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Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth
Featured on ITV's THIS MORNING and in SUNDAY TIMES MAGAZINE
'controversial and courageous' – DAILY MAIL
For years, we've been led to believe that depression is caused by a chemical imbalance in the brain and antidepressants are the solution. But what if this widely accepted belief has been built on unreliable truths?
In Chemically Imbalanced, renowned psychiatrist Joanna Moncrieff takes readers on a thought-provoking journey through the history of the serotonin theory of depression, from its origins in the 1960s to its widespread acceptance in the 1990s. With clarity and compelling evidence, Moncrieff exposes how scientific understanding has been swayed by social and economic forces, leading to misconceptions that have shaped treatment decisions for millions.
Accessible yet profoundly insightful, Chemically Imbalanced is essential reading for anyone seeking to make more informed choices about their mental health and understand the forces that shape the way we perceive and treat depression today.
'controversial and courageous' – DAILY MAIL
For years, we've been led to believe that depression is caused by a chemical imbalance in the brain and antidepressants are the solution. But what if this widely accepted belief has been built on unreliable truths?
In Chemically Imbalanced, renowned psychiatrist Joanna Moncrieff takes readers on a thought-provoking journey through the history of the serotonin theory of depression, from its origins in the 1960s to its widespread acceptance in the 1990s. With clarity and compelling evidence, Moncrieff exposes how scientific understanding has been swayed by social and economic forces, leading to misconceptions that have shaped treatment decisions for millions.
Accessible yet profoundly insightful, Chemically Imbalanced is essential reading for anyone seeking to make more informed choices about their mental health and understand the forces that shape the way we perceive and treat depression today.
413 pages, Kindle Edition
Published January 16, 2025
59 people are currently reading
502 people want to read
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Displaying 1 - 14 of 14 reviews
January 21, 2025
My review of 'Chemically Imbalanced' by Joanna Moncrieff. I'll admit, I was very hesitant to read this book, but saw so many people using it as evidence without reading it first, I thought i should. I changed my mind about the argument on nearly every page. Sometimes in support, sometimes opposed, sometimes critical. It started off ok and got my attention, I was finding myself enjoying it. But then it descended into an attack on all the negative responses the author had haf and just lost its way and purpose. It missed a real opportunity to offer help to those currently taking medication, those considering, as well as those harmed.
I have several conflicting biasses though when it comes to the topic of this book. I was put on a heavy dose of a trycyclic antidepressant when I was still a child, before I had any mood disorder symptoms, and I sometimes wonder if they contributed to my chronic difficulties and mood disorder as an adult. I've been put on many different drugs and combinations since, some causing significant harm. Some made me attempt to take my own life, to self harm, become manic, and so agitated I couldn't function. As well as physical harm, including damage to my liver and bladder and other more minor short term effects. But I've also experienced medication significantly improving my mental illness, keeping me stable for years. I was never led to believe the chemical imbalance theory. But I am an academic researcher, and so have always read and had access to up to date research on the topic. I have also been teaching about mental health for many years. Psychiatrists never told me this was the reason antidepressants would work and that I needed to be on them. To the contrary, as an adult they've all been hesitant to over medicate me and contributed my difficulties to other factors. I was therefore suprised by the outcry on social media at the release of this book and that people were shocked and that this was a revelation to them in 2024. But acknowledging my own biases, it is clear they were led to believe this myth, and that some Drs still tell patients this, perhaps not understanding it themselves in the case of GPs, and websites still dumb down the information to patients by saying this is how and why they work.
So the book! I'm glad she made it clear she didn't want to stop people taking meds, just to inform them, and more importantly, not to stop them suddenly without professional guidance. She states that she does still prescribe, which some might consider hypocritical giving her stance on them and believes she knows them not to work. But not much more I said on this and as a patient I'd really like to have found out more how she navigates this, or what she offers instead.
In terms of her argument, there are some striking contradictions. She makes clear that our brains are involved but we should consider a whole person, and that genetics clearly makes some people more susceptible than others. But then goes on to say there is no such thing as biopsychosocial causes, if biology is involved they categorically cannot be due to other psychosocial factors. She gives a clumsy analogy of a heart attack being caused by blocked arteries, stating that a biological cause would override any other factors. But what about the role of stress here even for a very physical conditions?
There was some interesting historical evidence of how the drugs came first, then influencing the theories on depression. With psychiatrists conducting very unscientific studies to fit their narratives. This was before Big Pharma got involved, so it seems a myth that Big Pharma created the theory, more so that they capitalised on it.
There is some bias in how she presents statistically significant findings. When they don't fit her narrative, such as statistically significant differences between placebos and antidepressants in meta analysis, they are only 'slight' differences. But when the significant results support her point, they are 'large'.
