Big Pharma's Trillion Dollar Deception on Mental Health | Joanna Moncrief

Key Takeaway

Depression isn't a chemical imbalance requiring lifelong medication—it's often a human response to life circumstances, poor nutrition, stress, and lack of connection. Instead of defaulting to antidepressants with minimal benefits beyond placebo, focus on what actually works: exercise, whole foods (the SMILES trial showed diet changes improved depression), addressing nutritional deficiencies (B12, folate, vitamin D, omega-3s), reducing stress, improving sleep, and building community. These interventions empower you to address root causes rather than suppressing symptoms with drugs that numb emotions and create dependence.

Episode Overview

Dr. Joanna Moncrieff, a psychiatrist and researcher, challenges the widely accepted chemical imbalance theory of depression, arguing that antidepressants don't work as advertised and are primarily effective due to placebo effects. She explores how pharmaceutical marketing created a myth around serotonin deficiency, discusses the social and biological root causes of mental illness, and advocates for addressing real factors like nutrition, exercise, stress, and community rather than relying on medications with questionable efficacy and significant side effects.

Full Transcript

Transcript of Big Pharma's Trillion Dollar Deception on Mental Health | Joanna Moncrief from The Dr. Hyman Show. Auto-generated from episode audio; may contain minor errors.

What I object to most about telling people that they've got a chemical imbalance is that that is a really depressing message. That's telling people there's something wrong with your brain. There's nothing you can do about it. You've got to rely on, you know, someone giving you a drug. just correcting that mistake and informing people that there isn't something wrong with their brains and that they do have the capacity to improve, to recover, to change is is actually a positive and a hopeful message. Before we begin, I'd like to note that today's conversation explores one perspective of an area of medicine that continues to be actively debated.

And while we discussed emerging evidence and critiques of current psychiatric practice, treatment decisions, especially involving anti-depressants or other prescription medications, should always be made in consultation with your healthcare provider. The views expressed by my guest are her own and reflect her interpretation of the available evidence. My goal in hosting conversations like this is to explore different perspectives, to examine the science, to encourage thoughtful discussion, not to provide individualized medical advice. So, if you're currently taking medication, please don't stop or change your treatment based on this conversation alone.

Instead, use this episode as a starting point for an informed conversation with your healthcare team. My hope is that these discussions encourage curiosity, critical thinking, and shared decision-m between patients and their clinicians. Well, Joan, it's great to have you on the podcast. Thanks for joining us today. Thanks for inviting me, Mark. Really excited to talk to you. I'm excited to talk to you because I think our our intellectual history is very similar. We were just chatting before the podcast and a lot of the seinal books in psychiatry we both read and they were really around challenging the orthodoxy and our way of thinking about mental illness and how we approach it and I think hopefully this conversation will sort of help us understand some of the challenges we're facing around our framing of mental illness our understanding of sort of some of the myths out there that are propagated that I think undermine uh people's public health and mental health the title of your book is is really really provocative chemical imbalance the making and unmaking of the serotonin myth which is going to probably strike people like wait a minute I thought depression was about a serotonin deficiency and Prozac was about actually helping fix that and my joke is that a depression is not a Prozac deficiency right right right and so I think your your central argument is really this whole chemical imbalance theory is it doesn't actually hold up when you look at it objectively scientifically and you're research scientist and you look at these issues objectively, you look at them dispassionately and uh and you're not um sort of ideologically driven, you're just driven by the science.

And I think I I find that very refreshing and also this is a big problem because when we look at anti-depressants as a class of drugs and depression is probably the most prevalent mental illness, it's $20 billion a year globally that's spent on this. and your your thesis is essentially that they don't really work and in a few cases in some cases they can be helpful but that maybe it's mostly driven by placebo. I I kind of want to dive into this conversation with you because we really are um at at a crisis.

I think we're seeing more and more mental illness. We're seeing less effective approaches to it. And uh you know, we keep trying to apply, you know, like we say, if all you have is a hammer, everything looks like a nail and and we're, you know, we we think someone's depressed, everybody needs a an SSRI or an antresscent. But you uh actually have sort of looked at this broken paradigm very carefully and and sort of have unmasked this myth of quote chemical imbalance as a root cause of mental illness and the serotonin myth.

And you you did a 2022 review, a landmark review that looked at all the data and you found that there's no no consistent evidence that depression is caused by low serotonin. Like we now can study this there's there's ways of objectively scientifically measuring this. So I you know if if there's no evidence that this is true, how how did this idea get established in our psyche? I I I did the research because I was aware that the majority of people thought that the link between serotonin and depression was an established fact and yet I knew that probably the majority of psychiatrists and doctors knew that actually it was a theory and that there was maybe a bit of evidence for it but probably a bit of contradictory evidence too.

And in fact, there hadd been people saying that the theory of that that depression is caused by low serotonin wasn't really supported by evidence for quite a few years. There was a paper published in 2005 suggesting that, but there was nowhere that you could really point to um to say, oh, you know, there's an overview of the evidence and it shows that really it doesn't stack up. So that's why we um you know that's that's why we did that review of the research on serotonin and depression that you mentioned that was published in 2022.

