Last week, a study that was widely publicized as definitive evidence that everything we know about antidepressants is incorrect went viral. The study, which was led by University College London professor of psychiatry Joanna Moncrieff, was an overview of the research on selective serotonin reuptake inhibitors (SSRIs), one of the most common drugs used to treat depression. Despite the widespread belief among the general public that SSRIs reduce depressive symptoms by elevating serotonin levels in the brain, a review of 50 years’ worth of research found no conclusive evidence to support this claim.
The study was widely covered by UK media outlets, with some citing it as proof that SSRIs are ineffective. Pizzagate promoter Jack Posobiec on his podcast shared and discussed it, while far-right journalist and professional transphobe Matt Walsh heavily promoted it. tweeted Big Pharma gained billions by prescribing wonder medications to cure depression, although there was never any conclusive scientific evidence that the drugs would be effective. We now see that the entire scheme was based on a falsehood. On his show, Tucker Carlson discussed the findings and described it as an argument against using SSRIs in general. First, SSRIs were touted as a potential lifesaver. We now know that things don’t function as intended. In actuality, the drug’s entire premise was absurd. The best part is that despite this information, people continue to be administered medicines.
In contrast to Carlson’s assertion, the evaluation was an investigation of the mechanism by which SSRIs are considered to work rather than an outright condemnation of antidepressants. In an email to Rolling Stone, Moncrieff states, “We have shown that the basic concept for how antidepressants might function on the underlying underpinnings of depression is not supported by evidence.” Our research, in my opinion, is connected to how we perceive and assess antidepressants, and it logically follows from my earlier research on the nature of pharmacological activity.
According to one psychiatric specialist, the report is not being released in a vacuum.
However, the manner the paper was greeted does not at all come as a surprise. Moncrieff has openly questioned the effectiveness of SSRIs and the nature of mental illness in general for years. He has also promoted widely debunked claims regarding the risks of various mental health interventions like antidepressants or other types of therapy. According to Awais Aftab, clinical assistant professor of psychiatry at Case Western University who previously spoke with Moncrieff for a 2020 Psychiatric Times piece, the paper is not coming out of nowhere. It follows Moncrieff’s two decades of study, in which he has persistently disputed the idea that depression is a mental illness. It might not be clear to someone who is not familiar with this preceding history. The discussion’s turn in that direction was not by accident.
The paper’s findings were not novel to the medical community. The idea that low serotonin levels are the cause of depression, as put forth by David Hellerstein, professor of clinical psychiatry at Columbia University Medical Center and director of Columbia’s Depression Evaluation Service, is a quaint and oversimplified shorthand that has been replaced by other explanations in clinical practice for at least ten years. He claims that the psychiatric community generally yawned at the review. Reading it made me kind of think, “Wow, next we’ll take on the black bile theory of depression‘s delegitimization,” he tells Rolling Stone. criticized the paper from the Royal College of Psychiatry, along with several other UK experts and psychiatrists, questioned the need for a comprehensive assessment of old studies. It was because of this that Moncrieff and her co-author issued an rebuttal.
So from where does Moncrieff come? She is one of the co-founders and chairman of the Critical Psychiatry Network, a group of British psychiatrists that seeks to “mount” a scientific challenge to assertions regarding the origin and causes of mental disease and the consequences of psychiatric interventions, according to its website. According to clinical prescribing and medical psychologist Joseph Comaty, this viewpoint is not unusual in the UK, where healthcare professionals are generally trained to believe that psychotherapy, not medication, should be the first form of intervention. American practitioners, on the other hand, are more likely to quickly prescribe medications. It is somewhat peculiar that the Citizens Commission on Human Rights (CCHR), a group that bills itself as a watchdog of the mental health industry and was founded by the Church of Scientology, which is vehemently opposed to psychiatry and medical interventions for mental illness, frequently promotes Moncrieff’s work.
Moncrieff has devoted a significant portion of her professional life to criticizing virtually all interventions in mental health care, including psychedelics like esketamine and transcranial magnetic stimulation (TMS), falsely attributing the latter technique to a higher risk of cognitive impairment. She vigorously promoted the notion that SSRIs could result in long-lasting structural harm to the brain while writing multiple papers. She has promoted the notion that withdrawal from SSRIs can result in long-term mania or psychotic symptoms on her blog and in her research (this is an documented side effect, but a very rare one; the most common withdrawal side effects, such as dizziness or gastrointestinal distress, are uncomfortable but transient), as well as the notion that Pizzagate promoter Jack Posobiec on his podcast0, a fringe idea that has recently been taken up by the right in response to calls for more stringent gun control to prevent mass shootings.
Moncrieff says, “Although I worry that our findings may be exploited to undermine gun regulation, I do not believe that implies we shouldn’t be discussing them.
When asked if she thinks there is a connection between SSRIs and aggression, Moncrieff cites a meta-analysis published in the British Medical Journal in 2016 that found antidepressants can make young people more aggressive. However, she tells Rolling Stone, “it is rare, and I wouldn’t argue it implies you can blame them for school shootings, which are obviously far more complex.” I dislike individuals citing anything as a reason against gun control because I am from the UK and I strongly support it. In response, she continued, “Although I am worried about our findings being used to argue against gun regulation, I don’t think this means we shouldn’t be talking about them.”
