Over the decades, the pharmaceutical industry and parts of the psychiatric profession lead us to believe that depression was caused by a chemical imbalance in the brain and that antidepressants helped correct it. Now a new effort is being made to say that antidepressants are effective, even if the biological mechanism is unclear. The problem is that both these narratives have been falling apart in the background for a long time.
Surprisingly for many, the difference in efficacy between a placebo and antidepressant is so small that many drug trials don’t find it and most patients would be unlikely to really notice it. It’s not that change doesn't happen, it’s that it happens in the placebo groups too. And then there are the risks to take into account.
In this episode, we discuss antidepressant drugs with Professor Joanna Moncrieff. She is Professor of Critical and Social Psychiatry at University College London. She is also the lead author of the impactful 2022 scientific review of the serotonin theory of depression. It is one of the 400 most shared scientific papers of all time out of the full 21 million tracked articles.
This episode discusses the decades of efforts to find a biological basis for depression and issues with the diagnosis. We dive into the interpretations of the small difference between antidepressants and placebos and discuss the increasing awareness of the risks of long-term antidepressant use. Finally, we discuss the influence of the pharmaceutical industry, the professional interests within psychiatry and the research funding channels. Is the funding system protecting patient safety? How much should we curtail the indications for antidepressant prescribing? And finally, is the turning point for mass prescribing in sight?
Episode timestamps:
0:00 The search for a biological basis and problems with the diagnosis
19:23 Disentangling placebo and antidepressant effects and emotional numbing
33:33 Withdrawal problems
44:05 Vested interests and high stakes
55:05 Problems with research funding
59:28 Finnish depression guidelines
1:02:50 The future of antidepressants
Related materials
- Molecular Psychiatry: The serotonin theory of depression: a systematic umbrella review of the evidence
- The Conversation: Depression is probably not caused by a chemical imbalance in the brain – new study
- Psychiatry & Big Pharma: Exposed (Dr. James Davies, videolecture)
- The Emperor's New Drugs: Exploding the Antidepressant Myth (Dr. Irving Kirsch, videolecture)
- Royal College of Psychiatrists: Antidepressants
- NICE Guidance: Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults
- Anatomy of an Epidemic (Robert Whitaker, book description)
Over the decades, the pharmaceutical industry and parts of the psychiatric profession lead us to believe that depression was caused by a chemical imbalance in the brain and that antidepressants helped correct it. Now a new effort is being made to say that antidepressants are effective, even if the biological mechanism is unclear. The problem is that both these narratives have been falling apart in the background for a long time.
Surprisingly for many, the difference in efficacy between a placebo and antidepressant is so small that many drug trials don’t find it and most patients would be unlikely to really notice it. It’s not that change doesn't happen, it’s that it happens in the placebo groups too. And then there are the risks to take into account.
In this episode, we discuss antidepressant drugs with Professor Joanna Moncrieff. She is Professor of Critical and Social Psychiatry at University College London. She is also the lead author of the impactful 2022 scientific review of the serotonin theory of depression. It is one of the 400 most shared scientific papers of all time out of the full 21 million tracked articles.
This episode discusses the decades of efforts to find a biological basis for depression and issues with the diagnosis. We dive into the interpretations of the small difference between antidepressants and placebos and discuss the increasing awareness of the risks of long-term antidepressant use. Finally, we discuss the influence of the pharmaceutical industry, the professional interests within psychiatry and the research funding channels. Is the funding system protecting patient safety? How much should we curtail the indications for antidepressant prescribing? And finally, is the turning point for mass prescribing in sight?
Episode timestamps:
0:00 The search for a biological basis and problems with the diagnosis
19:23 Disentangling placebo and antidepressant effects and emotional numbing
33:33 Withdrawal problems
44:05 Vested interests and high stakes
55:05 Problems with research funding
59:28 Finnish depression guidelines
1:02:50 The future of antidepressants
Related materials
- Molecular Psychiatry: The serotonin theory of depression: a systematic umbrella review of the evidence
- The Conversation: Depression is probably not caused by a chemical imbalance in the brain – new study
- Psychiatry & Big Pharma: Exposed (Dr. James Davies, videolecture)
- The Emperor's New Drugs: Exploding the Antidepressant Myth (Dr. Irving Kirsch, videolecture)
- Royal College of Psychiatrists: Antidepressants
- NICE Guidance: Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults
- Anatomy of an Epidemic (Robert Whitaker, book description)