The 5-HT hypothesis of depression: https://holeousia.com/2025/03/19/the-5-ht-hypothesis-of-depression-with-prof-philip-cowen-and-dr-sameer-jauhar/
This podcast was released by DRUG SCIENCE on 12 March 2025. The podcast can be listened to here.
As a former NHS psychiatrist and also as somebody who has been taking an antidepressant for nearly three decades I listened to this podcast with interest. I would like to share some of my reflections on this podcast. I will try and keep these brief.
DRUG SCIENCE was founded by Professor David Nutt in 2010.
Professor Nutt begins each of the DRUG SCIENCE podcasts by stating: “At its very core, drug science must remain independent. This means we don’t accept sponsorships.”
Professor Nutt has been a career-long paid opinion leader and available evidence would indicate that very few in the psychiatric profession, at least in the UK, will have received as much money from the pharmaceutical industry. His influence, over several decades, in relation to the education of UK psychiatrists on prescribing psychiatric drugs has been most significant.
In this Podcast [podcast 125], Professor Nutt starts out by presenting a faux argument: “But now we’re in a very unusual era, because we have a psychiatrist, Joanna Moncrieff, telling us that depression doesn’t exist, and she’s been making quite a lot of waves about this.”
To my best knowledge, Professor Moncrieff has not said that “depression doesn’t exist”. She has however challenged the “chemical imbalance” theory that has long permeated the cultural understanding of depression.
Professor Cowen and Dr Jauhar were the invited contributors to this DRUG SCIENCE podcast. They are both experts in their field. Throughout most of his career, Professor Cowen was a paid opinion leader for the pharmaceutical industry. Dr Jauhar is of a younger generation and has been paid by the makers of Esketamine and manufacturers of newer antipsychotics.
In this podcast, Dr Jauhar says of the ‘The serotonin theory of depression: a systematic umbrella review of the evidence’: “They set their own criteria for certainties. It’s a fairly arbitrary criteria. If you set your own criteria, well, odds are you’re going to find what you wish.” I would not disagree with this statement. However, it requires to be pointed out that the very same is true for ‘criteria’ on which the pharmaceutical industry ‘set out’ in their studies.
In this podcast, Dr Jauhar states “I think it’s also worth mentioning that no professional nowadays would say that a complex condition like clinical depression is caused by deficiency of a single neurotransmitter.” Again, I do understand where Dr Jauhar is coming from, however the word “nowadays” is doing a lot of heavy lifting. In my 25-year-long career as a psychiatrist, the ‘Serotonin hypothesis’ was ubiquitous. I can think of no other adjective that might suffice! Antidepressants ‘mode of action’ was promoted, professionally explained and prescribed on this basis. George Orwell, had he lived into our times, might have commented on how easily the past, even the recent past, can be re-written [the mutability of].
Dr Jauhar is a very careful scientist and repeatedly refers to – with his own ‘cri de coeur’ – the “Rules of Science”. In this podcast, Dr Jauhar suggests that scientists [experts] can somehow “take away anything emotional” [in other words be dispassionate about the subject being studied]. This approach is not possible. As humans we are all subjective and so we can only strive towards objectivity. It undermines the arguments of paid opinion leaders to fail to support full transparency in relation to all competing interests.
The use of language in this podcast is interesting:
- Dr Jauhar to Prof Cowen: “Your study, the beautiful Lancet study”
- In relation to the Umbrella Review on the Serotonin Hypothesis: “It’s just an embarrassment, to be honest”
- Prof Nutt to the experts in his podcast: “Well, the three of us were somewhat horrified by the quality of the analysis and bored by the conclusions”
In this podcast Prof Nutt raises the subject of ‘narrative control’: “… even with students it seems kind of it’s almost become, almost the sense in which people believe it, which I find really quite chilling. And for us, it’s proved very rather difficult to try to get a balancing narrative out there …”. The subject of narrative control is a big one [and is much more than the influence of the pharmaceutical industry]. Some years ago, I attempted to write about some of the issues involved. If interested you can read more here.
Prof Nutt went on to highlight: “I wanted to focus on . . . on a really important piece of evidence, which several studies have looked at and doesn’t get enough mention. And I guess the best paper is the Geddes paper from Oxford, Phil, showing that the real power of antidepressant medicines is to prevent relapse, is much more powerful in terms of producing a remission, but once people are well on them, they do seem to protect you.”
The Geddes study, ‘Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review’ was published in 2003. It is more than twenty years old. Whilst I have never been an academic in antidepressant trials, even when first published I could spot vital limitations in this systematic review and in the headline conclusions that it made. I would suggest that it is all ‘too easy’ for researchers, past and present, to mistake antidepressant withdrawal for relapse.
In this podcast, Prof Nutt [laughing to himself] went on to say: “we’re exploring the possible utility of psychedelics or depression, and we find that quite commonly, people will say, well, I want a psychedelic, but I don’t want to go on a traditional antidepressant, because they’re dangerous and addictive. And you think that’s a slight, maybe they’re not. You’re rather exaggerating. You know, you’re believing an exaggerated hostility so many millions people. I mean, I’ve been on for so many, so long, with such good outcomes and comparatively very, very low harms. Would you agree with my position on that?”
As the petitions to the Scottish Parliament and Welsh Parliament demonstrated, the harms related to antidepressants have been widespread, very real, life damaging and sometimes truly awful.