What is Depression?

It’s normal to feel a bit down from time to time, but if you’re feeling persistently unhappy for weeks or months on end, then you probably are suffering from depression.

Depression is a genuine health condition which people can’t ignore or ‘snap out of’. Depression can affect anyone at any age and it’s more common than you realise. Around one in ten people are likely to experience depression at some time in their lives.

Symptoms vary, but they include feeling constantly upset or hopeless, often resulting in a loss of interest in things they used to enjoy. It can also result in physical symptoms such as insomnia, tiredness, a low appetite or sex drive, and even physical pain. In extreme cases it can even lead to thoughts of suicide.

Depression is often triggered by traumatic events and those with a family history of depression may be more at risk. If you think you, or someone you know, has depression, it’s important to see a doctor because depression can be managed with lifestyle changes, therapy or medication.

Serotonin is a neurotransmitter, a chemical that transmits messages between nerve cells. It is thought to have a positive influence on mood, emotion and sleep, and it has long been thought that low levels of serotonin cause depression, but according to a major review, this is not the case. New research has called into question society’s ever-growing reliance on antidepressants such as Prozac and millions of sufferers take selective serotonin re-uptake inhibitors, (SSRIs) designed to boost levels of the ‘feel-good’ chemical. It is thought that SSRIs work by increasing serotonin levels in the brain’.

Leading the campaign against drugs such as Prozac is Professor Irving Kirsch, whose book, The Emperor’s New Drugs is a best-seller. Professor Kirsch’s ten-year research project revealed that the efficacy of antidepressant drugs was almost nil — in fact most patients recovered faster if they were not prescribed antidepressants. A control group who underwent Cognitive Behaviour Therapy (CBT) far outperformed the group given Prozac. Even a control group given a placebo and who were told there were being given a placebo outperformed the Prozac group! In fact there are numerous studies that suggest they are no better than a placebo.

Thus, the ‘chemical imbalance’ theory is inaccurate. One in six British adults and roughly 13% of Americans take antidepressants.

Tens of thousands of people in the UK suffer from the side effects of antidepressants, which can include severe withdrawal that can occur when people stop taking them, and yet prescription rates continue to rise. The fact is that depression is not grounded in science and NOT due to a chemical imbalance.

NHS data shows there has been a surge in prescriptions doled out in England, with 8.3million patients prescribed them in 2021/22 — 6% more than the previous year. The most common are fluoxetine (Prozac), citalopram (Cipramil) and sertraline (Lustral). These are preferred to other types of antidepressants because they cause fewer side effects, but they can still lead patients taking them to experience anxiety, diarrhoea, dizziness and blurred vision. Depressed patients can also be hit by crippling withdrawal symptoms when they try to come off the pills.

The UCL study, published in the journal Molecular Psychiatry, looked at 17 previous reviews and dozens of individual trials involving hundreds of thousands of people from various countries dating back to 2010. The studies do not necessarily prove Selective Serotonin Retake Inhibitors (SSRIs) don’t work, but they do suggest the drugs don’t treat depression by fixing abnormally low serotonin levels.

There is no convincing evidence depression is caused by abnormal serotonin levels, particularly by lower levels or reduced serotonin activity. There is no difference in serotonin levels between healthy people and people diagnosed with depression. Artificially reducing serotonin levels in healthy volunteers did not lead to depression. Over the long-term, powerful SSRIs may actually have the opposite effect. Worse, there is no clear knowledge of what exactly antidepressants are doing to the brain!

It is estimated that up to 95% of the public believe that low levels of serotonin are the culprit and that antidepressants work. The Royal College of Psychiatrists urges people with depression to continue taking their SSRIs.

It might be a better idea to tackle and treat the root cause of an individual’s depression, such as unemployment, stress, anxiety, failed or abusive relationships, bullying… the list is almost endless.

An analysis of NHS data published in July 2022 found the number of antidepressants doled out to 13 to 19 year-olds rose by a quarter between 2016 and 2020. It included prescriptions up to the end of 2020, following a year of national Covid lockdowns and school and university closures.

An increasing amount of evidence is beginning to accrue showing that restrictions took a heavy toll on young people’s mental health. The NHS data, obtained through a Freedom of Information (FOI) request, also showed antidepressants use rose sharply in adults in their 20s. There is a possibility young people are being given ‘chemical cosh’ drugs by GPs because they can’t get counselling due to pandemic backlogs.

Thousands of patients seek help from their GPs for depression, and thousands of GPs tell their patients they are suffering from ‘an imbalance of chemicals in the brain’. GPs are overstretched by their workload and simply don’t have time to sit and talk to patients about their problems — so prescribing a course of antidepressants (recommended by powerful drug companies) is the quickest and most efficient way of dealing with them.

But the problem with antidepressants is… they don’t work!

Irving Kirsch’s and the UCL research both confirm what many medical professionals have increasingly come to suspect… that the ‘chemical imbalance’ theory — that depression is due to a lack of serotonin — is just plain wrong. The idea that serotonin imbalance was the culprit was thought up in the late 1980s by pharmaceutical companies to justify their products. The myth has been perpetuated ever since.

A total of 17 major international reviews, collating the findings of more than 260 studies involving over 300,000 patients, including one by researchers at University College London (UCL) led by psychiatrist Professor Joanna Moncrieff, have discovered there is ‘no convincing evidence’ that depression is caused by serotonin imbalance. Professor Moncrieff stated that ‘we do not understand what antidepressants are doing to the brain, and giving people misinformation prevents them from making an informed decision about whether to take them or not.’

