00:11:00.160It's like if I have a glass of wine tonight,
00:11:02.100I'm going to feel a little bit more relaxed or whatever.
00:11:05.000Are they not having any effect like that?
00:11:07.600So 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.
00:11:27.700and and that contrasts with the mainstream view that what these drugs are doing is targeting some
00:11:34.740underlying abnormality so so your idea um that that you know drugs drugs that enter the brain
00:11:41.660you know are going to change our our normal feeling states uh is is is correct if we think
00:11:48.480of something like alcohol you know if you you can be feeling very depressed going out and have a
00:11:53.600shed load to drink and temporarily you might well feel better again obviously it's not solving
00:11:58.400anything um in the moment except in the moment yeah yeah um so so antidepressants at least
00:12:08.480probably most classes of antidepressants have some emotional numbing effect we know that because of
00:12:16.160lots of people describing that i think it's you know we've probably come across people who are
00:12:21.220taking antidepressants and describe how they can't cry and they don't feel sort of joy or
00:12:26.620excitement anymore. They might not feel as intensely sad as they were, but everything's
00:12:31.740a bit flat. So antidepressants have that effect. But whether that effect is actually beneficial
00:12:45.420or not is questionable. And I say that because the trials of antidepressants that have compared
00:12:52.960them with placebos, i.e. inactive dummy tablets, really don't show very much difference, even
00:13:00.340despite that emotional numbing effect. The difference between taking an antidepressant
00:13:05.580and a placebo in these trials is really small. It's two points on a 52-point, typical 52-point
00:13:13.380depression rating scale so it numbs numbs your feeling a little bit which is not super impactful
00:13:18.900um yeah so come back with me then to the question of well if it's not if depression is not a chemical
00:13:26.940imbalance and in fact even if there were different levels of serotonin it's like kind of like saying
00:13:32.520well people who are depressed don't smile as much therefore smiling is an antidepressant which you
00:13:37.380know i don't know if there's a lot of evidence for that but do we know what actually does cause
00:13:41.380depression? So the trouble with that question is it sort of presupposes that depression is a thing
00:13:48.620like lung cancer and we can, you know, we can target a particular cause. And I would suggest
00:13:54.300that that's the wrong way to think about it. I think depression is a personal state. Um, you know,
00:14:00.460it's, it's a type of emotion, a type of feeling and our feeling sadness. So, so yes, persistent
00:14:08.840sadness, loss of interest, loss of motivation, social withdrawal. These are all the common
00:14:16.860features that we recognize that are quite common and we may have experienced ourselves or seen in
00:14:27.400other people around us. And by and large, those reactions and feelings are caused by things that
00:14:35.800are happening in our lives. They are an understandable reaction to, you know, to events
00:14:42.520like, you know, relationship difficulties or loss or change or struggling at work, all those sorts
00:14:49.900of things. So, and the causes will be different in each person. You know, the reason I don't like
00:14:55.700this way that we talk about depression as if it is the same as having, you know, cancer is that
00:15:02.520it implies that it's the same thing in every person and therefore we can treat each person
00:15:07.500with depression in the same way. And of course, that's what we do. We give them, you know,
00:15:11.420antidepressants and, you know, cognitive behavioral therapy, which may be useful for
00:15:16.940some people. I'm not doubting that. But I think we ought to see depression as, you know, a reaction
00:15:23.280of an individual. And then, you know, the next logical step is to ask, well, why has this
00:15:29.540individual got into this state at this particular time, what's going on in their lives,
00:15:34.440and what sort of help do they need? And then you realise that each individual who has depression
00:15:38.700is going to need different sort of help and support. That makes sense. As always, I'm
00:15:44.000racking my brain for counter-arguments just to stress test what you're saying. A couple of things
00:15:49.940that I think where you might say, well, hold on, isn't this an imbalance or some kind of
00:15:55.080almost medical thing or at least chemical thing is something like postnatal depression where we
00:16:00.420know it's quite a common thing when actually something generally quite wonderful has happened
00:16:05.400right a woman gives birth has a child and then she is depressed uh is that different to or is
00:16:12.640well what's your take on that well the first thing to say is so so one of the arguments that was made
00:16:18.720when we published our paper on serotonin and depression was that there are lots of different
00:16:22.840types of depression. So, you know, you can't say that there's no biological cause of depression.
00:16:28.920I would change that round and say, well, there isn't any evidence of a biological cause in any
00:16:35.420sort of subtype of depression. That may be because people haven't done enough research into the
00:16:41.000different subtypes. But as it is at the moment, we can't say that postnatal depression is different,
00:16:46.840that we've found some sort of biological cause for that. And I would say that actually for most
00:16:53.940people, postnatal depression, although it seems a bit counterintuitive, is often a response to
00:17:01.920a major change in one's circumstances. Having a baby, having major responsibility at a time when
00:17:10.900yes, one's hormones are, you know, are flying around and, you know, probably not completely
00:17:17.060stabilised as well. So, but I don't think it's necessarily completely different from other
00:17:22.780cases. Well, the hormones thing is kind of my point, because I take your point about it's a
00:17:26.320major change, but if you put £10 million in my bank account, that is a major change. I'm very
00:17:31.060unlikely to develop post-millionaire depression or whatever you might call it. Do you see what I
00:17:35.540mean? So that's one. And the other one I was going to ask you is, what about, is there such a thing,
00:17:40.520Because 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.
00:17:48.640I think it makes it sound like you had a thing.