Also to note, she criticises the depression scale used in one hand when the findings are significant and don't support her point, but appears unphased when the same scale is used to reveal findings that do support her point. Do we trust the scales or not? Are depressants no better than placebo or do we just not have a great scale to use to measure depression?
The idea of an active placebo is interesting as you're taking an active drug with effects so will notice if you're on the real drug or not. But all this tells us is the significant improvement seen on antidepressants versus placebo could be due to an active placebo effect, but it could also be very real.
She goes on to then repeat throughout the whole book the conclusion that antidepressants are no better than an amplified placebo affect, but how can we know that when the methods used in the research were so flawed? It isn't an entirely true statement, and is more theory than fact.
What would be important here is research in people's experiences of whether they feel they benefit. She aludes to there being no such research, but it would have been good if she'd done some research on this for the book itself. Such as talking to those who have benefited.
She briefly talks about people who reported the benefits they experienced in a guardian article, but then dismisses them as either falling for the placebo effect or naturally getting better anyway. It's a real pity she hasn't done, and didn't do more work to actually speak to these people and find out more from them. If the placebo effect was this powerful, would we not see a greater improvement in the community studies she describes?
I'm not going to sit here and say 'why does it matter if they're just placebos as long as they work?' Or 'why does it matter how they work if they do work?' Because I understand taking these medications is a risk, that does come with some costs, for some people huge costs, and therefore we do need to know these things.
I was disappointed to see her throws in neurodiversity at the end, even though most conditions under that umbrella there are no medical treatments for, including autism, dyspraxia, and dyslexia.
Putting aside whether antidepressants are better than a placebo or not, as well as how Moncrieff's is reporting, It is clear that the biggest issue is the methods used to collect this data, and the absence of full studies considering the harm they can cause, negative effects, withdrawal effects, and long term effectiveness/damage.
People will use this book, and are already, some before even reading it, against those who do take medications and do feel it's beneficial. This book does not contain the proof to give anyone permission to do that. Instead, it highlights some very important concerns, convincing evidence, and what needs to be done about it.
However, i'm left with so many questions after reading this, it was a missed opportunity to offer more guidance and help as a psychiatrist, and I felt I was getting caught up in her dramas with other psychiatrists instead.
But what did i take from this book? I will continue with my medication, and trying to find one that works. Although I am now more hesitant and will raise these concerns with my psychiatrist. I will also ensure our students are aware of the limits to the biological research we teach them, and share newer more informed resources.
I have several conflicting biasses though when it comes to the topic of this book. I was put on a heavy dose of a trycyclic antidepressant when I was still a child, before I had any mood disorder symptoms, and I sometimes wonder if they contributed to my chronic difficulties and mood disorder as an adult. I've been put on many different drugs and combinations since, some causing significant harm. Some made me attempt to take my own life, to self harm, become manic, and so agitated I couldn't function. As well as physical harm, including damage to my liver and bladder and other more minor short term effects. But I've also experienced medication significantly improving my mental illness, keeping me stable for years. I was never led to believe the chemical imbalance theory. But I am an academic researcher, and so have always read and had access to up to date research on the topic. I have also been teaching about mental health for many years. Psychiatrists never told me this was the reason antidepressants would work and that I needed to be on them. To the contrary, as an adult they've all been hesitant to over medicate me and contributed my difficulties to other factors. I was therefore suprised by the outcry on social media at the release of this book and that people were shocked and that this was a revelation to them in 2024. But acknowledging my own biases, it is clear they were led to believe this myth, and that some Drs still tell patients this, perhaps not understanding it themselves in the case of GPs, and websites still dumb down the information to patients by saying this is how and why they work.
So the book! I'm glad she made it clear she didn't want to stop people taking meds, just to inform them, and more importantly, not to stop them suddenly without professional guidance. She states that she does still prescribe, which some might consider hypocritical giving her stance on them and believes she knows them not to work. But not much more I said on this and as a patient I'd really like to have found out more how she navigates this, or what she offers instead.
In terms of her argument, there are some striking contradictions. She makes clear that our brains are involved but we should consider a whole person, and that genetics clearly makes some people more susceptible than others. But then goes on to say there is no such thing as biopsychosocial causes, if biology is involved they categorically cannot be due to other psychosocial factors. She gives a clumsy analogy of a heart attack being caused by blocked arteries, stating that a biological cause would override any other factors. But what about the role of stress here even for a very physical conditions?
There was some interesting historical evidence of how the drugs came first, then influencing the theories on depression. With psychiatrists conducting very unscientific studies to fit their narratives. This was before Big Pharma got involved, so it seems a myth that Big Pharma created the theory, more so that they capitalised on it.