So where does this idea come from? Um its origins are in the 1960s. It was first proposed by psychiatrists and and people doing research on drugs that they were proposing might be anti-depressants anti-depressants anti-depressants back then. um that depression might be caused by a lack of noradrenaline or serotonin. Serotonin and noradrenine are both chemicals that are found in the brain and transmit nervous impulses between nerve cells. They're what we call neurotransmitters. call neurotransmitters. call neurotransmitters. So it was proposed back then there might be an abn abnormality of one of those chemicals that might be involved in depression.

But it it wasn't sort of widely popularized. It was you know it was a theory that was circulating within psychiatry and within you know aca ac academic research circles. There was a lot of research done to look into it in the 1970s sponsored by the US um national institute for mental health and that didn't report any findings and I would assume therefore didn't find evidence of any abnormalities. So it so it was sort of you know going into decline. The idea was going into decline in the 1980s and then the pharmaceutical industry recruited the idea to market their new range of drugs the SSRI anti-depressants which they brought out at the end of the 1980s.

Prozac was the first one that you mentioned earlier and then there were a range of other others that were brought in in the 1990s and the industry wanted to persuade people that these drugs were different from the old benzoazipines. They weren't just numbing you or tranquilizing you. They were doing something really important. They were targeting that you had an abnormality in your brain and they were going to target that and put it right. And that bzzodazzipene is like a volume. And that was a big drug in the 60s that was used for almost every housewife in America as a way of just keeping them calm and subdued and sedated.

But that's that that's that's that big class of drug. So that was that was the first psychiatric drug really. Yeah. Yeah. And that they they were enormously popular, very widely prescribed, but they'd got a very bad reputation by by the mid [clears throat] 1980s because it became clear that they were highly dependence inducing substances. So the pharmaceutical industry wanted to put clear water between the benzodioipines and their new drugs. And so they came up with this idea, persuade people they've got this chemical imbalance and they need to take the drug to rectify this.

They need to take it in a medical sense to put something right in their uh in in their biology, in their brain biology. So that's where it came from. And you know they they they just put so much money into marketing these drugs. That message was said again and again and again in advertisements in on on online sites. It was supported by medical institutions who also told people that depression was caused by a chemical imbalance. And there was never really any good strong evidence to support it.

And yet it, you know, it caught on because it was just so widely disseminated. It's true, you know, and I think, you know, when you're a busy doctor and these drug reps come in and they and I remember this and I was in practice, you know, early on, they'd come in and they'd have their scientific papers and they'd have all their SL, you know, so there's their slides and their graphics and their impressive data and, you know, they and you're you don't always have time to read all the literature as a doctor.

You're sort of going, "Okay, this makes sense. My patients are suffering. This sounds like a good idea." But it turned out there was just very little evidence that it actually worked. And when you look at the studies that they they kind of are rigged, I would say rigged in many ways. The way they design them, the way they do them, you know, that they the way they try to, you know, control the outcomes and write them up. And the, you know, when I started looking into this, when I wrote my book, The Ultra Mind Solution in in the mid 2000s, I I was shocked to find that, you know, the there was very little evidence that these actually worked and they didn't really work much more than placebo for mild to moderate depression.

And and yet they were being prescribed like water. I think one of the reasons that idea about the chemical imbalance and the drugs correcting it caught on is because is because it's so simple. you know, it it it it's yeah, it seems to make sense and you can show it with these nice diagrams. And so, I think it was sort of really compelling both for doctors and for patients or potential patients. But you're right, the the actual trials that were set up to demonstrate that anti-depressants were effective really show that they have little benefit.

They are minimally different from a placebo. um you know and that's that's just taking them as they are set up but then as you say they're actually rigged in various ways. They recruit people who often want some sort of drug treatment. So so they're they're hoping to get it. They're not completely double blind. That means that the people the people getting the the real drug and the people getting the placebo tablet are not meant to know what they're getting. Of course that's the whole point of these studies.

But actually people can often tell because taking, you know, anti-depressants are active drugs. They're not just dummy tablets and they make people feel different, have side effects. They give you a dry mouth. They might make you feel a bit sick. Um, and they might make you feel, you know, mentally a little bit different or a lot different depending on on the drug. They're they're, you know, they have very varied effects, different anti-depressants. anti-depressants. anti-depressants. And so they're not properly blinded. And the people who get the real drug, get some side effects, think, "Wow, I've got the real thing.

That's great." So, they probably get uh, you know, an additional placebo effect, what we might call an amplified placebo effect. Uh, and that in my view easily accounts for the very small difference that you're seeing between the drugs and the uh, placebo substances. substances. substances. So yeah, not really don't have many benefits. But but but I think it's important to say that's not that doesn't mean they are placeos. They are active drugs. They do have side effects. They do have effects. I mean they do affect people's emotions.

Most anti-depressants seem to produce this sort of an emotional numbing state, state of emotional numbness. emotional numbness. emotional numbness. um which in theory might be helpful if someone's intensely sad or intensely stressed. stressed. stressed. On the other hand, lots of people don't like that feeling of numbness. And it's it doesn't seem likely that that's really going to be helpful to people in the long run to sort out their their problems if they can't feel anything, you know, they can't feel happiness or or um or joy anymore either.