00:17:50.840I definitely was depressed at one point in my life, but it was a reaction to the circumstances and also partly to my own behavior.
00:17:58.700Right. 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.
00:18:08.960I guarantee you I'm going to be depressed at the end of that, right?
00:18:12.360But the counter-argument that people have always wheeled out was,
00:18:15.160yeah, yeah, but you don't have clinical depression.
00:18:18.120Clinical depression is a totally different thing.
00:18:20.600Is there such a thing as clinical depression?
00:18:23.480The news doesn't just tell you what's happening.
00:18:26.400It often tells you what to think is happening.
00:18:28.900And these days, the biggest red flag isn't what's said, it's what gets left out.
00:18:34.520It's the only app that compares how the same story is covered across the political spectrum
00:18:39.300and show you what whole audiences are not being told.
00:18:42.500The Blindsport feed is one of my favorite features.
00:18:45.220Every day, it flags upwards of 20 stories that are being ignored either by the left or the right.
00:18:50.040Follow along at ground.news slash trigonometry.
00:18:52.480Like this, a new study from UC San Diego found that climate change
00:18:56.680cost almost twice as much as we thought because earlier estimates left out damage to the oceans.
00:19:01.440That's a pretty big update and yet no coverage.
00:19:03.600literally zero, came from right-leaning outlets. Or this, a recent Gallup poll found trust in the
00:19:08.740media has hit a record low, with just 28% of Americans saying they trust newspapers, radio,
00:19:14.000and TV to report the news accurately and fairly. That's a staggering result, but if you only read
00:19:19.360left-leaning news, you likely never saw it at all. Go to ground.news slash trigonometry to get 40%
00:19:25.200off their unlimited vantage plan, the same one we use, and stop being managed by the media.
00:19:30.240so again there's no evidence that there is a specific subgroup of people with depression who
00:19:38.800have something that is biological and medical and different from the sort of depression that
00:19:44.820we might all experience we've been told for many many years now haven't we that there is you know
00:19:50.940a different thing called clinical depression which is a proper medical condition so you know
00:19:55.500most people are signed up to that if you're told something you know enough times you think it must
00:19:59.940be true especially if you're told by experts but actually there's no evidence you know all these
00:20:05.180studies on serotonin and depression were done with people with you know clinical depression
00:20:09.400they'd had depression diagnosed by their doctors which is all that we really mean by clinical
00:20:14.700depression and we're still not finding evidence for you know biological abnormalities um in them
00:20:20.920but also i think i think it's important to realize that there's no sort of secret ingredient to the
00:20:27.880diagnosis of depression. You know, someone who's feeling unhappy and struggling with life goes to
00:20:33.400their doctor, says, I'm, you know, I'm unhappy and I'm struggling. And the doctor, you know,
00:20:39.460on the day makes a judgment about whether or not they think they should be treated with
00:20:44.800antidepressants or not. You know, should we consider this to be a sort of medical case that
00:20:49.280we're going to give medical treatment to? And that, you know, that decision isn't made by,
00:20:56.380you know, rigidly following some very precise, um, uh, there's no antibody in the bloodstream.
00:21:03.820No, no. And there's certainly no objective physical tests that can tell the doctor.
00:21:08.140And so it depends a lot on the doctor you see, you know, whether they've seen a pharmaceutical
00:21:13.660industry rep that lunchtime before they saw you, um, their sort of outlook on life, how they
00:21:20.560understand emotions, the training they've had, and it depends on how the individual patient
00:21:29.020presents as well. So some people, you know, come to their doctor convinced that they have a medical
00:21:33.620problem, that they need, you know, an antidepressant or some sort of chemical solution. And some people
00:21:39.520come, you know, much more uncertain, not really knowing what the right, you know, what the right
00:21:45.620way to interpret this is. And that will influence whether the doctor says, you know, you have
00:21:49.760clinical depression or not as well. I'm putting myself in the shoes of a GP who's got this
00:21:56.540patient coming to them. They say they're depressed because, let's say, a bereavement.
00:22:01.400Their child has died. I feel that I have to do something. I can't send this person away.
00:22:07.040I can say, oh, you're going to get counselling or some type of CBT on the NHS, but the waiting
00:22:12.260list is 18 months. It's probably even longer than that. What am I going to do? I'm just going to let
00:22:16.700this person go no i need to be seen to be doing something because if they do something extreme
00:22:21.940then it's going to come back to me so in order to cover myself and to be seen to be doing something
00:22:27.420i'm going to prescribe antidepressants isn't that how it would work i i think it it absolutely does
00:22:34.320work like that and i think that's one of the main reasons why we have you know such huge rates of
00:22:39.560prescribing. And, you know, yes, understandably, GPs want to feel, you know, want to be able to
00:22:47.740offer people something. Waits for therapy were very long or there was no therapy available at
00:22:52.620all for, you know, many decades here. We do now, though, have a national therapy service,
00:22:59.560which has much, you know, waitingness of a few weeks. So that's not quite so bad. But I think,
00:23:07.660yeah i think that's a really good point i think you know and i think one of the problems is that
00:23:11.760because we've medicalized depression because we've told people to go and see their doctors
00:23:15.880then it just gets it just gets confirmed because you know if you if you if you have a hammer
00:23:21.880everything looks like a nail don't you and what do doctors have they have a prescription pad
00:23:25.400and a diagnostic book so you know they tell you yes you've got this condition and
00:23:30.220this is the treatment this this drug absolutely and to me one of the great tragedies about when
00:23:36.400we talk about depression or any type of mental health condition is because we don't know a lot
00:23:41.680about it, if we're being honest, because that does seem to be the central theme of the conversation
00:23:46.000is like, look, we don't actually know. So a lot of the time, the treatment or the procedures are
00:23:52.340actually do more harm than good. Yeah, absolutely. Absolutely. I mean, this is one of the main
00:23:58.920messages I would like to get across to people. There is no evidence that you have a chemical
00:24:04.620imbalance in your brain if you are depressed. So therefore, there's no evidence that that
00:24:10.180antidepressant you're being offered is going to correct that. But we do know that antidepressants
00:24:15.500are, you know, real drugs that enter the brain and change the normal state of our brain chemistry.
