EPI 245: What They Don't Tell You About ANTIDEPRESSANT Drugs. With Psychiatrist Dr. Joanna Moncrieff

Welcome back to another episode of the Peak Performance Life podcast. Today, I am very excited to be bringing to you an expert on a topic that we have not discussed on this podcast yet before. It's an incredibly important topic. And we have with us Dr. Joanna Moncreef. She is a practicing psychiatrist who wrote a book called Chemically Imbalanced, the Making and Unmaking of the Serotonin Myth. And she became interested in drug treatment because of the way that she sees it dominating our current approach to managing the suffering disturbance we call mental disorders. And she realized that embedded in our understanding of these drugs was an assumption that they had not been examined. And so that's really what she did. She examined these SSRIs and these drugs that are being heavily prescribed for mental health, which is obviously never been bigger than it is today. So, Joanna, thank you so much for joining us. I'm so excited to jump into this very important topic. Thank you for inviting me. Absolutely. So, we'd love to start with a little bit of a background of how you got interested in this topic. Yes. So, I'm a psychiatrist, as you said. So that means I've been working with people with mental health problems since I finished my training. And as you also said, I became interested in the nature of the drugs that we prescribe because that's what we do. That's how we generally treat people with mental health problems. Most people who have some sort of diagnosis are on. At least one sort of drug, many are on more than one drug. And the number of people that we consider to have mental health problems that get a diagnosis and treatment these days has been expanding and expanding. It's gone up. I mean, I don't know exactly, but I would say three or four times at least since I started practicing in the 1990s. The number of antidepressant prescriptions has certainly gone up over four times in that period. So yeah, just drug treatment is becoming so common. And along with it, I suppose, this idea that what we're treating is a chemical imbalance or some abnormality in the brain. And I wanted to look into that idea to see how certain we are that that is correct or whether we are certain that that is correct. Yeah, very interesting. I definitely want to get into what you found and what you studied and as well as what are some possible alternatives if these aren't the best options. But let's start with a little bit about what did you analyze then here? And also, I guess another side question is why do you think there has been such a big increase in the amount of prescriptions being written in this case? So maybe I'll start with a second part of your question, shall I? Yeah, sure. So this increase really dates back to the early 1990s, which by coincidence was when I was starting to work in psychiatry. And maybe that's partly why I became interested. In fact, around that time, there was a campaign in the UK called the Defeat Depression Campaign, which was a type of disease awareness campaign to make people aware that depression is a common medical condition and to encourage people to go and see their doctor about it and to take drug treatment in the form of antidepressants. And these campaigns were done all over the world. So I know there was one in the US in the late 1980s. Now, that campaign in the UK was partially funded by Eli Lilly, who are the makers of Prozac. Prozac was the first of the SSRI antidepressants, and it was introduced in about 1988, 89. And those drugs were marketed alongside this message that depression is a chemical imbalance. And that marketing was undertaken in order to distinguish these drugs from the drugs that went before them, which were the benzodiazepines, the most widely prescribed drugs up until that time, where benzodiazepines, that is drugs like valium, libraium, alprazolam, things like that, and Xanax. Xanax, yeah. And we don't use it so much in the UK, but I know you use it a lot in the US. Now, those drugs by the late 1980s have started to get a bad reputation, because it had become clear that they were dependence forming and they were being widely prescribed. And it was recognized that what they were doing was really just zonking people out, numbing people a bit to the problems of life. So that sort of model of drug treatment had got a bad reputation at that time. So the pharmaceutical industry recruited this idea that there's a chemical imbalance in the brain, which had been suggested a couple of decades earlier by psychiatrists, but never demonstrated. It was a theory. The pharmaceutical industry recruited that idea, widely promoted it, promoted it as if it was well established. And that helped to reassure people that taking drugs was the right thing to do. Because actually, one of the things that that Defeat Depression campaign found, they did some market research before they launched the campaign. And they asked people, what do you think causes depression? And people said, they didn't at that time think it was a brain problem. They thought it was caused by divorce or unemployment or child abuse, for example. And they also asked people what they thought about drug treatment for depression. And at that time, people said, we don't think it's a good idea. We think it just numbs people to the problems. It doesn't really solve anything. And we think it probably makes, is addictive, makes people dependent. So the