The UCL findings, published in the journal Molecular Psychiatry, undermine the basis for decades of prescribing of the most commonly used antidepressants, SSRIs because there is no convincing evidence that depression is caused by serotonin abnormalities.

The findings are a major upset, since SSRIs account for the majority of antidepressants prescribed in the UK, and millions of people in the UK rely on them. Of a record 7.4 million antidepressant prescriptions issued in England in March 2022 alone, almost four million were SSRIs. The majority of patients prescribed antidepressants were women.

There are currently eight different SSRIs prescribed in the UK, among them, Fluoxetine — better known as Prozac — is the most popular. Fluoxetine was developed by U.S. pharmaceutical giant Eli Lilly in the early 1970s, based on the theory that boosting serotonin would help treat depression. Prozac has become something of a gold mine for thyme company.

Prozac was approved for the treatment of depression in the U.S. in 1987. By 2002 it had been prescribed to more than 40 million patients worldwide, and achieved sales of $22 billion. Dr Mark Horowitz, one of the co-authors of the new study, says the story of chemical imbalances
in depression has become so prevalent because it was propagated by drug companies. Dr Horowitz is a training psychiatrist and clinical research fellow in psychiatry at University College London. He says that during his training he was also that taught depression was caused by low serotonin — and he taught this to students in his own lectures. Now he says that ‘it feels like everything I thought I knew has been flipped upside down’.

As the ‘chemical imbalance’ theory has become increasingly questioned, a statement on antidepressants by the Royal College of Psychiatrists in 2019 stated that ‘the original idea that antidepressants “correct a chemical imbalance in the brain” is an oversimplification’. Even so, the theory is still taught at medical schools and in psychiatric textbooks, claiming that SSRIs ‘modify neuronal transmission in the brain’. In other words, they work on serotonin levels.

But why are more women than men prescribed antidepressants? The answer is simple… women are more likely to ask for help. Women also understand the principle that there is a chemical imbalance and antidepressants will help rectify that imbalance. Professor Martin Marshall, chair of the Royal College of GPs, said this was because women are ‘more comfortable seeking help for mental health conditions’ than men.

There is no convincing evidence that serotonin is linked with depression, and none that low serotonin is a cause of depression. This will explain Irving Kirsch’s previous research which found that SSRIs and other antidepressants are no better than a placebo for depression. In other words, antidepressants ‘work’ because people believe they do. In reality, most antidepressant drugs are based on unproven science.

Antidepressants are active drugs that often have unpleasant side-effects, including loss of libido and emotional numbness. Some patients struggle to come off them because they suffer severe withdrawal symptoms.

A survey by the Women’s Nutritional Advisory Service in 2019 found that 40% of women experiencing perimenopause were prescribed antidepressants to help manage their (hormonal) symptoms. A 2022 study has found women were more than twice as likely to be diagnosed with anxiety and prescribed antidepressants.

What has emerged from this new research is just how strong an effect adverse life events play in depression — low mood is a response to what is happening in people’s lives, and not the result of a simple chemical reaction! Because the vast majority of patients have been led to believe that depression is caused by low serotonin or a chemical imbalance and this belief leads to a pessimistic outlook on the likelihood of recovery.

In June 2022, the National Institute for Health and Care Excellence (NICE) issued its first new guidance in 12 years on treating depression, indicating that SSRIs should be considered as the first-choice antidepressant for more severe patients, claiming its recommendations were “arrived at after careful consideration of the evidence available”.

The Royal College of Psychiatrists state that ‘Antidepressants are an effective, NICErecommended treatment for depression. We would not recommend for anyone to stop taking their antidepressants based on this review.’

Professor Marshall of the RCGP said: ‘This research is challenging, and it’s important it is taken into account as clinical guidelines are developed and updated. Professor Marshall said ‘Patients should not be concerned about taking antidepressants as a result, but if they are, they should continue to take them as prescribed and discuss this with their doctor at their next appointment.’

There are other NHS-approved therapy available for depression. Increasingly, doctors are recommending other evidence-based solutions.

Join a club or a choir: The opportunity to interact with others gives people something constructive to occupy their minds and provides a structure in their lives and also something to look forward to every week. There’s also the possibility of meeting new friends!

Talking therapies: Available on the NHS throughout the UK and include everything from counselling to Cognitive Behavioural Therapy (CBT), which aims to change the way people think about a situation, and Mindfulness.

Exercise classes: Studies show the benefit of exercise on mood. And GPs can now prescribe exercise for patients free or at a reduced cost. Whether it’s yoga, aerobics or something else will depend on what’s available in your area.

Swimming: Whether it’s the local pool or the sea, getting in the water improves mood. The chillier the better apparently. NHS anaesthetist Dr Mark Harper has helped set up Chill, which runs sessions around the UK to help people take advantage of the healing abilities of cold water.

Walking: If you live in the Oxford, Gloucestershire, Wiltshire and Gwynedd areas, you’re likely to be prescribed a stroll to chase the blues away. NHS Forest runs guided walks along their ‘Green Health Routes’.

Gardening: Working in a green space helps us relax, so doctors now refer patients to work in community gardens. The Lambeth GP Food Co-op plants gardens in GP surgeries and hospitals and says these have helped people’s mental health.

The UCL study was published in the journal Molecular Psychiatry

For further information, please see

Irving Kirsch The Emperor’s New Drugs: Exploding the Antidepressant Myth Published September 3rd 2009 by Bodley Head