This morning: antidepressants

On the 6 February 2025, Professor Joanna Moncrieff and Professor Sir Simon Wessely were interviewed on This morning, ITV. The subject being discussed was antidepressants. This is a transcript of the discussion:

Cat Deeley [presenter]: Since being approved in the UK in the 1960s, nearly nine million people across the country are now being prescribed antidepressants.

Ben Shephard [presenter]: Well exactly how they work still isn’t fully understood, they are thought to increase serotonin, which helps improve your mood. However, psychiatrist Dr Joanna Moncrieff claims her research shows that the idea of a chemical imbalance is a myth, and that they may only work as a placebo.

Cat Deeley [presenter]: Here to challenge those controversial claims is Professor Sir Simon Wessely, who says antidepressants are effective and should be prescribed to those who need them.

Presenters [together]: Good morning to you both. Morning, both of you. Morning, Simon, good morning.

Cat Deeley [presenter]: Can we first of all start off by saying what exactly are antidepressants? Because when I was reading the brief, I can’t believe that actually scientifically we don’t quite understand how they work.

Professor Joanna Moncrieff: We don’t understand very much about how they work at all. Right. And the name antidepressants is a misnomer because what we don’t know that they actually work by targeting an underlying brain mechanism that’s related to depression, because there’s no evidence that there, or there is no convincing evidence or consistent evidence of a brain mechanism that relates to depression that could explain the action of antidepressants.

And because so few people are aware of that was why I decided to write my new book, Chemically Imbalanced, which is out now . . . [Professor Sir Simon Wessely laughs out loud] … which explains to people that antidepressants don’t work in this way, but they are active drugs. They do change our normal brain chemistry and normal brain activity. And by doing that, they change our mental states in one way or another, just like having a drink of alcohol would change your mental states [Professor Sir Simon Wessely is seen to be typing on his computer whilst Joanna Moncrieff is talking] Now that may affect people’s underlying feelings.

One of the effects that antidepressants have is they numb emotions. People consistently report this effect. And of course that may reduce the intensity of people’s feelings of depression. It also reduces feelings of joy and happiness as well. But that’s a very different prospect from taking something that is correcting an underlying abnormality or serotonin imbalance.

And so, I think that’s something that people really need to know about. And then there’s also the research that supposedly shows that antidepressants are better than placebo, doesn’t actually show that they’re very different from placebo in the first place.

Ben Shephard [presenter]: Okay, let’s ask Simon about that. Simon, you’ve just been listening to Joanna with her response, and you sort of laughed initially. What’s your reaction?

Professor Sir Simon Wessely: Well, I’ve known Jo for 30 years, and there’s a lot I agree with, that we would agree that depression’s important, we’d agree it doesn’t have one cause, and we’d agree that it doesn’t have one treatment. But I think she goes a little bit too far to completely eliminate the possibility that there might be things going on in our brain that has some relationship to depression.

She says that the drugs, antidepressants, change normal brain chemistry. Is this necessarily a totally bad thing? Depression changes brain chemistry as well. So there’s no underlying impossibility that certain treatments like drugs might have an effect on depression. That’s quite probable. Indeed, I’ll argue that we know that they do.

But it is certainly the case we don’t really know how they work. That’s not a secret. Some of the old ideas, which really are very old now, back to when you and I were at medical school, Jo, aren’t really now followed by most people. We think they were too simplistic, and the things are much more, as they say, complicated than that. That’s true. But if you look on the website of NHS England, where I’m sitting at the moment, the first thing it says about antidepressants is that we don’t know how they work, which is correct. But the second thing it says later on, we do know they can be effective, which is also correct.

Cat Deeley [presenter]: Yes, because Joanna brought up the placebo and the fact that there wasn’t much differentiation between the two. But you’re saying that actually there is scientific proof that antidepressants do work.

Professor Sir Simon Wessely: Is that to address to me? Sorry.

Cat Deeley [presenter]: Yes, sorry, Simon. Yes, I’m turning to you.

Professor Sir Simon Wessely: Okay, fine. I’m freezing to death in the basement of NHS England.

Cat Deeley [presenter]: Oh, sorry. Sorry, Simon.

Professor Sir Simon Wessely: We can tell the public we’re not spending any money and wasting money in NHS England.