There is some bias in how she presents statistically significant findings. When they don't fit her narrative, such as statistically significant differences between placebos and antidepressants in meta analysis, they are only 'slight' differences. But when the significant results support her point, they are 'large'.
Also to note, she criticises the depression scale used in one hand when the findings are significant and don't support her point, but appears unphased when the same scale is used to reveal findings that do support her point. Do we trust the scales or not? Are depressants no better than placebo or do we just not have a great scale to use to measure depression?
The idea of an active placebo is interesting as you're taking an active drug with effects so will notice if you're on the real drug or not. But all this tells us is the significant improvement seen on antidepressants versus placebo could be due to an active placebo effect, but it could also be very real.
She goes on to then repeat throughout the whole book the conclusion that antidepressants are no better than an amplified placebo affect, but how can we know that when the methods used in the research were so flawed? It isn't an entirely true statement, and is more theory than fact.
What would be important here is research in people's experiences of whether they feel they benefit. She aludes to there being no such research, but it would have been good if she'd done some research on this for the book itself. Such as talking to those who have benefited.
She briefly talks about people who reported the benefits they experienced in a guardian article, but then dismisses them as either falling for the placebo effect or naturally getting better anyway. It's a real pity she hasn't done, and didn't do more work to actually speak to these people and find out more from them. If the placebo effect was this powerful, would we not see a greater improvement in the community studies she describes?
I'm not going to sit here and say 'why does it matter if they're just placebos as long as they work?' Or 'why does it matter how they work if they do work?' Because I understand taking these medications is a risk, that does come with some costs, for some people huge costs, and therefore we do need to know these things.
I was disappointed to see her throws in neurodiversity at the end, even though most conditions under that umbrella there are no medical treatments for, including autism, dyspraxia, and dyslexia.
Putting aside whether antidepressants are better than a placebo or not, as well as how Moncrieff's is reporting, It is clear that the biggest issue is the methods used to collect this data, and the absence of full studies considering the harm they can cause, negative effects, withdrawal effects, and long term effectiveness/damage.
People will use this book, and are already, some before even reading it, against those who do take medications and do feel it's beneficial. This book does not contain the proof to give anyone permission to do that. Instead, it highlights some very important concerns, convincing evidence, and what needs to be done about it.
However, i'm left with so many questions after reading this, it was a missed opportunity to offer more guidance and help as a psychiatrist, and I felt I was getting caught up in her dramas with other psychiatrists instead.
But what did i take from this book? I will continue with my medication, and trying to find one that works. Although I am now more hesitant and will raise these concerns with my psychiatrist. I will also ensure our students are aware of the limits to the biological research we teach them, and share newer more informed resources.
August 3, 2025
I came to this book after listening to an excellent podcast discussion between Dr Joanna Moncrieff (the author) and Dr Rangan Chatterjee. Dr Moncrieff, an NHS psychiatrist with decades of clinical and research experience, wrote this book in response to her 2022 systematic review (published in Molecular Psychiatry) examining the evidence behind the serotonin theory of depression.
This book is a thorough and well-argued takedown of the shaky science and lack of academic rigour underpinning the biological model of depression - not limited to the serotonin theory - and the subsequent development and unprecedented widespread rollout of antidepressants (20% of the UK population are currently taking them). As an NHS doctor myself, it was uncomfortable to read how the pharmaceutical industry and medical profession have fabricated, reinforced, and continue to defend this narrative.
It is an essential read for healthcare professionals and healthcare students - particularly those in mental health or prescribing roles. But it’s equally important for anyone who has experienced depression, has been prescribed antidepressants, or is considering starting them.
This book is a truly impactful reframing of depression and its treatment. Dr Moncrieff proposes that, instead of being due to a chemical imbalance in the brain, depression is a meaningful and emotional response to unwanted life events and circumstances.
She succinctly addresses the blaring discrepancies in the science of antidepressants, the alternative reasons why some people do feel better, the enduring side effects (of simply, effects), and the dangers/difficulties facing patients who wish to stop them. She also acknowledges the history of psychiatry, depression, and antidepressants to provide context.
This was an uncomfortable read for me as someone who has prescribed antidepressants to patients - and it clearly also struck a nerve within psychiatry itself, who when faced with the evidence chose backlash instead of self examination. That reaction in the media shows how deeply embedded the chemical imbalance theory is in both the medical profession and the public’s collective belief system. Dr Moncrieff courageously meets the criticism with unwavering commitment to evidence and scientific integrity.
The book ends with this quote:
“Forging a life in today's world is not easy. Most of us will experience anxiety, uncertainty and disappointments; for some, these will be difficult to overcome. Emotional crises are the understandable result. The meaning of these is not in our brain chemistry, it is in the world. And that is where the solutions lie too.”
