Rethinking Depression & The Serotonin Myth: Professor Joanna Moncrieff

CAUTION: If you are taking antidepressants or any other psychiatric medication, do not stop or adjust your dosage without first consulting a qualified healthcare professional. Coming off medication without proper guidance can lead to withdrawal symptoms. 

In this episode we’re joined by Professor Joanna Moncrieff, psychiatrist, researcher, and author of Chemically Imbalanced - a bold book that challenges one of modern medicine’s most accepted beliefs: that depression is caused by a “chemical imbalance” of serotonin in the brain.

We saw Joanna on Dr Chatterjee's Feel Better, Live More podcast and really hoped she'd agree to come onto ours - which she thankfully did!

In the UK alone, antidepressant prescriptions have almost doubled in the past decade – from 47 million in 2011 to 85.6 million in 2022–23. That’s over 8.6 million adults now taking them each year.

But what if we’ve been sold the wrong story? And what are the real effects of these drugs - especially for those of us navigating the complex emotional terrain of midlife?

In this episode, we explore the truth about the “chemical imbalance” theory, what psychiatric drugs actually do to the brain, the long term potential dangers, and what you can do to support your mental health without relying solely on medication.

Get ready for an eye-opening conversation that could change the way you think about mental health and what really drives healing.

Chemically Imbalanced: The Making And Unmaking Of The Serotonin Myth:

https://www.amazon.co.uk/Chemically-Imbalanced-Making-Unmaking-Serotonin-ebook/dp/B0DHV5LJX8/

Ibiza Retreat: https://themidlifementors.com/retreats/

Transcript

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The Midlife Mentors: Hello, and welcome to another episode of the midlife mentors with me James and me, Claire. So we're actually recording quite a lot of interviews back to back. And we're doing quite a lot of our own podcast back to back. So we don't really know what to update you on, because we don't know what timings these are going to be going out on. But yeah, by the time you listen to this, I should. I should have met up with my school friends and gone paddle boarding up the upper reaches of the Thames. Oh, my goodness, yeah, yeah.

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The Midlife Mentors: let's hope that all goes well. It doesn't look like it's going to rain. So yeah, I don't know what state you'll come back in. It'd be nice to have a day to myself. It will looking forward to that.

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The Midlife Mentors: Anyway. Today we've got a really fascinating subject to explore. And I something that will really resonate with you listeners because we do live, I think it's fair to say, in in a pandemic of anxiety, if not depression. At the moment in the modern world we know that mental health stats are going the wrong way. We seem to be facing an influx of increasing mental health problems, increased anxiety.

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The Midlife Mentors: depression, and

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The Midlife Mentors: we thought we'd get the most fascinating guest on to really deep dive into this. So so we came across her actually from Dr. Chatterjee's feel, better, live, more podcast and

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The Midlife Mentors: we were just fascinated, and we thought we'd love to get her on love to get her on, and I reached out, and we have. So I'm really thrilled when he said, she agreed. I was like Yay, brilliant, really thrilled. We have on Joanna Moncrieve, who's a psychiatrist, academic and author of the book, chemically imbalanced the making and unmaking of the serotonin myth.

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The Midlife Mentors: which, of course, obviously is all about depression and serotonin.

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The Midlife Mentors: Joanna welcome, and I mean I just can't wait to dive into this. Did you just want to tell our listeners a little bit about yourself and and your work, how you got into this.

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Joanna Moncrieff: Yes, hi, James! Hi, Claire, thanks for having me on. So I've been interested. I'm a psychiatrist. I work with people who come in and receive diagnoses of anxiety and depression along with other things, and I've been interested for a long time in the fact that the majority of people in that situation get prescribed some sort of medication.

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Joanna Moncrieff: frequently an antidepressant, and it's always seemed to me that in many cases this misses the mark, and we're not really treating the

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Joanna Moncrieff: the real problem. And so that led me to sort of really ask questions about what we're doing. Does the use of this medication work? What does it actually do? Is it good for us? Is it bad for us? And what's the history of it? How have we come to accept so unquestioningly this idea that we should and can medicate unpleasant emotions away.

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The Midlife Mentors: I love that because I think the title of your book there chemical imbalance, because the popular theory, I guess, is that depression is caused by insufficient levels of serotonin or feel good hormone, and that is, that's kind of the story that most people believe, and most antidepressants correct me if I'm wrong work by increasing increasing serotonin levels. But you're actually

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The Midlife Mentors: questioning all of that in your, in your book and your approach.

