The legitimacy of asking whether antidepressants work

The Sunday Times magazine has an article about Joanna Moncrieff promoting the publication this week of her new book, Chemically imbalanced: The making and unmaking of the serotonin myth. This follows the 2022 umbrella review, of which she was the first author, which concluded that there is no consistent evidence of an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations (see previous post). This conclusion has caused controversy within mainstream psychiatry that wants to hold on to the idea that serotonin is implicated in depression (see eg. another previous post). This is because it believes that antidepressants work and wants to suggest that their effect on the serotonin system must be something to do with the mechanism.

The efficacy of antidepressants is a legitimate scientific question and my reading of the evidence is that the issue is still open, despite mainstream psychiatry’s insistence the issue is closed. Jo is not convinced antidepressants have any use. There is little doubt that short-term trials of antidepressants on average show a small significant difference above placebo. But because of methodological problems with the clinical trials this apparent benefit may be an artefact (see eg. previous post).

The placebo effect is powerful. Doctors have always exploited the placebo effect. Their beliefs and hopes about treatment, combined with patients’ suggestibility, can have an apparent therapeutic effect. Participants’ subjective beliefs about receiving active or placebo treatment in a clinical trial can significantly influence the assessment of the outcome of treatment. Whether antidepressants are mere placebo is, therefore, a legitimate open scientific question (see eg. previous post). It should be possible to have this debate in public without having to label Jo as notorious.