TRIGGERnometry - June 24, 2026


The Truth About Depression - Dr Joanna Moncrieff


Episode Stats


Length

1 hour and 11 minutes

Words per minute

164.21

Word count

11,773

Sentence count

452

Harmful content

Toxicity

3

sentences flagged

Hate speech

3

sentences flagged


Summary

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

Dr. Joanna Moncrief is one of the few people who has challenged the widely accepted theory that depression is caused by a chemical imbalance in the brain. She argues that there is no evidence to suggest that this is actually the cause of the problem.

Transcript

Transcript generated with Whisper (turbo).
Toxicity classifications generated with s-nlp/roberta_toxicity_classifier .
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
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00:01:00.200 there is no evidence that you have a chemical imbalance in your brain if you are depressed
00:01:07.240 so therefore there's no evidence that that antidepressant you're being offered is going
00:01:10.980 to correct that they haven't asked that question about what antidepressants might be doing by just
00:01:15.960 messing about with our normal brain chemistry if you subscribe to this idea that you have a brain
00:01:21.100 chemical imbalance. You actually do worse. You have worse outcomes. The psychiatric profession
00:01:28.220 really seemed to me to just want to shut down the debate. They didn't want people to get an
00:01:33.860 inkling that actually depression has not been proven to be a biological condition.
00:01:40.920 How many people in our society are on these drugs?
00:01:43.560 So it's something like 8.7 million people in England who take them.
00:01:49.040 In England? 0.80
00:01:49.540 in England. So one out of five people of the adult population is on antidepressants. Almost
00:01:53.560 one out of five are taking antidepressants, which is absolutely staggering, isn't it?
00:01:59.600 Joanna Moncrief, welcome to Trigonometry. Thank you for having me. Oh, it's great to have you on.
00:02:03.880 You're one of the people who was instrumental in challenging the, what is the effect of consensus
00:02:10.160 on depression, the idea of it being that it's the product of a chemical imbalance,
00:02:16.300 which is something that was, I think it's fair to say,
00:02:18.860 effectively debunked in the last couple of years.
00:02:22.500 So what is depression and why do we have this false idea of it?
00:02:28.760 Well, I hope I've debunked that idea,
00:02:30.960 but I think it's actually still quite prevalent.
00:02:33.860 You can still find it on websites and things like that,
00:02:36.360 that depression is caused by lack of serotonin or whatever.
00:02:39.040 So we've had this idea since the 1990s
00:02:43.040 1990s that depression is caused by an abnormality, an imbalance of brain chemicals. Before that,
00:02:50.300 people used to think of depression as a reaction to bad circumstances, you know, unemployment,
00:02:55.880 divorce, child abuse, childhood trauma. And they saw it as an understandable reaction.
00:03:04.220 Of course, there would be variations between different people. Some people would react more
00:03:07.960 strongly to being made redundant than others, but that fundamentally it was an understandable
00:03:15.140 human reaction. And then in the 1990s, the pharmaceutical industry released their new
00:03:21.560 range of antidepressant drugs. They wanted to persuade people to take these drugs rather than
00:03:29.240 the old benzodiazepines, which were prescribed for anxiety and which had got this really bad
00:03:34.780 reputation because they caused quite severe dependency problems and so to distinguish these
00:03:42.360 new antidepressants from the old benzodiazepines they persuaded people they put out this idea
00:03:48.260 basically that depression is caused is a is a medical disorder that is caused by an abnormality
00:03:53.880 in the brain specifically a deficiency of serotonin which their new drugs happen to be able to put
00:04:00.420 right. So that's where the idea comes from, this idea that, you know, depression is this medical
00:04:06.020 condition. But it was superimposed onto people's, you know, underlying sort of intuition about what
00:04:12.180 depression was, which was quite different. And the sort of undercurrent on what you're saying is
00:04:18.440 this was a for-profit motivation that caused this to happen. Yes, yes. I mean, that idea that
00:04:26.040 depression was caused by a chemical imbalance, an abnormality or deficiency of brain neurotransmitters
00:04:33.180 was around. It was first proposed by psychiatrists and researchers working in the 1960s.
00:04:42.520 Again, in the context of developing drugs for emotional problems, but it wasn't sort of widely
00:04:49.340 accepted, certainly among the general public. And so it was the 1990s when the pharmaceutical
00:04:55.240 industry got involved and conducted these very thorough promotional campaigns that really spread
00:05:05.080 this idea. And yes, of course, they did it in order to sell more drugs.
00:05:09.380 And what does the evidence show about this? Is there any evidence to support the chemical
00:05:13.120 imbalance theory? And if there isn't, what is the evidence telling us about what depression
00:05:17.440 is and where it comes from? So I did a big review of the evidence,
00:05:21.180 which was published in 2022. And I wrote my book because of the reaction we got to publishing that
00:05:28.740 paper, the astonishment of lots of members of the public and the media that actually there wasn't
00:05:37.320 good evidence for this theory and pushback from the psychiatric profession itself. And what we
00:05:44.660 did was we got together all the evidence from different areas of research that have tried to
00:05:50.480 look at whether there are links between serotonin and depression. Now, there are thousands of
00:05:56.140 studies. And so what we did was we got together reviews of the studies in all the different
00:06:02.480 areas. Now, some of those studies find evidence of a link between serotonin and depression,
00:06:09.740 show that serotonin is, you know, a bit lower in people with depression compared to people
00:06:14.960 without depression. Some of the studies don't find any difference. And some of the studies
00:06:18.880 show that serotonin is a bit higher in people with depression compared to people without.
00:06:22.920 So overall, when you put all the results together, there's no consistent evidence of an abnormality
00:06:29.700 either way. And we're talking about the drugs and the medication. I presume we're talking about
00:06:35.780 what is known as SSRIs. So if you could explain what they are and how they work or how they're
00:06:42.960 meant to work and what the truth is yeah yeah so ssri ssri stands for selective serotonin reuptake
00:06:51.400 inhibitor and they were a range of drugs that started to be introduced in the 1990s or actually
00:06:57.600 late 1980s the first one was prozac and the generic name is fluoxetine and they've been the
00:07:05.220 most widely used antidepressants since then. Although some sort of similar drugs have been
00:07:16.020 introduced over the last 20 years. Now, SSRIs work by inhibiting the transporter protein that
00:07:24.960 takes serotonin out of the gap between the nerve cells where it has its action, where it transports
00:07:33.020 electrical signal from one nerve cell to another. So the SSRI drugs inhibit the protein that takes
00:07:44.100 the serotonin out of that space. And therefore the theory is that the serotonin will stay in
00:07:49.080 that space for longer and therefore its activity will be enhanced. That's the theory. We don't
00:07:55.240 really understand what they're actually doing in practice. They probably are having, you know,
00:08:00.940 enhance serotonin activity temporarily. But actually, some of the evidence that we looked
00:08:06.300 at in our review, and this was a surprise, it wasn't something that we set out expecting at all,
00:08:12.080 but some of the evidence we came across suggested that people who are on long-term
00:08:16.720 antidepressants actually may have lower serotonin activity rather than higher activity.
00:08:23.020 But I think at this point, it's probably important to clarify that the evidence that
00:08:30.220 serotonin has any impact on mood is very, very slim. It's basically the evidence that we looked
00:08:37.260 at that tests whether serotonin levels are different in people with depression or without
00:08:42.780 depression. And there have been experiments looking at whether serotonin is involved in
00:08:48.400 people's cognitive functioning as well, and animal studies as well, looking at that sort of thing.
00:08:53.580 That has not found consistent findings. There's also research looking at whether serotonin is
00:09:00.960 involved in sleep and appetite. Again, there are no really consistent findings coming out of that