00:24:21.380And that, you know, and that can have harmful consequences. That's not necessarily a, you know,
00:24:27.880harmless thing to do. We should be worried about messing about with our brain chemistry.
00:24:32.500And 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.
00:24:58.700What 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.
00:25:24.760but all these things have actually come out because people have been reporting them not
00:25:29.200because people were doing you know had set up systematic research studies to investigate the
00:25:34.640consequences of use in the first place and to me it derives as well from the fact that we just
00:25:40.620if we're being honest we don't really understand the brain i mean you look at the other organs and
00:25:46.580you go well you know we understand the kidney pretty well the heart i mean the heart is basically
00:25:50.600your muscle or the liver or whatever else but if even if you talk to the one of the most eminent
00:25:55.160neurologists of the day and you ask them a question about the brain I'm sure a lot of them
00:26:00.360would 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
00:26:06.100all this knowledge we're just thinking of these techniques of how to help people yeah yeah I mean
00:26:11.460I mean I think we've we've got a wrong impression that we know more about the brain than we do
00:26:16.900and that's partly because of the way that a lot of neuroscience findings are presented and reported
00:26:22.680you know so we're always seeing articles aren't we like you know you can boost your dopamine by
00:26:27.940doing this and you know if you have more dopamine you'll you'll uh you know be more active or a
00:26:33.660athlete or something like that and if you if you lack serotonin then you then you're you know not
00:26:40.820only just not as happy but but uh you know socially dysfunctional or something like that
00:26:46.460um so so you know these these headlines get put out there all the time so people have the impression
00:26:53.320that we know more about the brain than we do and i would agree we don't know very much about it
00:26:58.260for example we know we've identified a lot of the different chemicals that are active in the brain
00:27:04.800but we understand very little about what each of them do and why is that
00:27:10.000it's partly because they all interact so actually isolating the effect of one
00:27:17.220is is difficult it's also because sticking chemicals into into human brains is a very
00:27:24.460difficult thing to do so you know there's some research done on animals but not very much
00:27:28.860research on human beings that directly manipulates brain chemicals for obvious reasons
00:27:33.940because there's this fascinating when people talk about mental health they conflate it with
00:27:40.780mental illness so you talk we talk about depression and schizophrenia as if they're
00:27:46.840under the same umbrella when as anybody knows and i have people in my family have suffered
00:27:52.000from schizophrenia it is a very very different condition to depression i i think it's a very
00:27:58.300different condition, but there's not very good evidence for any biological basis for schizophrenia
00:28:07.440either. Really? So it's still a mental illness in the sense that it's an illness or condition that
00:28:15.380we diagnose or identify on the basis of how people behave. I guess what Francis is getting at,
00:28:23.220I think, is more that depression is something that we probably all experience at one point
00:28:29.380of our lives to a lesser or greater degree. Schizophrenia is a whole different story.
00:28:34.640Which I completely agree with. Yeah, yeah. No, absolutely. I mean, I think depression is1.00
00:28:38.000something understandable and familiar. And schizophrenia is quite a radically different
00:28:46.320state from our ordinary everyday lives. And I guess the other part of it, and this is,
00:28:51.100it's difficult to talk about because you never want to talk about people who have a particular
00:28:56.780problem from a kind of responsibility point of view because it sort of sounds like blame a lot
00:29:02.560of the time. But I guess you can probably speak about yourself. As I said earlier,
00:29:06.260I know how to give myself or put myself in the state of being depressed. I also have discovered
00:29:12.740how to get myself out of that state. And I think I would imagine, obviously, big pharma,
00:29:18.880People always want to make money from helping people fix their problems.
00:29:45.360there's a whole like you have to change your whole lifestyle or we can just give you this
00:29:50.080tablet and a lot of people would rather just take the tablet yeah yeah the problem is that we know
00:29:56.100that if you subscribe to this idea that you have a brain chemical imbalance you actually do worse
00:30:02.520you have worse outcomes and you are you you think that you can't do anything about your condition
00:30:09.480and you and you are more likely to believe that you will never recover yeah it feels like cancer
00:30:13.940Yeah. 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.
00:30:29.560At last, someone's helping me. I've got an explanation. You know, the drug's going to work.
00:30:34.200So 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.
00:30:49.000in in the long run they don't they don't work and when people start to realize actually i don't
00:30:56.400really feel better then they can feel being in an even worse state because then they think not
00:31:00.780only do i have this you know horrible medical condition that you know i need to take a drug
00:31:05.480to sort out but i'm not even responsive to this drug i'm treatment resistant you know i'm gonna
00:31:11.360it the treatment hasn't worked i've got to go back and get the next line of treatment and then that
00:31:16.780might not work. So actually people can end up in a really sort of negative and pessimistic state.
