Blowing the Lid off the Chemical Imbalance Myth with Dr Joanna Moncrieff

The story you’ve been told about depression is tidy, catchy, and comforting—and it doesn’t match the evidence. We sit down with Professor Joanna Moncrieff to unpack why the “chemical imbalance” narrative took hold, what her 2022 umbrella review actually found about serotonin, and how a drug-centered lens helps us make wiser choices about antidepressants. Instead of assuming pills fix a faulty brain, we look at how psychoactive drugs alter consciousness—sometimes helpful in crisis, often numbing across the emotional spectrum—and what that means for informed consent.

Joanna walks us through the gap between early, hyped studies and larger research that failed to replicate findings on serotonin. We explore what serotonin reliably affects (sexual function), where the data are inconsistent (mood, sleep, appetite), and how SSRIs may increase activity in the short term yet disrupt systems over time. We zoom out to the marketing that reframed distress as a biological condition requiring medication, cementing a professional identity while sidelining context—grief, trauma, values, and life events that actually shape how we feel.

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💊 Ready to Deprescribe Your Psych Meds?

Psych meds have harmed us—and we’re not just survivors, we’re deeply educated in psychopharmacology, psychology, and nutrition. As hosts of The Gaslit Truth Podcast, we guide people safely off psychiatric medications with strategies grounded in science and brain health

🔥 You’ve been harmed. You’ve been dismissed. It’s time to take your brain back—with guidance from people who’ve been there and know their stuff.

Chapters

• 0:00 Introducing Joanna Moncrieff And The Premise
• 0:57 Challenging The Chemical Imbalance Narrative
• 1:14 Hosts’ Mission And Deprescribing Support
• 3:42 From Asylums To Drug Effects Observed
• 6:00 The Drug-Centered Model Explained
• 10:32 Serotonin Theory: Hypotheses And Methods
• 12:20 2022 Umbrella Review Findings
• 15:05 Genes, Early Hype, And Non-Replication
• 18:20 What Serotonin Actually Affects
• 21:52 SSRIs, Mechanisms, And Myths
• 25:17 Marketing, Disease Campaigns, And Identity
• 28:48 Beyond Serotonin: ADHD, Dopamine, Stimulants
• 32:30 Critiques, Pushback, And Public Messaging
• 36:36 Agency, Humanity, And Meaning Of Depression
• 40:40 Addictions Parallels And Emotional Numbing
• 44:45 Withdrawal, Dependence, And Tapering Realities
• 49:30 What Will Change Minds And Practice?
• 1:01:15 Closing And Listener CTA

Transcript

Jennifer Schmitz: 0:02

She's a professor, researcher, and psychiatrist whose pioneering work dared to challenge the cornerstone myth of modern psychiatry, the so-called chemical imbalance. Her published research revealed a painful truth. These drugs often don't make people feel better at all. And for exposing that truth, she's been met with the very gaslighting she set out to uncover. We are your whistleblowing shrinks, Dr. Terry Lynn and Therapist Jen. Before we crack this wide open, hit like, smash, subscribe. And if you're on YouTube, ring that bell so you don't miss a thing.

Speaker: 0:36

And just remember, everyone, Dr. Terry and I, we are also deprescribers. We can help you get off of psychiatric medications safely for your brain and your body. If you are interested in doing that, shoot us an email at thegasliptruthpodcast at gmail.com. Please welcome Professor Joanna Moncrief to the show. Joanna works at University College in London, and she is also a practicing psychiatrist in the NHS in London. And she has got a bio that we could spend an hour reading because the woman has done all the things. And it is an honor to have you on the show. Welcome, Joanna.

Joanna Moncrieff: 1:14

Thanks, Jen. Thanks, Terry. It's lovely to be here.

Jennifer Schmitz: 1:17

Yeah. See, I must be her friend. She called me Terry. So there we are.

Speaker: 1:21

I'm just going to try to get through the show without going into this like real calming, soothing space I get when I listen to your voice, Joanna, because I kind of just travel off into this world of just like Skittles and Rainbows because you have a very soothing voice. I'm going to try to lock it in here today.

Jennifer Schmitz: 1:38

It's her psychiatry voice. It's a psychological voice. All right, Joanna, we want to hear from the start how you got to the space of the being curious about the chemical imbalance theory and how you got from there to where you are today. And it's a long story, I'm sure, but give us the high notes.

