The Truth About Depression - Dr Joanna Moncrieff

26:00And what do doctors have? They have a prescription pad and a diagnostic book. So they tell you, yes, you've got this condition and this is the treatment, this drug. Absolutely. And to me, one of the great tragedies about when we talk about depression or any type of mental health condition is because we don't know a lot about it, if we're being honest, because that does seem to be the central theme of the conversation. It's like, look, we don't actually know. So a lot of the time, the treatment or the procedures actually do more harm than good. Yeah, absolutely. Absolutely. I mean, this is one of the main messages I would like to get across to people.

26:39There is no evidence that you have a chemical imbalance in your brain if you are depressed. So therefore, there's no evidence that that antidepressant you're being offered is going to correct that. But we do know that antidepressants are real drugs that enter the brain and change the normal state of our brain chemistry. And that can have harmful consequences. That's not necessarily a harmless thing to do. we should be worried about messing about with our brain chemistry. And we haven't because the psychiatric profession and all the psychiatric research establishment has been so focused on this wrong idea that antidepressants target some underlying imbalance or some other sort of underlying dysfunction of the brain.

27:28They haven't asked that question about what antidepressants might be doing by just messing about with our normal brain chemistry? What are the consequences if you take these drugs for months and years at a time, as many people do? There's really not very good research on that. There are, as we mentioned earlier, some suggestions coming out that actually these drugs can be very damaging to people's sexual functioning, people's emotional life, that they can cause severe withdrawal symptoms. But all these things have actually come out because people have been reporting them, not because people were doing, you know, had set up systematic research studies to investigate the consequences of use in the first place.

28:15And to me, it derives as well from the fact that we just, if we're being honest, we don't really understand the brain. I mean, you look at the other organs and you go, well, oh, you know, we understand the kidney pretty well, the heart. I mean, the heart is basically a muscle or the liver or whatever else. But even if you talk to one of the most eminent neurologists of the day and you ask them a question about the brain, I'm sure a lot of them would go, look, we don't know about X, we don't know about Y, we don't know about Z. So we, in absence of all this knowledge, we're just thinking of these techniques of how to help people.

28:47Yeah, yeah. I mean, I think we've got a wrong impression that we know more about the brain than we do. And that's partly because of the way that a lot of neuroscience findings are presented and reported. So we're always seeing articles, aren't we, like, you can boost your dopamine by doing this. And if you have more dopamine, you'll be more active or a better athlete or something like that. And if you lack serotonin, then you're not only just not as happy, but socially dysfunctional or something like that. So, you know, these headlines get put out there all the time, so people have the impression that we know more about the brain than we do.

29:32And I would agree, we don't know very much about it. For example, we know, we've identified a lot of the different chemicals that are active in the brain, but we understand very little about what each of them do. And why is that? it's partly because they all interact so actually isolating the effect of one is is difficult it's also because sticking chemicals into into human brains is a very difficult thing to do so you know there's some research done on animals but not very much research on human beings that directly manipulates brain chemicals for obvious reasons because there's this fascinating when people talk about mental health they conflate it with mental illness so you talk we talk about depression and schizophrenia as if they're under the same umbrella when as anybody knows and i have people in my family have suffered from schizophrenia it is a very very different condition to depression i i think it's a very different condition, but there's not very good evidence for any biological basis for schizophrenia either.

30:45So it's still a mental illness in the sense that it's an illness or condition that we diagnose or identify on the basis of how people behave.

30:58Francis Foster:I guess what Francis is getting at, I think, is more that depression is something that we probably all experience at one point of our lives to a lesser or greater degree. Schizophrenia is a whole different story. Yeah, yeah, which I completely agree with. Yeah, yeah, no, absolutely. I mean, I think depression is something understandable and familiar. And schizophrenia is quite a radically different state from our ordinary everyday lives. And I guess the other part of it, and this is, you know, difficult to talk about because you never want to talk about people who have a particular problem from a kind of responsibility point of view because it sort of sounds like blame a lot of the time.