00:09:07.540 body of research. The only thing, the only area of our functioning where it seems that there's
00:09:13.460 fairly consistent evidence that serotonin has an effect is sexual functioning, and it's bad for it.
00:09:19.560 the more serotonin you have, the less likely you are to want sex or for your sexual organs and
00:09:28.760 everything to work properly. And that's something that I really wanted to talk about because
00:09:33.600 we don't talk enough about the side effects of these types of medication. And you look at the
00:09:40.860 stats of the amount of people who are on them, particularly in the US and the UK and in Northern
00:09:46.280 In Europe and Scandinavia, I mean, one word to describe it is frightening, really.
00:09:51.520 Yeah, yeah, yeah.
00:09:52.320 Can you give us those numbers, Joanna?
00:09:54.120 How many people in our society are on these drugs?
00:09:56.860 So it's something like 8.7 million people in England who take them.
00:10:02.340 In England? 0.89
00:10:02.820 In England.
00:10:03.820 And that works out as something between 15% and 17% of the adult population.
00:10:08.140 One out of five people of the adult population is on antidepressants.
00:10:10.980 Almost one out of five are taking antidepressants, which is absolutely staggering, isn't it?
00:10:14.860 and you know if they were just sugar pills i think there would still be some problems but
00:10:19.580 obviously not sort of major major physical problems um but they're not just you know
00:10:24.600 they're not in a they are drugs they do do something we're not it's not clear that they
00:10:30.100 do anything much to your mood but they do as we've said have this impact on sexual functioning
00:10:35.280 because we know that you know because they are doing something to the serotonin system
00:10:39.060 and we know that serotonin is involved in our sex lives.
00:10:44.020 You say they don't do anything for your mood.
00:10:45.860 My understanding, look, I've never taken antidepressants,
00:10:48.660 so I don't know, but even if they don't address
00:10:53.420 the chemical imbalance, I've always kind of thought,
00:10:55.360 well, if you give someone drugs,
00:10:57.020 they're probably going to feel better for a while
00:10:58.740 just because they're on drugs.
00:11:00.160 It's like if I have a glass of wine tonight,
00:11:02.100 I'm going to feel a little bit more relaxed or whatever.
00:11:05.000 Are they not having any effect like that?
00:11:07.600 So that's a really good point. And I've been writing about this for a long time. So what you've described, the idea that a drug will have some sort of impact on how you're feeling, is what I've called the drug-centred model of drug action. So that's one way of understanding how drugs might affect our moods and our feelings.
00:11:27.700 and and that contrasts with the mainstream view that what these drugs are doing is targeting some
00:11:34.740 underlying abnormality so so your idea um that that you know drugs drugs that enter the brain
00:11:41.660 you know are going to change our our normal feeling states uh is is is correct if we think
00:11:48.480 of something like alcohol you know if you you can be feeling very depressed going out and have a
00:11:53.600 shed load to drink and temporarily you might well feel better again obviously it's not solving
00:11:58.400 anything um in the moment except in the moment yeah yeah um so so antidepressants at least
00:12:08.480 probably most classes of antidepressants have some emotional numbing effect we know that because of
00:12:16.160 lots of people describing that i think it's you know we've probably come across people who are
00:12:21.220 taking antidepressants and describe how they can't cry and they don't feel sort of joy or
00:12:26.620 excitement anymore. They might not feel as intensely sad as they were, but everything's
00:12:31.740 a bit flat. So antidepressants have that effect. But whether that effect is actually beneficial
00:12:45.420 or not is questionable. And I say that because the trials of antidepressants that have compared
00:12:52.960 them with placebos, i.e. inactive dummy tablets, really don't show very much difference, even
00:13:00.340 despite that emotional numbing effect. The difference between taking an antidepressant
00:13:05.580 and a placebo in these trials is really small. It's two points on a 52-point, typical 52-point
00:13:13.380 depression rating scale so it numbs numbs your feeling a little bit which is not super impactful
00:13:18.900 um yeah so come back with me then to the question of well if it's not if depression is not a chemical
00:13:26.940 imbalance and in fact even if there were different levels of serotonin it's like kind of like saying
00:13:32.520 well people who are depressed don't smile as much therefore smiling is an antidepressant which you
00:13:37.380 know i don't know if there's a lot of evidence for that but do we know what actually does cause
00:13:41.380 depression? So the trouble with that question is it sort of presupposes that depression is a thing
00:13:48.620 like lung cancer and we can, you know, we can target a particular cause. And I would suggest
00:13:54.300 that that's the wrong way to think about it. I think depression is a personal state. Um, you know,
00:14:00.460 it's, it's a type of emotion, a type of feeling and our feeling sadness. So, so yes, persistent
00:14:08.840 sadness, loss of interest, loss of motivation, social withdrawal. These are all the common
00:14:16.860 features that we recognize that are quite common and we may have experienced ourselves or seen in
00:14:27.400 other people around us. And by and large, those reactions and feelings are caused by things that
00:14:35.800 are happening in our lives. They are an understandable reaction to, you know, to events
00:14:42.520 like, you know, relationship difficulties or loss or change or struggling at work, all those sorts
00:14:49.900 of things. So, and the causes will be different in each person. You know, the reason I don't like
00:14:55.700 this way that we talk about depression as if it is the same as having, you know, cancer is that
00:15:02.520 it implies that it's the same thing in every person and therefore we can treat each person
00:15:07.500 with depression in the same way. And of course, that's what we do. We give them, you know,
00:15:11.420 antidepressants and, you know, cognitive behavioral therapy, which may be useful for
00:15:16.940 some people. I'm not doubting that. But I think we ought to see depression as, you know, a reaction
00:15:23.280 of an individual. And then, you know, the next logical step is to ask, well, why has this
00:15:29.540 individual got into this state at this particular time, what's going on in their lives,
00:15:34.440 and what sort of help do they need? And then you realise that each individual who has depression
00:15:38.700 is going to need different sort of help and support. That makes sense. As always, I'm
00:15:44.000 racking my brain for counter-arguments just to stress test what you're saying. A couple of things
00:15:49.940 that I think where you might say, well, hold on, isn't this an imbalance or some kind of
00:15:55.080 almost medical thing or at least chemical thing is something like postnatal depression where we
00:16:00.420 know it's quite a common thing when actually something generally quite wonderful has happened
00:16:05.400 right a woman gives birth has a child and then she is depressed uh is that different to or is
00:16:12.640 well what's your take on that well the first thing to say is so so one of the arguments that was made
00:16:18.720 when we published our paper on serotonin and depression was that there are lots of different
00:16:22.840 types of depression. So, you know, you can't say that there's no biological cause of depression.
00:16:28.920 I would change that round and say, well, there isn't any evidence of a biological cause in any
00:16:35.420 sort of subtype of depression. That may be because people haven't done enough research into the
00:16:41.000 different subtypes. But as it is at the moment, we can't say that postnatal depression is different,
00:16:46.840 that we've found some sort of biological cause for that. And I would say that actually for most
00:16:53.940 people, postnatal depression, although it seems a bit counterintuitive, is often a response to
00:17:01.920 a major change in one's circumstances. Having a baby, having major responsibility at a time when
00:17:10.900 yes, one's hormones are, you know, are flying around and, you know, probably not completely
00:17:17.060 stabilised as well. So, but I don't think it's necessarily completely different from other
00:17:22.780 cases. Well, the hormones thing is kind of my point, because I take your point about it's a
00:17:26.320 major change, but if you put £10 million in my bank account, that is a major change. I'm very
00:17:31.060 unlikely to develop post-millionaire depression or whatever you might call it. Do you see what I