Joanna Moncrieff: 1:57

Right. Yes. Well, well, thanks, Terry, for the opportunity to tell it again. So I suppose I should start by saying that I've always had some skepticism about the general medical model of psychiatry, right from when I was a medical student. That's part of what attracted me into psychiatry. You know, to me, it always seemed that people's mental and emotional struggles had to be more complicated than just being the manifestation of some underlying little brain process that had gone slightly wrong, that they had to mean more. And that they were more interesting than that. So that's my starting point. Then when I started working in psychiatry, I became interested in drug treatment because that is what everyone gets. Everyone who has, you know, more or less everyone who comes under mental health services in the UK, and I'm sure it's the same in the States and other parts of the world, gets prescribed at least one sort of psychiatric drug, and usually several, or often several, sometimes at the same time. And so I started to, you know, try and work out what these drugs were doing. And the textbooks were telling me that the drugs, you know, have these miraculous properties. We've had we've had this new range of drugs since the 1950s, and they're and they're curative drugs that you know that get to the root of the problem, that get to the brain process that is causing the symptoms and normalize them, normalize people's situation, that they've enabled, you know, all the mental asylums to be shut down and people to live normal lives in the community. And at the time I was working in the in the last asylums that were still open. And there was still at that time big wards full of people who had what we, you know, they they'd be said to have chronic schizophrenia. And they were literally shuffling around, numbed, tranquilized, and and and a bit vacant, sort of very, you know, expressionless, unreactive often. And it was clear to me that this wasn't this wasn't them returned to a normal state. They were under the influence of the effects of the drugs that they were on. So that's what really started me thinking, well, it doesn't seem to me that the drugs are normalizing anything here. It seems more like they are suppressing something and uh overlaying underlying problems with drug-induced effects. So I then started to formulate my ideas about the models of drug action. So I contrasted the idea that drugs are working by targeting an underlying biological mechanism that produces symptoms, such as the idea that there's a chemical imbalance that the drugs can reverse, with the idea that drugs are that psychiatric drugs are similar in nature to other psychoactive drugs such as alcohol or cannabis. They change people's normal mental state, they change people's normal brain states, they change our normal brain chemistry, and thereby produce an altered state of mind, altered level of consciousness. You know, many of these drugs are quite sedating, altered emotions, a lot of them produce a state of emotional numbing, and sometimes altered behavior as a consequence of those mental alterations. And so this alternative way of understanding what drugs do is what I call the drug-centered model. And it's the idea that the alterations produced by the drugs are superimposed onto what's what's going on for the person underneath and may appear to be preferable in some circumstances. So the heavy duty tranquilizers that we use in people who are that we still use in people who are psychotic, they're slightly different from the the ones in the old days when I was training, but they still work along the same lines, I believe. Those heavy duty tranquilizers basically pacify people and and and suppress the psychotic symptoms, the delusions and hallucinations that have sort of taken over someone's mental life in that situation. And that can be helpful when someone is acutely psychotic in a really bad state, it can be helpful to have the that process suppressed at least temporarily until the person comes out of it. But that's a very different explanation from the idea that we're correcting, you know, the biological origins of schizophrenia or psychosis. And when we think about people with emotional problems like depression or anxiety, what the drug-centered model suggests is that we are we're changing someone's mental state, often numbing people's emotions to some extent. And that may temporarily suppress people's underlying emotions. But it doesn't just suppress the bad emotions. It doesn't just suppress the depression and the anxiety or the sadness or whatever it is. It also suppresses joy and excitement and surprise and uh and interest, crucially, interest in life. So overall, it's not clear, I think, that that state of suppression is actually a useful state. Anyway, to come back to your question, sorry, this would have been a long answer. To come back to the heart of the question. So I uh so I wrote about this idea of models of drug action and published, first published it in 2005, so 20 years ago this year. And for years and years no one took any notice. No one really challenged me because it's difficult to challenge that position, because actually, psychiatric drugs are brain and mind-changing substances. It's not really possible to deny that. No one, no one's trying to deny that, and therefore, obviously, the changes that they produce are going to interact with what someone is feeling and going through. So that wasn't really challenged. But I was aware that there was still this idea out there in the general public that uh depression is caused by a chemical imbalance. And and because this idea was so strongly set in people's minds in the case of depression, I think it also coloured people's understandings of other sorts of mental health problems as well. That idea that depression is caused by a chemical imbalance was heavily promoted back in the 1990s by the pharmaceutical industry.

dr Teralyn Sell: 9:03

Yeah.

Joanna Moncrieff: 9:04

And promoted both to people in the medical profession and to the general public by various means. And so it had really become, you know, well established. People thought that people thought this was, you know, this was incontrovertible scientific evidence, an incontrovertible scientific fact that depression was caused by a chemical imbalance. In fact, I knew, and most psychiatrists knew, that this idea was a theory, and that although there was some evidence suggesting it might be true, there was also a lot of evidence showing that it probably wasn't true. And so that's why I decided to look into this to get all the research together that reflects on the chemical imbalance theory of depression, particularly the the idea about serotonin so serotonin, a lack of serotonin being the origin of depression, so that so that I could show that this idea that there is, you know, that we have evidence of an underlying dysfunctional system, that drugs, you know, then go in to target and rectify is actually not based in on scientific evidence.

Jennifer Schmitz: 10:22

So what was your hypothesis then when you when you went in for are you talking about what you published in 2022? Yes. Yeah. So the hypothesis that you had for that research then was what? What were you hypothesizing?

Joanna Moncrieff: 10:38

So the hypothesis was that there would be lower levels of serotonin in people with depression compared to people without depression when we were looking at there are lots of studies of different aspects of the serotonin system that have compared people with depression and compared people without. Then there was also, then there is also a group of studies that slightly weird studies that have aimed to induce a depressed state by lowering serotonin levels in the brain. And so the hypothesis for those studies is that people who had this, this took this, it's a it's a special drink that lacks the amino acid that um is the precursor of serotonin. And so the hypothesis for those studies is that people who had this special drink lacking that precursor molecule would be more likely to get depressed and show depressive symptoms than people who had a control drink that didn't lack that that particular amino acid. So different hypotheses for the different types of research, but overall the hypothesis was that you know these studies would show some link between an abnormality in the serotonin system and the state of depression.

Speaker: 11:53

And for that review. So for those of you listening, Joanna's talking about the serotonin theory of depression, a systematic umbrella review of the evidence. This is the art the publication that she is discussing that she had put out. Can you share with our listeners the outcome, the discussion points in general of what you found with that hypothesis?