00:31:23.020So although it feels like it might be a nice, easy solution and beneficial in the long run,
00:31:31.960I think it's not. And Jana, we have had on the show on all sorts of different subjects and culture
00:31:37.400and politics and comedy and music and whatever, lots of people who have challenged the consensus
00:31:42.660in their field. It doesn't usually go that well. People don't tend to take on new ideas that
00:31:49.940easily. How have you found the response to bringing these ideas forward?
00:31:55.960Yeah, that's a good question. Well, there's been a lot of pushback from the psychiatric profession
00:32:02.740and some from members of the public and some from the media. I think members of the public
00:32:10.160sort of went two ways when we published that paper, which is part of what I write about in
00:32:14.620the book. You know, some people said, oh my goodness, you know, thank you for enlightening
00:32:19.280me. You know, now I realize, you know, I shouldn't be taking this medication that I was given and has
00:32:25.420never done me any good anyway. And then other people, you know, people who'd really changed
00:32:31.220their whole feelings about themselves, changed their self-beliefs, come to see themselves as
00:32:35.440someone who had this brain condition and, you know, was going to need this long-term treatment.
00:32:40.160and found having that idea of themselves challenged difficult, found that difficult
00:32:49.800to be challenged about that idea. Some of them pushed back and said, it's irresponsible to
00:32:56.060publish this. You're going to make people feel awful. So we had those sorts of responses.
00:33:03.000the psychiatric profession really seemed to me to just want to shut down the debate. They didn't
00:33:10.720want people to get an inkling that actually depression has not been proven to be a biological
00:33:17.580condition. I think they wanted people to go along under that impression, which is why
00:33:24.560no one has challenged this idea of the chemical imbalance theory earlier, because actually it's
00:33:30.680been known for a long time that the evidence didn't add up. I mean, although I got all the
00:33:35.400evidence together in a systematic way in this paper in 2022, a lot of people said when I published it,
00:33:42.400oh, we knew all that. Of course we knew there wasn't evidence for a chemical imbalance. Of
00:33:46.400course we knew there wasn't evidence for the serotonin theory of depression. And I think the
00:33:52.920reason that no one had highlighted that before is because actually it suited the profession
00:33:57.040for the public to go on believing that we had discovered the biological origins of depression
00:34:04.060so that they would go on subscribing to this medical view and taking the antidepressants.
00:34:12.300And in fact, the psychiatrists who sort of challenged the paper in that way often suggested
00:34:21.840that, well, okay, you haven't found a serotonin imbalance, but maybe it could be inflammation.
00:34:26.760You 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.
00:34:47.780so um you know yes there was lots of pushback but and and as i started with you know there are still
00:34:57.480lots of public information sites that tell people that depression is caused by a chemical imbalance
00:35:02.580in the brain but i think there are fewer now i know that for example the australian and new
00:35:09.340zealand royal college of psychiatrists took down their their blurb that tell told people that
00:35:15.400depression was due to a chemical imbalance. And I think other, some other sites have been changed
00:35:19.920as well. So if we don't know exactly what causes people to feel persistently sad, let's call it
00:35:26.740that, how much do we know about ways of consistently overcoming that state or getting out of that
00:35:33.680state? So we know that the vast majority of people will recover at some point spontaneously. So I
00:35:42.240think that's a really important point to state because we've sort of created the idea. And in
00:35:48.040fact, the president of the Royal College of Psychiatrists was on the radio the other day
00:35:52.020saying people don't get better from mental illness on their own. Well, people do get better from
00:35:56.700depression on their own. Whether you call it a mental illness or not is another matter. It
00:36:02.520certainly is classified as mental illness. And so it's important to know that people can get
00:36:10.520better on their own. And then how people get better depends on the reasons why they have
00:36:17.760become depressed, the particular individual causes in their situation. So some people might
00:36:26.420need relationship counselling to sort out relationship difficulties. Some people might
00:36:30.840need support at work. Some people will benefit from having general psychological therapy,
00:36:36.840talking therapy in order to work out why they're feeling depressed because we don't
00:36:43.320we don't all all obviously know and even if we know we may not be may not have any clear idea
00:36:50.840about how we can change those things that have made us made us depressed so I think therapy can
00:36:55.400help with that and I think therapy can also help with processing childhood trauma trauma you know
00:37:02.660major, major events. It can help people to build up self-esteem, which is often part of the problem
00:37:09.000as well. So I think therapy can be helpful, but I don't think it's necessarily a panacea or
00:37:13.740something that everyone, you know, has to have. And then there are general things that improve
00:37:20.500people's mood or wellbeing on a day-to-day basis, like exercise, like eating well, like social
00:37:27.440interaction like having meaning and purpose i think that's really important and i think that
00:37:32.800that is one of the major things that we struggle with in modern life you know now that now that
00:37:37.580we don't have meaning and purpose given to us in the form of a religion um obviously some people
00:37:43.120still subscribe but many people don't subscribe to a religious faith uh and and therefore we have
00:37:48.700to create our own and that's not always not always easy spring is a wonderful time of year right up
00:37:56.540until you're standing on a job site at 7 in the morning,
00:37:59.560wondering why your trousers are already soaked through
00:38:01.900and your pocket is 6 inches from where you expected it to be.
00:38:05.800TrueWork makes workwear that is actually built around those conditions.
00:39:39.280That'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.
00:39:56.000I'm never going to be able to have a relationship, maybe, you know.
00:39:59.580So, 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.
00:40:12.760And some people, I think, are just saying, I'm a bit different from other people.
00:40:20.320Some people, I think, you know, have bought into the idea that they have some, you know, problem with their brain.