00:17:35.540 mean? So that's one. And the other one I was going to ask you is, what about, is there such a thing,
00:17:40.520 Because I guess I've always been very sympathetic to the argument you're making as someone who was, I don't even like to say I had depression.
00:17:48.640 I think it makes it sound like you had a thing.
00:17:50.840 I definitely was depressed at one point in my life, but it was a reaction to the circumstances and also partly to my own behavior.
00:17:58.700 Right. I know how to become depressed if I stay indoors, don't exercise, don't eat well, drink alcohol, you know, don't talk to human beings for a couple of weeks.
00:18:08.960 I guarantee you I'm going to be depressed at the end of that, right?
00:18:12.360 But the counter-argument that people have always wheeled out was,
00:18:15.160 yeah, yeah, but you don't have clinical depression.
00:18:18.120 Clinical depression is a totally different thing.
00:18:20.600 Is there such a thing as clinical depression?
00:18:23.480 The news doesn't just tell you what's happening.
00:18:26.400 It often tells you what to think is happening.
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00:19:30.240 so again there's no evidence that there is a specific subgroup of people with depression who
00:19:38.800 have something that is biological and medical and different from the sort of depression that
00:19:44.820 we might all experience we've been told for many many years now haven't we that there is you know
00:19:50.940 a different thing called clinical depression which is a proper medical condition so you know
00:19:55.500 most people are signed up to that if you're told something you know enough times you think it must
00:19:59.940 be true especially if you're told by experts but actually there's no evidence you know all these
00:20:05.180 studies on serotonin and depression were done with people with you know clinical depression
00:20:09.400 they'd had depression diagnosed by their doctors which is all that we really mean by clinical
00:20:14.700 depression and we're still not finding evidence for you know biological abnormalities um in them
00:20:20.920 but also i think i think it's important to realize that there's no sort of secret ingredient to the
00:20:27.880 diagnosis of depression. You know, someone who's feeling unhappy and struggling with life goes to
00:20:33.400 their doctor, says, I'm, you know, I'm unhappy and I'm struggling. And the doctor, you know,
00:20:39.460 on the day makes a judgment about whether or not they think they should be treated with
00:20:44.800 antidepressants or not. You know, should we consider this to be a sort of medical case that
00:20:49.280 we're going to give medical treatment to? And that, you know, that decision isn't made by,
00:20:56.380 you know, rigidly following some very precise, um, uh, there's no antibody in the bloodstream.
00:21:03.820 No, no. And there's certainly no objective physical tests that can tell the doctor.
00:21:08.140 And so it depends a lot on the doctor you see, you know, whether they've seen a pharmaceutical
00:21:13.660 industry rep that lunchtime before they saw you, um, their sort of outlook on life, how they
00:21:20.560 understand emotions, the training they've had, and it depends on how the individual patient
00:21:29.020 presents as well. So some people, you know, come to their doctor convinced that they have a medical
00:21:33.620 problem, that they need, you know, an antidepressant or some sort of chemical solution. And some people
00:21:39.520 come, you know, much more uncertain, not really knowing what the right, you know, what the right
00:21:45.620 way to interpret this is. And that will influence whether the doctor says, you know, you have
00:21:49.760 clinical depression or not as well. I'm putting myself in the shoes of a GP who's got this
00:21:56.540 patient coming to them. They say they're depressed because, let's say, a bereavement.
00:22:01.400 Their child has died. I feel that I have to do something. I can't send this person away.
00:22:07.040 I can say, oh, you're going to get counselling or some type of CBT on the NHS, but the waiting
00:22:12.260 list is 18 months. It's probably even longer than that. What am I going to do? I'm just going to let
00:22:16.700 this person go no i need to be seen to be doing something because if they do something extreme
00:22:21.940 then it's going to come back to me so in order to cover myself and to be seen to be doing something
00:22:27.420 i'm going to prescribe antidepressants isn't that how it would work i i think it it absolutely does
00:22:34.320 work like that and i think that's one of the main reasons why we have you know such huge rates of
00:22:39.560 prescribing. And, you know, yes, understandably, GPs want to feel, you know, want to be able to
00:22:47.740 offer people something. Waits for therapy were very long or there was no therapy available at
00:22:52.620 all for, you know, many decades here. We do now, though, have a national therapy service,
00:22:59.560 which has much, you know, waitingness of a few weeks. So that's not quite so bad. But I think,
00:23:07.660 yeah i think that's a really good point i think you know and i think one of the problems is that
00:23:11.760 because we've medicalized depression because we've told people to go and see their doctors
00:23:15.880 then it just gets it just gets confirmed because you know if you if you if you have a hammer
00:23:21.880 everything looks like a nail don't you and what do doctors have they have a prescription pad
00:23:25.400 and a diagnostic book so you know they tell you yes you've got this condition and
00:23:30.220 this is the treatment this this drug absolutely and to me one of the great tragedies about when
00:23:36.400 we talk about depression or any type of mental health condition is because we don't know a lot
00:23:41.680 about it, if we're being honest, because that does seem to be the central theme of the conversation
00:23:46.000 is like, look, we don't actually know. So a lot of the time, the treatment or the procedures are
00:23:52.340 actually do more harm than good. Yeah, absolutely. Absolutely. I mean, this is one of the main
00:23:58.920 messages I would like to get across to people. There is no evidence that you have a chemical
00:24:04.620 imbalance in your brain if you are depressed. So therefore, there's no evidence that that
00:24:10.180 antidepressant you're being offered is going to correct that. But we do know that antidepressants
00:24:15.500 are, you know, real drugs that enter the brain and change the normal state of our brain chemistry.
00:24:21.380 And that, you know, and that can have harmful consequences. That's not necessarily a, you know,
00:24:27.880 harmless thing to do. We should be worried about messing about with our brain chemistry.
00:24:32.500 And we haven't, because the psychiatric profession and all the psychiatric research establishment has been so focused on this wrong idea that antidepressants target some underlying imbalance or some other sort of underlying dysfunction of the brain, they haven't looked, they haven't asked that question about what antidepressants might be doing by just messing about with our normal brain chemistry.
00:24:58.700 What are the consequences if you take these drugs for months and years at a time, as many people do? There's really not very good research on that. There are, as we mentioned earlier, some suggestions coming out that actually these drugs can be very damaging to people's sexual functioning, people's emotional life, that they can cause severe withdrawal symptoms.
00:25:24.760 but all these things have actually come out because people have been reporting them not
00:25:29.200 because people were doing you know had set up systematic research studies to investigate the
00:25:34.640 consequences of use in the first place and to me it derives as well from the fact that we just
00:25:40.620 if we're being honest we don't really understand the brain i mean you look at the other organs and
00:25:46.580 you go well you know we understand the kidney pretty well the heart i mean the heart is basically
00:25:50.600 your muscle or the liver or whatever else but if even if you talk to the one of the most eminent
00:25:55.160 neurologists of the day and you ask them a question about the brain I'm sure a lot of them
00:26:00.360 would go look we don't know about x we don't know about y we don't know about z so we in absence of
00:26:06.100 all this knowledge we're just thinking of these techniques of how to help people yeah yeah I mean
00:26:11.460 I mean I think we've we've got a wrong impression that we know more about the brain than we do
00:26:16.900 and that's partly because of the way that a lot of neuroscience findings are presented and reported
00:26:22.680 you know so we're always seeing articles aren't we like you know you can boost your dopamine by
00:26:27.940 doing this and you know if you have more dopamine you'll you'll uh you know be more active or a