Joanna Moncrieff: 12:19

Yeah, absolutely. So so yeah, just just to reiterate, that paper was published in 2022. I did the research with a little team of researchers, and we got together all these all these uh papers about all these different areas of research. So the main outcome is very easy to describe, and it wasn't a surprise to me, and that is that none of these different areas of research showed consistent or compelling evidence for any sort of link between serotonin and depression, let alone a causal link. Because of course, you know, it's it's possible that it it's likely that uh, you know, our brain chemistry may be affected if we're severely depressed or severely anxious, for example. But that doesn't necessarily that doesn't necessarily mean that what's going on in our brain is causing an emotional state. But we didn't find any link, as I said. There were a couple of things we found which were more surprising to me, or interesting, I should say. So one of the uh sets of studies we looked at was the is a set of studies on the uh gene for the serotonin transporter protein. The serotonin transporter protein is the protein that transports serotonin out of the synapse, that is the gap between the nerve cells where it has its action. So it essentially deactivates serotonin. And it's what uh SSRI antidepressants work on. They work by inhibiting this transporter protein and therefore, in theory, increasing serotonin activity in the synapse. So there are lots of studies of the serotonin transporter gene, and there's a theory that one type of this gene, which has a shorter arm, is going to be going to make people more likely to be depressed because it's likely to then lead to a malfunctioning of the serotonin system. Those studies started off by showing uh evidence that there might be some link between the serotonin transporter gene and getting depression. But as the studies got bigger and better, those effects disappeared. And this is, I think, just an important point to note about research in general that often early studies, you know, which get lots of publicity, find effects. Everyone jumps up and down and say, Oh, look, we found the cause of depression, we found the cause of schizophrenia. And then later studies quietly fail to replicate that but never get the same level of publicity. So that's why we're always under the impression that we we've you know, we know about the biological or we know that schizophrenia or depression, whatever it is, has biological origins when actually the evidence doesn't support that. So that was interesting. But the other interesting thing about these studies, there was also a hypothesis when it sort of started to become apparent that actually there was no link between the gene and depression, people started to hypothesize that maybe there was an interaction between having the gene, having um adverse life events, particularly in childhood, being the victim of abuse or neglect, and getting depression later on in life. And again, a landmark study came out in about 2005, I think, suggesting that there was this link by a group that said, look, we found a link, an interaction effect between the gene and adverse life events. Once again, subsequent studies that were better that were larger and really well conducted failed to replicate that finding. They found no link between adverse life events and the gene and depression. But what they did show overwhelmingly was that there was a link between adverse life events and depression. So if bad things have happened to you in your childhood, you are more likely to get depressed. We maybe didn't need million-pound, you know, genetic studies to show us that.

Jennifer Schmitz: 16:12

But perhaps not. That seems kind of like you know, what we should just know to be true, right? An adverse life event can create, you know, mental health issues, essentially. So that seems that seems to be like common knowledge.

Joanna Moncrieff: 16:28

What I what I one other sorry, just to finish that. So one other interesting thing that came out of that that research was that there was some evidence from a few studies that people who'd been on antidepressants long term, and these are likely to be SSRIs, actually had lower levels of serotonin in them.

Speaker: 16:47

Yep. That's what I was gonna ask you about, Joanna. That's exactly where I was going.

Joanna Moncrieff: 16:52

Yeah, yeah, yeah.

Speaker: 16:53

Yeah.

Joanna Moncrieff: 16:54

So so we actually, if we look at the evidence, we're not even really sure what antidepressants are doing. They probably they probably do increase serotonin activity in the short term, but in the long term, they may depress it or or they may just sort of interfere with that system in in a more general way. We're not really quite sure how. Is research on what serotonin does. So everyone's got this idea, you know, that serotonin is the happy chemical, is you know, related to calmness, and I think probably because it sounds like it comes for is derived from the word serenity. Actually, it's not at all, but uh but I think you know people associate the two, don't they? They do sound quite similar. But actually, there's there's no evidence of that. I mean, the idea that it was related to mood just comes from these studies on whether it's linked to depression, which as I said, if you add them all up, don't show that, don't show that it is at all. But there's it there's there's really no good evidence showing that it has showing it's that it has any effects on on our cognition or other aspects of our emotions. There have been lots of animal studies as well as human studies done on this, and they're completely inconsistent in their findings. The research on whether serotonin is related to sleep is inconsistent, appetite is inconsistent. The only area of research that really does seem to show some effect is research on serotonin and sexual function. And what it shows is that serotonin is bad for your sex life. It impairs all sorts of aspects of sexual functioning. So that's what that's what we know that serotonin does. I'm sure serotonin is doing many other things in the brain. I'm talking about serotonin in the brain, there's lots of serotonin in the rest of our bodies as well. There's serotonin in the gut, there's serotonin in blood cells, which interferes with clotting. So people who are on drugs that elevate serotonin levels can have bleeding problems. But we don't know as much about it as we as we think. And we don't know much, you know, we don't really know what antidepressants are doing either in terms of what they're actually doing to the brain.

Jennifer Schmitz: 19:19

When you talk about serotonin and sex life, do you are we talking about like high levels of serotonin, low levels of serotonin, or just like disruption in serotonin altogether is bad for your sex life? Like, what do you mean by that when you when you say that?

Joanna Moncrieff: 19:37

Yeah, so so that the evidence suggests that that raising your serotonin or higher serotonin levels of activity is bad for your sex life. Yeah. But there's there's increasing and it's very well recognized that people who are taking SSRI antidepressants in particular, but also other types of antidepressants, have sexual commonly report sexual dysfunction. But it's also now recognized increasingly that some people will have continuing sexual dysfunction after they stop taking the antidepressants. Now, whether that's it seems unlikely that that is to do with persistently high serotonin activity, and more likely to me, in any case, that that is to do with just some general disruption of the serotonin system and possibly other systems. You know, we really we really understand so little about what these drugs are doing. I think the bottom line is these are chemicals that we're putting into the brain. We don't really understand what they're doing, but they can have harmful consequences, as you would expect.