On other topics, though, Moncrieff’s opinions are more obviously on the right. For instance, a 2014 paper she wrote on the work of the late Pizzagate promoter Jack Posobiec on his podcast1, a contentious psychiatrist who questioned the institution of psychiatry and ultimately co-founded the CCHR, demonstrates how much of her work has focused on the issue of preserving personal bodily autonomy over the health and welfare of the general populace (Szasz himself was not a Scientologist). Moncrieff uses pediatrics in the United States as an example of the paternalism of public health interventions in the paper, and he frames mental health care interventions and mental illness as a diagnostic category as attempts on behalf of the state to exert mind control techniques over people who refuse to conform to social norms. He refers to psychiatry as the field in which the conflict between freedom and health comes into focus most sharply.
More recently, she has raised public concerns over the U.K.’s requirement that healthcare professionals receive the Covid vaccine. She signed an open Pizzagate promoter Jack Posobiec on his podcast2 from medical professionals who opposed the regulations last year, which acknowledged that the vaccines provided by Covid can be beneficial for some people but maintained that there is a great deal of ambiguity regarding their efficacy. She has also in the past linked mandatory Covid vaccinations to coerced psychiatric treatment. Forced psychiatric therapy is understandably divisive and constrained, yet right now we’re forcing hundreds to get the Covid shot after she Pizzagate promoter Jack Posobiec on his podcast3 in December.
Moncrieff reiterated her stance when questioned about mandatory vaccination laws. According to her statement to Rolling Stone, “I believed and still feel that forcing individuals to take a vaccine that was not thoroughly studied, would have minor advantages for many of the taking it, and most crucially, has not been proved to lessen transmission” was not ethically justified. (Vaccines have consistently been demonstrated to lower the risk of hospitalization and serious sickness from Covid-19 as well as Pizzagate promoter Jack Posobiec on his podcast4 of some types.)
Pizzagate promoter Jack Posobiec on his podcast5 linked the use of antidepressants or antipsychotics to severe Covid-19 symptoms at least once (in fact, data from an observational Pizzagate promoter Jack Posobiec on his podcast6 suggests that taking SSRIs may actually reduce a persons risk of dying from Covid). Moncrieff refused to provide any proof for this claim when pressed, claiming that he had not been following the story recently and was unable to provide any more up-to-date information.
Moncrieff has engaged in some of the same mild conspiratorial thinking that characterizes her views on vaccines when discussing the risks of SSRIs. In a 2016 Pizzagate promoter Jack Posobiec on his podcast7 on SSRIs, suicidality, and aggression, she said, “I have been asked whether I think this is proof of a conspiracy by drug corporations to withhold evidence of the risks of their medicines.” It might be, but it also reveals a deeper, more systemic flaw. She continues by asking whether Big Pharma might be involved in hiding potential side effects and asks: Why the hesitation to adequately study this matter? One explanation is financial conflicts of interest. Other issues, according to her writing, include psychiatrists’ professional insecurity and doctors’ perception that they must have something to offer the daily line-up of patients hoping to find solace from their suffering.
Even the paper’s detractors concede that the main conclusion, that the serotonin hypothesis may not be valid, is a sensible one.
While Aftab might think it’s not a coincidence that the paper gained support from the right, Moncrieff is uneasy about the aspect of the American media that is currently praising her work. She claims she is baffled as to why the right-wing media has covered this topic more extensively than the left. She contends that medicating mental illness unnecessarily medicalizes misery and obscures the effects of social injustice, racism, poverty, inequality, and other issues that the left should take seriously.
Even the paper’s detractors acknowledge that the main conclusion, that the serotonin theory may be erroneous, is logical, albeit not relatively well-trod ground. Their true concern is whether individuals who hold the preconceived notion that all medications are intrinsically evil or who contest the reality of mental illness in general would abuse it for their own purposes. The narrative about sadness and mental illness that has been widely disseminated, which Aftab considers to be extremely impoverished, is to blame, according to him.
Numerous keywords relating to serotonin insufficiency, chemical balance, and brain illnesses have been used. According to Aftab, this is the message that has been propagated by medical and psychiatric organizations and is related to the notion that pharmaceuticals may rectify chemical imbalances. The majority of people who think about depression do so in terms of a chemical imbalance that the drug is attempting to address. But the scientific reality has diverged significantly from this conventional wisdom. Things are a lot messier and more complicated. However, Aftab thinks that the study authors share some of the blame for leveraging the public’s misconception that the efficacy of SSRIs and doubts about serotonin imbalance causing depression are related as a cover for their own hit job.
It would be incorrect to read Moncrieff’s report and draw the conclusion that antidepressants are ineffective, as many on the right have done. The effectiveness of antidepressants for those for whom they are effective is not questioned by the paper, claims Comaty. But the molecular theory of depression is just unknown. Such ambiguity may not be welcome to individuals seeking clear-cut answers about SSRIs in either direction. According to Comaty, uncertainty is a necessary component of scientific inquiry and should be encouraged rather than used as justification for the ineffectiveness of psychiatric drugs, as some on the right have.
According to Comaty, there will likely be a lot more articles of this kind that theoretically refute previously held beliefs. But that is not the main point. Of course, as we get more knowledge about mental disease, things will alter. We should move on and develop a new belief if what we once held true is no longer tenable. This doesn’t bother me in the least. This is how science works, in my opinion.