00:40:26.440um and if you're one of those who's just saying i'm a bit different well you know maybe that's
00:40:32.220okay but again i sort of feel that it still might be limiting to feel that
00:40:36.320you know you have this difference that's a sort of intrinsic part of you um
00:40:41.840but people who've really bought into the full idea they've got a problem with their brain
00:40:46.720well first of all you know there there isn't evidence that that's true so they're buying into
00:40:52.760you know a mistaken mistaken idea and that's that's very limiting if you you know if you're
00:40:59.900thinking of yourself as someone who is flawed who has an abnormal brain that you know a broken brain
00:41:06.080as some people refer to it then obviously you will you know you will limit yourself and you will
00:41:13.120you know possibly possibly not lead as fulfilling life as you could otherwise have led
00:41:19.440And 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.
00:41:33.840Life gets, you know, things happen to me and therefore, you know, I'm a victim of life, et cetera.
00:41:39.580How much of this is people essentially assuming the mantle of being the victim?
00:41:44.220and as a result of that they don't have to take full responsibility in the same way that you know
00:41:50.060people go you know well i have adhd which means i have outbursts at times which means i can go
00:41:55.800around and tell you what i think of you which is unfortunately how some people behave so so let me
00:42:02.600tell you about a little project i did with a student um a few years ago we looked at people's
00:42:08.340the blogs of people who identified themselves as being depressed and having significant problems
00:42:14.680with depression. And we analysed how people seemed to understand their depression, but also
00:42:20.460what they did about it. And what was very interesting is that most of the people in
00:42:25.260these blogs were fully signed up to this medical idea that they had something wrong with their
00:42:30.040brain. And they were signed up because, you know, because this made them feel better about
00:42:37.120themselves. This excused them from feelings of shame, from feelings that they'd let other people
00:42:42.700down or weren't, you know, pulling their weight in their family or workplace or whatever.
00:42:48.800But what was very interesting is that when you moved, when you saw how they wrote about
00:42:54.800how they'd overcome depression, they all said that they had to take active steps themselves
00:43:02.420in order to change their lives, in order to overcome this problem. So none of them were
00:43:08.720saying that we just took the drug and it fixed our chemical imbalance and everything was fine.
00:43:14.320They were all saying we had to examine our lives, we had to examine, we had to understand why we
00:43:20.340felt as we did and we had to do something about it. We realised we had to change something.
00:43:25.220And that process of change had often involved a process of personal growth and development and
00:43:31.800and many of them felt that they'd become fuller and better people as a result of that self-examination
00:43:37.480process that they'd gone through. So I think that shows that it is important for people to have
00:43:43.960agency to examine what this means, what they're feeling as a response to, what's gone wrong for
00:43:52.900them, and what can they do to change it. But it also shows, as you say, how people do feel
00:44:00.500ashamed and embarrassed about letting people down and yes that it's nice to have a sort of peg to
00:44:08.160you know to hang those feelings on so that you don't have to you know keep battering yourself
00:44:14.680about them absolutely because look human beings are human beings and if you're going to give
00:44:20.240someone an excuse they're going to invariably take that excuse they just will because that's
00:44:26.320how we are. I think sometimes if we give people the idea that they can overcome something and that
00:44:34.300they have agency, I really do think that's a more effective solution than to tell people that they're
00:44:39.640going to be victims of this awful condition. Yeah, I do. And I agree with you. And that's why
00:44:46.540I think it's so important that people know that we don't have, you know, that this idea that
00:44:52.060depression is a chemical imbalance is not established is not proven because people who
00:44:59.260have this idea that you know they have this brain problem do you know and there's research showing
00:45:04.700this do feel that there's not much they can therefore do about it and so they you know
00:45:10.240they sit back and they're relying on the pill that you give them to make them feel better and
00:45:15.960And, you know, that's not going to work because the pills aren't very effective anyway.
00:45:21.140And so that's one of the reasons why I think it's really important to, you know, to disabuse people of this idea.
00:45:29.100And 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.
00:45:37.160How much of this is the drug company's involvement, vested interest, profits, et cetera?
00:45:45.960Well, it certainly all got kicked off by that, I would say. So as I said, the idea that depression
00:45:53.520was caused by a chemical imbalance wasn't initially dreamt up by them. The people who
00:45:58.840sort of came up with these theories were psychiatrists and researchers back in the
00:46:02.54060s. But it was the drug companies that really grabbed it and ran with it in the 1990s when
00:46:08.640they were trying to promote the SSRIs and the subsequent antidepressants that have come onto
00:46:13.720the market. And they flooded the medical airwaves with this idea. And then when the internet really
00:46:22.940got going and people got access to the internet, they flooded the internet with this idea that
00:46:28.520depression is caused by a chemical imbalance. I would say that they are very much responsible
00:46:34.020for having established this idea in the popular psyche. The drug companies are not that interested
00:46:40.580in antidepressants anymore. There are one or two coming online, but most of them are now
00:46:44.580off patent. So they're not really heavily being heavily promoted. Most of the antidepressants
00:46:49.300that we use now, it's not necessarily down to drug company activity that this idea is being
00:46:55.740maintained, but I think they had established it so well. And they'd had help. They'd had help from
00:47:01.100medical institutions that ran public information campaigns, often with backing from the
00:47:08.780pharmaceutical industry to you know to disseminate this idea to do disease awareness campaigns
00:47:15.020you know to tell people basically if you're feeling a bit down go and see your GP this
00:47:19.480could be a medical problem so they got lots of help from the medical profession and the medical
00:47:23.800professional and some medical some medical sites anyway are still putting this idea forward
00:47:29.840but definitely it was the pharmaceutical industry that really popularized it on a wide scale
00:47:35.520Well, 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?