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Joanna Moncrieff: Yes, I am. So I started writing the book, because in 2022,

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Joanna Moncrieff: together with some colleagues, I published a paper on the evidence for the links between serotonin and depression. And we looked at all the different areas of research that have happened over the last few decades and basically came to the conclusion that none of these areas of research show evidence that there is a link, any sort of link between serotonin and depression, let alone

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Joanna Moncrieff: substantiating the idea that serotonin is caused by a lack of serotonin. The depression is caused by a lack of serotonin.

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Joanna Moncrieff: and that paper

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Joanna Moncrieff: got a huge reaction. Lots of people in the media and members of the general public were surprised, stunned, shocked, to find out that this is the case.

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Joanna Moncrieff: But I was aware that a lot of the a lot of people in the psychiatric and mental health community, and and particularly academics and researchers, had known this for a long time had known that the evidence didn't really stack up, but

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Joanna Moncrieff: it seemed that at some probably subconscious level they had maybe wanted people to carry on, believing that this was the case because they wanted people to carry on taking the medication and not to worry about it too much. And of course, if you.

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Joanna Moncrieff: if you highlight that we don't know that there's any link between serotonin and depression, you're then immediately highlighting that we don't know what antidepressants are doing. You say that most antidepressants work by increasing serotonin?

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Joanna Moncrieff: Certainly a lot of them affect our serotonin system in some way. The Ssris in particular, probably do increase serotonin activity for a short period. But over the long term we're really not even sure what they do to serotonin. They may even lower it. There's some evidence. They may even lower our serotonin levels. They're certainly disrupting our normal serotonin system in some way.

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Joanna Moncrieff: but we don't understand the consequences of that very well. In fact, probably the

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Joanna Moncrieff: probably the main effect that we know is associated with the serotonin system is our sexual functioning, and of course it's well recognized that some antidepressants, particularly Ssris.

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Joanna Moncrieff: impair sexual functioning in various ways.

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Joanna Moncrieff: some of them, even in some cases it even seems that that effect persists after people stop taking the medication, which is obviously very concerning, but other than that effect on sexual functioning. We really don't understand the functions of serotonin very well at all, and all the evidence that it has something to do with mood, or even with cognition and behaviour, is very weak and inconsistent.

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The Midlife Mentors: I mean, that's fascinating, I mean, I guess my 1st question off the back of that is is, how did we end up in this place with it being, I guess, commonly accepted that

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The Midlife Mentors: a chemical imbalance is what causes depression like, I mean, that is the mainstream. If you ask the average person in the street, they'd be like, Oh, yeah, it's probably due to a chemical imbalance in the brain, something to do with hormones. And also that serotonin is is our happy hormone, and it's.

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Joanna Moncrieff: Yeah, yeah.

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The Midlife Mentors: And it does all these things. It's just been taken as red. So how did we get there?

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Joanna Moncrieff: Yes.

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Joanna Moncrieff: it's all over the Internet. That idea, isn't it? Yeah. Serotonin moments people talk about, don't they? And post sort of happy pictures of them doing nice things. So how do we get there? That's a really good question. So the idea that depression might have something to do with serotonin was 1st

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Joanna Moncrieff: 1st formulated back in the 19 sixties by psychiatrists who were experimenting with different sorts of drug treatments for depression, anxiety, and schizophrenia and bipolar disorder and other mental health problems, and there was a lot of sort of interest and fascination in

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Joanna Moncrieff: what drugs could do at that time, and it was very speculative, but some people suggested that maybe some of the antidepressants might be working on the serotonin system. Therefore

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Joanna Moncrieff: depression might have something to do with serotonin.

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Joanna Moncrieff: even though it wasn't terribly clear that the antidepressants were actually very effective or beneficial at this time, as it still isn't, we'll come on to that. So this idea was sort of knocking about. In the 19 sixties. In the 19 seventies the American National Institute for Health Research commissioned a big project to look at whether there were links between brain chemicals, including serotonin, also noradrenaline and depression, and

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Joanna Moncrieff: they published a number of papers from that project in the 19 eighties. They never published anything that showed any links that people with depression had any abnormality in any of these brain chemicals. So I think it's very likely that they didn't find anything, because that they were certainly looking for it.

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Joanna Moncrieff: So really the idea was starting to fade away in the 19 eighties, and then it was revived by the pharmaceutical industry when they launched their new range of products called the Ssris. In the late 19 eighties and early 19 nineties. The 1st one of these, of course, being Prozac, otherwise known as fluoxetine.