00:26:33.660 athlete or something like that and if you if you lack serotonin then you then you're you know not
00:26:40.820 only just not as happy but but uh you know socially dysfunctional or something like that
00:26:46.460 um so so you know these these headlines get put out there all the time so people have the impression
00:26:53.320 that we know more about the brain than we do and i would agree we don't know very much about it
00:26:58.260 for example we know we've identified a lot of the different chemicals that are active in the brain
00:27:04.800 but we understand very little about what each of them do and why is that
00:27:10.000 it's partly because they all interact so actually isolating the effect of one
00:27:17.220 is is difficult it's also because sticking chemicals into into human brains is a very
00:27:24.460 difficult thing to do so you know there's some research done on animals but not very much
00:27:28.860 research on human beings that directly manipulates brain chemicals for obvious reasons
00:27:33.940 because there's this fascinating when people talk about mental health they conflate it with
00:27:40.780 mental illness so you talk we talk about depression and schizophrenia as if they're
00:27:46.840 under the same umbrella when as anybody knows and i have people in my family have suffered
00:27:52.000 from schizophrenia it is a very very different condition to depression i i think it's a very
00:27:58.300 different condition, but there's not very good evidence for any biological basis for schizophrenia
00:28:07.440 either. Really? So it's still a mental illness in the sense that it's an illness or condition that
00:28:15.380 we diagnose or identify on the basis of how people behave. I guess what Francis is getting at,
00:28:23.220 I think, is more that depression is something that we probably all experience at one point
00:28:29.380 of our lives to a lesser or greater degree. Schizophrenia is a whole different story.
00:28:34.640 Which I completely agree with. Yeah, yeah. No, absolutely. I mean, I think depression is 1.00
00:28:38.000 something understandable and familiar. And schizophrenia is quite a radically different
00:28:46.320 state from our ordinary everyday lives. And I guess the other part of it, and this is,
00:28:51.100 it's difficult to talk about because you never want to talk about people who have a particular
00:28:56.780 problem from a kind of responsibility point of view because it sort of sounds like blame a lot
00:29:02.560 of the time. But I guess you can probably speak about yourself. As I said earlier,
00:29:06.260 I know how to give myself or put myself in the state of being depressed. I also have discovered
00:29:12.740 how to get myself out of that state. And I think I would imagine, obviously, big pharma,
00:29:18.880 People always want to make money from helping people fix their problems.
00:29:22.520 But let's be honest.
00:29:23.700 A lot of people, all of us, want an easy fix for things.
00:29:27.580 And if someone comes along and gives you a tablet,
00:29:29.860 instead of saying, okay, you've got this problem,
00:29:32.000 okay, here's what you do.
00:29:32.820 You exercise four times a week.
00:29:34.300 You don't eat any sugar. 0.99
00:29:35.420 You don't eat any other crap. 0.99
00:29:37.100 You make sure you speak to your family every day. 1.00
00:29:39.840 You do this.
00:29:40.340 That'll give you depression.
00:29:42.300 Whatever.
00:29:43.020 I mean, that probably will.
00:29:44.440 You know what I mean.
00:29:45.360 there's a whole like you have to change your whole lifestyle or we can just give you this
00:29:50.080 tablet and a lot of people would rather just take the tablet yeah yeah the problem is that we know
00:29:56.100 that if you subscribe to this idea that you have a brain chemical imbalance you actually do worse
00:30:02.520 you have worse outcomes and you are you you think that you can't do anything about your condition
00:30:09.480 and you and you are more likely to believe that you will never recover yeah it feels like cancer
00:30:13.940 Yeah. Yeah. So like you've got cancer. So I think what happens when when someone is prescribed an antidepressant, often they will they will initially get us, you know, get some sort of psychological benefit, some placebo, positive placebo effect, because they think, oh, you know, great.
00:30:29.560 At last, someone's helping me. I've got an explanation. You know, the drug's going to work.
00:30:34.200 So often people will start to feel a bit better. But because actually the drugs are not a long term solution, probably not really having much impact on your mood other than, you know, other than slightly numbing you, which is probably not helpful.
00:30:49.000 in in the long run they don't they don't work and when people start to realize actually i don't
00:30:56.400 really feel better then they can feel being in an even worse state because then they think not
00:31:00.780 only do i have this you know horrible medical condition that you know i need to take a drug
00:31:05.480 to sort out but i'm not even responsive to this drug i'm treatment resistant you know i'm gonna
00:31:11.360 it the treatment hasn't worked i've got to go back and get the next line of treatment and then that
00:31:16.780 might not work. So actually people can end up in a really sort of negative and pessimistic state.
00:31:23.020 So although it feels like it might be a nice, easy solution and beneficial in the long run,
00:31:31.960 I think it's not. And Jana, we have had on the show on all sorts of different subjects and culture
00:31:37.400 and politics and comedy and music and whatever, lots of people who have challenged the consensus
00:31:42.660 in their field. It doesn't usually go that well. People don't tend to take on new ideas that
00:31:49.940 easily. How have you found the response to bringing these ideas forward?
00:31:55.960 Yeah, that's a good question. Well, there's been a lot of pushback from the psychiatric profession
00:32:02.740 and some from members of the public and some from the media. I think members of the public
00:32:10.160 sort of went two ways when we published that paper, which is part of what I write about in
00:32:14.620 the book. You know, some people said, oh my goodness, you know, thank you for enlightening
00:32:19.280 me. You know, now I realize, you know, I shouldn't be taking this medication that I was given and has
00:32:25.420 never done me any good anyway. And then other people, you know, people who'd really changed
00:32:31.220 their whole feelings about themselves, changed their self-beliefs, come to see themselves as
00:32:35.440 someone who had this brain condition and, you know, was going to need this long-term treatment.
00:32:40.160 and found having that idea of themselves challenged difficult, found that difficult
00:32:49.800 to be challenged about that idea. Some of them pushed back and said, it's irresponsible to
00:32:56.060 publish this. You're going to make people feel awful. So we had those sorts of responses.
00:33:03.000 the psychiatric profession really seemed to me to just want to shut down the debate. They didn't
00:33:10.720 want people to get an inkling that actually depression has not been proven to be a biological
00:33:17.580 condition. I think they wanted people to go along under that impression, which is why
00:33:24.560 no one has challenged this idea of the chemical imbalance theory earlier, because actually it's
00:33:30.680 been known for a long time that the evidence didn't add up. I mean, although I got all the
00:33:35.400 evidence together in a systematic way in this paper in 2022, a lot of people said when I published it,
00:33:42.400 oh, we knew all that. Of course we knew there wasn't evidence for a chemical imbalance. Of
00:33:46.400 course we knew there wasn't evidence for the serotonin theory of depression. And I think the
00:33:52.920 reason that no one had highlighted that before is because actually it suited the profession
00:33:57.040 for the public to go on believing that we had discovered the biological origins of depression
00:34:04.060 so that they would go on subscribing to this medical view and taking the antidepressants.
00:34:12.300 And in fact, the psychiatrists who sort of challenged the paper in that way often suggested
00:34:21.840 that, well, okay, you haven't found a serotonin imbalance, but maybe it could be inflammation.
00:34:26.760 You know, there's lots of other theories. It could be inflammation, it could be problems with neuroplasticity, it could be other neurotransmitters. The problem is that none of those, those are all theories about possible biological causes of depression, but none of them have been proven either. And there's much less research in those areas than there is on serotonin and depression.
00:34:47.780 so um you know yes there was lots of pushback but and and as i started with you know there are still