Yes, Jo says that they’re a placebo and obviously there is a placebo effect, quite important and doctors would be in real trouble if we didn’t have placebos anywhere. But the evidence that they’re more than a placebo, I have to say now over all these years, is extremely compelling. We’ve done thousands of trials, I guess, I’m not sure how many, but lots and lots and lots and the truth is that sometimes the kind of placebo, as we call it, is much the same as depression. That was in studies we looked at years ago, Jo, as I’m sure you remember. But there isn’t a single study that shows that antidepressants are worse than placebo. There just isn’t and if they were all placebos, you would have tens of thousands of studies showing that as well.

So they are modestly effective, we know they’ve been around a long time, we know a lot about their side effects, and they’re certainly much safer than they used to be. If I got depressed, I would certainly want an antidepressant and I would want other things as well. I wouldn’t just want one thing, but one of the things I would think about would be to take an antidepressant.

Ben Shephard [presenter]: So Jo, from your perspective, I’m calling you Jo now [indicates that the was following Simon Wessely]. Apologies.

Professor Joanna Moncrieff: No, no, it’s fine.

Ben Shephard [presenter]: Joanna, your real concern is the over-prescribing of antidepressants. You don’t believe necessarily that they, because we don’t know what they do and you think that actually it’s a placebo, the over-prescribing is the big issue.

Professor Joanna Moncrieff: I think we should be concerned that so many antidepressants are prescribed, but my real concern is that people understand what they’re doing when they take them and that people are not led astray into thinking that we know that these drugs are …, that they’ve got some chemical imbalance and these drugs are targeting this underlying imbalance, because I think that does change the sort of decisions that people might make. You know, if you are aware that what you’re taking is a drug that we don’t understand what it’s doing, but it’s messing with your brain chemistry in some way, we would naturally be a bit worried about it.

Ben Shephard [presenter]: Patients very rarely are given antidepressants without having them explained by their doctor and whoever’s sort of giving that prescription of what it’s going to be, surely [Professor Sir Simon Wessely once again openly laughs]

Professor Joanna Moncrieff: Well, we know that people have frequently been told that they have a chemical imbalance and that the drugs are going to put that right, so that was misleading information that people were given and nowadays I expect people are told that, you know, that antidepressants are, you know, have been shown in clinical trials to be effective, so that’s not as dishonest, but isn’t conveying the fact that these are drugs that, you know, affect your brain and will affect your mental states in some way.

Ben Shephard [presenter]: So what do you think should be being given instead of these antidepressants?

Professor Joanna Moncrieff: So I think we need to think about depression differently and get away from this idea that it’s a medical condition that people have that’s the same in each person. I think depression is by and large a reaction to circumstances that are upsetting or threatening or stressful in some way, so we need to help each individual to address the circumstances that have led them to be depressed and then there are some general things that have been shown to be helpful as well, such as: Exercise, which is shown to be better than antidepressants in some studies, and Therapy, can obviously can be helpful for some people. Mindfulness is another one that’s been shown to.

Ben Shephard [presenter]: We’ve got about a minute left, Simon. All of those things we know make a difference, don’t we? Exercise, therapy, mindfulness. What’s your reaction that actually what Joanne is trying to say is that’s the sort of thing that should be given rather than the antidepressants?

Professor Sir Simon Wessely: No problems with any of that and if I could wave a magic wand, two things I would do would be to end bullying in schools and give more people jobs to reduce depression. But as I said, it isn’t just one thing and I don’t have any problem also thinking that there is a role for drugs that you say mess with the brain, but there are plenty of things that we sometimes want to do that for and lots of other disorders that create depression. And other illnesses where there are things are not working well, sometimes this other treatment that may be how it works. But what is not in doubt, and I just can’t emphasize it too much, is that they do add to the treatment of depression. Hundreds of thousands of people have been successfully treated with that. What nice guidelines say, it’s what the NHS say, and what’s the vast majority of professionals say is that they also help and can help for a very long time.

Ben Shephard and Cat Deeley [presenters]: Okay, thank you very much Simon. I’m sorry we don’t have more time, but thank you both, it’s a fascinating subject. You should always consult the healthcare profession before you adjust any medication. And if you’ve been affected by anything discussed today, you can visit our app to find the right support helpline.

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