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Joanna Moncrieff: which was a major bestseller, and from the beginning those drugs were marketed as correcting a chemical imbalance. This idea that depression is caused by low serotonin, and these drugs are going to come in and correct that deficiency was part and parcel of that marketing right from the beginning, even though at that stage

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Joanna Moncrieff: there was 0 evidence, or very little evidence, that that was that that was a factual, the supposition

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Joanna Moncrieff: so. So the idea that we have has been created by the pharmaceutical industry. They put out loads of

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Joanna Moncrieff: advertising in the Us. They did direct to consumer advertising. There were advertisements on the television, you know, telling people that depression was due to a chemical imbalance illustrating that in a famous advert by a little sort of gloomy looking blob that crawls around, and then, you know, then brightens up when it gets some, when it gets some

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Joanna Moncrieff: sertraline and

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Joanna Moncrieff: and other things, and the psychiatric institutions also reflected that message and included it in information to the general public, told people that depression was, or often they would say, might be caused by a chemical imbalance, but this was repeated so many times that people lost the might be, and it was never explained that actually it might be, but we don't have any evidence to suggest it is

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Joanna Moncrieff: so it became. It became a well accepted fact. People believed that this was not just a theory, but there was something that has been established, and that's why people were so shocked, I think, when we published our paper in 2022 that told people this was very far from being a scientific fact, and you know the evidence was all over the place, and really not at all convincing.

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The Midlife Mentors: Wow!

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The Midlife Mentors: I mean to some of our listeners. This is gonna be the 1st time that they've heard this. It's not the 1st time that James and I have heard this, but I hope that when you're hearing this your eyes are being as open as ours are, I mean, because, like you've just, said Joanna. It has been taken as absolute fact and read that that is the truth. The truth. Yeah.

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The Midlife Mentors: I have to say it's very, very brave of you and your colleagues to have come out saying this, thank you, is what I really want to say, because I know, before we just came online. I shared with you

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The Midlife Mentors: that when I went through my divorce, when I was about 31, I was put on antidepressants

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The Midlife Mentors: like straight away. And when you're in that state mental state, you're not really open to questioning. What's what? A doctor! What a Gp. Who has your health

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The Midlife Mentors: at the top of his that his agenda. So you think

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The Midlife Mentors: he's giving you so you don't really question it. So I was put on antidepressants, sertraline. So I was taking antidepressants. But I didn't feel. I remember, when I started taking them. I didn't feel comfortable, but I was so anxious, so depressed, that I was willing to kind of pretty much do anything to get myself through that really tough time.

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The Midlife Mentors: But the effects I had from it were very clear very quickly, and the negative implications I had from it were very clear very quickly. And so I went about doing my own research around what might be an alternative to help me through this anxiety and depression. That's when I turned my career around. So when I got involved interested in nutrition and exercise for the 1st time properly in my life, and

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The Midlife Mentors: that became my passion because I came off my antidepressants after about 6 months.

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The Midlife Mentors: The withdrawals that I had from those antidepressants was horrific.

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The Midlife Mentors: and only being on them for 6 months. And it's honestly it's why I do what I do now with all the nutrition and the personal training and stuff, and I just want to say Thank you, because I've been. Say, I hadn't understood it in the way you've just explained it, but I felt it intuitively that it wasn't okay for me to be on these, that I wanted to find a natural way of coming off them. And I've spoken about it online before a little bit, and I've been slammed for it myself.

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The Midlife Mentors: So it's a roundabout way of saying Thank you for putting this out there honestly, because it is very brave, and I would like to know, we would both like to know.

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The Midlife Mentors: have you had any backlash from your profession, from the pharmaceutical companies? And how have you handled that.

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Joanna Moncrieff: Yeah, thank you. That's a really good question. But be before I answer it, just let me say I'm really glad that you mentioned that about. You know there might be some listeners who are hearing this for the 1st time.

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The Midlife Mentors: Yeah.

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Joanna Moncrieff: And I can understand that it might be, really, you know, upsetting as well as shocking to to hear this. That's why I'm really pleased that I'm speaking in the context of your podcast where you help people to think about other ways of keeping healthy. And you know enhancing your enhancing and improving your mental health. So I think that's just important to say. And yes, I had a lot of backlash when I published the paper.

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Joanna Moncrieff: including people telling me, both members of the public and my colleagues, that I should not have published the paper.

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Joanna Moncrieff: and that I certainly shouldn't be publicising it because it was just going to be too difficult for people to hear, and it might put people off

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Joanna Moncrieff: going and seeking help if if they were depressed. And and so I you know I do acknowledge this is a difficult message, but

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Joanna Moncrieff: you know I still think you can't not tell people.

