me add a third part to this thought here. This is something that you’ve said before, which is that the side effects of these drugs might actually be the effects. So here’s the question. Are SSRIs actually sexual inhibitors?

Ms. Moncrieff:

The strongest and most consistent effect of SSRIs probably is sexual dysfunction. And actually, the emotional numbing effect is associated with a sexual numbing effect. These are, I think, part and parcel of the same effect. You know, emotionally dampened and sexually dampened. Now, I can’t remember exactly when I first heard about the idea that sexual dysfunction might be persistent. It’s been well recognized that antidepressants cause sexual dysfunction while people are taking them.

I think it’s been well recognized from the beginning. And I think quite early on, we understood that not everyone who took SSRIs got this sexual dysfunction.But the idea that the effect might continue after people had stopped taking the drugs I think was a very new thing and something that, you know, that I was initially unsure about. So I looked into the literature when I started to hear this. First of all, it’s very noticeable that people’s reports of it are consistent. It was being reported in the sexual health literature before it was widely reported or reported at all in the mental health literature.

So there were reports in sexual health journals about people coming into sexual health clinics saying, you know, hey doctor, since I’ve, you know, been on this Prozac, I haven’t been able to get an erection or have an orgasm or I can’t feel anything down there or I’ve got no sex drive anymore and I came off the Prozac, you know, two or three years ago, and I’ve still got the symptoms. So there were consistent reports about this, but then the real clincher for me was that there are animal studies showing that animals that were treated as adolescents with SSRIs show reduced sexual activity as adults.

Mr. Jekielek:

Even though they’re no longer subjected to the drug?

Ms. Moncrieff:

Even though they’ve been taken off the drug, exactly. So, as you say, to me, this is a huge issue that people need to be warned about and are not being warned about because people don’t know it. I don’t even know if most psychiatrists know about it.

Mr. Jekielek:

You’re talking about the possibility of permanent sexual dysfunction.

Ms. Moncrieff:

Everyone knows that SSRIs cause sexual dysfunction. All psychiatrists know it. I hope they know it anyway. Whether they tell their patients that that’s a side effect is another matter, but it’s certainly out there and in the literature and relatively easy to find. But the idea that they cause persistent sexual dysfunction has not been covered very much in the research literature, certainly not mentioned in textbooks. I think there’s probably still a lot of psychiatrists and primary care physicians who are not aware of this problem and therefore obviously not telling patients about it.

Mr. Jekielek:

You know, it strikes me as incredibly important that someone knows there’s a small chance that this type of sexual dysfunction becomes permanent. I mean, if you knew that there was even a small chance, and I’ve heard about numbers that are, you know, larger than many of us would want to accept, I would think that even knowing that there’s a small chance a lot of people might decide against taking these drugs.

Ms. Moncrieff:

Yes, absolutely. I mean, it makes all the difference in the world, I think, to be told that you’ve got a brain chemical imbalance and we’ve got a drug that can put this imbalance right, or to be told that we don’t know what’s going on in your brain, quite possibly nothing of particular interest. We’ve got this drug that’s going to mess about with your brain chemistry a bit.

And one of the consequences of this is that your sexual functioning is going to be adversely affected and that might continue after you stop taking the drug. I mean, those you’re going to make a very different decision in those two different situations, aren’t you? Those two different scenarios, most people are anyway.

Mr. Jekielek:

So as we finish up, I would love to have you back to talk more about a number of these issues. In fact, what would be a more appropriate approach to psychiatry? I mean, basically, you’re saying that there are really some foundational assumptions in psychiatry that are wrong. So what would be a better paradigm? What would be a better overall approach?

Ms. Moncrieff:

Instead of trying to treat brain conditions that actually no one has ever shown exist, we should be trying to help individual people with their individual problems. Emotional and behavioral problems, depression, anxiety, etc., almost always have a cause in someone’s life circumstances or someone’s life history. And that’s what needs to be addressed first and foremost. So if someone’s having relationship problems, maybe they need some relationship counseling or they need some employment support if they’re struggling at work. That is the first thing to do to help people with the problems that they have as individuals.

The second thing is there are some things that people can do to improve their mood and their sense of well-being in general, like getting good sleep and taking exercise. Exercise has been shown to be very effective at improving mood. Mindfulness has been shown to be useful.

And psychological therapy, I think, can be very helpful for some people. I don’t think it’s necessarily a panacea or needs to apply to everyone, but I think it can help some people, particularly people who maybe can’t quite work out why they’re feeling depressed or anxious, and to help people who’ve had very bad experiences, maybe in childhood or maybe more recently, to process those. So I think that the main part of the approach is that we’re helping—we need to help individuals with their individual problems rather than see ourselves as treating brain conditions.

Mr. Jekielek:

A final thought as we finish?

Ms. Moncrieff:

I just wish that people were better informed. And I think the tragedy is that people have been misinformed and misled, whether that’s deliberately or not deliberately, is, you know, irrelevant. They’ve been misled. We need to correct that situation and make sure people are properly informed so that they can make properly informed decisions about what to take into their bodies. Whether to take a drug is a really serious decision; you know drugs are chemicals that change our normal biological processes, and they have consequences, often harmful consequences.

So people need to be really well informed to make a decision about whether to start a drug or not. And I’m afraid they aren’t adequately informed at the moment. And I thank you for giving me this opportunity to help people be more informed about it.

Mr. Jekielek:

Well, Joanna Moncrieff, it’s such a pleasure to have had you on.

Ms. Moncrieff:

Thank you, Jan. I’ve really enjoyed talking to you.

This interview has been partially edited for clarity and brevity.