This book is a thorough and well-argued takedown of the shaky science and lack of academic rigour underpinning the biological model of depression - not limited to the serotonin theory - and the subsequent development and unprecedented widespread rollout of antidepressants (20% of the UK population are currently taking them). As an NHS doctor myself, it was uncomfortable to read how the pharmaceutical industry and medical profession have fabricated, reinforced, and continue to defend this narrative.
It is an essential read for healthcare professionals and healthcare students - particularly those in mental health or prescribing roles. But it’s equally important for anyone who has experienced depression, has been prescribed antidepressants, or is considering starting them.
This book is a truly impactful reframing of depression and its treatment. Dr Moncrieff proposes that, instead of being due to a chemical imbalance in the brain, depression is a meaningful and emotional response to unwanted life events and circumstances.
She succinctly addresses the blaring discrepancies in the science of antidepressants, the alternative reasons why some people do feel better, the enduring side effects (of simply, effects), and the dangers/difficulties facing patients who wish to stop them. She also acknowledges the history of psychiatry, depression, and antidepressants to provide context.
This was an uncomfortable read for me as someone who has prescribed antidepressants to patients - and it clearly also struck a nerve within psychiatry itself, who when faced with the evidence chose backlash instead of self examination. That reaction in the media shows how deeply embedded the chemical imbalance theory is in both the medical profession and the public’s collective belief system. Dr Moncrieff courageously meets the criticism with unwavering commitment to evidence and scientific integrity.
The book ends with this quote:
“Forging a life in today's world is not easy. Most of us will experience anxiety, uncertainty and disappointments; for some, these will be difficult to overcome. Emotional crises are the understandable result. The meaning of these is not in our brain chemistry, it is in the world. And that is where the solutions lie too.”
February 7, 2025
A brave and important book
Every now and then, a book comes along that everyone should read. Chemically Imbalanced is one such book. For years, Joanna Moncrieff, professor of Critical and Social Psychiatry at UCL, has been beating a lonely drum, questioning the medical profession’s over-reliance on drugs to treat mental health issues. In The Bitterest Pills, she highlighted the ‘troubling story’ of anti-psychotics. Now she has turned her laser-like attention to SSRIs – the most widely prescribed anti-depressants in the UK. (8.7 million people are currently on anti-depressants, according to the NHS.).
Chemically Imbalanced is a brave, fearless and comprehensive demolition of the Big Pharma narrative that depression has a biological cause – a chemical imbalance in the brain, in particular a lack of serotonin. Instead, she argues, SSRIs numb emotions and any benefits can largely put down to the placebo effect. Emotional problems cannot be cured with a pill: depression is a meaningful emotional response to the world around us, reflecting our individual desires and concerns. In short, she urges us to consider moods as a feature of the whole person and not just the brain.
In 2022, Moncrieff conducted a systematic review (with Dr Mark Horowitz) of all the scientific evidence for the widely accepted chemical imbalance theory of depression. She found marketing campaigns and slogans aplenty – “Depression is a flaw in chemistry, not character” – but no evidence. What she did discover was that Big Pharma, many of her colleagues in psychiatry, medical institutions and much of the media did not like her conclusions, and were soon doing everything they could to discredit her personally. As she says, antidepressants are “too big to fail”.
This courageous book outlines in depth the shocking findings of her review and answers her critics. Intriguingly, Moncrieff, a lifelong liberal, found more support in the right wing media than the liberals – Tucker Carlson, for example, took her findings and ran with them; Rolling Stone magazine was less keen – but don’t let that put you off. The book is a must-read for anyone on SSRIs, or considering going on them. And if you know someone who is contemplating antidepressants, give them this book so that they can make an informed choice.
With compassion, erudition and diligence, Moncrieff highlights the gruesome side effects of these drugs (so often ignored by GPs, who seem to be prescribing SSRIs with gay abandon). Reduced sexual desire, diminished intensity of orgasms and erectile dysfunction are common (even years after coming off the drug), so much so that SSRIs are now prescribed for sex offenders. Withdrawal is difficult, to put it mildly. And suicide ideation in under 25s can occur within days of taking SSRIs.
I would have liked more on how and why neoliberal society has encouraged us to view depression as a biological problem, whether that’s our brain chemistry, genetics or neural make up, but it’s a tiny quibble in an otherwise supremely authoritative account. (It must be more than a diversion tactic, as she argues – a way to avoid awkward questions about the state of our capitalist society today and the distress it causes us.)
To those who say this book will cause undue distress to the millions already on SSRIs, Moncrieff adheres to that age-old Hippocratic principle of ‘first, do no harm’ – unlike Big Pharma and many of her colleagues, who have long dismissed the well-documented downsides of SSRIs as trivial. Moncrieff is not prepared to stand on the sidelines and say nothing. People need to know the facts. Knowledge can be painful, as she says, but it is also power.