00:34:57.480 lots of public information sites that tell people that depression is caused by a chemical imbalance
00:35:02.580 in the brain but i think there are fewer now i know that for example the australian and new
00:35:09.340 zealand royal college of psychiatrists took down their their blurb that tell told people that
00:35:15.400 depression was due to a chemical imbalance. And I think other, some other sites have been changed
00:35:19.920 as well. So if we don't know exactly what causes people to feel persistently sad, let's call it
00:35:26.740 that, how much do we know about ways of consistently overcoming that state or getting out of that
00:35:33.680 state? So we know that the vast majority of people will recover at some point spontaneously. So I
00:35:42.240 think that's a really important point to state because we've sort of created the idea. And in
00:35:48.040 fact, the president of the Royal College of Psychiatrists was on the radio the other day
00:35:52.020 saying people don't get better from mental illness on their own. Well, people do get better from
00:35:56.700 depression on their own. Whether you call it a mental illness or not is another matter. It
00:36:02.520 certainly is classified as mental illness. And so it's important to know that people can get
00:36:10.520 better on their own. And then how people get better depends on the reasons why they have
00:36:17.760 become depressed, the particular individual causes in their situation. So some people might
00:36:26.420 need relationship counselling to sort out relationship difficulties. Some people might
00:36:30.840 need support at work. Some people will benefit from having general psychological therapy,
00:36:36.840 talking therapy in order to work out why they're feeling depressed because we don't
00:36:43.320 we don't all all obviously know and even if we know we may not be may not have any clear idea
00:36:50.840 about how we can change those things that have made us made us depressed so I think therapy can
00:36:55.400 help with that and I think therapy can also help with processing childhood trauma trauma you know
00:37:02.660 major, major events. It can help people to build up self-esteem, which is often part of the problem
00:37:09.000 as well. So I think therapy can be helpful, but I don't think it's necessarily a panacea or
00:37:13.740 something that everyone, you know, has to have. And then there are general things that improve
00:37:20.500 people's mood or wellbeing on a day-to-day basis, like exercise, like eating well, like social
00:37:27.440 interaction like having meaning and purpose i think that's really important and i think that
00:37:32.800 that is one of the major things that we struggle with in modern life you know now that now that
00:37:37.580 we don't have meaning and purpose given to us in the form of a religion um obviously some people
00:37:43.120 still subscribe but many people don't subscribe to a religious faith uh and and therefore we have
00:37:48.700 to create our own and that's not always not always easy spring is a wonderful time of year right up
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00:38:25.640 It will not surprise you to learn that I am not exactly a man who works with his hands.
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00:39:10.260 Do you think also the part of the problem is, Joanna,
00:39:12.780 that mental illness and mental health have now become an identity?
00:39:16.740 You see it with people in their bios, on Twitter, on social media, say ADHD, bipolar, etc.
00:39:25.020 If that's your identity, you're not going to want to get better, are you?
00:39:28.880 Yeah, I think this is a big problem.
00:39:30.940 And I think that's absolutely right that it can give people the impression that they'll never get better.
00:39:37.720 And also that limits people.
00:39:39.280 That's what worries me about this, you know, having a mental health identity, is that you might think, well, because I've got this thing, you know, this mental health problem, I can't do that sort of job.
00:39:53.620 I can't do that activity.
00:39:56.000 I'm never going to be able to have a relationship, maybe, you know.
00:39:59.580 So, and again, it's sort of this, I mean, I think people who adopt a mental health identity have different ideas about what it really means.
00:40:12.760 And some people, I think, are just saying, I'm a bit different from other people.
00:40:17.620 You know, this is who I am.
00:40:20.320 Some people, I think, you know, have bought into the idea that they have some, you know, problem with their brain.
00:40:26.440 um and if you're one of those who's just saying i'm a bit different well you know maybe that's
00:40:32.220 okay but again i sort of feel that it still might be limiting to feel that
00:40:36.320 you know you have this difference that's a sort of intrinsic part of you um
00:40:41.840 but people who've really bought into the full idea they've got a problem with their brain
00:40:46.720 well first of all you know there there isn't evidence that that's true so they're buying into
00:40:52.760 you know a mistaken mistaken idea and that's that's very limiting if you you know if you're
00:40:59.900 thinking of yourself as someone who is flawed who has an abnormal brain that you know a broken brain
00:41:06.080 as some people refer to it then obviously you will you know you will limit yourself and you will
00:41:13.120 you know possibly possibly not lead as fulfilling life as you could otherwise have led
00:41:19.440 And also as well, and this is, by the way, there's no judgment on my behalf because this is not an identity, but there are times where I have embraced this particular type of viewpoint, which is that of being a victim.
00:41:33.840 Life gets, you know, things happen to me and therefore, you know, I'm a victim of life, et cetera.
00:41:39.580 How much of this is people essentially assuming the mantle of being the victim?
00:41:44.220 and as a result of that they don't have to take full responsibility in the same way that you know
00:41:50.060 people go you know well i have adhd which means i have outbursts at times which means i can go
00:41:55.800 around and tell you what i think of you which is unfortunately how some people behave so so let me
00:42:02.600 tell you about a little project i did with a student um a few years ago we looked at people's
00:42:08.340 the blogs of people who identified themselves as being depressed and having significant problems
00:42:14.680 with depression. And we analysed how people seemed to understand their depression, but also
00:42:20.460 what they did about it. And what was very interesting is that most of the people in
00:42:25.260 these blogs were fully signed up to this medical idea that they had something wrong with their
00:42:30.040 brain. And they were signed up because, you know, because this made them feel better about
00:42:37.120 themselves. This excused them from feelings of shame, from feelings that they'd let other people
00:42:42.700 down or weren't, you know, pulling their weight in their family or workplace or whatever.
00:42:48.800 But what was very interesting is that when you moved, when you saw how they wrote about
00:42:54.800 how they'd overcome depression, they all said that they had to take active steps themselves
00:43:02.420 in order to change their lives, in order to overcome this problem. So none of them were
00:43:08.720 saying that we just took the drug and it fixed our chemical imbalance and everything was fine.
00:43:14.320 They were all saying we had to examine our lives, we had to examine, we had to understand why we
00:43:20.340 felt as we did and we had to do something about it. We realised we had to change something.
00:43:25.220 And that process of change had often involved a process of personal growth and development and
00:43:31.800 and many of them felt that they'd become fuller and better people as a result of that self-examination
00:43:37.480 process that they'd gone through. So I think that shows that it is important for people to have
00:43:43.960 agency to examine what this means, what they're feeling as a response to, what's gone wrong for
00:43:52.900 them, and what can they do to change it. But it also shows, as you say, how people do feel
00:44:00.500 ashamed and embarrassed about letting people down and yes that it's nice to have a sort of peg to
00:44:08.160 you know to hang those feelings on so that you don't have to you know keep battering yourself
00:44:14.680 about them absolutely because look human beings are human beings and if you're going to give
00:44:20.240 someone an excuse they're going to invariably take that excuse they just will because that's
00:44:26.320 how we are. I think sometimes if we give people the idea that they can overcome something and that
00:44:34.300 they have agency, I really do think that's a more effective solution than to tell people that they're
00:44:39.640 going to be victims of this awful condition. Yeah, I do. And I agree with you. And that's why
