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See Inside August/September 2006

...Yet Antidepressants Offer No Cure

Do antidepressants “cure” depression? No, says Joanna Moncrieff, a psychiatrist at University College London—no more so than insulin “cures” diabetes or alcohol “cures” social anxiety.

Moncrieff, who has published several critical studies of psychiatric drugs in leading medical journals, advocates a “drug-centered” rather than “disease-centered” model for understanding psychoactive medication. “Instead of relieving a hypothetical biochemical abnormality,” she says, antidepressants themselves cause “abnormal brain states,” which may coincidentally relieve psychiatric symptoms.

As for curing depression, Moncrieff notes that “there are no known drug-induced effects consisting of long-term elevation of mood,” nor is there is any evidence that medication corrects a “chemical imbalance,” as both pharmaceutical advertising and physicians often claim. These results may explain why, despite much greater use of antidepressants in recent years, there is “little evidence outside of controlled drug studies that long- or short-term outcomes for depression are changing.”

Indeed, Moncrieff adds, some studies show that depressive episodes are more frequent and last longer among antidepressant users than nonusers. A drug-centered approach to treating psychiatric conditions, she says, would look at each medication's specific alleviating effects—some act as stimulants or as sedatives, whereas some blunt emotions—rather than labeling any as an “antidepressant” when no drug has been proved to deliver long-term mood elevation.

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