Jon Stock (aka JS Monroe), author of The Sleep Room
Every now and then, a book comes along that everyone should read. Chemically Imbalanced is one such book. For years, Joanna Moncrieff, professor of Critical and Social Psychiatry at UCL, has been beating a lonely drum, questioning the medical profession’s over-reliance on drugs to treat mental health issues. In The Bitterest Pills, she highlighted the ‘troubling story’ of anti-psychotics. Now she has turned her laser-like attention to SSRIs – the most widely prescribed anti-depressants in the UK. (8.7 million people are currently on anti-depressants, according to the NHS.).
Chemically Imbalanced is a brave, fearless and comprehensive demolition of the Big Pharma narrative that depression has a biological cause – a chemical imbalance in the brain, in particular a lack of serotonin. Instead, she argues, SSRIs numb emotions and any benefits can largely put down to the placebo effect. Emotional problems cannot be cured with a pill: depression is a meaningful emotional response to the world around us, reflecting our individual desires and concerns. In short, she urges us to consider moods as a feature of the whole person and not just the brain.
In 2022, Moncrieff conducted a systematic review (with Dr Mark Horowitz) of all the scientific evidence for the widely accepted chemical imbalance theory of depression. She found marketing campaigns and slogans aplenty – “Depression is a flaw in chemistry, not character” – but no evidence. What she did discover was that Big Pharma, many of her colleagues in psychiatry, medical institutions and much of the media did not like her conclusions, and were soon doing everything they could to discredit her personally. As she says, antidepressants are “too big to fail”.
This courageous book outlines in depth the shocking findings of her review and answers her critics. Intriguingly, Moncrieff, a lifelong liberal, found more support in the right wing media than the liberals – Tucker Carlson, for example, took her findings and ran with them; Rolling Stone magazine was less keen – but don’t let that put you off. The book is a must-read for anyone on SSRIs, or considering going on them. And if you know someone who is contemplating antidepressants, give them this book so that they can make an informed choice.
With compassion, erudition and diligence, Moncrieff highlights the gruesome side effects of these drugs (so often ignored by GPs, who seem to be prescribing SSRIs with gay abandon). Reduced sexual desire, diminished intensity of orgasms and erectile dysfunction are common (even years after coming off the drug), so much so that SSRIs are now prescribed for sex offenders. Withdrawal is difficult, to put it mildly. And suicide ideation in under 25s can occur within days of taking SSRIs.
I would have liked more on how and why neoliberal society has encouraged us to view depression as a biological problem, whether that’s our brain chemistry, genetics or neural make up, but it’s a tiny quibble in an otherwise supremely authoritative account. (It must be more than a diversion tactic, as she argues – a way to avoid awkward questions about the state of our capitalist society today and the distress it causes us.)
To those who say this book will cause undue distress to the millions already on SSRIs, Moncrieff adheres to that age-old Hippocratic principle of ‘first, do no harm’ – unlike Big Pharma and many of her colleagues, who have long dismissed the well-documented downsides of SSRIs as trivial. Moncrieff is not prepared to stand on the sidelines and say nothing. People need to know the facts. Knowledge can be painful, as she says, but it is also power.
Jon Stock (aka JS Monroe), author of The Sleep Room
February 2, 2025
I was reluctant to read this based on media interviews and edited excerpts published but I’m glad I did.
However, the author writes with a tone of condescension that I struggled to get past and whilst she made some valid and important points (over medicalisation of emotions, lack of awareness about side effects) I felt little compassion for the reality of living with severe depression (for example she cites a brief period of low mood in her teens that resolved itself as depression).
Whilst it’s good to have the conversation about over-prescribing, she seems to denigrate any evidence that medication does help people on the basis that we don’t know how (which is true for other medications and conditions).
Overall, I felt the book was more a personal response to bad press than being written to engage with readers.
However, the author writes with a tone of condescension that I struggled to get past and whilst she made some valid and important points (over medicalisation of emotions, lack of awareness about side effects) I felt little compassion for the reality of living with severe depression (for example she cites a brief period of low mood in her teens that resolved itself as depression).
Whilst it’s good to have the conversation about over-prescribing, she seems to denigrate any evidence that medication does help people on the basis that we don’t know how (which is true for other medications and conditions).
Overall, I felt the book was more a personal response to bad press than being written to engage with readers.
February 27, 2025
A brave and important book
Every now and then, a book comes along that everyone should read. Chemically Imbalanced is one such book. For years, Joanna Moncrieff, professor of Critical and Social Psychiatry at UCL, has been beating a lonely drum, questioning the medical profession’s over-reliance on drugs to treat mental health issues. In The Bitterest Pills, she highlighted the ‘troubling story’ of anti-psychotics. Now she has turned her laser-like attention to SSRIs – the most widely prescribed anti-depressants in the UK. (8.7 million people are currently on anti-depressants, according to the NHS.).