pharmaceutical industry wanted to overcome people's natural reluctance to take drugs to deal with emotional problems. And that's why they marketed this idea that there's a chemical imbalance in the brain. And one of the reasons I wanted to really look into the evidence for this idea was because I was aware, even from those early days, that although this message was being disseminated everywhere as if it was fact, there wasn't anywhere you could point to in the literature that said, yeah, look, here's the research. It shows you there's an imbalance, a lack of serotonin. There were various studies. Some showed there might be some effect, but some showed there was no effect. Some showed opposite effects. So in probably about, I don't even remember quite when, probably about 2018, 2019, I got a little team together to look at this subject and to get all that research together so that we could come to an overview about whether there is good cause to say that depression is caused by a lack of serotonin specifically. We looked at serotonin research, partly because that's what's been done most commonly. There have been probably thousands of studies on serotonin and depression. And those studies have looked at various different aspects of serotonin functions. So some of them have looked at levels of serotonin in the blood. You can't stick needles into the brains of human beings, and we only looked at human studies. So they don't look directly at brain levels, but some of them look at the concentrations in the cerebrospinal fluid. So that's the fluid that surrounds the brain and the spinal cord. So we looked at levels in cerebrospinal fluid. We looked at research on serotonin receptors and research on serotonin genes and various other things. And basically we found that in none of those areas was there consistent or compelling evidence for any sort of abnormality of serotonin in people with depression, compared to people without depression, let alone a distinct lack of serotonin that might explain the onset of depression. Very, very interesting. So yeah, there's kind of this assumption that serotonin is this happy chemical and that if you're low in it, that's what, that's kind of the thing that we hear over and over now from these companies. It's amazing to learn that a lot of this came from a marketing campaign sponsored by a drug company. Very, very interesting there. And so I don't know if you studied this at all and maybe you just studied whether it's serotonin or not, but do you have maybe personally, whether with research or in your own opinion, have any opinion, what does cause depression if it's not serotonin? So I was asked this a lot after we published the paper. A lot of journalists would say to me, well, if it's not serotonin, what is the cause of depression? And the way this question was asked seemed to assume that it was not serotonin, it must be some other chemical or some other biological process. Now, there are numerous other theories about the biological, possible biological origins of depression. So people have proposed that it's other brain chemicals, for example, people have proposed that it's due to abnormalities of the inflammatory system or related to gut problems or related to other hormone problems. There is no definitive evidence that depression is caused by any of these other things either and there's been very much less research done on all these other areas. So we can't say that we have found at least any physical cause for depression. Now, I think going back to people's understanding of depression before these sort of campaigns to convince us it was a medical disorder, I think that we need to understand depression differently. We need to see it as a natural human reaction to our circumstances when they're not going well for us. Of course, everyone's different as well and the way that we react to our circumstances is colored by what's happened to us in the past. Our emotions are part and parcel of who we are. They're influenced by our personalities and our histories and our upbringing. And that means that depression is a different sort of thing. It's a signal that there's something wrong in our life and I think that we can therefore see it as something that we can learn from and grow from if we understand what it is that we're reacting to and we can find some way of changing that. Yeah, yeah, absolutely. And I think, yeah, there's no definition. Like depression is this or caused by this. I think there's so many different factors at play. Obviously, we have had other psychiatrists in the past on this podcast who talk about when you change someone's diet from eating ultra-processed horrible foods to natural whole foods, that seems to dramatically help with their mood. And they sometimes can go outside, get a little sunlight, be in nature, these kind of things we know have a positive effect. Obviously, nothing is proven, every person is different, but we know obviously if someone sits in doors staring at a screen for 12 hours a day versus someone who's outside, active, moving around, eating healthy, getting a little sunlight and being in nature, we know certain things there obviously can have a positive impact, but there's so many different factors at play. So I would certainly agree with you there. Yeah, I mean, I think you're absolutely right. I think our physical health, being in good physical health is very important for having good mental health and having a good mood. And if you're not in good physical shape, you are