Jennifer Schmitz: 21:27

So when you're talking about an increase in serotonin, just to make the audience understand, the medications don't increase serotonin, they increase the available serotonin in the synaptic gap, right? So it you're not producing more serotonin. The theory is that there's more in the gap to be useful. Is that the is that the correct way to explain this?

Joanna Moncrieff: 21:53

That's yes, that's that's that's what they're designed to do. SSRIs are designed to inhibit that transporter protein. But like I say, they're probably having more global effects than that, I would think, on both a serotonin system and other systems.

Jennifer Schmitz: 22:08

And others, yeah. Well, because you can't get something for nothing. There's always going to be an outcome someplace else. I just wanted to make that clear because there's a lot of people that believe that, you know, an SSRI or an SNRI increases the amount of serotonin molecules that are essentially made in your body, and they don't do that at all. So that's why the happiness chemical thing, like, oh, you're going to make more serotonin, you're not going to make more serotonin.

Joanna Moncrieff: 22:35

But I think it's also really important that people know that we don't the idea that serotonin is a happiness chemical is ridiculous. You know, serotonin is is, you know, an anti-afhrodisiac drug. You know, it's it's a sexual dysfunction.

Jennifer Schmitz: 22:51

Um how how we can distill down there it's it's always odd to me because we try to distill down depression or some type of an emotional health piece into one thing, whether it's serotonin molecule or a genetic SNP, like we we like to be like one thing. I just want everybody to know that we are the sum of the whole human experience. We're not the sum of one molecule or one genetic SNP that's gonna, you know, cause all of this dysfunction. And everything in our body works together. And as Jen always says, the head bones connected to the neck bone, the neck bones connected to the shoulder bone. Like it all, we are all real simple.

Speaker: 23:37

Like we learned it when we were about five. There was a song about it, right? Yes. How long is that? Yeah, I was just, I wanted to add that idea is part of the marketing genius and uh that came to be when psychiatric drugs really, really came into mainstream. The idea that was proposed was that we can, we they did silo this out. They did silo out the idea of we have figured it out. It has everything to do with the serotonin neurotransmitter. It has everything to do with that. And so the narrative that we have been fed started with that and it still continues to this day, which is why I think sometimes when we talk about this, people have such a hard time understanding how it is that your other neurotransmitters in the body are being impacted by a drug that is marketed just as only going to touch your serotonin, because everything is interconnected. This is this is why when you can take these psychiatric drugs, there's year after years, there's so many problems with sexual side effects, metabolic dysfunction, cognitive decline, because it is all interconnected. But the message, the narrative that has been fed for many, many, many years is that it's very siloed. This isn't going to impact your dopamine and your GABA and your glutamate and all these. This is just serotonin, which is markedly inaccurate.

Joanna Moncrieff: 25:14

Yeah. So they've been marketed as magic bullets, which is completely dishonest. And and the reason for that is that the pharmaceutical industry, and I write about this in my in my book, Chemically Imbalanced, I was very excited to find this out because uh I went into the archives of the defeat depression campaign, which was a campaign, a disease awareness campaign run by the Royal College of Psychiatrists in the 1990s. And it was it was clear from the documents in those archives that at that time, because they did a lot of market research, at that time people understood depression and anxiety to be reactions to life events. When when they asked people what causes depression, people said, you know, child abuse, divorce, unemployment, etc. And they didn't say, you know, it's a brain state, a brain chemical imbalance, or it's a genetic disorder or anything like that. And the defeat depression campaign and other disease awareness campaigns set out to change people's mindsets, to persuade people that depression was a proper biological condition and they they needed proper medical treatment for it. That campaign didn't explicitly tell people that it was a chemical imbalance, but that idea was sort of you know in the ether by that time anyway, and being put across by the pharmaceutical industry. And the pharmaceutical industry were particularly keen to persuade people of this idea because in the 1980s the drugs that were most commonly prescribed for people with emotional problems, which were the benzodiazepines, and they had been revealed to cause dependence and really bad withdrawal problems for many people. So they had got a really bad reputation. And they were clearly something, because their effects are actually quite similar to alcohol, clearly something that were just clearly drugs that were just numbing people, you know, zonking people out a bit and drowning, you know, drowning their sorrows as a glass of a few glasses of whiskey might might equally do. And so the pharmaceutical industry wanted between the benzodazapines and their new range of drugs, the SSRIs. And that's why they really promoted this idea that the SSRIs were silver bullets that targeted this underlying process, this you know, this lack of serotonin. So that's where that simplified message comes from, and that's what motivated it.

Jennifer Schmitz: 27:45

There's simplified messages across all psychiatric medications, in my opinion. Another one, and and if you're uncomfortable talking about this, because I know yours is more about serotonin, but even stimulants with ADHD, it's a dopamine problem. So can your theories apply to more than just SSRIs and serotonin? Do they apply to chemical imbalance of any mental health disorder?

Joanna Moncrieff: 28:12

Yes, absolutely. I mean, the the serotonin that the one of the reasons I picked the serotonin theory of depression is it's been, you know, very thoroughly researched. There's a lot of research out there, lots of different studies of different sorts. And other other chemical theories, such as the dopamine theory of ADHD, haven't been as well researched. The dopamine theory of schizophrenia might might have attracted as much research. I've also written about that a few years ago. But but but the but these are these theories are equally flawed. So, for example, stimulant drugs affect most of our neurotransmitter systems. They're not they're not precisely targeted drugs at all. They actually probably have stronger effects on noradrenaline than on dopamine. They do affect dopamine, undoubtedly, but but they also have have effects on other systems. They also they also stimulate serotonin release, for example. I I think that I think that trying to understand drugs in this way is misleading. And it actually it's much better to look at what effects do they produce in people. Stimulants produce effects that do in the short term make people focus on boring material or enable people to focus on boring material. If if you give them at the right dose, if you want too high a dose, I'd be too distracted. But and and and slightly counterintuitively make people again at low doses make people calmer, so change people's behavior. So stimulants for ADHD make people make hyperactive children look as if they're doing better, but they're not having any special effect on the ADHD. They have the same effects in all children, all and and animal studies as well, if you give them it the same sort of dose. And there's there's quite a bit of research that shows that although people will spend more time doing boring tasks, like for example, schoolwork or homework that they don't really want to do, they're not necessarily doing it any better. They don't necessarily achieve any more at the end of the day. They they think they are, at least if if you give adults stimulants, they think they're doing better. But but tests show that they're not actually doing better, even though they do spend more time trying to more time focusing on on these tasks.

