The Anti-depressant Fairy Tale

Fairy Tales are fictional short stories. In other words, fairy tales are made up. This blog is entitled ‘The Anti-Depressant Fairy Tale’ because much of what you ‘know’ about anti-depressants is made up. If you thought that low levels of serotonin caused depression, you’d be wrong. If you thought that anti-depressants cure depression, you’d be wrong. And if you thought that anti-depressants caused no major long-term harm, you’d be wrong. So indulge me for 10 minutes; let me tell you a story. But alas, this story is no fairy tale. This story is the truth.smiley-pills

In the early 20th century the medical profession made some important advances. Specifically, they managed to determine the specific biological abnormalities underlying prevalent illnesses. For example they figured out that Diabetes occurred due to high blood sugar levels. Once they had this information regarding the causes of the disorder, they developed medicine that directly targeted that biological system i.e. insulin lowers blood sugar levels. During this time researchers also developed a number of antibiotics (e.g. penicillin) that were designed to target specific biological systems in the treatment of scarlet fever, diphtheria and pneumonia amongst other illnesses. So far so good, Doctors had evidence as to what microbes caused illness and then they developed treatments to kill those microbes.

Then a funny thing happened. In developing these new treatments for medical illnesses, Doctors began to notice that some drugs had interesting side effects. Of specific interest in this story was the development of Isoniazid and Iproniazid. These drugs were designed and successfully used in the treatment of Tuberculosis. However Physicians soon began to notice that after taking these drugs their patients seemed to be ‘energized’ and some clients, who were previously bed ridden, were said to be ‘dancing in the wards’.

This prompted some doctors to believe that these drugs could be useful in nullifying the symptoms of psychiatric disorders. In the 1950’s anti-depressant drugs were introduced to the world of Psychiatry, not with the promise of curing depression, but with the aim of providing a tonic that would make the effects of depression less severe. Despite this, with no evidence as to the long-term effects of this class of drugs, it wasn’t long before anti-depressants were advertised as little magic happiness pills that could take away our blues (See David Healy’s “The Antidepressant Era” for the interesting tale of how this happened).

Let me break this down. With medical diseases they designed drugs based on evidence of what caused the illness. For example, they developed Isoniazid to kill microbes associated with Tuberculosis. Yet in psychiatric disorders like depression, we had the drug treatment long before we had any idea of what caused depression. Of course it was not long until people started asking this question but the answer was not easy to find. What psychiatrists did know was that anti-depressants tended to increase the amount of serotonin in the biological system. Therefore, in a backwards science fashion, they concluded that low levels of serotonin caused depression. This cued 50 years of developments in the multi-billion dollar anti-depressant industry.serotonin Incidentally the other commonly used term used to describe antidepressants; Selective Serotonin Reuptake Inhibitors (SSRI’s). For those of you interested in the science, SSRI’s work by blocking the reuptake of serotonin into the presynaptic cell, thereby increasing the amount of serotonin in the synaptic cleft available to bind to the post synaptic receptor. For those of you who want the take home message; SSRI’s increase the amount of serotonin in our biological systems!

Now here is where is gets real interesting. As of 2012, there is absolutely no evidence that people who are depressed have low levels of serotonin. Just read that again. For half a century we have been feeding people drugs designed to increase low levels of serotonin in order to cure depression, and yet people with depression don’t have low levels of serotonin. And don’t just believe me on this. The top Psychiatrists in the world have rejected the serotonin theory of depression on multiple occasions in the last 20-30 years (see the end of this blog for examples). I wonder how many of my friends know that. In fact, I wonder how many Medical Doctors who prescribe anti-depressants to depressed patients know that SSRI’s target a biological system that has nothing wrong with it.

But anti-depressants are not sugar pills that have no effect on our biological systems. Anti-depressants do indeed inflate the amount of serotonin in our bodies. The problem with this is that once our body realizes that we have excess serotonin, it tones down the entire serotonin system i.e. in attempting to return to equilibrium, the brain sends out signals telling our bodies to produce less serotonin. Researchers have found that over the course of time, these changes that occur in our biological system are very difficult, if not, impossible to reverse. In other words, anti-depressants may be causing abnormalities in normal biological functioning!

I guess knowing this information makes a couple of things unsurprising.

Firstly, if anti-depressants cured depression then we would expect the amount of disabled mentally ill to have decreased since the introduction of Prozac in 1987. And yet, between 1987 and 2004 the amount of people seeking disability in the US increased from 3.3 million to 5.7million, that is 410 new people every day!