Chemically Imbalanced is a brave, fearless and comprehensive demolition of the Big Pharma narrative that depression has a biological cause – a chemical imbalance in the brain, in particular a lack of serotonin. Instead, she argues, SSRIs numb emotions and any benefits can largely put down to the placebo effect. Emotional problems cannot be cured with a pill: depression is a meaningful emotional response to the world around us, reflecting our individual desires and concerns. In short, she urges us to consider moods as a feature of the whole person and not just the brain.
In 2022, Moncrieff conducted a systematic review (with Dr Mark Horowitz) of all the scientific evidence for the widely accepted chemical imbalance theory of depression. She found marketing campaigns and slogans aplenty – “Depression is a flaw in chemistry, not character” – but no evidence. What she did discover was that Big Pharma, many of her colleagues in psychiatry, medical institutions and much of the media did not like her conclusions, and were soon doing everything they could to discredit her personally. As she says, antidepressants are “too big to fail”.
This courageous book outlines in depth the shocking findings of her review and answers her critics. Intriguingly, Moncrieff, a lifelong liberal, found more support in the right wing media than the liberals – Tucker Carlson, for example, took her findings and ran with them; Rolling Stone magazine was less keen – but don’t let that put you off. The book is a must-read for anyone on SSRIs, or considering going on them. And if you know someone who is contemplating antidepressants, give them this book so that they can make an informed choice.
With compassion, erudition and diligence, Moncrieff highlights the gruesome side effects of these drugs (so often ignored by GPs, who seem to be prescribing SSRIs with gay abandon). Reduced sexual desire, diminished intensity of orgasms and erectile dysfunction are common (even years after coming off the drug), so much so that SSRIs are now prescribed for sex offenders. Withdrawal is difficult, to put it mildly. And suicide ideation in under 25s can occur within days of taking SSRIs.
I would have liked more on how and why neoliberal society has encouraged us to view depression as a biological problem, whether that’s our brain chemistry, genetics or neural make up, but it’s a tiny quibble in an otherwise supremely authoritative account. (It must be more than a diversion tactic, as she argues – a way to avoid awkward questions about the state of our capitalist society today and the distress it causes us.)
To those who say this book will cause undue distress to the millions already on SSRIs, Moncrieff adheres to that age-old Hippocratic principle of ‘first, do no harm’ – unlike Big Pharma and many of her colleagues, who have long dismissed the well-documented downsides of SSRIs as trivial. Moncrieff is not prepared to stand on the sidelines and say nothing. People need to know the facts. Knowledge can be painful, as she says, but it is also power.
Jon Stock (aka JS Monroe), author of The Sleep Room
Every now and then, a book comes along that everyone should read. Chemically Imbalanced is one such book. For years, Joanna Moncrieff, professor of Critical and Social Psychiatry at UCL, has been beating a lonely drum, questioning the medical profession’s over-reliance on drugs to treat mental health issues. In The Bitterest Pills, she highlighted the ‘troubling story’ of anti-psychotics. Now she has turned her laser-like attention to SSRIs – the most widely prescribed anti-depressants in the UK. (8.7 million people are currently on anti-depressants, according to the NHS.).
Chemically Imbalanced is a brave, fearless and comprehensive demolition of the Big Pharma narrative that depression has a biological cause – a chemical imbalance in the brain, in particular a lack of serotonin. Instead, she argues, SSRIs numb emotions and any benefits can largely put down to the placebo effect. Emotional problems cannot be cured with a pill: depression is a meaningful emotional response to the world around us, reflecting our individual desires and concerns. In short, she urges us to consider moods as a feature of the whole person and not just the brain.
In 2022, Moncrieff conducted a systematic review (with Dr Mark Horowitz) of all the scientific evidence for the widely accepted chemical imbalance theory of depression. She found marketing campaigns and slogans aplenty – “Depression is a flaw in chemistry, not character” – but no evidence. What she did discover was that Big Pharma, many of her colleagues in psychiatry, medical institutions and much of the media did not like her conclusions, and were soon doing everything they could to discredit her personally. As she says, antidepressants are “too big to fail”.
This courageous book outlines in depth the shocking findings of her review and answers her critics. Intriguingly, Moncrieff, a lifelong liberal, found more support in the right wing media than the liberals – Tucker Carlson, for example, took her findings and ran with them; Rolling Stone magazine was less keen – but don’t let that put you off. The book is a must-read for anyone on SSRIs, or considering going on them. And if you know someone who is contemplating antidepressants, give them this book so that they can make an informed choice.