00:48:02.660you're in a very difficult position where you're like the dinosaur who doesn't get it,
00:48:07.580you know, while your child is basically being drugged for problems in a way that's not actually
00:48:13.340being solved. Yeah, I've come across a few accounts from parents where that's happened,
00:48:18.620where their teenage or young adult child has gone off and got a diagnosis and they feel that
00:48:27.140actually this is, you know, an understandable situation and there could be other ways of
00:48:31.980dealing with it, and, you know, worry, understandably, about that person, you know,
00:48:37.340getting started on an antidepressant, but potentially entering into a cascade of medical
00:48:43.060treatments, you know, which people do because the drugs aren't effective. So, yeah, no, I agree.
00:48:50.320There was one other thing I wanted to ask you in relation to the side effects of SSRIs.
00:48:55.160I don't know if this is true, but I do remember reading in the wake of a number of
00:48:59.360very highly publicized mass shootings in the US, that there was at least a correlation
00:49:05.840between SSRI use and mass acts of violence of that kind. Do we know anything about that
00:49:14.220scientifically? So there is quite a bit of research that shows a correlation, as you say,
00:49:20.420between acts of violence and also suicidal behavior and taking antidepressants. Maybe
00:49:26.660the correlation between suicidal behaviour isn't so surprising. It's difficult to
00:49:33.380disentangle cause and effect. So, of course, people who are suicidal get put on antidepressants
00:49:44.920and people who have violent tendencies may well also be diagnosed with depression and put on
00:49:50.960antidepressants because their behaviour is already problematic. But there is a little bit
00:49:57.580of research that suggests that antidepressants can occasionally make people suicidal and violent
00:50:03.440and aggressive, particularly young people. I don't know why it's particularly in young people,
00:50:08.720but that does seem to be a consistent finding. And these studies that show this are randomised
00:50:15.260controlled trials. So they are studies that are comparing the effects of people taking
00:50:19.920antidepressants and placebo um so they're not you know they're not they're not that that's that's
00:50:25.980factored out the um the problem of trying to disentangle cause and effect and some of those
00:50:33.380some of those studies do suggest that there is a small increase in violent behavior and in suicidal
00:50:38.860behavior in people on antidepressants compared to people taking a placebo and Joanna something
00:50:46.760that piqued my interest when we were talking earlier was when you were explaining about all
00:50:51.740the drug companies they're no longer interested in antidepressants the the patent has expired
00:50:57.140therefore there's not much money to be made and there's a little light in my brain went
00:51:01.500so what are they interested in now and what are they seeking to make money from and then i thought
00:51:07.860about the explosions in rates of adhd diagnosis autism diagnosis my conspiracy theorist or is
00:51:16.200there something else going on so you're absolutely right adhd is is a big development area at the
00:51:22.840moment there are lots of not not lots but there are a few drugs being being launched or that were
00:51:28.240launched a few years ago for adhd including adhd in adults which has obviously mushroomed in in
00:51:34.220recent years and there are some uh there are some new drugs for depression being being promoted
00:51:41.760for example esketamine which is a relative of ketamine and um then the this is my point yeah
00:51:49.200yeah if you give people drugs they're gonna feel good for a while absolutely absolutely so so it's
00:51:55.700it's really going in that direction there is um it looks like the pharmaceutical industry are
00:52:01.480producing more and more psychoactive drugs that are directly related to to drugs that are used
00:52:07.680on the recreational drug scene. I wonder whether, this is really conspiratorial, but I wonder
00:52:14.240whether they've looked at the opioid crisis in the States and thought, well, they got
00:52:18.700away with it. You know, they got a lot of people, they sold a lot of opiates by telling
00:52:23.600people that they're not addictive and they got away with it. And maybe we should, you
00:52:29.280know, try some drugs a bit like that. So there are opiate-like drugs being developed for
00:52:35.160the treatment of depression, believe it or not. What? Yeah, absolutely. You want to have a good
00:52:41.000time. Here you go. But this is what I'm saying. It's like, if you can't legalize drugs or make
00:52:49.360a profit from selling people weed, well, you just call it, you know, something else. You add a
00:52:56.240little thing in front of her or at the end or whatever, and you just give it to them. And then
00:52:59.340they have a great time and everybody's happy so so yeah i mean it's not that ludicrous that is
00:53:06.000what is happening i mean these just just to clarify these opioid drugs that are claimed
00:53:10.280not to have opioid-like effects um but but it does look as if they do have some sort of opioid
00:53:16.740type profile and then of course we've got this huge um sorry can i just pause it there just one
00:53:23.920second as somebody whose people seeing the effects in my family of depression and addiction
00:53:29.380the last thing that you want to do with somebody who is depressed is give them a highly addictive
00:53:34.900substance yeah yeah absolutely absolutely although antidepressants are dependence forming um but uh
00:53:41.760not you know don't cause sort of misuse in the way that opioids do but but yeah no absolutely
00:53:47.300absolutely sorry this interview is descended but i just find this so ridiculous like the way we
00:53:51.880talk about this stuff it's almost like you're not allowed to like put two and two together anymore
00:53:55.720and go well if you're just giving people drugs that people take recreationally i know they're
00:54:01.900probably not going to solve anything so s ketamine is a good example if i can just talk about this
00:54:06.320so s ketamine which is very closely related to ketamine essentially has the same effects as
00:54:12.220ketamine no one disputes that and it's been trialed in in trials giving it twice a week to people
00:54:18.580in trials just as if it was an antidepressant with the idea that you know people people should
00:54:24.660just you know be on this for a few months or you know possibly a few years i'm sure with the
00:54:30.180anticipation that people will actually go on it for years and years and you know and and they they
00:54:37.140do depression measurement scales and then they do side effect scales one of the side effects being
00:54:42.480dissociation and conclude that, you know, because your depression symptoms come down after you've
00:54:49.360taken this esketamine, that you've somehow recovered from your depression. I mean, it's
00:54:54.760completely absurd. And, you know, and the normal psychoactive effects of ketamine are all contained
00:55:02.100in the little side effect scale. And it's as if these are completely separate, the way that they
00:55:07.000affect your mood and the way that they, you know, cause the dissociation and euphoria.