Secondly, if anti-depressants cured depression then we would expect people who take anti-depressants to fare significantly better than those receiving a placebo sugar pill. But this is not what the research shows. Although short-term use of anti-depressants seems to cause little harm or gain compared to placebo (though we can experience physical dependence within 2-4 weeks), the long-term effects of taking antidepressants may be detrimental. Ironically, the exact pill that makes the promise of helping us to live better may function to restrict the way in which we live! One major example of this is the re-analyzed data from the infamous STAR D trial. The results showed that participants taking anti-depressants recorded only a 2.7% remission (recovery) rate, which is far worse than those who experience a natural un-medicated course of depression. Other research suggests that people who take anti-depressants are more likely to relapse, are more likely to experience a continuation of depressive symptoms, are less likely to return to work, are more likely to be on long term disability and are more likely to be incapacitated (see below for some interesting references).

So lets dispel this fairy tale right now;

1. Serotonin has nothing to do with depression.
2. Anti-depressants do not cure depression.
3. We don’t really know what anti-depressants are doing to our bodies but early indications suggest that they may be irreversibly altering our biological make up.
4. The long-term effects of antidepressants may be detrimental.

We get sold the story that scientists have spent many years developing this little magic pill for happiness. And we believe them because we don’t have the time to learn of these complicated things. And trusted medical professionals, who also don’t have the time to look into these things, usually corroborate this message which they may have learned at fancy five star lunches put on by Psycho-Pharmaceutical companies! But the actual evidence for the utility of anti-depressants is not representative of the confidence that we, as a society, have in these pills. We believe that SSRI’s kill depression in the same way that penicillin kills infection. But what is interesting about penicillin is that once the infection has disappeared drug treatment stops. And yet people who take anti-depressants tend to take them for the rest of their lives.

We all know why we have become so reliant on anti-depressants; everybody wants to be happy and taking a pill is far easier than seeing a shrink! And yet as a result of playing The Happiness Game in this way, or as a result of believing the Anti Depressant Fairy Tale, it is likely that people who take anti-depressants will end up far worse than if they would have taken no medication at all, and just waited for time to pass. I think it is time for people to have access to this information before they make any decisions regarding the use of anti-depressants.

Note 1: I am far from an expert on these things. However should you want further information then this extraordinary situation is superbly documented in the book “Anatomy of an Epidemic” by Robert Whitaker, finalist for the 1999 Pulitzer Prize for Public Service (see also I am also much appreciative to Dr. Rob Purssey for his help in putting together this blog.

Note 2: If you are currently taking anti-depressants then please do not come off them cold turkey. This is because if you have taken anti-depressants in the long term then it is likely that you have developed psychological and physiological dependence on them. Instead discuss potential options with a medical professional.

The Serotonin Theory of Depression?

“Although it is often stated with great confidence that depressed people have a serotonin or norepinephrine deficiency, the evidence actually contradicts these claims” Elliot Valenstein (Professor of Neuroscience, University of Michigan).

Elevations or decrements in the functioning of serotonergic systems per se are not likely to be associated with depression.” –NIMH.

“…there is no “real” monoamine deficit” Stephen M. Stahl (University of California, San Diego and Creator of The Neuroscience Education Institute).

“We have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them” Kenneth Kendler (Professor of Psychiatry, Virginia Commonwealth University).

After more than a decade of PET scans measuring chemical depletion “There is little evidence to implicate true deficits in serotonergic, noradrenergic, or dopaminergic neurotransmission in the pathophysiology of depression.” Krishnan and Nestler, AJP

Other interesting sources

E.Weel-Baumgarten,“Treatment of depression related to recurrence,” J Clin Psychiatry & Therapeutics 25 (2000):61-66.

D. Goldberg. “The effects of detection and treatment of major depression in primary care.” British Journal of General Practice 48 (1998):1840-44.

C Dewa.“Pattern of antidepressant use and duration of depression-related absence from work.” British Journal of Psychiatry 183 (2003):507-13.

W. Coryell. “Characteristics and significance of untreated major
depressive disorder.” American Journal of Psychiatry 152 (1995):1124-29.


  1. Wow! What a shocker. I had no idea there was so little evidence on that theory….and Im a mental health professional, who thinks of himself to be quite well informed. I knew of the questionable effectiveness of antidepressants, but that was it really. Thanks Nick.

  2. Hi Nick,

    4 years ago, I took antidepressants for a year. Last year my depression got worse but meditation helped me a lot and feel totally fine now. But, your article made me worry that there might be a future harm that I’m exposed to, should I worry about this? And what to do about it?

    • Hi Chris, Yea you won’t be alone in having such worries. What’s most important to know is that the data doesn’t guarantee harm after long term use. So in my opinion, you’ll be fine provided you continue to take a holistic perspective on how to manage melancholy I.e exercise, sleep, eat well, meditate etc. I hope the argument I presented wasn’t too shocking to hear; it’s always a risk to write such things.