much more likely to be unhappy, to be anxious, to be stressed and to struggle with your circumstances. So I think that's really important. But I suppose the message I'm really trying to get across to people is that depression is not a uniform thing in your head, in your brain. We become depressed as people for different reasons in different sorts of circumstances. And when you're trying to work out how to help someone with depression as a therapist or a clinician or a friend or a relative, the most important thing is to identify why someone is depressed on what can be done about that, what can be changed about their circumstances that they are reacting to. Yeah, I'm curious, these SSRIs, did they have to go through double-blind placebo-controlled trials? And the reason I mentioned that for the audience listening double-blind placebo-controlled trial is that we see, I'm a big believer that the placebo effect can be very real. And I think before they started doing double-blind placebo-controlled trials, many, many drugs could pass, even if they had very little efficacy, in my opinion, from what I've seen. I'm curious, did they have to go through these or were they able, how were they able to get this to market so effectively? Yeah, yeah, so good question. And the other question I got asked, commonly after we published the paper that we did on serotonin research and depression was, well, what are antidepressants doing then if they're not rectifying the serotonin imbalance that it turns out we don't have, what are they doing? Now, antidepressants are drugs that enter the brain and change the normal state of our brain chemistry and our brain activity. And that changes our mental state in more or less subtle ways. Antidepressants come from lots of different chemical classes. They're not all the same as each other. Even the SSRIs are somewhat different from each other in the way that they affect the brain and therefore the way that they affect our experience, our feelings, our sensations, our moods, et cetera. Now, one of the effects that antidepressants, many antidepressants have is they seem to numb our emotions. So people may not feel as intensely unhappy or sad or whatever, but they also don't feel joy or pleasure or excitement anymore. And that emotional numbing actually is probably related to the fact that they are well recognized to cause sexual dysfunction, including numbing of the genitals and reduction in libido and sexual desire as well. So they seem to have this numbing property, physical and at least sexual and emotional numbing property. Now, that may be useful in someone who's intensely depressed. Actually, a lot of people find it really to be quite unpleasant though. There are randomized controlled trials that have compared antidepressants with placebo. And what do they show? They show a very small difference between antidepressants and placebo. Now, if you put together all the randomized trials that have ever been done, which involve thousands and thousands of people, the difference, although it's very small numerically, is statistically significant. That means that it's unlikely to have occurred by chance. And in order for a drug to get licensed and be used as a treatment, get licensed by the FDA, it needs to be proven in at least a couple of studies that it is better than a placebo. The problem is you can have two studies that are positive and then 10 studies that are negative that you keep in the bottom drawer of the pharmaceutical companies record office and never see the light of day. But it looks like overall antidepressants are slightly better than placebo, possibly because of that numbing effect, also possibly because, because I totally agree with you, I think the placebo effect is very significant. And the difference between the placebo and antidepressant, I think also might be partly because many people in these studies can guess whether they're getting the real drug or the placebo tablet or the dummy tablet. And so the people taking the real drug can get a sort of enhanced placebo effect because they think, oh, I've got the real drug here because people going into a drug trial now are told very clearly, you know, you're gonna be randomized, you might get the real drug, you might get the placebo, you don't know what you're getting, but if, but you know, these are all the side effects that are associated with these drugs. So people are sort of primed to try and work out what they're taking. And so I think there's an enhanced or amplified placebo effect that's operating in these trials, even though they're trying to be what's called double blind, trying to make sure that people don't know exactly what they're taking. So they have been trials, they show a very small difference. It's probably an amplified placebo effect difference. It may be related to the emotional numbing effect, but if it is, it's not a large benefit anyway. And then the other thing to say is what, you know, what are these trials measuring exactly? You know, we're sort of assuming that measuring someone's mood is as simple as measuring blood pressure. And of course it's not, it's a completely different thing. And whether we can really quantify mood, I'm not sure. I'm not sure that it really makes sense to say that this person is exactly two and a half times more depressed than this person because they've scored two and a half times more on this rating scale that we've got. We measure mood using rating scales, which are fairly arbitrary collections of