The serotonin myth and the medicating of Australia

Increasing antidepressant use in Australia is forcing an overdue reckoning with the serotonin myth, overprescribing and the medicalization of ordinary human afflictions, writes Professor Vince Hooper.

PROFESSOR Joanna Moncrieff For two decades he has been telling anyone who will listen that the chemical imbalance theory of depression is a marketing slogan disguised as neuroscience.

Moncrieff 2022 umbrella review Molecular PsychiatryThis article, now downloaded over a million times, concluded what the careful reader of the literature had long suspected: There is no consistent evidence linking serotonin to depression. None.

The reaction falls into two distinct camps: those who are relieved (“I knew that”) and those who are angry (“how dare you”). Either answer tells you something about how deeply buried the serotonin story is; not as a hypothesis to be tested, but as folk wisdom about what it is to be human.

Australia needs to pay attention. We are not innocent spectators of this drama. We are heroes.

Lately, Australian Medical Journal An article was published by Katharine Wallis from the University of Queensland, Anna King and Joanna Moncrieff herself.

The title was polite: ‘Antidepressant prescribing in Australian primary care: time for re-evaluation’. The contents were not like that.

Nearly one in seven Australians, or 3.9 million people, or 14% of the population, now use antidepressants. For people aged 75 and over, this rate increases to 26 percent. Women are prescribed 1.5 times more than men. 92% of the scripts are written by general practitioners. And prevalence continues to rise by roughly a third over the past seven years. Sertraline and escitalopram, both selective serotonin reuptake inhibitorsIt currently ranks in the top ten medicines in terms of daily doses determined per thousand Australians.

Nearly two million of us are long-term users. Even if 2 percent suffer severe deprivation and the real figure is considerably higher; That means 40,000 Australians are trapped on medication they might have started a decade ago for a temporary crisis.

The story of how we got here, like most pharmaceutical tales, is half science and half advertising. Selective serotonin reuptake inhibitors emerged in the late 1980s. ProzacIt was marketed on the elegant premise that depression was a chemical deficiency that medication would correct.

It was a beautiful story. It was also unfalsifiable, just as horoscopes are unfalsifiable: vague enough to feel real, specific enough to sell pills. Pharmaceutical companies did not invent the serotonin hypothesis, but they pushed it far beyond what the evidence would bear. Patients understood the message and asked their GP accordingly. Practitioners who have limited time and are overwhelmed by the alternatives offered have to do this.

Moncrieff’s overview did not claim that antidepressants do nothing. He claimed that the mechanism by which they are said to work by correcting serotonin deficiency is not supported by data. This is a narrower and more devastating claim than the headlines suggest. 36 senior psychiatrists lined up to attack him Molecular Psychiatry In 2023, they conceded the point, mostly in small print, while insisting that the drugs still worked.

Maybe for some, they sometimes do this through a mechanism. But the basic story told to a generation of patients, that brain diseases were corrected with a precise pharmacological tool, has been quietly retired by all but those who took the pills, including me.

We have built a national system in which the cheapest, quickest, and most institutionally rewarded response to a distressed teenager, a widow in her seventies, or a worker on the brink of divorce is a serotonin reuptake inhibitor, which will likely be in the medicine cabinet in 2035. PBS makes it affordable. A visit to the GP makes this easier. The cultural scenario makes this expected.

The objection that “this is what patients want” deserves a harsher response. Patients want what they are told to work. If a 75-year-old woman has been using escitalopram since her husband died at 62, and no GP has the time, training or courage to discuss reducing the dose, it is not a choice for her to continue using it. This is path dependency disguised as autonomy.

Australian Medical Association he’s finally starting to accept it; the Royal Australian and New Zealand College of Psychiatristsquite a few. Neither of them could produce a descriptive framework that was remotely commensurate with the size of the problem.

None of this epitomizes stoicism, denial of pain, or the cancellation of psychiatry. major depressive disorder It’s real, it kills people, and for a significant group of patients, antidepressants are truly lifesaving. Frankly, it’s that they’re being prescribed on an industrial basis on this continent to people whose distress is loneliness, grief, abuse, financial stress, chronic pain, insomnia, or the predictable consequence of the simple human condition of being unhappy for reasons no amount of molecules can solve.

We medicalized ordinary sadness, then we subsidized medicine, then we built an elder care system in which a quarter of our senior citizens swallow a pill every morning whose mechanism no one can explain.

A warning is in order for anyone who reads this and feels a hint of recognition. Getting off SSRIs is not a weekend project. Speaking from experience, the honest way to reduce citalopram after 15 years to a single tablet a week for six months is gradually through an understanding GP. hyperbolic taper measured in months or years and the willingness to back down if the body objects.

Sudden quitting can produce withdrawal symptoms severe enough to be confused with a return of the original disease, and sometimes worse. Don’t settle for the power of an opinion piece. If you stop, stop at the appropriate medical company.

What would a serious national response look like? Honest conversations between GPs and patients about what antidepressants can and cannot do. Properly funded speech therapies, ten individuals Medicare-supported therapy sessions annually Better Access initiative he reluctantly provides. A national disclosure protocol that includes resources to support people through retreat. Frank takes into account the social factors, loneliness, family breakdown, and economic insecurity that we treat with chemistry because the politics of treating them with anything else are so difficult.

Moncrieff is not a heretic, but a consultant psychiatrist who read the literature, applied the methods his colleagues taught him, and came to an inappropriate conclusion. Chemistry was a story. Prescription is a habit. Three point nine million Australians deserve to know the difference.

Depression and anxiety are nothing to be ashamed of.

Professor Vince Hooper is a proud Australian-British citizen and professor of finance and discipline at the SP Jain School of Global Management, which has campuses in London, Dubai, Mumbai, Singapore and Sydney.

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