But but this the trials suggest that it it's not really that useful anyway because there's so little difference between the anti-depressants and the placebo. Have you ever climbed into bed exhausted but your body just won't switch off? Your mind keeps racing, your muscles feel tight, and you can't fully relax. Well, a lot of times that can come down to one foundational nutrient, magnesium. It plays a critical role in sleep recovery, stress regulation, and muscle function. Yet, many people simply are not getting enough. And that's why I've recommended Magnesium Breakthrough from Bioptimizers for years.

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It's sort of like a vicious cycle. Yeah. It's just unbelievable, isn't it? that we're giving people things for depression that actually are going to, you know, numb numb your sex drive, interfere with your sexual functioning. They're going to make your life worse. In other words, and then they're really and then they're really hard to get off of. They're not like you can just stop it like an antibiotic or any other many other drugs. You you have to taper off of them. It's complicated. There's often a rebound effect.

You get serotonin syndrome. I mean, it's it's actually quite significant and can be very serious. So, can you talk about how in that in that way they're not completely benign and and that they we need to think about how do we help people um understand that? To start off with, I think presenting these drugs as drugs that have specific effects on underlying mechanisms like a chemical imbalance is is really dishonest and and and prevents people from fully understanding what they're doing when they take an anti-depressant.

And that is they are taking a foreign chemical substance that alters the normal state of your brain chemistry and activity and in ways that we don't fully understand and whose consequences we haven't fully worked out either. So they're doing something risky. When you mess with the the state of your brain, you're doing something risky. Uh and and I think if we you know if we said that to people straight up, at least that would be more honest. you know, if we said we what what you're taking is is a drug that's going to, you know, modify your normal biology in a way that we don't properly understand.

I think people would then understand better that what they're doing is something risky. something risky. something risky. And as you say, some of the risks are things like sexual dysfunction, uh, dependence problems, dependence problems, dependence problems, particularly for people who've taken anti-depressants for, you know, years on end, they may might well have difficulty coming off them. And sometimes they can um, especially, it seems, if people come off too quickly, can get into a really bad state and have really bad problems. So, it's very important to come off slowly.

If anyone's thinking about doing that, the most important thing really is that we should should stop prescribing so many anti-depressants in the first place, particularly to young women to avoid these problems. Well, that sort of begs the question of like, you know, what is the right framing for mental illness and what are the root causes? And I if it's true that you know this we we've gone through this period of um you know massive pharmaceutical marketing to create a market literally they they made a market for these drugs.

Uh they convinced everybody they need them that they convinced doctors to prescribe them and then people got on them and had a hard time getting off of them. And you know we're kind of in this pickle now where mental illness is on the rise and yet what are we going to do? like what what are we going to do and how do we address the root cause of these this crisis we're in we're in we're in as you were suggesting I think I think one of the origins of this one of the origins of this problem is that we've developed a wrongheaded way of thinking about mental health problems um so you know and it start it really sort of got going with this idea of the chemical imbalance it was very interesting I when was very it was very interesting I when I was doing the research for the book I went and looked at the archives of one of these depression awareness campaigns that was run by the Royal College of Psychiatrists in the UK in the early 1990s 1990s 1990s and they did some market research before they started their campaign.

Their campaign was to go and convince people that depression was a medical condition. Go and see your GP, get treatment. Of course, it was partly funded by Eli Liy who were the makers of Prozac. But the market research they did was really interesting. They they went out and they asked people, this is in in about 1991 probably, what do you think causes depression? And people didn't say um you know, I think it's a chemical imbalance or a brain problem or a genetic problem even. They said unemployment, divorce, child abuse.

And they said that they didn't think that taking a drug to deal with emotional problems was a good idea because it would just numb the problem and there was a potential that people might get dependent. So people people had a different idea back then. Their idea back then was that depression is part of the range of our emotional reactions to the world. And And And and I think we need to go back to that understanding that we that got buried by this campaign to medicalize depression and to medicalize other mental health struggles and difficulties.

I think that's an important point. I think you know that you know humans are these incredibly emotive beings and we have a whole range of emotions throughout our lifetime and they're often situation dependent. you know, someone dies, you break up with a partner, you know, something tragic happens, there's an illness, you know, I, you know, I I just had a very close friend who just died. I mean, I I understand, you know, when you start to feel these emotions and we just want to like plate them or subdue them or suppress them instead of actually feeling the full range of what it is to be a human being.

And I think I think that's that's an important point. And often, you know, those those are temporary situations, but they're they're also, I think, um, they're also, you know, we live in a very stressful world right now geopolitically. Those those things are real and they're destabilizing. I think, you know, there's divisiveness never before. There's increasing, you know, inequities and economics. There's there's challenges with chronic stress from social media and everything else. So, we've got so many things that are making us mentally challenged. Um, but I also think that there's there's another part of this, which is that, you know, that there's there's just, you know, this there's a rise in the sort of um biological factors that I think are actually a more accurate description of what's causing mental illness than than a serotonin deficiency.