Jennifer Schmitz: 31:16

How many when you did this big meta-analysis, how how many research articles did you look at and review to get to these outcomes?

Joanna Moncrieff: 31:28

That's a good question. And I can't quite remember. I think so. Oh. Well, what we did, because there are so many, I mean, dozens, if not hundreds, of research studies on serotonin and depression, what we did is we looked at other systematic reviews and meta-analyses that had already got the research together in all the different main areas of research. So that sort of you know cut the number down a bit a bit. So I think I think in the end we looked at about 17 studies, but they involve thousands of, you know, thousands of patients overall, even though many individual studies would probably have been quite small. So that's how we did it.

Jennifer Schmitz: 32:07

What has some of the criticism been from the studies or from that study in general? What have you what criticism have you received?

Joanna Moncrieff: 32:16

So so the reaction to that study was really interesting, and another reason that I wanted to write write my book, Chemically Imbalanced. And it was interesting because it started off with people saying, Oh, yeah, we knew that. Yeah, we knew there was no evidence for the serotonin theory of depression.

Jennifer Schmitz: 32:33

Um I just have to say this because after it came out in 2022, I remember I was on vacation and I saw it and I was like, oh wow. And then I started looking at it. And all these psychiatrists were like, Well, we already knew that. That's not new information. And I'm like, then what?

Speaker: 32:50

Like, I was what's the basis of your practice then? Yeah, exactly. What what theoretical orientation are you purchasing in then?

Joanna Moncrieff: 33:02

So they said it's not important in in more or less polite terms. And and but but they also said, but it doesn't, but antidepressants work and it doesn't matter how they work. Now I think that's a really disingenuous position. I think it matters profoundly how antidepressants work, and that many of the people who have taken antidepressants, because they were told they had something wrong with their brain, and this drug would put it right, would not have taken them had they been told we have a chemical substance that changes your brain chemistry. It may make you feel a bit numb, that might be useful, but we don't really know about what it's quite what it's doing or what the long-term consequences are, which would be an honest presentation of antidepressants. I think far fewer people would would have decided to take them. Anyway, so that was the first reaction. It's not important, we knew that, but keep taking the drugs anyway. And then there was and then a group of psychiatrists, mostly from the UK, got together to basically try and discredit the paper. They threw loads of accusations at us. You missed this study, you misinterpreted this study, you know the other main things. I can't remember all that. I can't remember all that. Lots of little, lots of little nitpicking part of it. Most of which were completely wrong because the studies they thought we had missed, we had not missed. You know, that they didn't fulfill our criteria, inclusion criteria, yeah. And and and they were very critical of our certainty rating, but we'd never, you know, that was never a sort of big part of the paper. I mean, certainty ratings are, you know, very subjective, subjective things. That's that's well acknowledged. And you know, didn't it didn't affect our conclusions anyway. So so they made sort of lots of uh lots of trivial and mostly inaccurate criticisms, and then concluded there's some evidence for uh a serotonin abnormality and depression. Well, we've never said that there wasn't any evidence at all. What we said is there's there's some evidence suggesting a link, there's some evidence not suggesting a link, and when you put it all together, it you know it's not it's inconsistent and not compelling. So they didn't actually you know uh challenge or or oppose our conclusions. But and and I think the main reason for doing this was to sow doubt in people's minds so that people would go on believing that depression is uh either caused by a chemical imbalance or has some sort of biological roots. And and I think that idea that depression is a biological biological condition is is not only important to the pharmaceutical industry, I think it's foundational for the profession of psychiatry. I think it's become foundational anyway. Yeah. I mean psychiatry actually used to used to be much more concerned with people with you know people with psychosis and those sorts of conditions, but but now many psychiatrists, you know, only see outpatients, and most people have depression or anxiety or those sorts of problems. And so this idea that it's a biological condition and that there are legitimate biological treatments is important for psychiatry's sort of identity, I suppose. Right. So I think, you know, I think this paper was striking at the heart of that because uh I mean another reaction, another reaction when the paper was published is oh yeah, of course we knew it wasn't serotonin, but but it could be this, it could be inflammation or or it's this or it's that, you know, loads of other sort of biological theories were hurled out there. Again, I think to to keep people believing that there is some biological origin to depression. And sorry, lost my thread now.

Jennifer Schmitz: 37:05

I was all I was thinking of was just imagine if all the people who critiqued this research would could critique the research that's put out by big pharma in the same way. Just imagine if they would do that, then maybe we wouldn't be here where we are stuck in this big pharma world when it comes to mental health care. If if they were that critical here, like take that critical thinking in research and apply it to why you prescribe in the first place, like to the actual med that you're prescribing. Go critique some of those research studies that are so short and so flawed, but you're not doing that. You're you're critiquing somebody else who's bringing something different to the table, like, hey, we need to think through this, you know, very differently. Just imagine the world we'd live in if there's actually this type of critique where it where it belongs.

