Joanna Moncrieff (Flint Books)
Joanna Moncrieff was a 鈥減recocious 14-year-old鈥� when she experienced 鈥渁 period of what might have been called depression鈥�. She didn鈥檛 seek treatment, however. 鈥淚 didn鈥檛 want to take anything that would stop me reading my philosophy books.鈥� Luckily, she changed schools, met 鈥渁 lovely boyfriend鈥� and was happy again. 鈥淚 expect my resistance was coloured by my parents鈥� general stoicism,鈥� she writes in her new book, Chemically Imbalanced: The making and unmaking of the serotonin myth.
Moncrieff cautions that 鈥渘one of us can speak for anyone else about the nature of our feelings鈥�, yet, for me, her wording does imply that others simply lack the necessary stoicism to weather feelings of hopelessness and despair. We have been misled, she says, by the idea depression is a 鈥渄irect result of a biological process鈥� rather than 鈥渢he expression of one鈥檚 character鈥�.
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Moncrieff, a professor of critical and social psychiatry at University College London, attracted widespread attention in 2022 as co-author of reviewing evidence for the 鈥渟erotonin theory鈥� of depression. This posits that depression is caused by low levels of serotonin, a key neurotransmitter that helps transmit signals between brain cells and may help regulate mood. In the paper, she concluded there was 鈥渘o convincing evidence鈥� for the idea. In her book, she is blunter, writing that 鈥渢his narrative is a myth鈥�.
There is no denying the research鈥檚 importance. Doubts about the serotonin theory had been growing, but Moncrieff鈥檚 analysis provided the most comprehensive rebuttal to date 鈥� and rightly received considerable coverage for exposing this gap in understanding mental illness.
The big question, for many, concerned the implications for the largest class of antidepressants, selective serotonin reuptake inhibitors, or SSRIs, which had been thought to work by raising levels of the neurotransmitter within the brain鈥檚 synapses.
Here, however, things get messy. Moncrieff鈥檚 review didn鈥檛 assess the effectiveness of these drugs, but have found that they do significantly reduce symptoms. So, even though we don鈥檛 know why they work, many psychiatrists believe that SSRIs remain a valid treatment.
Joanna Moncrieff says we have been misled by the idea depression is a direct result of a biological process
It may be that SSRIs decrease inflammation, which has been linked to depression. They may also encourage neurogenesis (the growth of new brain cells) and neuroplasticity, thought to be impaired in some mental illness.
One person鈥檚 depression might have different causes to another鈥檚. This raises possibilities of new, personalised treatments that target the specific pathways 鈥� as neuroscientist Camilla Nord compellingly described in her book, The Balanced Brain. But Moncrieff dismisses such research with far less rigour than in her analysis of the serotonin theory.
Many doctors and scientists believe that biological factors may predispose some to depression, and influence the progression of the disease. But Moncrieff writes that it 鈥渟ounds nice to have a half-way house, where personal and biological factors mingle equally, but when biological processes are genuinely causal, they override human inclinations鈥�. Yet mingling is where much expert opinion lies.
Moncrieff concludes that we should see depression as a 鈥渕eaningful human reaction鈥� to life problems. This may be true in some cases. But even if we dismiss any neurological explanation of depression, much psychological research shows that depression is often accompanied by serious cognitive distortions 鈥� such as catastrophising 鈥� that warp our view of reality and exacerbate and prolong our symptoms. I worry some readers will see Moncrieff鈥檚 message as saying their depressive symptoms are an accurate reflection of themselves and the world rather than a condition that can be treated.
But she is right to say that 鈥淲hen you are offered a solution to a complex problem in life that sounds too good to be true, it probably is.鈥� Depression is undoubtedly complex, and we desperately need new ways to understand and treat it.
David Robson is an award-winning science writer and author of The Laws of Connection: 13 social strategies that will transform your life
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