Uh, and and this is more sort of the work that I've sort of focused on around functional medicine. And and you know there's been clinical trials for example called the Smiles trial where we looked at people who were eating processed food getting them on real food randomized control trial showed that just eating a healthier diet actually helped with depression. And I've seen this over and over in my practice when you when you treat nutritional deficiencies whether it's B12 or folate or vitamin D or omega-3 fats all of these have been linked to you know low mood or depression.

So there's a lot of biological reasons, but I I think you you you you are when you say biological cause of depression, you're you're really focusing more the this sort of chemical imbalance framework and not these other aspects which I think are pretty well understood. Is that is that right? right? right? Yes. Um predominantly on these theories that uh depression is caused by specific by deficiencies of specific brain chemicals. chemicals. chemicals. Um Um Um but I uh I I I worry that any sort of specific biological mechanism biological mechanism biological mechanism might be used in the same way might be might be used as a sort of way of suggesting that depression is you know is a physical and bodily thing and forgetting about the elements that we bring to our feelings and emotions that are about us as people rather than us as bodies.

But I completely agree with you that um one has to be physically healthy to to have a sense of well-being that it's very you know that if you are badly nourished or inactive uh you are much more likely to be you know to be depressed or anxious or stressed. I mean, we know that there's, you know, there's lots of literature on that. And we know that um doing exercise is really good for your for your mental well-being and also very good for depression. depression. depression. Yeah, exactly.

Exercise is great for depression. Meditation is great for depression. Lowering stress levels is great for depression. Sleeping is great for depression. All all these common sense things that we kind of forget. And I think, you know, it got exciting to think, oh god, I don't need to spend 40 years, 5 days a week doing psychoanalysis for treating my mental health. I can take this pill once a day and then be done with it. But it's kind of been a it's it's been an unfortunate trajectory because it hasn't allowed us to to get to the real root causes.

And you also talk about the sort of the the social factors, right? The poverty, the you know, housing instability, loneliness, childhood trauma. I mean, I think we've kind of distracted ourselves from some of this contextual stuff and are trying to sort of almost blame the individual rather than understand the social and political environmental causes. So, I'd love you to sort of speak about that because I think this is a really important framing. Well, yes. And and and and you were talking earlier about what's going on in the world and how frightening that is and how stressful that is.

And you know, we can add to that all the sort of social and economic um chaos that we've seen over the last, you know, 15 years or so since the crash since the economic crash of 2008. And and I would add to that that I think there's a you know that a lot of people have this feeling that there's nothing they can do about these events, that there's no way to change them. And you know I think that's partly a consequence again of of changing social conditions of the you know loss of community people you know families and communities being much more fractured and dispersed than they were trade unions not being very powerful anymore anymore anymore uh organized religion having much less role in in society and in people's lives.

So I think on top of all the stresses that we're dealing with there are people just can't see a way to change change the world change not only to change the world but just to change their world you know to change their environment and so I suppose there's a degree of learned helplessness that you know that that um that people are experiencing that feeds into mental health problems and I completely agree with you that the problem with this medical model that we've got and with encouraging encouraging encouraging you know, encouraging the idea that you can treat depression with with a with a pill is that it discourages people themselves from trying to work out what they might be able to change about their own lives, how they might be able to improve their own lives, how they might be able to, you know, take an active role in their recovery and discourages governments from asking why why so many people are depressed and unhappy.

and introducing social policies that might improve people's, you know, living conditions. conditions. conditions. It's really interesting. I think I think those are all so essential things. I mean, we we have to deal with the the social determinance of health. Um, but, you know, there's also the commercial determinance of health. I don't know if you've ever heard that term, but it was sort of developed by the WHO as a way of understanding the way in which corporations corporations corporations are determining our health through their actions, whether it's the ultrarocessed food industry, tobacco, alcohol, pharmaceutical industry, all driving for profit and undermining public health.

And I think the these promote this these ongoing social, political, and environmental causes. So it's it's just this really kind of almost uh disease um creating context we live in in the world today. And it's it's it's the individual is often at the effect of all this stuff. And unless you have some understanding of how to have agency and how all these things affect you, the average person has no clue that if they're eating ultrarocessed food, it's going to give them depression. Like you know, they they may know it's not the healthiest for them.

They may know make make them gain a little weight but they don't understand the full impact of of these behaviors or things and I think you know empowering people with agency you talk a lot about this how do how do we have more agency and how how do you help people have more understanding of what they can actually do themselves to in some ways to protect themselves from the onslaught from the medical industrial complex and from the pharmaceutical you know industrial complex and the commercial interests that are driving towards towards people being unhealthy andre producing you know commercial benefit but really undermining public health.

So h how do you help people think about that on an individual level? You're a psychiatrist. I mean this is kind of how you how you have to think about these things. So we have we have a food industry that you as you say is thrusting ultrarocessed food at people making people unhealthy and then we pharmaceutical industry that's coming up with drugs that you know anti-obesity drugs uh to to great business model weight. Yeah. Exactly. As well as anti-depressants to deal with the fact that, you know, when you're unhealthy and overweight, you're much more likely to be unhappy as well.