With compassion, erudition and diligence, Moncrieff highlights the gruesome side effects of these drugs (so often ignored by GPs, who seem to be prescribing SSRIs with gay abandon). Reduced sexual desire, diminished intensity of orgasms and erectile dysfunction are common (even years after coming off the drug), so much so that SSRIs are now prescribed for sex offenders. Withdrawal is difficult, to put it mildly. And suicide ideation in under 25s can occur within days of taking SSRIs.
I would have liked more on how and why neoliberal society has encouraged us to view depression as a biological problem, whether that’s our brain chemistry, genetics or neural make up, but it’s a tiny quibble in an otherwise supremely authoritative account. (It must be more than a diversion tactic, as she argues – a way to avoid awkward questions about the state of our capitalist society today and the distress it causes us.)
To those who say this book will cause undue distress to the millions already on SSRIs, Moncrieff adheres to that age-old Hippocratic principle of ‘first, do no harm’ – unlike Big Pharma and many of her colleagues, who have long dismissed the well-documented downsides of SSRIs as trivial. Moncrieff is not prepared to stand on the sidelines and say nothing. People need to know the facts. Knowledge can be painful, as she says, but it is also power.
Jon Stock (aka JS Monroe), author of The Sleep Room
August 16, 2025
Joanna Moncrieff’s Chemical Imbalance demonstrates how political, professional and financial interests shape the narratives of science—often by presenting unproven theories as facts, and by manipulating speculation through the language of scientific authority.
It is really sad to realise how many people, both known and unknown to me, remain trapped on medications that not only fail to resolve their underlying struggles but can actually make things worse. Antidepressants often introduce withdrawal symptoms, undermine confidence, and destroy self-esteem. I have seen this first-hand: a friend of mine has been on antidepressants since his teenage years. Despite many attempts, he has been unable to withdraw, and now suffers from consequences such as insomnia and weight gain. Like Moncrieff, his mother was a pharmacist and firmly believed in the “chemical imbalance” narrative. Raised in such background, he became another victim of it.
Another friend of mine offers a different example. He was diagnosed with depression due to overwork, prescribed antidepressants the very same day, and a week later announced he had recovered—deciding to stop taking the drug altogether. I found it shocking that such a diagnosis could be made so lightly, when there is no scientifically established test or criteria for depression. Equally shocking was how readily a GP prescribed a medication that does not target an identifiable disease but instead alters brain chemistry with potentially disastrous side effects. Like the author, I see depression as a meaningful human response to life experiences—whether unemployment, divorce, or burnout. Feeling depressed can be the body’s way of signalling that something in life needs to change, rather than an issue to be “fixed” with medication.
Moncrieff’s arguments also resonate with how other medical narratives have been framed in recent years. The way antidepressants are promoted mirrors how COVID-19 vaccines were rolled out. Few questioned a vaccine that had not gone through robust, long-term trials, yet many accepted it unquestioningly—even as evidence emerged of side effects and breakthrough infections. Governments and regulators, heavily funded by pharmaceutical companies, suppressed concerns, downplayed adverse events, and branded any doubts as conspiracy theories, pseudoscience, or “right-wing” ideology.
History provides other examples of how powerful industries manipulate narratives. Decades ago, cigarette companies exploited feminism to market smoking as liberation for women. Today, antidepressants are framed as part of a “progressive” or “liberal” worldview. Anyone questioning this framing risks being labelled anti-science or a bigot.
It is really sad to realise how many people, both known and unknown to me, remain trapped on medications that not only fail to resolve their underlying struggles but can actually make things worse. Antidepressants often introduce withdrawal symptoms, undermine confidence, and destroy self-esteem. I have seen this first-hand: a friend of mine has been on antidepressants since his teenage years. Despite many attempts, he has been unable to withdraw, and now suffers from consequences such as insomnia and weight gain. Like Moncrieff, his mother was a pharmacist and firmly believed in the “chemical imbalance” narrative. Raised in such background, he became another victim of it.
Another friend of mine offers a different example. He was diagnosed with depression due to overwork, prescribed antidepressants the very same day, and a week later announced he had recovered—deciding to stop taking the drug altogether. I found it shocking that such a diagnosis could be made so lightly, when there is no scientifically established test or criteria for depression. Equally shocking was how readily a GP prescribed a medication that does not target an identifiable disease but instead alters brain chemistry with potentially disastrous side effects. Like the author, I see depression as a meaningful human response to life experiences—whether unemployment, divorce, or burnout. Feeling depressed can be the body’s way of signalling that something in life needs to change, rather than an issue to be “fixed” with medication.