31:40Francis Foster:But I guess you can probably speak about yourself. As I said earlier, I know how to give myself or put myself in the state of being depressed. I also have discovered how to get myself out of that state, right? And I think I would imagine, you know, obviously big pharma, People always want to make money from helping people fix their problems. But let's be honest. A lot of people, all of us, want an easy fix for things. And if someone comes along and gives you a tablet, instead of saying, okay, you've got the problem, okay, here's what you do. You exercise four times a week. You don't eat any sugar.

32:12Francis Foster:You don't eat any other crap. You make sure you speak to your family every day. You do this. That'll give you depression. Whatever. I mean, that probably will. You know what I mean? There's a whole, like, you have to change your whole lifestyle. or we can just give you this tablet. And a lot of people would rather just take the tablet. Yeah, yeah, yeah. The problem is that we know that if you subscribe to this idea that you have a brain chemical imbalance, you actually do worse. You have worse outcomes and you think that you can't do anything about your condition and you are more likely to believe that you will never recover.

32:50Francis Foster:Yeah, it feels like cancer. Yeah, yeah. It feels like you've got cancer. So I think what happens when someone is prescribed an antidepressant, often they will initially get some sort of psychological benefit, some placebo, positive placebo effect, because they think, oh, you know, great, at last someone's helping me. I've got an explanation. You know, the drug's going to work. So often people will start to feel a bit better. But because actually the drugs are not a long term solution, probably not really having much impact on your mood other than, you know, other than slightly numbing you, which is probably not helpful.

33:28in the long run, they don't work. And when people start to realise, actually, I don't really feel better, then they can be in an even worse state because then they think, not only do I have this horrible medical condition that I need to take a drug to sort out, but I'm not even responsive to this drug. I'm treatment resistant. The treatment hasn't worked. I've got to go back and get the next line of treatment and then that might not work. So So actually people can end up in a really sort of negative and pessimistic state. So although it feels like it might be a nice, easy solution and beneficial in the long run, I think it's not.

34:10Francis Foster:And Joanna, we have had on the show on all sorts of different subjects and culture and politics and comedy and music and whatever, lots of people who have challenged the consensus in their field. It doesn't usually go that well. People don't tend to take on new ideas that easily. How have you found the response to bringing these ideas forward? Yeah, that's a good question. Well, there's been a lot of pushback from the psychiatric profession and some from members of the public and some from the media. I think members of the public sort of went two ways when we published that paper, which is part of what I write about in the book.

34:52You know, some people said, oh, my goodness, you know, thank you for enlightening me. You know, now I realize, you know, I shouldn't be taking this medication that I was given and has never done me any good anyway. And then other people, you know, people who'd really changed their whole feelings about themselves, changed their self-beliefs, come to see themselves as someone who had this brain condition and, you know, was going to need this long-term treatment. and found having that idea of themselves challenged, difficult, found that difficult to be challenged about that idea. Some of them pushed back and said, it's irresponsible to publish this, you're going to make people feel awful.

35:37So we had those sorts of responses. The psychiatric profession really seemed to me to just want to shut down the debate. They didn't want people to get an inkling that actually depression has not been proven to be a biological condition. I think they wanted people to go along under that impression, which is why no one has challenged this idea of the chemical imbalance theory earlier, because actually it's been known for a long time that the evidence didn't add up. I mean, although I got all the evidence together in a systematic way in this paper in 2022, a lot of people said when I published it, oh, we knew all that.

36:20Of course we knew there wasn't evidence for a chemical imbalance. Of course we knew there wasn't evidence for the serotonin theory of depression. And I think the reason that no one had highlighted that before is because actually it suited the profession for the public to go on believing that we had discovered the biological origins of depression so that they would go on subscribing to this medical view and taking the antidepressants. And in fact, they, you know, these psychiatrists who sort of challenged the paper in that way often suggested that, well, okay, you haven't found a serotonin imbalance, but maybe it could be inflammation.