So, we've got all these, you know, different different huge commercial sectors working in synergy with each other almost. almost. almost. Maybe it's maybe going to be a new drug, ompic combined with Prozac. Yeah. Yeah. Exactly. Yeah. Yeah. Yeah. Yeah. Don't even don't even put that out there. I'm still someone I know. But this is how pharmaceutical industry thinks. They they're trying to manufacture illnesses and they've done this I've seen this happen throughout my career and we graduated medical school around the same time and it's like the sort of the the sort of medicalization of problems is sort of what you're talking about.

Um and and this medicalization undermines our ability to really look at you know when one of what are the bigger context issues that we just talked about. You know, one of the things I I see emerging, I love your perspective on this because it it does kind of it is kind of nagging me in the back of my head because I don't quite understand it. And there's this sort of psychedelic revolution going on in psychiatry and there's a lot of work being done in the UK along the US and a lot of clinical trials and the orders of magnitude of improvement is so far greater uh than placebo and then anti-depressants and other psychiatric medications for PTSD, for anxiety, for depression, psilocybin, MDMA, uh even now Ibagane is being talked about more which is a root medicine from from Gabone in West Africa that has profound neurochemical effects.

Uh and and I've actually even taken it myself and I I can tell you it is profoundly neurochemically altering not just in the moment but it seems to have lasting effects around you know trauma and brain repair and um brain trophic factors to get released. And I wonder how you think about that because in in some ways, you know, it is a biological know, it is a biological framework for understanding how to treat disease. And they and the interesting thing about these compounds is that it's not like an antress where you have to take one a day for the rest of your life.

It's, you know, a couple of treatments or not that many that seem to have really profound long-lasting effects. So I'd love your perspective on that. I don't know if it's an area you think about, but it it just kind of as you're talking about the the biology of this, I'm think, oh wait, you know, maybe we should talk about this. No, no, absolutely. I do think about it because they're they're also they're also um very popular in or or becoming popular in the UK this whole area of psychedelic medicine.

So this is how I think about it. I I think that we need to think about all the drugs we use that's whether we use them recreationally or whether they're prescribed if they're drugs that cross the bloodb brain barrier they're drugs that alter our mental states in one way or another. And that's how I think we should think about all drugs rather than as things that target underlying pathological mechanisms because no drug that we use for mental health whether that's anti-depressants or antiscychotics or Valium or mood stabilizers or anything else has been shown to actually do that to work in that way.

Um so psychedelics are psychoactive substances. They are psychoactive substances that give people a very unusual experience. And some people find that experience to be enlightening and to give them insights into their lives and into their pasts that might help them going forward. And the original the original introduction of psychedelics into psychiatry or original it the they were sort of reintroduced maybe a decade or so ago um in the context of what was called psychedelic assisted psychotherapy. And the idea was that you'd have one or two psychedelic experiences and then you would pro on in a sort of clinical setting and then you would process what your experience what you might have learned from that with a therapist.

And the idea was that for some people there would be insights that would help them to get over what they were suffering from and to move forward in their lives. The problem is that model isn't isn't great for people who want to sell psychedelics or psychedelic experiences because it's just once or twice that you're going to take the things and um you know if you're setting up a psychedelic clinic like with the ketamine clinics that have got going in the states you wanted people to keep coming back.

coming back. coming back. You want an annuity but that's not how we should be practicing medicine. It's like it's like we give an antibiotic for an infection. we we know it's only for a week and that's great as long as you take antibiotics for the rest of your life. So I think you know I think most doctors probably do care about doing the right thing. It's just the system is set up not for that. And so what has happened with ketamine which which was set up with the same sort of model, same idea in mind is that the psychotherapy has gradually dropped away and people are in you know people are encouraged to and certainly have got into the habit of going back repeatedly for their shots of ketamine and so it becomes a long-term treatment.

And we have no idea about the safety or well actually we do have some idea about the lack of safety of long-term ketamine use because we've got data from recreational drug users on how it damages your bladder and things. We don't have terribly good data on long-term repeated use of other psychedelics because because they're they're not so often used in that way. So that's my concern about about psychedelics. I think the idea that some people get insights from using them is fine, but I worry that we will end up with the same old model of people just going on to chronic long-term treatment because that's what makes organizations money without knowing very much about the possible negative consequences of doing that.

doing that. doing that. Yeah. Although I don't you can go to work on Prozac. You can't go to work if you take a big dose of mushroom or MDMA. But but of course this micro doing idea has come in hasn't it? What do you think about the micro doing? I mean I think you you look at the literature on the toxicity of these uh drugs like uh not intimate particularly but like psilocybin or LSD there there seems to be a very low toxicity and very high safety threshold for these drugs.

So micro doing as a as a therapeutic option is something it's interesting and I've been talking to some scientists about it. And it seems there's some increasing, you know, both anecdotal and and clinical literature on this. There's a film, there's a Swedish film that's come out recently which is about I'll try and remember the name of it before I finish um which is about a group of teachers who decide to go to work um having had a a glass of wine or a small amount of beer or something like that, having had some alcohol.

