Mar 3, 2018
This week, we interview Dr Joanna Moncrieff. Dr
Moncrieff is a psychiatrist, academic and author. She has an
interest in the history, philosophy and politics of psychiatry, and
particularly in the use, misuse and misrepresentation of
psychiatric drugs. As an author, Dr Moncrieff has written
extensively on psychiatric drugs and her books include The Myth of
the Chemical Cure, A Straight Talking Introduction to Psychiatric
Drugs and The Bitterest Pills: the troubling story of antipsychotic
She is one of the founding members of the Critical Psychiatry
Network which consists of psychiatrists from around the world who
are sceptical of the idea that mental disorders are simply brain
diseases and of the dominance of the pharmaceutical industry.
We talk about the recent meta-analysis of the efficacy and
tolerability of 21 antidepressant drugs, widely reported in the UK
news media on February 22nd.
In the episode we discuss:
- The approach taken in the largest ever meta-analysis of
efficacy and tolerability of 21 common antidepressant drugs.
- The problems inherent in comparing antidepressants with each
other, as opposed to trials that compare the active drug to a
- That the main conclusion reached was that all the
antidepressants studied were better than placebo at reducing
- The limitations of the study, particularly how response rate
was selected as the primary outcome measure.
- That ‘response’ is mostly defined as a reduction in the
Hamilton Depression Rating Scale (or other scale) rating of 50% or
more during the study.
- That the response rate can artificially inflate the difference
between drug and placebo.
- The problems with blinding in the supporting trials and the
effects of including people who are already receiving
- That the study did not include adverse effects or withdrawal
difficulties, only dropout rates which are not representative of
the whole picture of taking the drugs.
- The short-term nature of the supporting trials, mainly 8 weeks,
with a range of 4 to 12 weeks, which cannot be easily compared with
the real world experience of people taking the drugs for much
- That, when the primary data is analysed (the depression rating
scale scores) the differences between placebo and
antidepressants are very small and probably clinically
- The uncritical and sensational nature of the media reporting of
the study and the link to the Science Media Centre.
- The concerns about the reporting that depression is
under-treated in the UK which is not supported by the results of
- That people should carefully consider the balance of benefit
versus risk, taking into account the potential for adverse effects
or difficulties stopping the drugs.
Comparative efficacy and acceptability of 21 antidepressant drugs
for the acute treatment of adults with major depressive disorder: a
systematic review and network meta-analysis
Challenging the New Hype About Antidepressants
The Hamilton Depression Scale
Empirically derived criteria cast doubt on the clinical
significance of antidepressant-placebo differences
antidepressants in adults
The Science Media