Joanna Moncrieff: 37:57

Yeah, it was I I think we we would be using far, far fewer psychiatric drugs if we had that sort of thorough critique of the of the evidence base. I think we'd be much more open about the possibility of of harmful effects of these drugs. I think the problem is that psychiatrists definitely desperately want to be able to offer people something medical. And part of that comes from a good place. I should acknowledge that. You know, part of that comes from the fact that they want to help people, you know. Therapist, you have the same experience, you know, they're desperate. And the idea that you can give them something nice and simple like a pill, is obviously really appealing, both for the both for the psychiatrist, the prescriber, and for the you know, the person themselves. The problem is life is not that simple. And not only are you giving something, not only are these pills ineffective or very minimally effective at best and harmful, they are also and biologically harmful. They are also giving people a message that what they're experiencing is out of their control. And we know that if you tell people that depression is caused by a chemical imbalance, they are more pessimistic about their chances of recovering of recovery, and they they have less belief in their own ability to help themselves. So, yes, you know, it it's I I'm I'm doing what I can to try and set the record straight so that people understand how how little we know about these drugs, how ineffective they are, and you know, all the harmful consequences that can come from using them, particularly if people, you know, when people get stuck on them for long periods of time.

Speaker: 39:52

So, as a practicing psychiatrist, Joanna, one, I would love to be a fly on the wall to hear an actual real informed consent conversation because I'm going to guess for you that goes into detail when we are talking about risks and benefits and alternatives. One, I would just, I'd love to be a fly on the wall for that. But but two, do you how do you how do you maintain a practice as a psychiatrist? And do you bring in a lot more actual patients time, letting people sit with their pain before it gets medicated, almost like a very much so of a counseling role. Have you found that you bring more of that in?

Joanna Moncrieff: 40:34

So so I mean, I work in the NHS in the UK, in in a team, in a mental health team, and most of the people that come to me are already taking antidepressants or some sort of psychiatric medication because they they've been prescribed by their general practitioners. Not absolutely everyone, but but most people. So I'm usually in the business of seeing people whose antidepressant hasn't worked and explaining to them why it hasn't worked and how this you know chemical approach to treating depression is not effective and it's based on ideas that haven't been supported by scientific evidence, and then and then helping them to decide whether they want to try and come off their antidepressant, or maybe that's it's not the right time for them to do that, but thinking through with them what other sorts of things they can do to help improve their mood and improve their situation. And that brings me back to something I wanted to say actually to one of your comments earlier. So you know, this this idea that depression is in the brain, you know, it is is to my mind a fundamental misunderstanding of what it is to be depressed, to have emotions, to have feelings, whether they're good or bad feelings. Emotional states, including moods like depression, are by definition reactions to circumstances of people, of whole people, of individuals, not of brains, but of people who have personalities that have been formed by you know all the experiences of their individual lives and who have values. You know, what we what makes us happy and what makes us sad depends on what we what we like, what we love, what we value, what we care about, what we want, you know, what we aim for, what we hope for. All those aspects of our personality feed into our emotional reactions to what's going on in our lives. And therefore, you can't possibly find depression in the brain. Depression is a property of of people, of full human beings with their their life history and their circumstances and their and their richness.

Jennifer Schmitz: 42:47

I love that. I I really appreciate you saying all of that, because I think again, we distilled down the idea of humanity. We can't we can't pill our way out of the human experience, which is what we're trying to do. I I find very big similar similarities as you did between the mental health world and the addiction world, too. It's it's a very similar conversation, you know, addiction world, it's it's a biological medical problem that needs a medical solution. Same thing with mental health. It's a biological medical problem that needs a medical solution. And I think both of them are just problems with humanity and existence, you know, if we want to get deeply philosophical today. But I think that that's what it is. And as a society, we're just we're not that deep right now, nor do we want to be that deep. We just want to not feel. And so I think there are very big similarities between the addiction world, who everyone would agree they don't want to feel, which is why they are using substances. But when it comes to mental health, you use substance because you have a broken brain. Well, I think you use it because you don't want to feel, because you're not going to feel positive or negative emotions. And I don't know that there are any exceptions to that. I think people just don't realize how much they don't feel when they're on medications. I really don't think there's many exceptions to that rule that you will be flatlined or new in living in a neutral space. Like the pleasure principle of life is huge, and this these meds take take that away from you. They take away your humanity, in my opinion.

Speaker: 44:29

This is actually a great segue into something, Joanna. We wanted you to talk about. There is the drug-centered model, right? And then there is something that you have come up with. Uh, which is you do talk about this in your in your book, which is a little bit opposite of some of this. Can you sh can you share that with us?

Joanna Moncrieff: 44:51

So my models of drug action work. I think I I think I covered that at the beginning.

Speaker: 44:56

Okay. Well, I was thinking about this idea of like how you you you discuss what the drug-centered model is, but here you're talking, and Terry, you guys are talking a little bit more about something that is so much bigger than that in terms of what is influencing, influencing us. And so to say that it's just in the brain, right, is actually grossly inaccurate to say that a depression is a state that is simply in the brain, and to not actually look at the idea of somebody's whole story, to look at the idea of somebody being taught to listen to themselves and to have some agency, so to say, about their care and their choices that they're making. And you you do speak a little bit about this in in your in your book, and it's just being this opposite of what we do, at least here in our Western medicine model, of everything going around there is a sickness, there is an illness, there is a medical-based issue that then leads to the drug. Yeah, yeah. Versus the flip opposite of that, which is what you're talking about here.