And they will they they their theory is that, you know, if they just have a small amount and maybe have to top it up a bit during the day, they'll be at that lovely sweet spot where they're, you know, confident and outgoing but not too drunk. And the film is about how that goes horribly wrong. Really, wrong. Really, wrong. Really, micro doing alcohol, I don't think, is a good strategy because we know that's a lethal poison. lethal poison. lethal poison. But but I but the point is that you know I think these ideas are fine but actually when you're dealing with you know psychoactive substances it's maybe not so easy to you know to control it in that way or to get the the sweet spot.

Exactly. And we don't as I've said we you know we just don't have any good research on on the long-term effects of regular daily use of psychedelics which hasn't been how they've been used traditionally. traditionally. traditionally. This episode is brought to you by Row Nutrition's liposomaal dim. And here's the thing most women are never told. A lot of symptoms people write off as quote just hormones or mood swings, a stubborn weight around the hips, the skin issues, the PMS that derails your whole week. Well, they're often an estrogen metabolism problem, not an estrogen level problem.

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They're altering brain structure. They they increase neuroplasticity, neurogenesis, neuroplasticity, neurogenesis, neuroplasticity, neurogenesis, um and also neurochemistry in ways that seem to have like lasting effects. And I I don't um I don't know how to comport that with the sort of the what you're talking about, which is sort of this sort of failure of this chemical theory of of mental illness. Maybe we're just thinking about it wrong. I I don't know how to think about it. I love your sort of advice on that. Well, well, I I I worry about all these um ideas that they're enhancing neuroplasticity.

I don't think there's actually that much evidence that they are, but if they are, if there is research showing that, it's not necessarily a good thing because because often you're seeing neuroplasticity, neurogeneration when you're getting damage. damage. damage. There there was, you know, there there was um a suggestion that anti- psychotics and anti-depressants improve neuroplasticity, improve neuroplasticity, improve neuroplasticity, but we uh but we know and and and the evidence that was offered was that they're, you know, altering some some growth, some nerve growth factors, but actually we know those are altered in the same way by having a stroke or having a brain injury.

So, it doesn't necessarily show that the drugs are doing, you know, something that's good. It may be that they're harming the brain. And what we're seeing is the brain's repairerative mechanism. No, that's interesting. That's one so complicated, isn't it? I mean, I want to pivot a little bit because you you talk about this sort of drug centered model versus a disease centered model. I'd love you to sort of unpack that. I I I don't quite um think most people are familiar with that. I'd love you to sort of explain your your view on this.

The conventional way of thinking about drugs like anti-depressants is this idea that they are working by targeting some underlying biological mechanism that leads to the symptoms of depression that that's often been said to be you know a deficiency of serotonin but it could be some other some other abnormality. So people have, you know, recently proposed abnormalities in inflammation and they may be related somehow to how anti-depressants are having their effects. But it's it's that basic idea. And what I'm saying is that anti-depressants like alcohol, like cannabis, like psychedelics are mindaltering substances.

They they change the normal state of our brain chemistry and our brain activity and they therefore change our underlying thoughts and thought processes, feelings, sensations, etc. in more or less subtle ways. So, I'm not saying anti-depressants are exactly the same as alcohol. Of course, they're not. They're different sorts of chemicals. They have different sorts of effects. Uh and some anti-depressants have quite noticeable effects, make people feel quite different, quite groggy, lethargic for example. And some of them have much more subtle effects. And one of the effects they have is this emotional numbing effect.

Um but so so that's that's what I've called a drug centered model of drug action. at is understanding these drugs as drugs, as foreign chemical substances that induce mental alterations that are then superimposed onto people's underlying feelings in the same way that that the effects of alcohol are. So, you know, we know that if you might be feeling down, you go out and you have, you know, a few drinks temporarily, you might then feel better because of the effects of alcohol. That's not because it's, you know, rectified a chemical imbalance.

And certainly not because it's rectified an alcohol deficiency. It's because it it's because the characteristic alterations induced by alcohol is temporarily superimposed onto your underlying feelings. underlying feelings. underlying feelings. And then and how does that sort of connect to the the drug centered versus disease- centered framing of of mental health? So what I'm saying is that drugs like anti-depressants have been misleadingly portrayed as having these disease centered or disease targeting effects whereas actually what the way we should understand them is having drug centered effects as being drugs that produce alterations to our normal or undrugged states undrugged states undrugged states which is which makes a lot it makes a lot of sense.

So given all that um you know sort of what what's a more honest look at mental health today in terms of an evidence-based model of what mental health care and mental health approach to mental illness could be. The first thing to say about an honest approach is that we really don't have evidence to conclude that any sort of mental health condition but particularly things like depression or anxiety are biological diseases in the sense that Parkinson's disease is a biological disease. we haven't detected any underlying underlying underlying disease processes that might explain you know or count for the symptoms.

Um and there are other ways as we've discussed of understanding uh the distress the sadness the unhappiness the despondency that people that people go through at different times in their lives. Um, so I think that's the first thing to say and then also that we have been misled about the nature of the drugs that we're that are prescribed for mental health problems into seeing them as these specific targeted sophisticated um substances. Whereas actually what they're doing like alcohol, like other recreational drugs, is inducing a an altered artificial mental state that may temporarily suppress underlying feelings, but it is not resolving anything anything anything like a band-aid.