37:04You know, there's lots of other theories. It could be inflammation. It could be problems with neuroplasticity. It could be other neurotransmitters. The problem is that none of those, Those are all theories about possible biological causes of depression, but none of them have been proven either. And there's much less research in those areas than there is on serotonin and depression. So, you know, yes, there was lots of pushback. But and as I started with, you know, there are still lots of public information sites that tell people that depression is caused by a chemical imbalance in the brain. But I think there are fewer now.

37:43I know that, for example, the Australian and New Zealand Royal College of Psychiatrists took down their blurb that told people that depression was due to a chemical imbalance. And I think some other sites have been changed as well.

37:57Francis Foster:So if we don't know exactly what causes people to feel persistently sad, let's call it that, how much do we know about ways of consistently overcoming that state or getting out of that state? So, we know that the vast majority of people will recover at some point spontaneously. So I think that's a really important point to state, because we've sort of created the idea, and in fact, the president of the Royal College of Psychiatrists was on the radio the other day saying people don't get better from mental illness on their own. Well, people do get better from depression on their own. Whether you call it a mental illness or not is another matter.

38:39It certainly is classified as mental illness. um and uh so so it's important to know that people can get better on their own and then how people get better depends on the reasons why they have become depressed their the particular individual causes in in their situation so you know some people might need relationship counseling to sort out relationship difficulties some people might They need support at work. Some people will benefit from having general psychological therapy, talking therapy, in order to work out why they're feeling depressed, because we don't all obviously know. And even if we know, we may not have any clear idea about how we can change those things that have made us depressed.

39:31So I think therapy can help with that. and I think therapy can also help with processing childhood trauma, trauma, you know, major, major events. It can help people to build up self-esteem, which is often part of the problem as well. So I think therapy can be helpful, but I don't think it's necessarily a panacea or something that everyone, you know, has to have. And then there are general things that improve people's mood or well-being on a day-to-day basis, like exercise, like eating well, like social interaction, like having meaning and purpose. I think that's really important. And I think that that is one of the major things that we struggle with in modern life, you know, now that we don't have meaning and purpose given to us in the form of a religion.

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42:30I can't do that activity. I'm never going to be able to have a relationship maybe, you know. And again, it's sort of this... I mean, I think people who adopt a mental health identity have different ideas about what it really means. And some people, I think, are just saying, I'm a bit different from other people. This is who I am. Some people, I think, have bought into the idea that they have some problem with their brain. and if you're one of those who's just saying I'm a bit different well you know maybe that's okay but again I sort of feel that it still might be limiting to feel that you know you have this difference that's a sort of intrinsic part of you but people who've really bought into the full idea they've got a problem with their brain well first of all you know there isn't evidence that that's true so they're buying into a you know a mistaken idea.

43:33And that's very limiting. If you're thinking of yourself as someone who is flawed, who has an abnormal brain, a broken brain, as some people refer to it, then obviously you will limit yourself and you will possibly not lead as fulfilling life as you otherwise have led. And also as well, and this is by the way, there's no judgment on my behalf because this is not an identity, but there are times where I have embraced this particular type of viewpoint, which is that of being a victim. Things happen to me and therefore I'm a victim of life, et cetera. How much of this is people essentially assuming the mantle of being the victim.

44:22And as a result of that, they don't have to take full responsibility in the same way that, you know, people go, you know, well, I have ADHD, which means I have outbursts at times, which means I can go around and tell you what I think of you, which is unfortunately how some people behave. So let me tell you about a little project I did with a student a few years ago. We looked at people's, at the blogs of people who identified themselves as being depressed and having significant problems with depression. And we analysed how people seemed to understand their depression, but also what they did about it.