Joanna Moncrieff: 46:04

Yeah. So so I so I I describe a few, you know, a few people who who spoke to me about their experiences of being told that they had a chemical imbalance when they were going through a bad period of life. One one of them, you know, describes how initially that was that that was positive for him. And he thought, oh, you know, thank goodness, now I now now I know what's wrong with me. I just need to take this pill, I'll feel better. Took the pill, felt a bit better for a week while he, you know, while he was still buoyed up by by that idea that something would make him better, and then realized actually it wasn't making him better. And then he felt even worse because he thought, oh my goodness, I'm I'm you know, I'm a non-responder. I'm you know, there's I'm not only have I got treatment resistant. Exactly. I've got a doubly bad chemical imbalance, you know, that doesn't even respond to the drugs. So then, you know, got really despondent and and hopeless. And you know, I I I see this clinically a lot of people who've bought into this medical view, and it's just actually making them more and more depressed because because they they've lost their agency, they no longer believe that that there's anything they can do to get out of it. And and and so so yeah, you know, I I think that's a really good point. And and and Terry's point about the similarities with the addiction world, I also think is is really interesting. I've I've worked in addictions quite a lot in the past. And you know, that if addicts, you know, addicts that they, you know, if they can't get hold of their heroin or their drug of choice, they'll they'll take whatever prescribed drugs are on offer, particularly if there's someone who likes opiates, they particularly like the more sedating prescribed drugs. And and I I remember a few who would even take prescribed haloperidol, which most people find to be a very unpleasant drug. It's a drug that's used, was used very much anymore for people with psychosis generally. And and there have been a few volunteer studies of it where people have described it as being a very unpleasant experience. But but people with addiction are looking for chemical means to remove, you know, to change their normal reality, desperate, desperate not to not to have to feel normal and will even, you know, will take whatever chemical they can to change their mindset. And and that and that's you know, and that's what we're doing to people when we prescribe antidepressants and other sorts of pills. You know, we're changing people's changing people's mental states, dining down their emotions. That may be appealing for some people who just think, oh no, I, you know, just can't can't manage to to feel this.

Jennifer Schmitz: 48:55

Well, and in doing in doing that, we're telling them that we don't believe that they can manage their emotions by themselves.

Joanna Moncrieff: 49:01

Yes, yes, yeah. So exactly. That's a good point. Yeah, yeah. So we're not even really enabling people to see if they can get through. Right.

Jennifer Schmitz: 49:08

Therapist, too. I think when we were talking right before the set the I called it a session. That's funny. Uh not a session. I know. We were talking before this, and you know, I said, I think I said something like therapist fear often moves people into, you know, go see a psychiatrist because I'm afraid that you can't handle your emotions, and I'm afraid of your emotions. So I'm gonna, you know, send you off to get medication. And so that gives the person a clear thing, my emotions are too much. You know, even my therapist is afraid of them and thinks that I need medication and I can't possibly survive without, you know, medication. But the obviously the obvious difference is one is, you know, an illegal drug and the other one is a prescription that somebody says you need. Both your dealer and your prescriber are telling you the same thing. You need this to survive, right? People are gonna hate me for talking about this comparison because the mental health world wants so badly to separate themselves from the addiction community, where I think there are so many parallels and similarities. And I think we need to have more conversations that are that are more inclusive of each other because they've both been treated the same way. You know, same thing with addiction. When you come off of something, odds are you're going to be put on pharmaceuticals instead. But that is appropriate. That is okay. Just the illegal drug is not okay.

Joanna Moncrieff: 50:37

You know, I mean, I think you can make an argument that the dealer who sells you your heroin or whatever it is is actually more honest than the doctor who's giving out antidepressants because at least they're, you know, then they're not telling you that this is going to target some underlying chemical imbalance or something wrong with your brain. You know, it's quite obvious that they're giving you this because it's going to zonk you out, you know, enable you to forget whatever it is you want to forget temporarily. And and and yet the doctor is, or doctors have been for decades telling people that they have an underlying brain problem, that it's their brains that are wrong, and that these drugs are just nice, benign little substances that are going to put that right, which and omitting a lot of information.

Jennifer Schmitz: 51:22

Yeah, they don't they omit so much information because when you're a client going to somebody, all they tell you is the the benefit, you know. And if you ask if there's a risk, it's like, well, it's small, or it's the or it's just brushed off, right? So the I'll call it lying through omission is what we would say. Like they're not, they're not giving you the entire truth. I had this just reminds me a quick little story. I I had a client years ago in the prison system, and on the streets, he was called the pharmacist because he knew exactly what to give people and how much a person needed as far as their dose of illegal drugs that wouldn't kill them. And he knew they wanted him at parties because he knew what to do in case you actually did overdose. And I'm like, this is mind-blowing to me. Like, this is he he was more informed consent than you know, a prescriber of psychiatric medications. Crazy. It was it was nuts. And I was like, that's that's bizarre to me. Anyway, that's the story that came to my mind when we're talking about all of this.

Joanna Moncrieff: 52:26

True, and and it is it is tall that prescribers of psychiatric drugs know so little about what they're prescribing. And that is because of this obsession with this idea that you know what they're doing is targeting some particular system, some particular receptors, or something like that, rather than acknowledging that you know, these are psychoactive drugs that are, you know, probably disrupting all sorts of aspects of your brain chemistry. You know, but there's just not been enough interest or you know, there's there's been a complete blind spot to understanding what psychiatric drugs really are, that they are drugs, they're mind and they're brain-changing drugs.