Yeah. Just just to emphasize this is not I'm not trying to because I think this fits in with some of your views as well. I'm not trying to suggest that the brain is irrelevant. We are biological creatures. We're embodied creatures and and and the reason that we have the range of sophisticated and refined emotions that we do is because we have our large such large brains, such large and complex brains. It's our large brains that enable us to interact with the environment in a super sensitive way and flexible way.

That that kind of begs the question of what now? you know, how if if these drugs are not the answer, what is and and how do we support people with depression without necessarily defaulting to anti-depressant medication? medication? medication? I think we need a really radical change in how we approach mental health problems. This this medical model encourages us to see, you know, us in the health professions to see ourselves as treating diseases. But what we should be seeing ourselves as doing is helping people with their individual problems.

I think if you if you see if if you get away from that disease model then you can understand that you know everyone who is depressed is depressed for different reasons. There are different causes for everyone. There are as many causes of depression as there are people with depression. And we need to help people with their individual situations to identify why they are feeling as they feel now and what can be done to change that. and and that's, you know, and that's it's not complicated to do that, but we're so entrenched in this medical framework that that sort of forces us down the route of thinking that we're treating some thing that is somehow the same, some condition that's somehow the same in everyone who has it.

Uh that that we are failing to treat people as individuals often and to really identify what their problems are. I mean I think this happens you know this is happening out there in in the community as well because people I find and I'm sure you find the same you know will often come to me saying oh you know I think I've got depression I think I've got ADHD I think I've got this I think I've got that think I've got yeah you know a diagnosis that they they might have sort of spent quite a lot of time looking up and it can be quite difficult then to get underneath this label that people have decided they have to to find out what the actual problems are what are the difficulties that they're having with their dayto-day life.

Just wanted to add something something more to that because because people people often say to me um well, you know, that that's all very well for, you know, for a lot of people, but but what about people who have really severe depression or have depression when there doesn't seem to be any obvious cause, any obvious reason for them to be depressed? So, just like to address that cuz I think that's important. That was going to be my next question. question. question. It's important to say that the that there is no evidence that severe depression is caused by any specific biological mechanism either.

But of course, we're all different and some people will react to possibly quite trivial problems in their lives in a much more severe or intense way than other people will. Yeah. Um and so there are some people obviously who get into a really bad state um who you know take to bed. Sometimes they refuse to eat or drink. Some people you know get sort of depressive delusions and in that situation we need to make sure that we take care of people. The evidence that anti-depressants are any use in that situation is no better than than in any other situation.

They're not they haven't been shown to have um you know clinically relevant substantial effects in people with really se severe depression anymore than they have for people with milder milder episodes of depression. But it certainly is important that we help and take care of people in that situation because they can well often they can't take care of themselves and you know sometimes people can try and commit suicide. So it is important to keep people safe and to remember that remember that remember that almost everyone will come out of it eventually.

eventually. eventually. Most people will recover from depression eventually naturally in their own time. Hopefully helped by being cared for and as soon as they're able to do it, being helped to identify things that might improve their situation. Because even people with this very severe depressive reactions are often reacting to circumstances. So it's quite typical people who get into this severe state, it's quite typical that they're older people who have just been affected by a bereavement, loss of their spouse or or um other loved ones or or retirement is is another another thing that can trigger these sort of episodes.

People listening are going, "Well, gosh, if these things don't work and you know, there's $20 million of these drugs prescribed a year globally. Millions and millions of people are taking them and they're listening. What do they do? And how do you responsibly deprescribe them? And how do you support them as they're getting off of them? And how do you direct them to resources that can actually help address those underlying causes? underlying causes? underlying causes? First of all, it's it's important that people take their time to think about it.

think about how the drugs are affecting them, the pros and cons of those effects. And then if they decide that and read up about the side effects that they might be experiencing, because sometimes people are getting side effects and they're not aware that it's, you know, they're not aware that it's the drug that's making them feel sleepy or groggy or or maybe interfering with their sleep. sleep. sleep. And and then if people decide that they do want to come off the drug, I would suggest that people go and see their doctors.

Hopefully the doctor will be sympathetic and will draw up a a plan with you to come off it slowly and sens. If your doctor tells you to come off in in, you know, 2 to 4 weeks, don't take their advice, particularly if you've been taking these drugs for years at a time, because you may end up in a in a really bad state. Um there is there's information for people out there now about how to come off anti-depressants safely. A colleague of mine wrote something called the Msley deprescribing guidelines that give that gives really detailed evidence on how to reduce doses gradually um if you're experiencing you know difficult significant withdrawal effects.

So yes, so so the main evidence is um don't do anything in a hurry. Make a plan. Try and get support from your doctor or from some health professional and come off slowly, particularly if you've been taking the drugs for a long time. time. time. One of the questions I get all the time is what's the healthiest way to boost your energy? Here's the truth. Many people depend on coffee to get through the day. But for a lot of people, it can become part of the problem.