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The Midlife Mentors: No.

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Joanna Moncrieff: The scientific truth, especially when people have been so badly misled for so long, you know. So I am not telling anyone that they mustn't take antidepressants, or that they need to instantly come off them. In fact, I would definitely say, don't you know? Just go and throw them down the toilet. It's really important. If you do decide, you want to come off them, that you do that slowly and carefully, to avoid the

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Joanna Moncrieff: severe withdrawals that some people can get as you illustrated Claire. Not not necessarily everyone who's been on them for a short period, but

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Joanna Moncrieff: certainly people who've been on them for longer. It's quite common to get some withdrawal symptoms.

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Joanna Moncrieff: So so I'm not doing this to tell people what to do. But I want people to be able to make informed decisions about whether they want to take medication, to deal with various forms of distress, and whether they want to stay on medication. If they already are. I think people deserve to have that information so they can make up their own minds.

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Joanna Moncrieff: And and and also to add

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Joanna Moncrieff: to something that you said so. I was talking about how the pharmaceutical industry, you know, really created this idea. Not only that, but they actually suppressed our previous understandings of what depression and anxiety consist of.

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Joanna Moncrieff: So I went and looked at the archives of a campaign called the Defeat Depression Campaign that was run in the 19 nineties to increase awareness of depression and to encourage people to come and get treatment, and that was often

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Joanna Moncrieff: antidepressant treatment for depression. And as part of that campaign. They did some market research in the early nineties, and they found that at that time people felt that depression was not caused by a chemical imbalance or some other

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Joanna Moncrieff: biological abnormality. They thought it was caused by divorce, unemployment, child abuse, things that were going on or had gone on in people's lives, and they thought that taking drugs to deal with depression was not a sensible thing to do, that it would cloud people's minds and make them dependent, and the pharmaceutical industry.

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Joanna Moncrieff: including in that campaign, deliberately set out to basically suppress those ideas that people had, and to make them think, instead of depression, as a medical condition that could be, and should be treated in a medical way.

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The Midlife Mentors: Wow, I mean, I'm not. I'm not surprised by that sadly, because we know the kind of I guess the reputation the pharmaceutical industry has for pushing an agenda

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The Midlife Mentors: on occasion to look at the profit margin. Right? But yeah, it's shocking, because I was. My questions is, you know, if if depression isn't due to a chemical imbalance, what is it? And you've kind of answered that it's what we'd expect right lifestyle factors. If you live in a really horrible environment if you're being beaten down every day by life, if you're going through a divorce, if you had trauma when you were oh, yeah, all these things

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The Midlife Mentors: cause depression. Right? So it's more likely lifestyle events and emotion and emotion, emotional trauma.

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Joanna Moncrieff: Yes, I mean, our emotions and moods are by definition reactions to what's going on around us, you know. That's that's what emotions are. They're, you know their features are of

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Joanna Moncrieff: the intelligent beings that we are that react to our circumstances. And of course, you know, people are different. So some people feel emotions more intensely than others, and some people will react to something that other people won't react to. Of course there is. There is that variety, and some people will struggle with anxiety or low mood.

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Joanna Moncrieff: partly because that's how they are, partly because probably of what you know what's happened to them in their their upbringing and things like that. But that doesn't mean that that doesn't mean that medicating them is the right approach. I would always say that we need to deal with emotions as we would normally think we should deal with emotions. We need to

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Joanna Moncrieff: remove the cause of our anxiety and depression as well as doing things that can generally make us feel better.

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Joanna Moncrieff: You know, exercise eating well, etcetera.

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The Midlife Mentors: Well, I also think that we are in a society where we're where we're offered so much distraction from our emotions. We're almost like not taught. We don't.

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The Midlife Mentors: We've been separated from that ability to

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The Midlife Mentors: be resilient around our emotions, to feel them, to know that it's okay to feel them, to know that life is going to go in waves and peaks and troughs where there's going to be some intense emotion, and but we just run away because it's easy to, and we're distracted. And then we have pharmaceutical drugs.

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Joanna Moncrieff: Yeah.

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The Midlife Mentors: That that we think are are going to help.

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Joanna Moncrieff: Yeah. And and one of the things antidepressants do is is numb emotions a little bit. And and so, and for that reason, particularly if people get put on them early in life, they they often don't learn to manage their emotions because they're, you know, they're being suppressed. And and then often when people come off antidepressants, they get this sort of huge resurgence of

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Joanna Moncrieff: even stronger emotions than they would normally have had, because they've been, you know, dampened down for so long.