Speaker: 53:05

You speak, you speak to this idea, Joanna, in an article that you and Mark had written not too long ago that came out this past summer, and it was about antidepressant withdrawal. And you specifically talk about this idea in in in this in the article when you went through and actually laid out some of the information on long-term users of antidepressants versus shorter-term users of antidepressants, right? You were differentiating between like someone who is using an SSRI for say six months versus someone who's been on it for over two years. And this idea that is still not acknowledged. It's very minimally acknowledged in the psychiatric community. And I think Terry and I, as deprescribers, we we get the back end of this because patients are coming to us and people are coming to us to say, help me get off of this. Because the advice I've been given is cut it in half, take it every other day, after a few weeks, after two, three, four, five decades of use, you'll be able to come off of it. And so you speak to this idea. And I and it's it's just going to back to something that you were saying about what psychiatrists actually don't know. But I would argue that there is enough literature out there and subjective experience to actually take this idea if you combine them and go the model of telling clients to just go off something after a couple of weeks after long-term use is grossly dangerous.

Joanna Moncrieff: 54:33

I I think that's such a good point. I mean, another major blind spot has been about the fact that antidepressants produce dependence, physical dependence, and withdrawal symptoms. And I think psychiatrists have just found it very difficult to acknowledge that a drug that they've been dishing out very commonly actually can have, can quite commonly have these, you know, really serious, really significant adverse effects. And the paper you referred to, we we studied people who were actually attending an NHS therapy service but who were also using antidepressants. And we found that people who had been using antidepressants for more than two years very commonly reported significant withdrawal symptoms and significant difficulties trying to come off antidepressants if they'd tried. In fact, I think about 80% of that group of people who'd been taking for more than two years couldn't stop, or tried to stop, but couldn't stop their antidepressants. People who'd taken them for only six months much more, you know, didn't didn't frequently report withdrawal. So so dependence and withdrawal symptoms are a common complication of long-term antidepressant use. I think that's what needs to be emphasized. And psychiatrists have also had this idea not only that dependence is not common, but that it's you know, if it happens, it's trivial, just a few weeks of you know mild symptoms. And, you know, again, we're seeing that that's not the case for many people. It will be for some people, it will be for some people, but many people actually will experience really significant symptoms for you know at least a few weeks, often a few months, and sometimes for years during or after they've stopped taking antidepressants. And you know, some people uh get into a really you know, really severe state, often if they've cut tried to come off antidepressants too quickly, where you know they get really bad symptoms, that they can often be bedbound, they can't work, uh you know, that they they have electric zaps, dizziness, brain fog, fatigue, insomnia, all sorts of symptoms, severe anxiety, which is probably, I think, a rebound. You know, the drugs have been suppressing people's emotions, and then suddenly you get a sort of surge up of emotions when you come off them. So, yes, withdrawal symptoms can be really significant, and it's really important that people are supported to come off these drugs, help slowly and carefully, and given support with this emotional rebound as well, which I think can be can be really difficult for some people.

dr Teralyn Sell: 57:11

Yeah.

Jennifer Schmitz: 57:12

I just want to thank you for as particularly that research article, that article, because it it validates so many lived experiences that have been dismissed. So I think that was a pretty profound article. I do have a final question for you. If research doesn't change the minds, so we live in this age of like evidence-based practice and research this and research, and here you have like this huge research base and this huge research article that didn't change minds. What do you think would change the narrative around psychiatric medications? Do you have any thoughts?

Joanna Moncrieff: 57:54

I mean, that's that's such a good question and a difficult one to answer. You know, not not I I mean, I think, I think our 2022 paper has changed things a bit. I think that you know, I think it did get through to to some people, not to everyone, but I think it did get through to some people. So it was quite widely publicised at the time. So I think that's changed things somewhat. I I I mean it reminds me of, you know, I've been I've been highlighting how ineffective antidepressants are for a long time, as well as my work on drug models. And every time I I produce another paper on this, I did I produ published one recently on the amplified placebo effect, you know, showing that people in these placebo-controlled trials of antidepressants that supposedly support the efficacy of antidepressants, actually they're not double blind. And you can show that people who guess they're on antidepressants because they get some side effects or something do better because that because of their guess rather than because of what they're actually taking taking. I thought that I hear at last we've got a paper that really shows these are ineffective and no one takes any notice. And they go on, you know, proclaiming how effective they are and how they save lives, and you know, of course they're very useful for people. So how do we how do we change that? I don't know. I don't know apart from you know just carrying on as we are. I mean, I suppose things don't, you know, things don't change quickly and it's always frustrating, but you know, I've lived through the rise of social media and we're in a so much better position now to get you know to get our voices heard than we were 10 or 20 years ago, certainly 30 or 40 years ago. You know, it's it's much easier for people to to find ideas that are maybe not reflected in the mainstream, to read up the research for themselves, you know, a lot of uh a lot of evidence is now open access, so everyone can read it. That's absolutely great. So, you know, I think eventually that that will change things. And I feel I feel now that for for most people, you know, for people who are reasonably inquisitive and prepared to sort of go and do a little bit of their own research on the internet, they can find yes, they they can find the evidence-based information about depression and antidepressants if they're looking for it, which would not have been true, you know, 10 or 20 years ago.

Jennifer Schmitz: 1:00:24

Very true, very true. Well, if you've hung out with us so far, we are here with Joanna Moncrief, and we are so happy that you came on here sharing this information with us and with our listeners. And if you are listening, please make sure you like, comment, subscribe, and share your Gaslit Truth stories with us at the Gaslit Truth Podcast at gmail.com. Thank you so much, Joanna, for being here.

Joanna Moncrieff: 1:00:49

Thank you, Joanna.

Jennifer Schmitz: 1:00:50

Thank you.

Joanna Moncrieff: 1:00:51

Thank you, Terry, thank you, Jen. It was a great conversation. Enjoyed it, and thank you for your work. Thank you very much.

Speaker: 1:00:56

You bet.