44:59And what was very interesting is that most of the people in these blogs were fully signed up to this medical idea that they had something wrong with their brain. And they were signed up because this made them feel better about themselves. This excused them from feelings of shame, from feelings that they'd let other people down or weren't, you know, pulling their weight in their family or workplace or whatever. But what was very interesting is that when you moved, when you saw how they wrote about how they'd overcome depression, they all said that they had to take active steps themselves in order to change their lives in order to overcome this problem.

45:44So none of them were saying that we just took the drug and it fixed our chemical imbalance and everything was fine. They were all saying, we had to examine our lives. We had to examine, we had to understand why we felt as we did and we had to do something about it. We realized we had to change something. And that process of change had often involved a process of personal growth and development and many of them felt that they'd become fuller and better people as a result of that self-examination process that they'd gone through. So I think that shows that it is important for people to have agency to, you know, examine what this means, what they're feeling is a response to, what's gone wrong for them, and what can they do to change it.

46:33But it also shows, as you say, how people, you know, do feel ashamed and embarrassed about letting people down. And yes, that it's nice to have a sort of peg to, you know, to hang those feelings on so that you don't have to, you know, keep battering yourself about them. Absolutely. Because look, human beings are human beings. And if you're going to give someone an excuse, they're going to invariably take that excuse. They just will, because that's how we are. I think sometimes, and if we give people the idea that they can overcome something and that they have agency. I really do think that's a more effective solution than to tell people that they're going to be victims of this awful condition.

47:19Yeah, I do, and I agree with you. And that's why I think it's so important that people know that we don't have, you know, that this idea that depression is a chemical imbalance is not established, is not proven, because people who have this idea that, you know, they have this brain problem, do, you know, and there's research showing this, do feel that there's not much they can therefore do about it. And so they, you know, they sit back and they're relying on the pill that you give them to make them feel better. And, you know, that's not going to work because the pills aren't very effective anyway.

47:58And so that's one of the reasons why I think it's really important to, you know, to disabuse people of this idea. And because we have to tackle this, Because there's going to be a pretty large swathe of people who are watching this or listening to it going, how much of this is the drug company's involvement, vested interests, profits, etc.? Well, it certainly all got kicked off by that, I would say. So, as I said, the idea that depression was caused by a chemical imbalance wasn't initially dreamt up by them. the people who sort of came up with these theories were psychiatrists and researchers back in the 60s.

48:40But it was the drug companies that really grabbed it and ran with it in the 1990s when they were trying to promote the SSRIs and the subsequent antidepressants that have come onto the market. And they flooded the medical airwaves with this idea. And then when the internet really got going and people got access to the internet, they flooded the internet with this idea that depression is caused by a chemical imbalance. I would say that they are very much responsible for having established this idea in the popular psyche. The drug companies are not that interested in antidepressants anymore. There are one or two coming online, but most of them are now off patent, so they're not really heavily being heavily promoted, most of the antidepressants that we use now.

49:29It's not necessarily down to drug company activity that this idea is being maintained, but I think they had established it so well. And they'd had help. They'd had help from medical institutions that ran public information campaigns, often with backing from the pharmaceutical industry, to disseminate this idea, to do disease awareness campaigns, you know, to tell people basically if you're feeling a bit down, go and see your GP, this could be a medical problem. So they got lots of help from the medical profession and the medical professional and some medical sites anyway are still putting this idea forward.

50:08But definitely it was the pharmaceutical industry that really popularized it on a wide scale.

50:13Francis Foster:Well, coming back to your conversation you were having about, you know, people feeling like they're victims, the people I feel really, really sorry for, I think most of all, is the parents of children who've been told this. And I imagine that's a very difficult situation because if your child believes this medical theory and they have all the weight of expertise behind it and you're there kind of going, well, why don't you go for a walk and see your friends more and do this and do that? You are in a very difficult position where you're like the dinosaur who doesn't get it, you know, while your child is basically being drugged for a problem in a way that's not actually being solved.

