Anti-Depressants Have Been Debunked: Joanna Moncrieff.

I feel very sad that my profession has
not taken the harms the drug treatments can do more seriously very sad about that I'm very sad that the profession is neglecting the other ways that we can help people it is neglecting to develop other possibilities and and other avenues to help and support people and to enable people to help and support themselves and each other of course there were people in the psychiatric profession who very nobly have stood up and in critical of drug treatments there have always been people like that but to many people I think too many psychiatrists have just accepted that drug treatments are good and have not wanted to contemplate that actually these treatments could be harmful so I've called this mainstream view the disease centered model of drug action and this is the idea as I said that these drugs are working by correcting an underlying abnormality and it's an idea that's borrowed from general medicine where most drugs are also understood to act in that way so but it doesn't necessarily mean that the drug is targeting the cause of the disorder so for example insulin in diabetes might be a drug that you think of is working in this way it's not it's not treating the cause of diabetes but by replacing the deficient insulin supply it's helping to normalize it's helping to rectify the underlying abnormality helping to normalize the body so the other way that we can think about what psychiatric drugs might be doing is what I call the drug centered model and I've called it this to emphasize that these drugs are drugs that is substances that alter the way that the body functions and what I'm suggesting in this model is that far from working by normalizing the body these drugs are working by creating an abnormal or altered state and because they are a special sort of drug called psychoactive drugs that is they work on the brain and therefore they alter feelings thoughts emotions behavior the altered states they create interact with the symptoms or problems that we call mental disorders and sometimes these these altered states may be useful in someone who is suffering from a deep depression or an intense psychotic state but it's not that anything's been normalized it's that the altered state the drugs create may be preferable to the the mental experiences that they're having at the time so an example of this way of thinking about drugs that maybe not too controversial is the idea that alcohol is useful for social anxiety disorder which was something I was taught when I was training just in case you think that ingesting just bringing that in so the idea was not that alcohol corrected a chemical imbalance or obviously that it riveted that it replaced an alcohol deficiency the idea was that the the characteristics of alcohol intoxication which we're all familiar with include being becoming socially less inhibited which can be useful for someone who is particularly who finds social situations difficult psychiatric drugs are psychoactive substances and this is sometimes forgotten so that's this is just why I'm putting this this slide up there is no fundamental difference between them and other psychoactive substances the ones were familiar with of course are the substances that are used recreationally the difference might be that most psychiatric drugs produce states that are not particularly pleasant but that doesn't mean that they're they're fundamentally different in any way they still like all drugs alter the body and like all psychoactive drugs because they work on the brain they they produce altered mental states as well and like all drugs they produce tolerance that is the effects that they have initially don't necessarily last because the body adapts to their presence and for the same reasons you get withdrawal symptoms when they're stopped like other psychoactive substances the states that they produce means that people are not necessarily very good at judging how they're how they're functioning when they're under influence of the drug what someone called Peter Breggin an American psychiatrist has called a process of spellbinding we're familiar with that with alcohol for example aren't we that we're not necessarily very good judges of of what we can do when we're intoxicated with alcohol Joanna thank you so much for taking the time to chat with me today for the mad at America podcast I wanted to ask you about the recent study into antidepressant efficacy announced in The Lancet and widely covered in the UK news media on Thursday February 22nd you've written about some of the limitations of that study including a piece format in America so the study is a better analysis so that means that the authors have got the data from together from lots of different trials of antidepressants and combine the data to get an overall effect measure the the main conclusion is that antidepressants are more effective than than placebo and that conclusion is what's being used as the basis of the headlines all over the world media to say that it's confirmed that antidepressants work the problem with that conclusion is that other innumerous problems with it but one of the problems is that the way that they've analyzed the data actually inflates the difference between antidepressants and placebo and if you analyze that if you analyze the data differently which in fact they did in their study in the appendices if you get as far as reading them they're actually finding effects that show that the difference between antidepressants and placebo are very small so maybe I should just I just like to expand on that a bit more cuz it's quite a complex point so the the data that they've analyzed is what they call response rates they define response in the same way that most trial ists define response as the percentage of people whose rating depression rating scale scores drop by 50% or more