symptoms like, you know, how do you, you know, what's, how depressed do you feel? How low do you feel? Have you had suicidal thoughts? Have you lost interest in things? Are you sleeping badly? So we've got these measurement scales, but whether they're really valid, whether they really do capture the severity of someone's mood, I think is another question. Yeah, and I also wonder how long of a timeframe are you just measuring how effective are they in the first 90 days and what are the long-term effects of being on something like this? And what really, I don't know if you've, there's a guy called Chris Masterjohn, PhD, and he recently, he has a newsletter, and he's a very in-depth researcher, and he really went deep on SSRIs and the problems with coming off SSRIs and how they affect people as mitochondria and different things. And it was way over my head. He's a deeply highly researched guy, but it was really like, gave me a wow moment of, wow, these things are not so, maybe not so safe as people think. So what have you seen in terms of the trying to come off? Like if someone goes on SSRI, I assume they don't want to be on it for the rest of their lives. And in that case, how can they safely come off? Really good question. So you asked at the beginning, how long are these trials? And the vast majority of them last for about eight weeks. There are very few trials that have followed people up who've been using them for more than a few months. And yet we know in ordinary life, people end up taking these drugs for years. So what that means is we just don't really have very good data about how they affect people in the long term as people actually use them. But data has been coming out that shows from people reporting things and other studies that have followed people up, even though they're not randomized studies. And it's becoming more and more apparent that these drugs do cause dependence problems. So although I was emphasizing how they're not much better than a placebo, I'm not trying to suggest they are placebos. They are drugs, they are real drugs. They do change the normal state of our brains. And it looks as if there are some serious consequences, particularly from taking them for a long period of time. And one of them is this dependence issue that it can become very difficult to get off them. Some people will experience really severe withdrawal symptoms. And it looks like it gets more and more difficult to come off them the longer you use them. We did a survey, some colleagues and I did a survey in our local NHS therapy service, in which about half the people who come are using antidepressants. And people who had used antidepressants for at least two years or more, 80% of them said they had tried but could not manage to come off their medication. So they wanted to, but hadn't been able to come off their medication. So I think it can get, you know, withdrawal symptoms can be really serious and severe if people take them long term. People who've taken them for shorter periods of time, many of them will be able to get off them relatively easily. And the other thing to say is that there also seems, what also seems to be the case is that sometimes when people have stopped them and probably particularly if people come off them too quickly, they will get into a protracted state of withdrawal or a protracted state that may be due to an injury that the drug has done to the brain. People can become really debilitated, very fatigued, find it difficult to get out of bed, have really severe brain fog and find it, you know, have to take time off work, relationships break up, there are all sorts of consequences of getting into this severe withdrawal state, which as I say seems to occur particularly if people have been on the drugs a long time and come off them too quickly. So a really important message is if anyone is, you know, rethinking their medication after hearing this, they should, if they want to try and come off it, come down very slowly and get some proper guidance. There are lots of sites now, internet sites that give people good guidance on how to come off these drugs really slowly to make sure you don't get into this state. And then another thing I'd like to mention, another long-term complication that I think is important for people to know about is we know that these drugs cause sexual dysfunction while people are taking them, but in some instances it seems that people, that the sexual dysfunction persists after people have stopped taking them and again it seems that this problem can go on for months and sometimes for years and also is sometimes associated with persistent emotional numbing. I think this all just shows us that we really don't understand very well how what these drugs are doing to the brain. And that's not surprising, we're putting in, you know, a foreign chemical, the brain's not used to it, it's trying to sort of counteract its effect, it's trying to compensate for what it's doing and then when you take it away, some of the changes that have happened in the brain will just go back to normal, but some might not do. And I think that's, you know, I think, I think basically these drugs are having unpredictable effects after long-term use, but it is predictable that this would occur. Yeah, that makes a lot of sense. Just so that we're not completely one-sided on this conversation, or maybe we will be, but I'm curious, in your practice, are there ever instances where maybe it doesn't, you know, for example, if someone is, God