  3. Hi Nic, nice article, thank you. You are totally correct. No serotonin imbalance – or imbalance of any other brain chemical imbalance – has ever been identified.
    This has been a disgraceful chapter in the history of medicine – the mass deception of the public, in order to legitimise the mass prescribing and consumption of these substances and to copperfasten control of global mental health with the realm of the medical profession and the pharmaceutical industry.
    While coming off antidepressants can be difficult – because despite the protestations of drug companies and the medical profession these substances cause physical dependence – most people come through this and have no ongoing adverse effects.
    Another reference for you – my 2015 book “Depression Delusion: The Myth of the Brain Chemical Imbalance”, foreword by Robert Whitaker, whom you mention in your article. Here is a link to a review of that book on the MadinAmerica blog by psychologist Phil Hickey, who described the book as “remarkable” –
    Best wishes,
    Terry Lynch.
    Physician, psychotherapist, author, mental health educator.

    • Sorry Terry, just realised that you wrote that book you recommended! I’m a sleep deprived dad so you’ll have to forgive me! Like I said, on the new year I’ll put it on my reading list and try to write a blog about it! Thanks for your encouragement. Nic.

      • Thanks Nic.
        This issue is very important, and I’m very glad that you have written so intelligently and accurately about it.
        To illustrate the major need to have this serotonin nonsense debunked, when you get a chance, have a look at this 10-minute YouTube video, by an American MD, unequivocally asserting the “serotonin deficiency” is known to occur in depression, OCD, anxiety, etc etc
        I have been tackling the author, as one can see in the comments. I don’t think he has coped very well with my questioning of him.
        You know far more about the real situation regarding serotonin than he does.
        But, because he is an MD, his words of misinformation will be – and are being – believed –
        (PS I do hope you get some sleep soon!!).

  4. Hi Nic, As someone who has experienced major depressive disorder since the age of 16, I can tell you that I would have topped myself years ago if not for anti-depressant medication. It literally saved my life. Now I don’t necessarily know how it worked but I went from severe bed-ridden suicidality to returning to normal functioning using anti-depressant medication. I am concerned the views expressed in your article may encourage people in situations such as mine to reject psycho-pharmacological interventions at great risk to themselves.

  5. Hi Nic, As someone who experiences major depressive disorder, I can tell you that I would have topped myself years ago if not for anti-depressant medication. It literally saved my life. Now I don’t necessarily know how it works but I went from severe bed-ridden suicidality to returning to normal functioning using anti-depressant medication. I am concerned the views expressed in your article may encourage people in situations such as mine to reject psycho-pharmacological interventions at great risk to themselves.

    • Hi pmorohan, I’m sorry you feel that way, I’m sorry you had such troubles and I totally understand your concern. Nevertheless my feeling is that people should have access to all of the information about psychiatric drugs in order to make informed decisions that are based on scientific studies. For every one of you there is someone else who has become significantly worse AS A RESULT of the drugs. I hope you can respect that. Best wishes, Nic.

  6. This is actually quite brilliant.

    You know, for a number of years now, I have been at loggerheads with the British medicine regulator, the MHRA. I have asked them repeatedly for a list of benefits of antidepressants. We all know what the risks are because we read about them on the package insert.

    To date, the MHRA have not been able to list one single benefit which kind of makes a mockery of their licensing practice. To bring a drug to market the “benefits must outweigh the risks” – in the case of antidepressants, this has not been proven because, as I said, to date not one person from the British drug regulatory agency has been able to provide me with one single benefit.

    Great article and well written.

  7. Very glad I have found your site – it was an accidental thing on etsy!

    finding something material and real world to give based on your work. ie. the diary is awesome, smart and forward thinking 🙂

    I’ve always thought as depression as merely ‘thought heavy’ and ‘stagnant. One up on depression and what I think we have is melancholy.. which is a pretty good space to be in for creative thinking and study.

    We can’t always be ‘happy’.. sometimes we have to go through other chemical make ups and have other experiences. Its been interesting reading this actually because though the research is new to me, the idea isn’t. I’ve always been interested in how we get dopamine hits and what foods we can eat to maintain serotonin levels.

    I’m rather anti pharma so will always deny factory drugs, but I like to delve into the science because one can never be certain. I remember my mum once trying to convince me to take SRRI’s so I read around for months and decided that I would take up excercise instead 🙂 That.. and eat more bananas and get more sunlight.

    I think its really important that this type of knowledge and education become widespread – although to be honest, I think the younger generation are clocking on to how harmful anti depressents can be and we have such an increase in awareness of mental health issues that I can see people looking for other ways to ‘get better’.. like excercise and nutrition and purpose driven lives.. etc etc and blah blah what I just said above.

    Anyway, very cool to come across your work and looking forward to reading some of your publications.
    Many blessings

  8. I’m personally conflicted on this issue, as I have believed myself to have experienced considerable benefit from antidepressants, but have been aware for years of their apparent ineffectiveness vs placebo in research studies. Was my experience just a placebo effect, and I would have got better just as fast without the drugs?