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Joanna Moncrieff: And that can you know, that can be really difficult for people to deal with, especially if they've been on these drugs for a long time, and haven't got used to. You know what it feels like to feel sad and anxious and distressed.

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The Midlife Mentors: Well for me. Just numbing of my emotions was absolutely what I felt, and it was almost pretty immediate, quite odd, actually, to go through that process, and also very reckless.

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The Midlife Mentors: So that's that's what I experienced. So.

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Joanna Moncrieff: That's really interesting. A lot of people say that that because their emotions are numb, they sort of become a bit disinhibited in a weird way, because they're not having the sort of normal feedback mechanisms that your negative emotions might, you know, might have on you sort of restraining. Oh, gosh, no, that's probably not a good idea that might make me feel feel bad or ashamed, or make someone else unhappy. Yeah.

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The Midlife Mentors: Yeah, well, thank you for saying that. But I mean, I understand this looking backwards now that that is kind of something that's quite normal. But again, I just

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The Midlife Mentors: for people listening to this that might be experiencing this, podcast. Is always really, I hope to help people understand themselves a little bit better. So if you are on them. That's what I experienced was this numbness like numbness, but also a reckless.

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Joanna Moncrieff: Yeah.

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The Midlife Mentors: Abandon almost because there was no feedback loop like you were saying.

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Joanna Moncrieff: Yes, yeah, yeah. So I think so. This is one of the important points that I've tried to get across to people in my books and papers that I've written before. And this is this is to highlight to people that

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Joanna Moncrieff: this idea that drugs, like antidepressants, correct a chemical imbalance, or some other biological mechanism, because, of course, as soon as we said, you know, there's no evidence for the serotonin theory of depression. People popped up with lots of other possible biological mechanisms that might be related to depression.

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Joanna Moncrieff: There's no evidence that antidepressants act on any underlying mechanism. There's no evidence for any underlying mechanism, whether that's biological, whether that's serotonin or anything else or not, no evidence, but no compelling evidence. There's always one study or another.

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Joanna Moncrieff: Saying something. So

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Joanna Moncrieff: so this idea that drugs work by correcting some underlying mechanism is really not supported by scientific facts. But what we do know is these are drugs, and they're drugs that enter the brain. They change the normal state of the brain, and therefore they inevitably change our mental states and our behaviors in more or less subtle ways, and depending on the individual sensitivity to them, of course.

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Joanna Moncrieff: So you know, this is just like alcohol. You know. We know that if we have a drink of alcohol, we feel different. We behave differently, and it's pretty dramatic and obvious. If you take an antidepressant, the effects are generally more subtle than alcohol, and I'm not saying they're exactly the same as alcohol, either. These are different drugs. They have different sorts of effects.

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Joanna Moncrieff: But, as I said, emotional numbing is one of their well recognised effects as well as, for example, people often feel a bit lethargic on them. Some people

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Joanna Moncrieff: get a bit of insomnia and a bit of agitation. Some people feel a bit sort of foggy and sexual dysfunction, as I've also mentioned, is very common, so they cause all these alterations. And of course these alterations will impact on people's underlying mood. You know, if you're a bit numbed, you probably won't feel so intensely depressed or anxious anymore. And that's 1 way in which antidepressants

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Joanna Moncrieff: affect people and might be interpreted as working in people who have depression and anxiety. But it's also the case that actually the evidence

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Joanna Moncrieff: that has the trials that have been set up to investigate whether antidepressants work or not. These placebo control trials that compare an antidepressant to a placebo have found that there's very little difference between taking an antidepressant and taking a placebo. So although this emotional numbing effect may in theory be useful, particularly if someone's really acutely distressed.

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Joanna Moncrieff: The studies don't really seem to sort of back up the fact. The idea that it is useful, certainly in the sort of medium to long term.

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The Midlife Mentors: It's really, really interesting. And it's fascinating stuff. And when you talk about the emotional numbing, and we say in inverted commas, it works. This is getting rid of the distress, the negative feelings, but it's also numbing out the positive feelings and the person

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The Midlife Mentors: to feel, you know, happiness and joy. So they end up in this kind of limbo land a lot of the time when Prozac 1st came out. You know, it was then we had the book, Prozac Nation. And you, I remember meeting people on Prozac. And you're just like you could tell. They're just like kind of slow, unfocused, neither happy nor sad it was. Yeah, it was.

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Joanna Moncrieff: And I think this is partly why they don't help ultimately, because if you numb positive emotions.