forbid, suicidal, maybe they do need to be numbed for a little while until they can get into a different state of mind. So I guess the question is, in your practice, is there ever a time when you use them at all? So I do use them because I feel that other doctors prescribe them so it would be wrong for me to withhold them. So when someone's in a sort of state where I think another doctor would offer an antidepressant, I do that. I explain my view about them and give people all the information on adverse effects and help people to make their own decision. And some people will decide that they want to take them. I mean, you know, people, it can be in very desperate straits and feel that they want to do something. But I'm not convinced that antidepressants are useful even in someone who's acutely suicidal or even in someone who's severely depressed because the evidence just doesn't really show that. The evidence from randomized controlled trials suggests that if anything, antidepressants can make people suicidal on occasions. Particularly younger people seem to sometimes get this odd reaction where the drugs can make them quite agitated and sort of preoccupied with suicidal thoughts and impulsive, so they sometimes do impulsive things. I think that's quite a rare state, but it does seem to happen particularly in younger people for some reason. And as far as severe depression is concerned, the evidence really doesn't show that antidepressants are particularly useful in people who have really severe depression, the sort of depression that happens when people, you know, take to their bed, stop eating and drinking, sometimes have sort of delusional ideas. Yeah, that leads into the next question I wanted to ask you about, which is, I mean, I'm hearing so many people who have, let's say, teenage kids and they say, oh, my teenager is depressed and so they're on SSRIs now. I mean, we're talking about 13, 14, 15 years old, very, very young. And yeah, it's just, it is a little bit concerning for me. And then also, I do even wonder as well about this, sort of the, in a way, the reverse placebo effect on this, right? So now you start taking this drug at the age of 13, 14, 15, you're taking it for a few years, who knows what it's doing to your brain chemistry, but then it's also a thing of like, it's like, oh, I take antidepressants, I'm a depressed person. I think that could be an issue with, from all the psychology and things that I've studied related to that, it seems like that could potentially, they could be developing an identity of I am a depressed person. Now, again, these parents don't know any better. These parents say, my child comes and says they're depressed, I wanna help my child, I go to, I take them to go speak with someone, that person prescribes them medication, who am I to say that that's not what should be done? So it's a very challenging situation, but just curious to get your opinion overall on youth and the huge rise in SSRIs being prescribed to them. I think this is worrying on so many levels, so many levels actually. I think you're absolutely right that I think there's a negative placebo effect. If people come to understand themselves as having some sort of defective brain, they do become, we know, they've been research studies that show that people who have those beliefs are more pessimistic about their chances of ever getting better or feeling happier, and they stop believing that there's anything they can do to help themselves, that they can do to change the situation. So I think it's really worrying if people get into that mindset young. And then the other things you mentioned, you know, the physical effects on young people, we know that young people's brains are more susceptible to the effects of drugs or sorts of drugs. And if you're giving teenagers, particularly drugs that numb their emotions during that period where one's emotions are very turbulent and quite difficult to manage, it worries me that people don't then have the realization that those feelings get better. Either we get better at managing them or they become less intense. I'm not really sure what it is, but you know, you do get through that difficult period. If people are taking medication that's numbing them, they never learn that they have actually managed to get through that period. They don't get that positive reinforcement from thinking, wow, you know, actually things are getting better. I can manage how I feel. I can manage this situation. So I think that's really significant. And then of course, you know, the fact that these drugs are messing with people's sexual functioning and libido during this time is also really, really worrying about, you know, how it's affecting their sexual maturity, their relationships, all sorts of things. Yeah, yeah, I agree 100%. And so I guess people listening now might be wondering, okay, well, what should I do then? What, you know, my teenager has been telling me they're depressed, what do I do? Or if someone came to you, for example, in your practice and let's say it was a teenager or a young adult even, or an adult and they say, you know, I'm feeling depressed and you're not a believer so much in SSRIs. And so what would you, how would you work with them or what are, in your opinion, what are better solutions than SSRIs? Yeah, yeah, great question. And of course, really important. So, you know, I think the first thing always is to try and work out why someone is feeling depressed. You know, what is this a reaction