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You know, what do I do? So, yeah, that's a really good question, too. And also during the process of withdrawal, people might feel um one of one of the withdrawal symptoms is to feel sort of really intense emotions, tearfulness, anxiety, all those things can happen during withdrawal. And often people will assume that they're having a relapse because of those emotional symptoms. Um but those those symptoms can be part of the withdrawals process and to the extent that they are part of the withdrawal process they will gradually fade as as the body gets used to having not having the drug in the system anymore.

So that's the first thing. Then the second thing if people are still depressed is the same as is the same advice as as as I would give to people who are depressed for the first time and thinking about possibly going to see their doctors. The most important thing is to try and identify why you feel as you feel. What is it in your life? What what is this emotion signaling to you? What is it in your life that is getting you down and that you might be able to change uh to improve how you feel?

That's the first thing. M thing. M thing. M the second thing is as we've been saying earlier earlier earlier take exercise, eat well, optimize your physical health because that will make you feel better mentally and emotionally. emotionally. emotionally. I think that's important is that you know we we have to lean in on the things we know have been scientifically proven to work. eating a whole real food diet, regular exercise, especially cardiovascular exercise, getting adequate sleep and circadian rhythm regulation, managing stress and and just learning how to regulate your nervous system.

And then and then there are other things that are easily addressed, you know, whether they're nutritional deficiencies, which are extremely common, whether it's omega-3s or vitamin D or folate or B12, things we know from the scientific literature do actually impact you. And then there's, you know, the whole other layer of things that can cause depression that we know can can drive inflammation in the brain, whether it's the microbiome changes that we now are understanding or whether it's environmental toxins. So there's there's actually a pathway and I it's what I spent a lot of my life thinking about and and I think you know it it sort of speaks to sort of really reframing the narrative of mental health from this sort of idea of some chemical imbalance which was sort of the the framework of your book to really a more sort of holistic view of understanding of health both from the sociological political environmental aspects and some of the other biological factors around lifestyle that we're just ignoring and uh I think that's That's it's a really important moment I think in psychiatry.

It feels like a it feels like a really historical moment where we're basically understanding one the the degree of which trauma affects us from our childhood and two I think the psychedelic revolution is also opening up a different perspective of how did these things work and I think we're sort of entering a new era of of of um psychiatry and mental health and hopefully it get not like just like okay well proac didn't work let's just stop it and then you're all like kind of left holding the bag.

I think that's a depressing thought literally in itself. So I think I think it's kind of a hopeful moment. Do you do you feel hopeful about the future of psychiatry? Possibly. I'm not sure. The backlash the backlash I've had to both the book and the FDA panel on pregnancy is is a bit depressing. But I I'm always hopeful at an individual level because I see people who sometimes have been been depressed for years who do nevertheless manage to recover the agency to overcome what they're feeling and to make changes and to feel better.

I see that all the time. And I think I think you know this is what I object to. What I object to most about telling people that they've got a chemical imbalance is that that is a really depressing message. That's telling people there's something wrong with your brain. There's nothing you can do about it. You've got to rely on, you know, someone giving you a drug. And so I think just just um you know correcting that mistake and informing people that there isn't something wrong with their brains and that they do have the capacity to improve, to recover, to change is is actually a positive and a hopeful message.

hopeful message. hopeful message. Amazing. Well, everybody definitely should should take that to heart and should check out your new book, Chemically Imbalanced, the Making and Unmaking of the Serotonin Myth. It was definitely a wrong left turn that we took. took. took. in the '9s and I think thank you for helping us correct it and rethink our approach. I really appreciate you being on the podcast. Is there any final words or thoughts you'd like to share with our audience? I I suppose inform yourself because because you know especially with the backlash I got to the book I realized that there are elements of the medical profession that don't want people to think for themselves that want people just to go on you know believing expert pronouncements about things which are not always accurate.

I know that's a scary message, but I think we need to we need to be informed as as as patients, as consumers nowadays. We need to to inform ourselves and not just take things on trust. We have been essentially lied to about the nature of depression for, you know, two and a half decades now. Um so, so yeah, people need to do their own research and and not just take things on trust as as we may be used to. I I think that I think we're in that moment in medicine where people are are wanting to have more agency are less u sort of idealizing the sort of medical profession as a know-it-all profession and and sort of the emperor has no closed a little bit here and I think I think it's important not that medicine doesn't have a lot of value and that and we've both been trained in traditional healthcare and medicine and it it it does have a lot of really good things about it and doctors are generally very compassionate kind good people who want to do well for their patients It's just that we even even our own profession has been hijacked in ways by commercial interests that that leaving leave leave us not knowing what's true sometimes.

I think people need to realize there are areas of debate and discussion within medicine and and you know things aren't aren't necessarily as clear-cut as the media and um scientists themselves sometimes portray them. Absolutely true. and you know, thank you for having the courage to um take on something that's quite controversial and and and challenging the orthodoxy and and moving science forward. I really appreciate your work and uh it kind of validates what I was even seeing almost 20 years ago that were early signs in the literature that you know even in the 2000s there was like wait a minute this isn't quite what it was promised to be.

So thank you for doing the hard work and uh making people like me look smarter. Thank you. Thank you. It's been a real pleasure. pleasure. pleasure. If you loved that last video, you're going to love the next one. Check it out here.