00:55:10.980So basically, a guy comes into your office and says,
00:55:13.140I'm depressed, you go out and have 10 pints.
00:55:15.140And then while he's having the 10 pints, you go,
00:56:43.620See website for full details, restrictions and important safety information.
00:56:48.240Individual results may vary based on studies of topical and oral minoxidil and finasteride.
00:56:54.600It's deeply irresponsible because if any of you followed the story about Matthew Perry, the Friends actor,
00:57:01.420He 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.
00:57:10.120Yeah, yeah, yeah, absolutely. And it's not just restricted to him.
00:57:15.460There 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.
00:57:31.940And there were people desperate that their local clinic had closed down
00:57:37.680and they couldn't go and get their next, you know, treatment.
00:57:41.360So, you know, basically people had become dependent,
00:57:45.160probably a mixture of psychological and physical dependence
00:57:48.140on having their regular ketamine infusions.
00:57:52.460And then suddenly the whole service shut down and they couldn't get it.
00:57:56.900But isn't it interesting, like, just the language?
00:58:00.320and i think it's very important to stay you know big pharma that's done a lot of good let's be
00:58:06.260honest about that but the the names s ketamine you go a ketamine infusion like what are you
00:58:13.840talking about you're just getting off your nut on ketamine and and and the latest thing that's
00:58:18.280come in is psychedelics so you know um psilocybin um uh psilocybin ecstasy uh and and again you
00:58:27.320know, there are serious trials of these things going on with this idea that they might cure
00:58:31.440treatment-resistant depression. It's quite interesting. It started out as what's called
00:58:38.240psychedelic-assisted psychotherapy. So the initial idea, which isn't maybe quite so crazy,
00:58:44.380is that you had a psychedelic experience, you had a trip under supervision, and then you processed
00:58:52.120what you experienced during that trip in some subsequent psychotherapy. And the idea was that
00:58:58.340maybe the psychedelic experience would give you some insights into why you were depressed or what
00:59:05.140you might do to improve yourself and your life and your mood. And that was what was helpful. So,
00:59:12.060I mean, I still think that's a sort of rose-tinted view of what drugs can achieve in people who are,
00:59:18.800you know, deeply depressed. But there's some logic to it. At least it was acknowledging these
00:59:23.540are psychoactive substances. You have a psychoactive experience. You go into an
00:59:28.740altered state for a bit. But what's happened is that that has sort of morphed into this idea that
00:59:35.640actually what they're doing is, you know, fixing some brain chemical receptor problem or some
00:59:42.600chemical imbalance and that of course easily translates into the idea that what you need to
00:59:50.060do is take them long term just as people take antidepressants long term and of course that's
00:59:54.740how it's going to go because it's not a good business model is it to have you know to set up
00:59:59.800a clinic where you come in and you have one psychedelic experience a couple of psychotherapy
01:00:03.460sessions and then you're cured which is which is what the initial idea was is it by the way
01:00:08.760on the psychedelic point it's something that we we have talked to one or two people on the show
01:00:13.220who have suggested that it might actually be effective for things like ptsd uh and other
01:00:20.100things is there any evidence on that that you're aware of so there was a trial done on ptsd and
01:00:28.420ecstasy i think and ecstasy is not psychedelic is it well it's a little bit psychedelic it's a
01:00:36.880a bit psychedelic and a bit amphetamine-like.
01:01:06.520Yes, 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.
01:01:31.780um so so the problem is that you can't effectively blind you can't effectively
01:01:39.180disguise what people are getting and so there's probably an enhanced placebo effect associated
01:01:46.080with thinking that you're getting the real active substance so they so this trial of um
01:01:53.940ecstasy and PTSD I think they did find a small effect but there are concerns that it you know
01:02:02.800that it was basically due to due to this unblinding effect due to the fact that people
01:02:07.220knew what they were getting. What about psilocybin more specifically is there any evidence on that?
01:02:12.520So there were a couple of small trials of psilocybin um trying to uh revive my memory of
01:02:20.720There's one that's compared psilocybin to an antidepressant and didn't find any difference.
01:02:26.980That was done by a group in this country.
