Antidepressants work, top doctors insist as they hit back with bombshell study
Leading psychiatrists have hit out at the authors of a bombshell study that cast doubt on the effectiveness of antidepressants, calling the findings “absurd” and “grossly exaggerated”.
Last week, researchers at University College London said they had disproved a theory dating back to the 1960s that depression is caused by low levels of serotonin, a brain chemical believed to control mood. mood.
Led by Professor Joanna Moncrieff, a respected consultant psychiatrist, the study looked at decades of research, involving tens of thousands of patients with the condition, and found “no convincing evidence” of a link between mental illness and serotonin levels.
Professor Joanna Moncrieff, pictured, a consultant psychiatrist at University College London, has led a team of researchers who have dismissed the long-held belief of a link between low serotonin levels and depression.
The findings have been considered important as most antidepressants, taken by more than eight million Britons, are designed to increase serotonin levels.
“Thousands suffer side effects from antidepressants, including the serious withdrawal effects that can occur when trying to stop them, yet prescription rates continue to rise,” Professor Moncrieff said. “We believe this has been driven by the false belief that depression is due to a chemical imbalance. It’s time to inform the public that this belief is not based on science.’
However, leading brain experts have criticized Professor Moncrieff, who has written best-selling books casting a negative light on antidepressants. They argue that it is not true to say that scientists believe that depression is caused by low levels of serotonin. Instead, they say, the prevailing theory is that depression is caused by many factors and that antidepressants have been clinically shown to help.
Dr Michael Bloomfield, a consultant psychiatrist and colleague of Professor Moncrieff at University College London, said his conclusion “makes no sense”.
“Depression has many different symptoms, and I don’t think I’ve ever met a serious scientist or psychiatrist who thinks that all causes of depression are due to a simple chemical imbalance of serotonin.”
Added: ‘[This paper] has grouped depression as if it were a single disorder, which from a biological perspective makes no sense.’
David Curtis, honorary professor at UCL’s Institute of Genetics, agreed: “The notion that depression is due to a chemical imbalance is outdated, and the Royal College of Psychiatrists wrote that this was an oversimplification in a statement published in 2019”. Phil Cowen, professor of psychopharmacology at Oxford University, appeared to accuse Professor Moncrieff of cherry-picking data to suit his hypothesis.
Doctors in the 1960s first found a link between low serotonin levels and depression, then provided GPs with a weapon to attack the condition.
He noted that the review had omitted a pivotal study suggesting that depressed patients had lower levels of compounds integral to the production of serotonin in the blood.
“The possible role of serotonin in depression is a separate issue from the antidepressant effects of [antidepressants],’ he said.
Other experts point to several studies showing that taking antidepressants can increase depression, regardless of their effect on serotonin levels.
“We know through years of research that antidepressants work and save lives,” says Professor David Nutt, head of the Center for Neuropsychopharmacology at Imperial College London.
‘The conclusions of this article are absurd. The authors have greatly exaggerated the importance of serotonin levels. No one ever said that a serotonin imbalance is the only cause of depression.
He adds that newer studies, not included in Professor Moncrieff’s review, which used more precise testing methods, had found a “diminished serotonin-releasing capacity” in people with depression. “Dismissing the serotonin hypothesis of depression at this point is premature,” he said.
Psychiatrists say it’s not understood exactly why antidepressants work, but that’s not uncommon. “It’s hard to be absolutely sure what makes a drug work in the brain,” says Professor Nutt. “In the case of antidepressants, it could be having an effect on things other than serotonin receptors.”
Crucially, they argue, even if depression isn’t caused by an imbalance of serotonin, that doesn’t mean it can’t be effectively treated by increasing levels of the brain chemical.
Responding to criticism, Professor Moncrieff said the aim of the study was not to argue that antidepressants don’t work, but to question whether the pills should be prescribed in the first place.
“People are told that the reason they feel depressed is that there’s something wrong with their brain chemistry and antidepressants could correct that. But if there’s no evidence that there’s anything wrong with brain chemistry, it doesn’t seem like a sensible solution. This profession has misled people for so long about the need for antidepressants, and now doctors don’t want to admit they were wrong.”