during the study now that is an arbitrary definition of response and it's not the primary data that was collected the primary data that is collected in these trials is the the score that people have on the depression rating scales so what you should analyze in a trial and in a meta-analysis of trial is the primary data is the scores on the rating scales and if you analyze that data as I said before what you find is that difference between antidepressants in placebo in terms of depression scores is very small and way below the difference that probably indicates a minimal clinically significant level of improvement the other interest group that's obviously been influential in promoting this view of psychiatric drug treatment is the pharmaceutical industry although interestingly in the 1950s and 60s up to the 1980s really the pharmaceutical industry will also could play both games they could promote psychiatric drugs as disease-specific or as as psychoactive substances and they were they were quite happy to do both but then there was and they were involved in the early days of creating the modern idea of depression along with the antidepressants in the early 1960s but then in the 1980s there was a crisis over the widespread use of benzodiazepines and the idea of using mind-altering substances to shut people up keep people quiet stop people complaining got a very bad reputation rightly of course and so was david Healy's very cleverly shown they started to change the market for the benzodiazepines into a market for antidepressants and they needed to get away from that bad reputation they needed to portray the antidepressants as something that were avert were reversing an underlying disease so that disease center model became very important to them in the early 1990s so the idea that there was an underlying deficiency or disease was sold in a package with the drugs they very much came together the idea that you had a chemical imbalance and therefore you needed an antidepressant in the 1990s with the marketing of the SSRIs like prozac Eli Lilly were one of the funders of a big campaign in the UK and I know they've been campaigns here and campaigns in Australia that a similar campaigns designed to increase the use of antidepressants by increasing the number of people who are diagnosed with the depression so this campaign suggested that 5% of the general population had depression ten percent of people attending general practitioners it was it emphasized that antidepressants are not addictive which has transpired is completely wrong and is now accepted as completely wrong and it emphasized that they should be given for for a few months and not just used for a brief period it was very successful we've already seen how much the prescribing of antidepressants has increased I'm trying to I'm trying to suggest that there's a better way of thinking about what drugs might be doing when we use them for mental health problems that we need to acknowledge that their drugs that they're psychoactive substances and we need to understand those effects more and when we do that we can use them in a rational and more collaborative way and a more cautious way because this the point about the disease centered model that I think so dangerous is that it assumes that drug treatment is going to be beneficial because of course if there's an underlying problem and the drugs are helping to normalize it well of course it's a good idea to take them why wouldn't you the drug centered model on the other hand by emphasizing that these substances are drugs assumes that they might be harmful and therefore you have to make a good case for using them and I think it's I hope that I've shown you that I think it's only when we stand back from this literature that you're able to realize how we've got to this situation where we have a potentially dangerous and completely unfounded model of the way that psychiatric drugs work that model has become the standard accepted way of understanding these substances and the basis on which they are used it's all based on the idea that the drugs are somehow rectifying some underlying problem and until we understand that they're not doing that or that we've got no evidence that they're doing that we don't really know how to interpret the evidence we've got so for example if you give children a sedative drug like an anti-psychotic and measure their mania schools their mania schools will go down a bit they will be less hyperactive less irritable and they'll sleep more that doesn't mean that we've cured anything or done anything very useful what we've done is we've sedated those children and until we understand what the drugs we give to people are doing we don't know how to interpret the evidence that's my position on it why because people talk about fantastic results but people have always talked about fantastic results with all sorts of therapies that we now know were completely useless and often quite dangerous so you have to do proper studies and what the proper studies show as you probably know is that drugs like antidepressants are only very minimally different from a placebo and that minimal difference in my opinion is because they are psychoactive mind-altering drugs they make people feel different they suppress their emotions of it so that's what we're doing to people that's why we need to understand what the drugs are that we're using what sort of effects do they have what sort of mind-altering behavior altering effects do they produce and I think that the effects that say antidepressants produce are just not useful I don't see why being a little bit suppressed emotionally is going to help someone and feeling a bit groggy and having your libido taken away that your libido taking right I don't see why that's going to help someone who's depressed I'm not I'm saying is we really have no evidence that these drugs are curing depression [Music] evolution