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Joanna Moncrieff: you know, you numb all the sort of natural feedback mechanisms that we have, that that make life worthwhile, that make us understand what it is that we want. You know why why we need to go on living.

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The Midlife Mentors: Yes.

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The Midlife Mentors: related question for you. We hear a lot about the kind of the poor mental health state of of the nation, particularly, you know, kind of post covid, and you know anxiety triggered all kinds of sorry. Lockdown triggered all kinds of anxieties and things.

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The Midlife Mentors: Do you do you think that we genuinely are experiencing higher levels of mental distress, although it's just become more

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The Midlife Mentors: acceptable for people to talk about it. And some people are actually not recognising. I think you've referred to earlier. Like, you know, feeling a negative emotion is just part of daily life. So whereas and I don't want to categorize too much an earlier generation might just go. No, I feel a bit down today. I'll just do something to lift my spirits and move on. Someone else now might be like, oh, this is this is anxiety in a kind of clinical sense. What do you.

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Joanna Moncrieff: That helps.

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Joanna Moncrieff: So that's a really brilliant question, and I don't know what the answer is. I think there are probably a number of different things happening. I think there are ways in which modern life can be very stressful. And for some people more than others, and you know there are a lot of people in financial hardship and insecure housing and insecure employment. And you know who.

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Joanna Moncrieff: you know, genuinely worried about how they're going to get through the next few days, weeks, months, or whatever it is.

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Joanna Moncrieff: So you know, I think there are lots of worries and anxieties that people have, but I also think that as we've become, you know, more accepting of mental health problems, people have probably become more ready to label

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Joanna Moncrieff: their state as being a mental health problem, when, as you say, previously, they might have just regarded themselves as under, you know, going through a normal period of sadness or anxiety, or

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Joanna Moncrieff: a normal up and down of life.

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Joanna Moncrieff: So I think probably both things are happening at the same time.

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The Midlife Mentors: Yeah, yeah, I do. Because, well, it's this is very selfish. All these selfish questions I want to ask, because obviously, I've experienced this. But you know a lot of midlifers that we speak to that are going through hormonal changes. You know, menopause andropause.

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The Midlife Mentors: we hear a lot of stories about those people going to their Gp. And instead of asking about lifestyle factors.

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The Midlife Mentors: concluding that it might be perimenopause menopause andropause. We hear a lot of stories about those people being prescribed antidepressants.

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The Midlife Mentors: And obviously that's a real passion of ours to give people

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The Midlife Mentors: alternatives before that they go on a pharmaceutical drug to really go armed, go armed with information to their Gp. Understand what might be going on with their hormones. One of those things is, their mood is going to change because of the hormonal shifts. But personally, I would love to know what are some of the long term risks that you've heard of that you know, about

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The Midlife Mentors: from going and being put on antidepressants. You've almost asked my question, because I want to add a bit on the end as well like, how do we change the culture for GPS, because anecdotally, we do hear that people present with, like, you know, I'm just having a tough time and straight away. It's like, here's antidepressants. Here's antidepressants. How do we start to shift that?

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The Midlife Mentors: Yeah, there's 2 questions, 2 questions.

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Joanna Moncrieff: And I also wanted to come back to your previous question. And just you know, I think you sort of said it. You know there are particular stresses for people in midlife which are both physical and hormonal and social and psychological, aren't they? You know, children growing up and moving away.

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Joanna Moncrieff: you know, parents getting getting old and needing and needing help, and often being at a stage where you feel you need a new purpose, you know. Nice to. You know.

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Joanna Moncrieff: possibilities are opening up, and that can be exciting, but it can also be worrying and stressful. So I think midlife is a time when people can become quite stressed. But it's important to try and unpick the reasons for that. As you've done so to answer the question about the consequences of taking antidepressants. Long term

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Joanna Moncrieff: the so. So there are lots of relatively rare and serious

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Joanna Moncrieff: harmful effects as there are with all drugs which include Ssris in particular make you bleed more easily, so. People are more susceptible to haemorrhages. Older people can get dizzy and have falls. Osteoporosis. The rate of osteoporosis is increased rate of heart disease is increased.

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Joanna Moncrieff: you're more likely to. You're more likely to drop down dead as a result of having a heart attack or a heart event than you would be if you weren't taking antidepressants. But I should emphasize that. You know that risk is still very low, possibly due to this sort of disinhibiting effect that you've described.