    So, I’m encouraged to find a recent article which persuasively argues that the findings of ineffectiveness result from the studies having used HDRS-17-sum, a multi-item rating scale from the 50s, as the outcome measure.
    When a more relevant outcome measure is examined, the same studies confirm a reliable antidepressant effect.

    Here’s the title and abstract. I’d be interested in comments.

    Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression

    F Hieronymus, J F Emilsson, S Nilsson & E Eriksson

    Molecular Psychiatry (2016) 21, 523–530 (2016)

    “The recent questioning of the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs) is partly based on the observation that approximately half of company-sponsored trials have failed to reveal a significant difference between active drug and placebo. Most of these have applied the Hamilton depression rating scale to assess symptom severity, the sum score for its 17 items (HDRS-17-sum) serving as effect parameter. In this study, we examined whether the negative outcomes of many SSRI trials may be partly caused by the use of this frequently questioned measure of response. We undertook patient-level post-hoc analyses of 18 industry-sponsored placebo-controlled trials regarding paroxetine, citalopram, sertraline or fluoxetine, and including in total 6669 adults with major depression, the aim being to assess what the outcome would have been if the single item depressed mood (rated 0–4) had been used as a measure of efficacy. In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (P<0.001). The observation that 29 out of 32 comparisons detected an antidepressant signal from the tested SSRI suggests the effect of these drugs to be more consistent across trials than previously assumed. Further, the frequent use of the HDRS-17-sum as an effect parameter may have distorted the current view on the usefulness of SSRIs and hampered the development of novel antidepressants.

    • Hi Jack,

      I’ll respond to both of your posts here, and I’ll bullet point them!

      1. You have to do what works for you. I am a skeptic, of course. Consequently, I would be asking the question, if they do work for you, then how do they work? Given the over confidence we have in the drugs there are next-to-no studies showing that certain chemical imbalances were the problem in the first place.
      2. The first paper you cited concluded that there was a high risk of bias in a lot of the studies reviewed and the corresponding author of the second paper you cited worked for Eli Lilly. When money is involved, science goes out of the window.
      3. People, including me, will analyze data in ways that suit them. People, including you and me, will look for information that aligns with what they already ‘know’. So if antidepressants are working for you, and help you to live a full life, then stay on them. I didnt mean to scare people off drugs with this blog, it was just designed to undermine the false confidence that we have in drugs.

      Hope that makes sense!


  9. Thank you for writing this article. In David Healy’s book, Let Them Eat Prozac it is stated that “By 1970…[George] Ashcroft had concluded that, whatever was wrong in depression, it was not lowered serotonin.” Prof George Ashcroft was my psychiatrist in 1979. I don’t remember him ever telling me about his conclusions. He prescribed me my first antidepressant and I continued to take antidepressants of various kinds until 2015, believing that somehow I needed them and fearing the consequences (suicide) if I didn’t. I realise now that I have been entirely misled for decades, believing that there was something wrong with my brain. I hope patients in future will be much better informed and avoid the mistakes I have made.

  10. I am a 42 year old man from India. I took antidepressants and other psych drugs for 15 years for OCD. They have completely ruined my life. I have now withdrawn from them but have become effectively disabled. I am single and unable to work any more. I am bed-ridden and unable to leave my house. Earlier I was working very well as a software engineer. These drugs are poison. I highly recommend Robert Whitacker’s book

    • Hi Sameer, the drugs may well have made your life worse but it is hard to read that you feel nothing can change. Things can change. Start will giving some serious thought to what you want, then maybe develop some skills that will help you to manage the unwanted thoughts and feelings that will show up when you start moving towards them. There is a book called ‘The Happiness Trap’ by Russ Harris that might be worth a read.

  11. Hi Nic, Thankyou for this blog which I’ve only just come across but after reading Lost Connections by Johann Hari, another author who cites the same arguments. I’ve been trying to explain what you’ve described to friends and family currently taking antidepressants (in one case for 10 years Post bereavement), perhaps not as articulately (!) and it’s falling on deaf ears. People don’t want to trust the non-gp who ‘should know’ what’s good for them. With the increases in concerns regarding mental health how can we all come together to have a stronger voice about this issue?

    • Hi Sally, thanks for reaching out. I’ve thought about this issue a lot. There are initiatives out there led by people like David Healy and Robert Whitaker but I think that the sheer financial power of pharmaceutical companies makes it an uphill battle. Im not sure what strategy could even the playing field.

    • Hi Laura,

      I’m not quite up to date in this but I’d assume that there is no reliable chemical imbalance theory for anxiety either. Robert Whitaker’s work and website, should be useful in this regard.

    • Yes, the serotonin/chemical imbalance theory is utterly unproven in relation to all emotional and mental health situations.

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