to? This is an emotional state. It has meaning. There is a reason, almost all the time, why someone feels depressed or anxious or stressed. And that's the most important thing to identify, you know, what's the reason and how can this individual be supported with that? You know, is it something to do with school? Is it something to do with friendships? Is it something to do with relationships? Is it anxiety about one's future career, about becoming an adult and all the stresses that, you know, that involves? I mean, there are just so many things that young people are facing these days, you know, in their day-to-day lives, let alone, you know, thinking about what's going on in the wider world. So, you know, I think it's a number one, it is that it is trying to work out what why people feel as they do. Then as we were talking a bit about earlier, I think there is some healthy living habits that it's important for people to adopt. So being awake during the day rather than during the night. I know, you know, I know teenagers like to sleep in late and stay up late and all that sort of thing, but actually I think it's good for people's mood and wellbeing if they're awake during daylight hours when other people are awake and not awake all the time into the small hours of the morning. Doesn't mean you can't go partying now and then of course, but in general. And to have something to do, to be occupied, and of course to have purpose, you know, preferably to have something to do that you enjoy or that you feel is leading to something, all that you feel does some good in the world. So, you know, even if what you're doing, you know, every day is going into a factory and feels pretty meaningless. If you can do something at the weekends like some voluntary work or something that makes you feel that you're contributing to society, then, you know, then that will be helpful. And of course, you know, keeping yourself healthy as we were saying before. So I think it's different in each individual circumstance. Oh, and of course, therapy, you know, therapy can be helpful for some people. I don't think it's necessary for everyone or I don't think it's a panacea. I don't think it's something, you know, I don't think we should just be swapping pills for therapy, but I think it can be very helpful for some people, partly to explore the reasons why they're feeling as they feel, because it's not always clear to us. We can quite often feel really unhappy or stressed or anxious and not really know why. So therapy's a way of exploring that and working out what it is that we need to change. And I also think therapy can be very helpful for people who've gone through, you know, a difficult childhood, a difficult experience, a difficult period, and are trying to process that. So I think therapy can be useful in those situations. So there are lots of things that can be done. And also, I think it's really important, you know, to give people a hopeful message that, you know, most everyone does eventually learn to get to grips with their emotions better. And it is difficult, you know, when you're a teenager, but there is light at the end of the tunnel. I know it's always difficult to hear that message when you're in the middle of it, but I do think it's important to reinforce it. Yeah, I completely agree. And even going back to what you said before, I think for a teenager, if they can, let's say, be down, you know, let's say they're down on themselves for a little while, but then they see, okay, a week later I feel better without running for the medication. And now they have this experience is, oh, I was sad last week, and now I'm no longer sad this week. Things can change without me having to run for medication. And just learning these things, I think sleep is a huge thing. I have two teenage daughters, and I can see a noticeable difference when they were up really late the night before and sleeping in half the day and then waking up. And I can see it in the way that their attitude is, the way that they feel and act. So I think, like some of the other things we mentioned, obviously exercise and things like that. And I think obviously the whole phone addiction and things like that are not helpful because people are just home staring at a screen versus running around outdoors, which I think we used to do a lot more of many years ago. Children used to do a lot more of. So yeah, I think these are really, really important points that you're mentioning here. In terms of therapy, is there any type of therapy that you particularly like or have seen good results? I know cognitive behavioral therapy seems to have some good studies or data behind it. Not sure how accurate those studies are, but is there anything that you think you've seen consistently have good results? So my understanding of the research, but I would say that I'm not an expert in this area, but what I understand is that actually, most therapies have the same results. And what's really important is your relationship with your therapist, how well you get on and you click. And there's been a lot of research on cognitive behavioral therapy, so there's sort of more evidence for it. But actually, if you compare it to other sorts of therapy, I don't think there's necessarily much difference. Interesting. And even therapy, you know, I'm personally, this is just a personal preference. Maybe other people have trauma that they need to go back and revisit and things like that. But I'm curious what your perception is on the type