50:51Yeah, I've come across a few accounts from parents where that's happened, where their teenage or young adult child has gone off and got a diagnosis. And they feel that actually this is an understandable situation and there could be other ways of dealing with it. And worry, understandably, about that person getting started on an antidepressant, but potentially entering into a cascade of medical treatments. which people do because the drugs aren't effective. So, yeah, no, I agree.

51:28Francis Foster:There was one other thing I wanted to ask you in relation to the side effects of SSRIs. I don't know if this is true, but I do remember reading in the wake of a number of very highly publicised mass shootings in the US that there was at least a correlation between SSRI use and mass acts of violence of that kind. Do we know anything about that scientifically? So there is quite a bit of research that shows a correlation, as you say, between acts of violence and also suicidal behaviour and taking antidepressants. Maybe the correlation between suicidal behaviour isn't so surprising. It's difficult to disentangle cause and effect.

52:13so of course you know people people who are suicidal get put on antidepressants and people who have violent tendencies may well also be diagnosed with depression and put on antidepressants because their behaviour is already problematic but there is a little bit of research that suggests that antidepressants can occasionally make people suicidal and violent and aggressive particularly young people. I don't know why it's particularly in young people but that does seem to be a consistent finding and these studies that show this are randomized controlled trials so they are studies that you know are comparing the effects of people taking antidepressants and placebo so they're not you know they're not they're not that's factored out the problem of trying to disentangle cause and effect and some of those some of those studies do suggest that there is a small increase in violent behavior and in suicidal behavior in people on antidepressants compared to people taking a placebo.

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54:21Am I a conspiracy theorist or is there something else going on? So you're absolutely right. ADHD is a big development area at the moment. There are lots of, not lots, but there are a few drugs being launched or that were launched a few years ago for ADHD, including ADHD in adults, which has obviously mushroomed in recent years. And there are some new drugs for depression being promoted. For example, esketamine, which is a relative of ketamine. And then the... This is my point.

54:56Francis Foster:If you give people drugs, they're going to feel good for a while. Absolutely. So it's really going in that direction. It looks like the pharmaceutical industry are producing more and more psychoactive drugs that are directly related to drugs that are used on the recreational drug scene. I wonder whether, this is really conspiratorial, but I wonder whether they've looked at the opioid crisis in the States and thought, well, they got away with it you know they got a lot of people they sold a lot of opiates by telling people that they're not not addictive um and they got away with it and maybe we should you know try some drugs a bit like that so there are be there are opiate like drugs being developed for the treatment of depression believe it or not what yeah absolutely there's you want to have a good time.

55:49Francis Foster:Here you go. But this is what I'm saying. It's like, if you can't legalize drugs or make a profit from selling people weed, well, you just call it, you know, something else. You add a little thing in front of her or the end or whatever, and you just give it to them. And then they have a great time and everybody's happy. So, I mean, it's not that ludicrous. That is what is happening i mean these just just to clarify these opioid drugs are claimed not to have opioid like effects um but but it does look as if they do have some sort of opioid type profile and then of course we've got this huge um so can i just pause it there just one second as somebody who's people seeing the effects in my family of depression and addiction the last thing that you want to do with somebody who is depressed is give them a highly addictive substance.

56:43Yeah, absolutely. Absolutely. Although antidepressants are dependence forming, but don't cause sort of misuse in the way that opioids do. But yeah, no, absolutely.

56:55Francis Foster:Sorry, this interview has descended, but I just find this so ridiculous. The way we talk about this stuff, it's almost like you're not allowed to put two and two together anymore and go, well, if you're just giving people drugs that people take recreationally, they're probably not going to solve anything. So S-ketamine is a good example, if I can just talk about this. So S-ketamine, which is very closely related to ketamine, essentially has the same effects as ketamine. No one disputes that. And it's been trialed in trials, giving it twice a week to people, in trials just as if it was an antidepressant, with the idea that people should just be on this for a few months or possibly a few years.