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Joanna Moncrieff: Some people, particularly younger people, develop suicidal thoughts on antidepressants, new suicidal thoughts that they didn't have before, and they are possibly very occasionally, rarely, thankfully related to actual suicide. So there are all those really sort of serious medical complications to think of, but there are some much more common ones which I think people need to have in the front of their mind, and that is the problem of dependence and withdrawal effects that you've already mentioned

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Joanna Moncrieff: so particularly. People who've taken antidepressants for

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Joanna Moncrieff: a year or a couple of years are at risk of

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Joanna Moncrieff: developing withdrawal symptoms when they come off them, and sometimes these can be really quite severe. And in a small percentage of people they can go on for a long time, you know, for months or years after they've actually come off the drug. That's why it's really important for people to reduce the drug gradually, because that gives the body time to get used to the reducing dose, and probably reduces the incidence of really severe withdrawal.

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Joanna Moncrieff: The other thing that people really need to be aware of is the sexual dysfunction. It's well recognized that Ssris and Snris, that's drugs like Venlafaxine or Effexor in particular cause, sexual dysfunction, while people are taking them.

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Joanna Moncrieff: But there is more and more evidence now that some people and it could be up to about 10% of people have persistent sexual dysfunction after they come off antidepressants.

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Joanna Moncrieff: So that is clearly a really worrying thing. And there are now large communities of people online who are reporting these effects, who say that they've been robbed of their libido. You know, they don't have any sexual desire anymore. Often that seems to be coupled with persistent emotional numbing.

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Joanna Moncrieff: And and and some people describe ongoing genital anesthesia. They're just not as sensitive in their, you know, particularly sensitive regions, like the genitals, physically sensitive, and problems with

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Joanna Moncrieff: orgasm and

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Joanna Moncrieff: and erections and things like that. So all the gamut of sexual dysfunction can occur and and can persist after people have stopped taking the drug. And the most compelling evidence on this is the evidence from animal studies that shows that animals that are given antidepressants for a period of time. Some of them show reduced sexual behaviour when they come off their antidepressants. So this is not just

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Joanna Moncrieff: depressed. People who, you know, were attributing their depression, related sexual problems to the drug.

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The Midlife Mentors: Yes.

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Joanna Moncrieff: It has been shown in animals, and then the final area that I think people really need to be aware of is the effects of antidepressants on both fertility and pregnancy. I think this is and fetal development. These are really important areas. So

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Joanna Moncrieff: so antidepressants have been shown to reduce sperm motility and viability

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Joanna Moncrieff: don't seem to have the same effects in women thankfully, but they do increase the rate of miscarriage, probably of premature birth. Certainly they increase the risk of fetal malformations, particularly serious heart malformations. These are rare, but you are increasing your risk. If you take one of these drugs during pregnancy.

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Joanna Moncrieff: there are quite a lot of studies now, showing that the risk of your

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Joanna Moncrieff: child being diagnosed with autism and possibly with Adhd, is higher among women who take antidepressants during pregnancy. And again, there's some animal research to back that up. You can show that animals that the offspring of

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Joanna Moncrieff: pregnant animals that were fed. Ssris given Ssris show less social behavior and reduce sexual functioning as well in their subsequent life. And then finally.

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Joanna Moncrieff: babies get dependent on Ssris in the womb, just as as the mothers get dependent, and so they have 30% of babies, almost a 3rd have a withdrawal syndrome when they're born, and and that can.

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Joanna Moncrieff: it doesn't usually permanently harm the baby, but it can be quite unpleasant and involve difficulties, breathing the blood, not getting around the body properly and oxygenating the baby properly, so it can be quite worrying. And certainly these babies may need some additional care. So

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Joanna Moncrieff: there are, and it's

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Joanna Moncrieff: altogether those pregnancy complications are not that uncommon, and certainly people need to be aware of them if they're taking an antidepressant and thinking of getting pregnant, or

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Joanna Moncrieff: if they're a young person, a young woman particularly thinking of starting an antidepressant in their twenties. They may have no thoughts about wanting to have children for years and years in the future, but if they get onto that antidepressant and get stuck on it, then they will be in the position potentially of.

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Joanna Moncrieff: you know, wanting to get pregnant and being on an antidepressant, that they might find it difficult to get off

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Joanna Moncrieff: after taking it for years.

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The Midlife Mentors: Wow!

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Joanna Moncrieff: And therefore, you know, they're having all those risks.

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The Midlife Mentors: It's such important, such an important conversation that you're having, and I can't. I know I've said this, but I can't thank you enough, because

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The Midlife Mentors: because we need people like you that give alternative rationales to something that has just been that I know I've said that. But given us truth. So

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The Midlife Mentors: thank you. Thank you for sharing and.