00:44:46.540 I think it's so important that people know that we don't have, you know, that this idea that
00:44:52.060 depression is a chemical imbalance is not established is not proven because people who
00:44:59.260 have this idea that you know they have this brain problem do you know and there's research showing
00:45:04.700 this do feel that there's not much they can therefore do about it and so they you know
00:45:10.240 they sit back and they're relying on the pill that you give them to make them feel better and
00:45:15.960 And, you know, that's not going to work because the pills aren't very effective anyway.
00:45:21.140 And so that's one of the reasons why I think it's really important to, you know, to disabuse people of this idea.
00:45:29.100 And because we have to tackle this, because there's going to be a pretty large swathe of people who are watching this or listening to it going.
00:45:37.160 How much of this is the drug company's involvement, vested interest, profits, et cetera?
00:45:45.960 Well, it certainly all got kicked off by that, I would say. So as I said, the idea that depression
00:45:53.520 was caused by a chemical imbalance wasn't initially dreamt up by them. The people who
00:45:58.840 sort of came up with these theories were psychiatrists and researchers back in the
00:46:02.540 60s. But it was the drug companies that really grabbed it and ran with it in the 1990s when
00:46:08.640 they were trying to promote the SSRIs and the subsequent antidepressants that have come onto
00:46:13.720 the market. And they flooded the medical airwaves with this idea. And then when the internet really
00:46:22.940 got going and people got access to the internet, they flooded the internet with this idea that
00:46:28.520 depression is caused by a chemical imbalance. I would say that they are very much responsible
00:46:34.020 for having established this idea in the popular psyche. The drug companies are not that interested
00:46:40.580 in antidepressants anymore. There are one or two coming online, but most of them are now
00:46:44.580 off patent. So they're not really heavily being heavily promoted. Most of the antidepressants
00:46:49.300 that we use now, it's not necessarily down to drug company activity that this idea is being
00:46:55.740 maintained, but I think they had established it so well. And they'd had help. They'd had help from
00:47:01.100 medical institutions that ran public information campaigns, often with backing from the
00:47:08.780 pharmaceutical industry to you know to disseminate this idea to do disease awareness campaigns
00:47:15.020 you know to tell people basically if you're feeling a bit down go and see your GP this
00:47:19.480 could be a medical problem so they got lots of help from the medical profession and the medical
00:47:23.800 professional and some medical some medical sites anyway are still putting this idea forward
00:47:29.840 but definitely it was the pharmaceutical industry that really popularized it on a wide scale
00:47:35.520 Well, coming back to your conversation you were having about, you know, people feeling like they're victims. The people I feel really, really sorry for, I think most of all, is the parents of children who've been told this. And I imagine that's a very difficult situation because if your child believes this medical theory and they have all the weight of expertise behind it and you're there kind of going, well, why don't you go for a walk and see your friends more and do this and do that?
00:48:02.660 you're in a very difficult position where you're like the dinosaur who doesn't get it,
00:48:07.580 you know, while your child is basically being drugged for problems in a way that's not actually
00:48:13.340 being solved. Yeah, I've come across a few accounts from parents where that's happened,
00:48:18.620 where their teenage or young adult child has gone off and got a diagnosis and they feel that
00:48:27.140 actually this is, you know, an understandable situation and there could be other ways of
00:48:31.980 dealing with it, and, you know, worry, understandably, about that person, you know,
00:48:37.340 getting started on an antidepressant, but potentially entering into a cascade of medical
00:48:43.060 treatments, you know, which people do because the drugs aren't effective. So, yeah, no, I agree.
00:48:50.320 There was one other thing I wanted to ask you in relation to the side effects of SSRIs.
00:48:55.160 I don't know if this is true, but I do remember reading in the wake of a number of
00:48:59.360 very highly publicized mass shootings in the US, that there was at least a correlation
00:49:05.840 between SSRI use and mass acts of violence of that kind. Do we know anything about that
00:49:14.220 scientifically? So there is quite a bit of research that shows a correlation, as you say,
00:49:20.420 between acts of violence and also suicidal behavior and taking antidepressants. Maybe
00:49:26.660 the correlation between suicidal behaviour isn't so surprising. It's difficult to
00:49:33.380 disentangle cause and effect. So, of course, people who are suicidal get put on antidepressants
00:49:44.920 and people who have violent tendencies may well also be diagnosed with depression and put on
00:49:50.960 antidepressants because their behaviour is already problematic. But there is a little bit
00:49:57.580 of research that suggests that antidepressants can occasionally make people suicidal and violent
00:50:03.440 and aggressive, particularly young people. I don't know why it's particularly in young people,
00:50:08.720 but that does seem to be a consistent finding. And these studies that show this are randomised
00:50:15.260 controlled trials. So they are studies that are comparing the effects of people taking
00:50:19.920 antidepressants and placebo um so they're not you know they're not they're not that that's that's
00:50:25.980 factored out the um the problem of trying to disentangle cause and effect and some of those
00:50:33.380 some of those studies do suggest that there is a small increase in violent behavior and in suicidal
00:50:38.860 behavior in people on antidepressants compared to people taking a placebo and Joanna something
00:50:46.760 that piqued my interest when we were talking earlier was when you were explaining about all
00:50:51.740 the drug companies they're no longer interested in antidepressants the the patent has expired
00:50:57.140 therefore there's not much money to be made and there's a little light in my brain went
00:51:01.500 so what are they interested in now and what are they seeking to make money from and then i thought
00:51:07.860 about the explosions in rates of adhd diagnosis autism diagnosis my conspiracy theorist or is
00:51:16.200 there something else going on so you're absolutely right adhd is is a big development area at the
00:51:22.840 moment there are lots of not not lots but there are a few drugs being being launched or that were
00:51:28.240 launched a few years ago for adhd including adhd in adults which has obviously mushroomed in in
00:51:34.220 recent years and there are some uh there are some new drugs for depression being being promoted
00:51:41.760 for example esketamine which is a relative of ketamine and um then the this is my point yeah
00:51:49.200 yeah if you give people drugs they're gonna feel good for a while absolutely absolutely so so it's
00:51:55.700 it's really going in that direction there is um it looks like the pharmaceutical industry are
00:52:01.480 producing more and more psychoactive drugs that are directly related to to drugs that are used
00:52:07.680 on the recreational drug scene. I wonder whether, this is really conspiratorial, but I wonder
00:52:14.240 whether they've looked at the opioid crisis in the States and thought, well, they got
00:52:18.700 away with it. You know, they got a lot of people, they sold a lot of opiates by telling
00:52:23.600 people that they're not addictive and they got away with it. And maybe we should, you
00:52:29.280 know, try some drugs a bit like that. So there are opiate-like drugs being developed for
00:52:35.160 the treatment of depression, believe it or not. What? Yeah, absolutely. You want to have a good
00:52:41.000 time. Here you go. But this is what I'm saying. It's like, if you can't legalize drugs or make
00:52:49.360 a profit from selling people weed, well, you just call it, you know, something else. You add a
00:52:56.240 little thing in front of her or at the end or whatever, and you just give it to them. And then
00:52:59.340 they have a great time and everybody's happy so so yeah i mean it's not that ludicrous that is
00:53:06.000 what is happening i mean these just just to clarify these opioid drugs that are claimed
00:53:10.280 not to have opioid-like effects um but but it does look as if they do have some sort of opioid
00:53:16.740 type profile and then of course we've got this huge um sorry can i just pause it there just one