57:36I'm sure with the anticipation that people will actually go on it for years and years. And they do depression measurement scales, and then they do side effect scales, one of the side effects being dissociation, and conclude that because your depression symptoms come down after you've taken this esketamine that you've somehow recovered from your depression. I mean, it's completely absurd. And, you know, and the normal psychoactive effects of ketamine are all contained in the little side effect scale. And it's as if these are completely separate. They're the way that they affect your mood and the way that they, you know, cause the dissociation and euphoria.

58:18So basically a guy comes into your office and

58:20Francis Foster:says, I'm depressed. You go, go out and have 10 pints. And then while he's having the 10 pints, you go, how are you feeling? It's a lot much better, doc. And that's basically what you've built. Yeah, yeah, yeah, exactly. And I mean, not only that, but ketamine and esketamine are both being promoted as rapid onset treatments for suicidal thoughts. So, you know, you come in and you have your infusion of ketamine and someone measures your, you know, suicidal thoughts ratings and they've gone down and therefore this is, you know, thought to be a treatment. I mean, it - Sounds like a joke. It does, doesn't it?

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59:35That's hims.com slash trigger for your free online visit. hims.com slash trigger. Featured products include compounded drug products, which the FDA does not approve or verify for safety, effectiveness, or quality. Prescription required. See website for full details, restrictions and important safety information. Individual results may vary based on studies of topical and oral minoxidil and finasteride. It's deeply irresponsible because if any of you followed the story about Matthew Perry, the Friends actor, he was obviously highly depressed, struggled with addiction for all of his life, used ketamine as a way to overcome his addiction and effectively died of a ketamine overdose.

1:00:17Yeah, yeah, yeah, absolutely. And it's not just restricted to him. There was an article in, I think it was The Guardian, a couple of years ago, that was interesting, which was about how a lot of ketamine clinics were closing down because, you know, there'd been, you know, the market was saturated and too many had opened up, essentially. and there were people desperate that their local clinic had closed down and they couldn't go and get their next treatment. So basically people had become dependent, probably a mixture of psychological and physical dependence on having their regular ketamine infusions and then suddenly the whole service shut down and they couldn't get it.

1:01:04But isn't it interesting that just the language and I think it's very important to state, you know, big pharma has done a lot of good, let's be honest about that, but the names, esketamine, you go a ketamine infusion, what are you talking about? You're just getting off your nut on ketamines. And the latest thing that's come in is psychedelics, so, you know, psilocybin, psilocybin, ecstasy, and again, you know, there are serious trials of these things going on with this idea that they might cure treatment-resistant depression. It's quite interesting. It started out as what's called psychedelic-assisted psychotherapy.

1:01:48So the initial idea, which isn't maybe quite so crazy, is that you had a psychedelic experience. You had a trip under supervision, and then you processed what you experienced during that trip in some subsequent psychotherapy. And the idea was that maybe the psychedelic experience would give you some insights into why you were depressed or what you might do to improve yourself and your life and your mood. And that was what was helpful. So, I mean, I still think that's a sort of rose-tinted view of what drugs can achieve in people who are deeply depressed. But there's some logic to it. at least it was acknowledging these are psychoactive substances.

1:02:32You have a psychoactive experience. You go into an altered state for a bit. But what's happened is that that has sort of morphed into this idea that actually what they're doing is fixing some brain chemical receptor problem or some chemical imbalance. And that, of course, easily translates into the idea that what you need to do is take them long term just as people take antidepressants long term and of course that's how it's going to go because it's not a good business model is it to have you know to set up a clinic where you come in and you have one psychedelic experience a couple of psychotherapy sessions and then you're cured which is which is what the initial idea was

1:03:15Francis Foster:is it by the way on the psychedelic point it's something that we have talked to one or two people on the show who have suggested that it might actually be effective for things like ptsd and other things. Is there any evidence on that that you're aware of? So there was a trial done on PTSD and ecstasy, I think.