of therapy where you're constantly revisiting things from your childhood and talking about my childhood. And I'm like this because of my childhood. And going in, obviously there's times where you need to go back and revisit things and resolve them. But I think there's an old kind of traditional thought of therapy where it's like, you're just sitting there talking about the same old problems from your childhood for 10 years and just doing that over and over. Is there, yeah, curious to your opinion on that? I certainly see people who get stuck in this sort of therapy where they're just constantly going back over things. And I feel that it's really not productive and not helpful. So I would definitely agree that I think generally therapy needs to be directed towards the future. What's happening in your life now and what needs to change and where do you want to get to? And how can that be achieved rather than what's gone wrong for me? Yeah, so focusing on the future and on positive things that can be done to change people's circumstances. I agree, yeah, I resonate a lot with that. It's one of the reasons why I've always had coaches, not necessarily psychiatrists, but definitely if you have a good one there. In many cases they're similar, of course there are many not so very good coaches out there. They just can get a certification overnight. But if you find the right coach who again, helps me think about what are the issues I'm having now? How can I get over them? How can I, what do I want to build for the future? So similar things of what you're talking about rather than just dwelling on the past. So yeah, I think this is very, very helpful. Any other things in your book, anything else in particular that maybe we haven't touched on that is maybe an important topic that we should touch on here before we wrap up? I think we've covered everything guys, it's simply, I suppose I just want to say, just want to emphasize that just because I'm saying that antidepressants don't work or certainly don't work well, doesn't mean that we shouldn't try and help people who are struggling. People, I think it's important to recognize people do have times when they're struggling, they will need support from other people. That doesn't have to be taking a pill. And indeed, I think it's much better if it's not taking a pill, but still people might need someone to lean on, someone to talk to, to help them get through bad times. Yeah, absolutely. And I think I've heard many stories both ways, right? We have heard of many people who said, yes, this SSRI was a lifesaver for me. There are people, whether that's placebo or not, whatever it is, I have heard some people say that while obviously others have said it hasn't worked out. Of course, many people think that antidepressants have helped them. And I also like to emphasize, I'm not trying to tell anyone not to take them, but I do think it's important that people are properly informed when they take them. And part of being properly informed is knowing that this drug is not correcting a chemical imbalance in your brain. No one has found that there's anything wrong in the brains of people who are depressed. And it's a drug. It's a drug that changes your normal biology and taking a drug, taking chemicals, foreign chemicals, long term has consequences. It's very rarely a free lunch. So people need to think very carefully if they do decide that this is something they want to do and feel will be useful for them. Great advice, great advice, Joanna. This has been an absolute pleasure. Where can people follow you if they want to learn more, find you, buy your book? So I've got a website, which is joannamoncreef.com, and I'm on X. And my book, as you said at the beginning, is Chemically Imbalanced, The Making and Unmaking of the Serotonin Myth, which is available from most book suppliers. Amazing. Well, thank you so much for sharing this information, coming out and giving a different perspective that I think many people in your profession, quite frankly, don't have the courage to come out and say, even if they believe it. So I really commend you on coming out and sharing this information. And hopefully, many people listening here have gotten some value and learned something very important. And yeah, thank you so much for everything you're doing, and I hope we can do this again sometime. It's been a pleasure. Thank you so much for having me on. Really enjoyed it. Thank you. Thank you for listening. If you enjoyed this episode, it would really mean a lot to me. If you would forward this episode along to any friends, family members, anyone that you think that would get value out of it and learn something important, the mission at Peak Performance is to help people prioritize and transform their health. And so if you think someone will get value, please, please, please do forward this episode along to them. Also, if you could please rate and review and subscribe on whatever podcast player you are listening to this on, we would greatly appreciate that as well. It means a lot. And I want to tell you about a couple of new products that we just released. You can get 20% off your first order at buypeakperformance.com. That's B-U-Y, peakperformance.com. We just released a brand new grass-fed beef protein isolate. This is my favorite new protein powder because it's great for muscle building and recovering and all that kind of stuff. 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Thank you so much and we'll talk to you again soon.