00:53:23.920 second as somebody whose people seeing the effects in my family of depression and addiction
00:53:29.380 the last thing that you want to do with somebody who is depressed is give them a highly addictive
00:53:34.900 substance yeah yeah absolutely absolutely although antidepressants are dependence forming um but uh
00:53:41.760 not you know don't cause sort of misuse in the way that opioids do but but yeah no absolutely
00:53:47.300 absolutely sorry this interview is descended but i just find this so ridiculous like the way we
00:53:51.880 talk about this stuff it's almost like you're not allowed to like put two and two together anymore
00:53:55.720 and go well if you're just giving people drugs that people take recreationally i know they're
00:54:01.900 probably not going to solve anything so s ketamine is a good example if i can just talk about this
00:54:06.320 so s ketamine which is very closely related to ketamine essentially has the same effects as
00:54:12.220 ketamine no one disputes that and it's been trialed in in trials giving it twice a week to people
00:54:18.580 in trials just as if it was an antidepressant with the idea that you know people people should
00:54:24.660 just you know be on this for a few months or you know possibly a few years i'm sure with the
00:54:30.180 anticipation that people will actually go on it for years and years and you know and and they they
00:54:37.140 do depression measurement scales and then they do side effect scales one of the side effects being
00:54:42.480 dissociation and conclude that, you know, because your depression symptoms come down after you've
00:54:49.360 taken this esketamine, that you've somehow recovered from your depression. I mean, it's
00:54:54.760 completely absurd. And, you know, and the normal psychoactive effects of ketamine are all contained
00:55:02.100 in the little side effect scale. And it's as if these are completely separate, the way that they
00:55:07.000 affect your mood and the way that they, you know, cause the dissociation and euphoria.
00:55:10.980 So basically, a guy comes into your office and says,
00:55:13.140 I'm depressed, you go out and have 10 pints.
00:55:15.140 And then while he's having the 10 pints, you go,
00:55:17.080 how are you feeling?
00:55:17.660 It's a lot much better, doc.
00:55:18.660 Yeah, exactly.
00:55:19.120 And that's basically what you've got.
00:55:20.300 Yeah, yeah, yeah, exactly.
00:55:21.320 And I mean, not only that, but ketamine and esketamine
00:55:23.760 are both being promoted as rapid onset treatments
00:55:27.140 for suicidal thoughts.
00:55:29.240 So, you know, you come in and you have your infusion of ketamine
00:55:32.340 and someone measures your, you know, suicidal thoughts ratings
00:55:36.780 and they've gone down.
00:55:38.660 and therefore this is, you know, thought to be a treatment.
00:55:41.760 I mean, it sounds like a joke.
00:55:42.940 It does, doesn't it? It does.
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00:56:54.600 It's deeply irresponsible because if any of you followed the story about Matthew Perry, the Friends actor,
00:57:01.420 He was obviously highly depressed, struggled with addiction for all of his life, used ketamine as a way to overcome his addiction and effectively died of a ketamine overdose.
00:57:10.120 Yeah, yeah, yeah, absolutely. And it's not just restricted to him.
00:57:15.460 There was an article in, I think it was The Guardian a couple of years ago that was interesting, which was about how a lot of ketamine clinics were closing down because, you know, the market was saturated and too many had opened up essentially.
00:57:31.940 And there were people desperate that their local clinic had closed down
00:57:37.680 and they couldn't go and get their next, you know, treatment.
00:57:41.360 So, you know, basically people had become dependent,
00:57:45.160 probably a mixture of psychological and physical dependence
00:57:48.140 on having their regular ketamine infusions.
00:57:52.460 And then suddenly the whole service shut down and they couldn't get it.
00:57:56.900 But isn't it interesting, like, just the language?
00:58:00.320 and i think it's very important to stay you know big pharma that's done a lot of good let's be
00:58:06.260 honest about that but the the names s ketamine you go a ketamine infusion like what are you
00:58:13.840 talking about you're just getting off your nut on ketamine and and and the latest thing that's
00:58:18.280 come in is psychedelics so you know um psilocybin um uh psilocybin ecstasy uh and and again you
00:58:27.320 know, there are serious trials of these things going on with this idea that they might cure
00:58:31.440 treatment-resistant depression. It's quite interesting. It started out as what's called
00:58:38.240 psychedelic-assisted psychotherapy. So the initial idea, which isn't maybe quite so crazy,
00:58:44.380 is that you had a psychedelic experience, you had a trip under supervision, and then you processed
00:58:52.120 what you experienced during that trip in some subsequent psychotherapy. And the idea was that
00:58:58.340 maybe the psychedelic experience would give you some insights into why you were depressed or what
00:59:05.140 you might do to improve yourself and your life and your mood. And that was what was helpful. So,
00:59:12.060 I mean, I still think that's a sort of rose-tinted view of what drugs can achieve in people who are,
00:59:18.800 you know, deeply depressed. But there's some logic to it. At least it was acknowledging these
00:59:23.540 are psychoactive substances. You have a psychoactive experience. You go into an
00:59:28.740 altered state for a bit. But what's happened is that that has sort of morphed into this idea that
00:59:35.640 actually what they're doing is, you know, fixing some brain chemical receptor problem or some
00:59:42.600 chemical imbalance and that of course easily translates into the idea that what you need to
00:59:50.060 do is take them long term just as people take antidepressants long term and of course that's
00:59:54.740 how it's going to go because it's not a good business model is it to have you know to set up
00:59:59.800 a clinic where you come in and you have one psychedelic experience a couple of psychotherapy
01:00:03.460 sessions and then you're cured which is which is what the initial idea was is it by the way
01:00:08.760 on the psychedelic point it's something that we we have talked to one or two people on the show
01:00:13.220 who have suggested that it might actually be effective for things like ptsd uh and other
01:00:20.100 things is there any evidence on that that you're aware of so there was a trial done on ptsd and
01:00:28.420 ecstasy i think and ecstasy is not psychedelic is it well it's a little bit psychedelic it's a
01:00:36.880 a bit psychedelic and a bit amphetamine-like.
01:00:41.360 The results showed some benefit,
01:00:44.640 but the problem with all these trials is, of course,
01:00:46.580 you can't blind people at all.
01:00:48.440 I mean, you can't blind people in an ordinary antidepressant trial
01:00:50.960 very reliably, but you certainly can't blind people
01:00:53.360 if you're giving people ecstasy or psilocybin or something like that,
01:00:56.560 or ketamine.
01:00:58.680 Just for people who are not medical experts,
01:01:01.460 you're not poking their eyes out.
01:01:02.720 What you mean when you say you can't blind them
01:01:04.720 is they know they're taking ecstasy.
01:01:06.520 Yes, yes. So you set up this trial where you compare taking ecstasy to taking a placebo tablet, and you give people the placebo with the idea that people won't know whether they're getting the real drug or the placebo. But of course, if you're comparing something like ecstasy with a chalk or sugar tablet, people will know the difference. And it's the same with antidepressants to some extent, although it's probably less immediately obvious.
01:01:31.780 um so so the problem is that you can't effectively blind you can't effectively
01:01:39.180 disguise what people are getting and so there's probably an enhanced placebo effect associated
01:01:46.080 with thinking that you're getting the real active substance so they so this trial of um
01:01:53.940 ecstasy and PTSD I think they did find a small effect but there are concerns that it you know
01:02:02.800 that it was basically due to due to this unblinding effect due to the fact that people
01:02:07.220 knew what they were getting. What about psilocybin more specifically is there any evidence on that?
01:02:12.520 So there were a couple of small trials of psilocybin um trying to uh revive my memory of
01:02:20.720 There's one that's compared psilocybin to an antidepressant and didn't find any difference.
01:02:26.980 That was done by a group in this country.
01:02:31.560 There might be another one that's compared it with placebo, I think, and found some immediate difference,
01:02:40.880 but much less difference when you follow people up a bit later, as you would expect,