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Joanna Moncrieff: That's a pleasure. I'm just aware I haven't answered James's question.

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The Midlife Mentors: Yeah, how do we change?

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The Midlife Mentors: That's a long question.

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The Midlife Mentors: I forgot that we've got a few strings there, haven't we? Yeah.

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Joanna Moncrieff: So maybe just to say a few words because it was a really important one on, you know, how do we change GPS behavior and public behavior. You know, how do we change expectations around this idea of getting a pill to deal with emotional distress? And you know, I think, GPS,

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Joanna Moncrieff: you know, doctors are trying to help people. Of course they are, and it's very difficult if someone comes to you when they're really distressed, to turn them away with nothing.

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The Midlife Mentors: Yes.

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Joanna Moncrieff: You know, I think this is one of the problems.

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Joanna Moncrieff: Yes, so I do think that we, you know, need to provide some sort of

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Joanna Moncrieff: some sort of service that can provide people with some sort of containment, some immediate psychological therapy. It doesn't need to be terribly in depth, but some sort of containment and and help to.

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Joanna Moncrieff: you know, help to point people in the direction of services that might help them. And this services like this are starting up. We do have a national therapy service in this country now. Yes, there is a wait of a few weeks, but it's not too bad a wait

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Joanna Moncrieff: and a lot of places now have what's called a social prescriber, which is someone who can direct people to activities and organizations in the community that might help them either address problems or make social connections and help their mood in that way.

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Joanna Moncrieff: So I think we need that. And I think we also need. You know, a public education campaign. Essentially, you know about the actual state of the science and the minimal benefits and risks that people run if they do take antidepressants.

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The Midlife Mentors: Yeah, agree with that. Agree with that? Totally. I guess. At least, probably the final question. We kind of answered it, I think. But if if antidepressants aren't the answer.

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The Midlife Mentors: what what is? And I think could be, what could be, could be.

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Joanna Moncrieff: Yeah.

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Joanna Moncrieff: Well, the 1st thing I'd like to say that I don't think I've said before is that this sort of highlights the problems in our view of depression, you know, if we see depression as a sort of medical thing, we think there's got to be an answer for it.

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The Midlife Mentors: And.

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Joanna Moncrieff: But if we see it as a reaction to people's circumstances, then we immediately realise that actually there is no one answer. Each person with depression or anxiety.

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Joanna Moncrieff: is different, and there's going to be a different answer for each one of them. And 1st and foremost, it involves

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Joanna Moncrieff: sorting out what is making you depressed or anxious in the 1st place, or if you're a therapist or clinician, helping someone to identify what that is and seek the appropriate help. And then.

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Joanna Moncrieff: on top of that, people can do things which will improve their mental health, which will boost their mood. Like exercise. Exercise has been shown over and over again to be as good as if not better than antidepressants in boosting mood. Yeah, absolutely. And you know, and then there are other things which

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Joanna Moncrieff: haven't necessarily been tried and tested in trials. But, you know, makes sense, like, you know, finding finding social activities, things that give you meaning and purpose, and that you enjoy doing, and that you can do with other people.

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The Midlife Mentors: And and eating well, and having time to relax, and looking after yourself and all those sorts of things.

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The Midlife Mentors: all that great stuff that modern life has eroded. Yeah, because we sit on our screens most of the time disconnected from each other, disconnected in a hyper connected world, but feel more lonely than ever, and just sit.

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Joanna Moncrieff: Yes.

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The Midlife Mentors: Hoping that our phones is going to somehow miraculously make us feel less depressed or anxious. But kelsaprise it. Does the complete opposite.

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Joanna Moncrieff: Yes, yes, I think that's a good point.

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The Midlife Mentors: Joanna, thank you so so much. This has been so so fascinating to talk to you for hours and hours and hours. We really could. We might have to ask you back on at some point, but we try and keep these 2 little bite-sized chunks. But honestly, Joanna, again, thank you for doing this work. Thank you for agreeing to come on to our podcast this is something that's very close to my heart and obviously to James's as well, so

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The Midlife Mentors: keep- keep going.

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Joanna Moncrieff: Thank you both for the work you're doing. That is also really important to give people a different way into, you know, understanding, mental well-being and improving. You know people's situations.

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The Midlife Mentors: Thank you. Thank you and listeners. If you want to know more on this, that we can't recommend enough. Joanna's book chemically imbalanced, we'll put a link to it in the show notes. But yeah, do do check that book out. Yeah, thank you, Joanna, thank you so much. Thank you so much.

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Joanna Moncrieff: Thank you. Thanks.