1:03:40Francis Foster:Ecstasy is not psychedelic, is it? Well, it's a little bit psychedelic. It's a bit psychedelic and a bit amphetamine-like. The results showed some benefit, but the problem with all these trials is, of course, you can't blind people at all. I mean, you can't blind people in an ordinary antidepressant trial very reliably, but you certainly can't blind people if you're giving people ecstasy or psilocybin or something like that, or ketamine. Just for people who are not medical experts, you're not poking their eyes out. What you mean when you say you can't blind them is they know they're taking ecstasy.

1:04:14Francis Foster:Yes, yes. So you set up this trial where you compare taking ecstasy to taking a placebo tablet, and you give people the placebo with the idea that people won't know whether they're getting the real drug or the placebo. But of course, if you're comparing something like ecstasy with a chalk or sugar tablet, people will know the difference. And it's the same with antidepressants to some extent, although it's probably less immediately obvious. So the problem is that you can't effectively blind, you can't effectively disguise what people are getting. And so there's probably an enhanced placebo effect associated with thinking that you're getting the real active substance.

1:04:57So this trial of ecstasy and PTSD, I think they did find a small effect, but there are concerns that it was basically due to this unblinding effect, due to the fact that people knew what they were getting.

1:05:15Francis Foster:What about psilocybin more specifically? Is there any evidence on that? So there were a couple of small trials of psilocybin. I'm trying to revive my memory of them. There's one that's compared psilocybin to an antidepressant and didn't find any difference. That was done by a group in this country. there might be another one that's compared it with placebo I think and found some immediate difference but much less difference when you follow people up a bit later as you would expect if this was if they were actually picking up if what you're picking up is people's drug-induced experience there's going to be people listening and watching this who are already thinking themselves you know what I've been on antidepressants for a while maybe it's time to get off what advice would you give because i'm sure it wouldn't be just take your antidepressants throw them in the bin and go cold turkey it's a really important question thank you for asking me um so the most important thing to say is don't do that don't just put them in the bin particularly if you've been taking them for a long period of time because they can be associated with quite severe withdrawal symptoms so people need to come down on them slowly.

1:06:31Now, some people will need to do that very slowly, particularly if they've been on them for years and years, in order to minimise the withdrawal symptoms that they will get. The other thing that's important to say is that withdrawal symptoms include emotional symptoms like anxiety, tearfulness, and changeability of mood, feeling down, feeling sad. They include a lot of emotional symptoms in the same way that, you know, coming off alcohol or heroin, you know, any psychoactive substance, you know, messes up your mood when you're coming off it. So people will experience emotional symptoms when they're coming off their antidepressants.

1:07:13They shouldn't just assume that that means they're having a relapse because I think very commonly that has happened, that people have started to come off, started to feel a bit anxious, a bit more emotional than usual, assume that they're having a relapse and that they need to go back on their medication. And many of those people then think, oh, well, I've just got to take it for life, which is really tragic because actually, probably if they'd just reduced, if they'd known what was happening, A, and B, reduced more slowly, they might well have got off their antidepressants. So people should, you know, people need to be aware that there are withdrawal symptoms.

1:07:50These include emotional symptoms. Also, some people get physical symptoms like dizziness, like feelings of electricity going through the brain quite typically. And these can be minimized by coming off slowly. It's particularly important to come off the last bit slowly. So to get down to low doses, then don't just throw it in the bin, keep reducing the dose very slowly. There are guides now to help people with that. The Royal College of Psychiatrists have some good information on their stopping antidepressants section of their website that was written by a colleague of mine who's had personal experience of coming off antidepressants.