01:02:31.560There might be another one that's compared it with placebo, I think, and found some immediate difference,
01:02:40.880but much less difference when you follow people up a bit later, as you would expect,
01:03:13.600particularly if you've been taking them for a long period of time, because they can be associated
01:03:18.880with quite severe withdrawal symptoms. So people need to come down on them slowly. Now, some people
01:03:24.980will need to do that very slowly, particularly if they've been on them for years and years,
01:03:29.260in order to minimise the withdrawal symptoms that they will get. The other thing that's important
01:03:35.080to say is that withdrawal symptoms include emotional symptoms like anxiety, tearfulness,
01:03:43.600and, you know, changeability of mood, feeling down, feeling sad. They include a lot of emotional
01:03:50.640symptoms in the same way that, you know, coming off alcohol or heroin, you know, any psychoactive
01:03:57.200substance, you know, messes up your mood when you're coming off it. So people will experience
01:04:02.560emotional symptoms when they're coming off their antidepressants. They shouldn't just assume that
01:04:07.320that means they're having a relapse, because I think very commonly that has happened, that people
01:04:12.000have started to come off, started to feel a bit anxious, a bit more emotional than usual,
01:04:17.460assume that they're having a relapse and that they need to go back on their medication.
01:04:21.500And many of those people then think, oh, well, I've just got to take it for life,
01:04:24.380which is really tragic because actually, probably if they'd just reduced, if they'd known what was
01:04:29.820happening, A, and B, reduced more slowly, they might well have got off their antidepressants.
01:04:35.560So, 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.
01:04:52.800um and these can be minimized by coming off slowly and particularly coming off it's particularly
01:05:00.700important to come off the last bit slowly so uh to get down to low doses then don't just throw it
01:05:08.260in the bin keep keep reducing the dose very slowly there are guides now to help people with that
01:05:13.860the royal college of psychiatrists have some good information on their stopping antidepressants
01:05:18.620the section of their website that was written by a colleague of mine who's had personal experience
01:05:24.240of coming off antidepressants and he's also co-authored a book called the Maud's DD Prescribing
01:05:29.980Guidelines which gives people lots of information it's it's it's massive and very dense and quite
01:05:36.340expensive but it's something that people could potentially recommend their GPs to get if their
01:05:41.880GPs were uncertain about how to help people or if people were worried that their GPs were telling
01:05:46.860them to come off too fast, as I think is probably quite often the case. So, I mean, that's worrying
01:05:53.520that the GPs don't really know how to get people to come off these drugs, because if they come off
01:05:58.900too fast, what you're basically saying is that the side effects can be quite severe.
01:06:04.420Yeah, absolutely. And there's evidence that some people, probably particularly people who come off
01:06:12.220too fast, will get into a persistent withdrawal state or a persistent state whereby they often
01:06:22.400feel foggy, debilitated, tired. Some people can't get out of bed. People have to stop work or reduce
01:06:30.240their hours. It can cause all sorts of social problems. And I know more and more about this
01:06:37.880because along with colleagues, I've set up a little deprescribing service in the mental health
01:06:44.380trust that I work in. And we are increasingly referred people who are in these terrible states
01:06:50.980having come off antidepressants too fast. So it's really, and sorry, and I brought that up because
01:06:56.800I think that not that many GPs and doctors are aware of this problem, are aware that there are
01:07:04.440these persistent states that people can get into if they come off too fast. It's tragic that we're
01:07:10.320not aware enough about that because actually the same problem was shown with benzodiazepines back
01:07:16.200in the 1980s. It was shown that some people who came off benzodiazepines again showed persistent
01:07:23.820problems, often persistent neurological symptoms and persistent anxiety. So it does seem that some
01:07:32.860drugs you know if you come off them too fast can can really cause a lot of damage and you're saying
01:07:38.380persistent what does that mean it means so so good question it means that the symptoms can go
01:07:44.540on for months and sometimes for years so people have reported these sometimes for years and while
01:07:51.480we're on that subject can i just bring up the subject of persistent sexual dysfunction i think
01:07:56.140that's also something thank you for looking at me when you said that
01:07:59.540i just think it's something that's really important and again again something that's not
01:08:06.480not nearly well recognized enough um by the the profession as well as by the public so there's
01:08:14.260it's well acknowledged that antidepressants cause sexual dysfunction while you're taking them
01:08:19.200because they're disrupting the serotonin system that's that's not in dispute and affects a lot
01:08:25.000of people who take them. What has become evident over the last couple of decades, I would say,
01:08:31.340with increasing reports is that some people will have persistent problems with their sexual
01:08:37.000functioning after they stop taking their antidepressants. And not only has this come
01:08:42.040out from reports of patients, it's evident from animal studies that show that young animals,
01:08:52.580rats and mice that are treated as adolescents or young adults with antidepressants show persistent
01:08:59.420problems with their sexual functioning after they've stopped the after this drug has been
01:09:04.980stopped we don't know how common this problem is i mean i hope to goodness that it's rare but there
01:09:11.280you know there are increasing reports there's and there have been a couple of attempts to
01:09:16.000try and work out how prevalent it is which one of which suggests it might affect up to around about
01:09:21.58010% of people who stopped taking antidepressants. And again, we don't know how long the problems
01:09:27.760might last. It might just be a few months for some people, but there is definitely people who
01:09:32.020report that it lasts for years. And many people say that it's not just sexual functioning,
01:09:38.160it's their emotional functioning as well, that they feel generally numbed,
01:09:42.860you know, emotionally and sexually. So really important for people to be aware of that and
01:09:49.120to be aware that their doctors may well not be aware of that.
01:09:53.620Joanna, it's been an absolute pleasure.
01:10:04.260I mean, I think we've covered everything that I need to cover.
01:10:08.300As I've said, my mission is to make sure that people are informed.
01:10:12.900Maybe I can just sort of finish by saying that.
01:10:14.720I 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.
01:10:34.940Well, thanks for coming on and sharing that with people.