01:02:45.400 if they were actually picking up,
01:02:47.320 if what you're picking up is people's drug-induced experience.
01:02:51.480 There's going to be people listening and watching this
01:02:53.680 who are already thinking to themselves,
01:02:55.140 you know what, I've been on antidepressants for a while,
01:02:57.880 maybe it's time to get off.
01:03:00.940 What advice would you give?
01:03:02.380 Because I'm sure it wouldn't be just take your antidepressants,
01:03:04.900 throw them in the bin and go cold turkey.
01:03:06.620 It's a really important question, thank you for asking me.
01:03:09.800 So the most important thing to say is don't do that,
01:03:12.600 don't just put them in the bin,
01:03:13.600 particularly if you've been taking them for a long period of time, because they can be associated
01:03:18.880 with quite severe withdrawal symptoms. So people need to come down on them slowly. Now, some people
01:03:24.980 will need to do that very slowly, particularly if they've been on them for years and years,
01:03:29.260 in order to minimise the withdrawal symptoms that they will get. The other thing that's important
01:03:35.080 to say is that withdrawal symptoms include emotional symptoms like anxiety, tearfulness,
01:03:43.600 and, you know, changeability of mood, feeling down, feeling sad. They include a lot of emotional
01:03:50.640 symptoms in the same way that, you know, coming off alcohol or heroin, you know, any psychoactive
01:03:57.200 substance, you know, messes up your mood when you're coming off it. So people will experience
01:04:02.560 emotional symptoms when they're coming off their antidepressants. They shouldn't just assume that
01:04:07.320 that means they're having a relapse, because I think very commonly that has happened, that people
01:04:12.000 have started to come off, started to feel a bit anxious, a bit more emotional than usual,
01:04:17.460 assume that they're having a relapse and that they need to go back on their medication.
01:04:21.500 And many of those people then think, oh, well, I've just got to take it for life,
01:04:24.380 which is really tragic because actually, probably if they'd just reduced, if they'd known what was
01:04:29.820 happening, A, and B, reduced more slowly, they might well have got off their antidepressants.
01:04:35.560 So, people need to be aware that there are withdrawal symptoms. These include emotional symptoms. Also, some people get physical symptoms like dizziness, like feelings of electricity going through the brain, quite typically.
01:04:52.800 um and these can be minimized by coming off slowly and particularly coming off it's particularly
01:05:00.700 important to come off the last bit slowly so uh to get down to low doses then don't just throw it
01:05:08.260 in the bin keep keep reducing the dose very slowly there are guides now to help people with that
01:05:13.860 the royal college of psychiatrists have some good information on their stopping antidepressants
01:05:18.620 the section of their website that was written by a colleague of mine who's had personal experience
01:05:24.240 of coming off antidepressants and he's also co-authored a book called the Maud's DD Prescribing
01:05:29.980 Guidelines which gives people lots of information it's it's it's massive and very dense and quite
01:05:36.340 expensive but it's something that people could potentially recommend their GPs to get if their
01:05:41.880 GPs were uncertain about how to help people or if people were worried that their GPs were telling
01:05:46.860 them to come off too fast, as I think is probably quite often the case. So, I mean, that's worrying
01:05:53.520 that the GPs don't really know how to get people to come off these drugs, because if they come off
01:05:58.900 too fast, what you're basically saying is that the side effects can be quite severe.
01:06:04.420 Yeah, absolutely. And there's evidence that some people, probably particularly people who come off
01:06:12.220 too fast, will get into a persistent withdrawal state or a persistent state whereby they often
01:06:22.400 feel foggy, debilitated, tired. Some people can't get out of bed. People have to stop work or reduce
01:06:30.240 their hours. It can cause all sorts of social problems. And I know more and more about this
01:06:37.880 because along with colleagues, I've set up a little deprescribing service in the mental health
01:06:44.380 trust that I work in. And we are increasingly referred people who are in these terrible states
01:06:50.980 having come off antidepressants too fast. So it's really, and sorry, and I brought that up because
01:06:56.800 I think that not that many GPs and doctors are aware of this problem, are aware that there are
01:07:04.440 these persistent states that people can get into if they come off too fast. It's tragic that we're
01:07:10.320 not aware enough about that because actually the same problem was shown with benzodiazepines back
01:07:16.200 in the 1980s. It was shown that some people who came off benzodiazepines again showed persistent
01:07:23.820 problems, often persistent neurological symptoms and persistent anxiety. So it does seem that some
01:07:32.860 drugs you know if you come off them too fast can can really cause a lot of damage and you're saying
01:07:38.380 persistent what does that mean it means so so good question it means that the symptoms can go
01:07:44.540 on for months and sometimes for years so people have reported these sometimes for years and while
01:07:51.480 we're on that subject can i just bring up the subject of persistent sexual dysfunction i think
01:07:56.140 that's also something thank you for looking at me when you said that
01:07:59.540 i just think it's something that's really important and again again something that's not
01:08:06.480 not nearly well recognized enough um by the the profession as well as by the public so there's
01:08:14.260 it's well acknowledged that antidepressants cause sexual dysfunction while you're taking them
01:08:19.200 because they're disrupting the serotonin system that's that's not in dispute and affects a lot
01:08:25.000 of people who take them. What has become evident over the last couple of decades, I would say,
01:08:31.340 with increasing reports is that some people will have persistent problems with their sexual
01:08:37.000 functioning after they stop taking their antidepressants. And not only has this come
01:08:42.040 out from reports of patients, it's evident from animal studies that show that young animals,
01:08:52.580 rats and mice that are treated as adolescents or young adults with antidepressants show persistent
01:08:59.420 problems with their sexual functioning after they've stopped the after this drug has been
01:09:04.980 stopped we don't know how common this problem is i mean i hope to goodness that it's rare but there
01:09:11.280 you know there are increasing reports there's and there have been a couple of attempts to
01:09:16.000 try and work out how prevalent it is which one of which suggests it might affect up to around about
01:09:21.580 10% of people who stopped taking antidepressants. And again, we don't know how long the problems
01:09:27.760 might last. It might just be a few months for some people, but there is definitely people who
01:09:32.020 report that it lasts for years. And many people say that it's not just sexual functioning,
01:09:38.160 it's their emotional functioning as well, that they feel generally numbed,
01:09:42.860 you know, emotionally and sexually. So really important for people to be aware of that and
01:09:49.120 to be aware that their doctors may well not be aware of that.
01:09:53.620 Joanna, it's been an absolute pleasure.
01:09:56.020 Thank you for coming on the show.
01:09:57.560 Final question is always the same.
01:09:59.040 What's the one thing we're not talking about that we really should be?
01:10:02.860 Oh, gosh.
01:10:04.260 I mean, I think we've covered everything that I need to cover.
01:10:08.300 As I've said, my mission is to make sure that people are informed.
01:10:12.900 Maybe I can just sort of finish by saying that.
01:10:14.720 I don't have any beef with people taking antidepressants or, you know, seeking a diagnosis of depression as long as people understand what the implications are and particularly what the effects of antidepressants are and how little we know about what the long term consequences might be.
01:10:34.940 Well, thanks for coming on and sharing that with people.
01:10:37.360 Really valuable.
01:10:38.540 We're going to go to Substack where people are going to ask you their questions now.
01:10:41.800 So head on over to triggerpod.co.uk, and we'll see you there.
01:10:46.660 Should teenagers be taking all these medications for ADHD?
01:10:50.240 I worry about taking something during these developing years.
01:10:53.280 Shouldn't they get help but talk about the issues and give them problem-solving strategies instead?
01:11:11.800 We'll be right back.