1:08:33And he's also co-authored a book called the Maud's DD Prescribing Guidelines, which gives people lots of information. It's massive and very dense and quite expensive, but it's something that people could potentially recommend their GPs to get if their GPs were uncertain about how to help people or if people were worried that their GPs were telling them to come off too fast, as I think is probably quite often the case. So, I mean, that's worrying that the GPs don't really know how to get people to come off these drugs because if they come off too fast, what you're basically saying is that the side effects can be quite severe.

1:09:11Yeah, absolutely. And there's evidence that some people, probably particularly people who come off too fast, will get into a persistent withdrawal state or a persistent state whereby they often feel foggy, debilitated, tired. some people can't you know can't get out of bed people have to stop work or reduce their hours cause can cause all sorts of of social problems um and i know more and more about this because along with colleagues i've set up a little deprescribing service in in the the mental health trust that i work in and we are increasingly um referred people who are in these terrible states having come off antidepressants too fast.

1:10:01So it's really, and sorry, and I brought that up because I think that not that many GPs and doctors are aware of this problem, are aware that there are these persistent states that people can get into if they come off too fast. It's tragic that we're not aware enough about that because actually the same problem was shown with benzodiazepines back in the 1980s. It was shown that some people who came off benzodiazepines again showed persistent problems, often persistent neurological symptoms and persistent anxiety. So it does seem that some drugs, if you come off them too fast, can really cause a lot of damage.

1:10:45And you're saying persistent. What does that mean medically? So good question. it means that the symptoms can go on for months and sometimes for years. So people have reported these sometimes for years. And while we're on that subject, can I just bring up the subject of persistent sexual dysfunction? I think that's also something that needs highlights. Thank you for looking at me when you said that, Joanne. I just think it's something that's really important. And again, something that's not nearly well recognised enough by the profession as well as by the public. So it's well acknowledged that antidepressants cause sexual dysfunction while you're taking them because they're disrupting the serotonin system.

1:11:29That's not in dispute and affects a lot of people who take them. What has become evident over the last couple of decades, I would say, with increasing reports is that some people will have persistent problems with their sexual functioning after they stop taking their antidepressants. And not only has this come out from reports of patients, it's evident from animal studies that show that young animals, rats and mice that are treated as adolescents or young adults with antidepressants show persistent problems with their sexual functioning after they've stopped after this drug has been stopped. We don't know how common this problem is.

1:12:16I mean, I hope to goodness that it's rare, but there are increasing reports and there have been a couple of attempts to try and work out how prevalent it is, one of which suggests it might affect up to around about 10 % of people who stop taking antidepressants. And again, we don't know how long the problems might last. It might just be a few months for some people, but there is definitely people who who report that it lasts for years. And many people say that it's not just sexual functioning, it's their emotional functioning as well, that they feel generally numbed, you know, emotionally and sexually.

1:12:53So really important for people to be aware of that and to be aware that their doctors may well not be aware of that. Joanna, it's been an absolute pleasure. Thank you for coming on the show. Final question is always the same. What's the one thing we're not talking about that we really should be? Oh, gosh. I mean, I think we've covered everything that I need to cover. As I've said, my mission is to make sure that people are informed. Maybe I can just sort of finish by saying that. I don't have any beef with people taking antidepressants or seeking a diagnosis of depression, as long as people understand what the implications are, and particularly what the effects of antidepressants are, and how little we know about what the long-term consequences might be.

1:13:42Francis Foster:Well, thanks for coming on and sharing that with people. Really valuable. We're going to go to Substack, where people are going to ask you their questions now. So head on over to triggerpod.co.uk and we'll see you there. Should teenagers be taking all these medications for ADHD? I worry about taking something during these developing years. Shouldn't they get help but talk about the issues and given problem-solving strategies instead?

1:14:48We'll see you next time. Understand, that's what you get when you have farmers.

1:14:54Francis Foster:Bum, bum, bum, bum, bum, bum. Learn more at farmers.com. Underwritten by farmers truck or fire insurance, exchanges or affiliate. Products not available in every state.