Moncrieff’s arguments also resonate with how other medical narratives have been framed in recent years. The way antidepressants are promoted mirrors how COVID-19 vaccines were rolled out. Few questioned a vaccine that had not gone through robust, long-term trials, yet many accepted it unquestioningly—even as evidence emerged of side effects and breakthrough infections. Governments and regulators, heavily funded by pharmaceutical companies, suppressed concerns, downplayed adverse events, and branded any doubts as conspiracy theories, pseudoscience, or “right-wing” ideology.
History provides other examples of how powerful industries manipulate narratives. Decades ago, cigarette companies exploited feminism to market smoking as liberation for women. Today, antidepressants are framed as part of a “progressive” or “liberal” worldview. Anyone questioning this framing risks being labelled anti-science or a bigot.
March 24, 2025
Absolute joke of a book.
Moncrieff takes down the idea of the "chemical imbalance" which "mainstream psychiatry" teaches. It would be a worthy venture if it had a degree of truth to it. Psychiatry does not teach that mental illness is caused by a "chemical imbalance". The whole book is predicated on a straw man. She does have an appendix to show evidence that the "chemical imbalance" is still in use and has been pushed by psychiatry, but this is absolutely laughable and is clutching at straws.
She posits that antidepressants are either harmful, or don't work, and seems to indicate they can do anything apart from alleviate depression. Wherever she can, the goalposts are moved, pushing an 'accelerated' placebo, for when her placebo arguments has limitations. Interesting to note she doesn't really consider nocebo at all.
One would question her basic understanding of medicine with her crude comparison of the "disease based" vs "drug based" approach, even confusing her own definitions by getting herself in a muddle asserting why paracetamols make sense in the "disease centred" view whilst antidepressants don't. The whole thing is bizzare, it's as if she was forming a terribly simplistic version of the already simplistic Thomas Szasz..... oh wait, she does say she admired him. I guess that's exactly what it is then.
Much of the book is filled by playing the victim and squabbles that she's had online.
This book is gaining traction in the media, and it's unfortunate because it is nothing short of disgraceful that a qualified psychiatrist could have the audacity and such limited understanding to publish such a disgustingly bad work.
Moncrieff takes down the idea of the "chemical imbalance" which "mainstream psychiatry" teaches. It would be a worthy venture if it had a degree of truth to it. Psychiatry does not teach that mental illness is caused by a "chemical imbalance". The whole book is predicated on a straw man. She does have an appendix to show evidence that the "chemical imbalance" is still in use and has been pushed by psychiatry, but this is absolutely laughable and is clutching at straws.
She posits that antidepressants are either harmful, or don't work, and seems to indicate they can do anything apart from alleviate depression. Wherever she can, the goalposts are moved, pushing an 'accelerated' placebo, for when her placebo arguments has limitations. Interesting to note she doesn't really consider nocebo at all.
One would question her basic understanding of medicine with her crude comparison of the "disease based" vs "drug based" approach, even confusing her own definitions by getting herself in a muddle asserting why paracetamols make sense in the "disease centred" view whilst antidepressants don't. The whole thing is bizzare, it's as if she was forming a terribly simplistic version of the already simplistic Thomas Szasz..... oh wait, she does say she admired him. I guess that's exactly what it is then.
Much of the book is filled by playing the victim and squabbles that she's had online.
This book is gaining traction in the media, and it's unfortunate because it is nothing short of disgraceful that a qualified psychiatrist could have the audacity and such limited understanding to publish such a disgustingly bad work.
June 26, 2025
I have read a number of books about drugs and procedures being marketed without any scientific evidence on how, or indeed if they work and what the long-term effects might be (think of lobotomy, ECT, thalidomide, puberty blockers, drugs claimed to be non-addictive - oxycodone, anyone?)
Joanna Moncrieff is a brave woman, exposing the problems around SSRIs. You criticise Big Pharma at your peril, and the backlash she experienced was as predictable as it is appalling.
Ever more profits are generated by antidepressants as normal life experiences such as stress and unhappiness are medicalised as 'anxiety' and 'depression', and then medicated, and this is why I don't believe there is a mental health crisis. Late capitalism makes life intolerable for many, who are told there's nothing wrong with the system, it's their brains that are malfunctioning, thus adding insult to injury. So people are drugged into compliance, and the rich get even more obscenely rich. For more on this, see also 'Sedated: How Modern Capitalism Created Our Mental Health Crisis' by James Davies.
Joanna Moncrieff's book is impassioned and articulate. It's both easy and hard to read: easy because her writing style is clear and flowing, and hard because you are likely to get very very angry with Big Pharma and the medical professionals who allow themselves to be seduced (i.e. bribed and corrupted) by Big Pharma.
For more info on how medical trials are used and abused see also 'I Think You'll Find It's a Bit More Complicated Than That' by Ben Goldacre.
Joanna Moncrieff is a brave woman, exposing the problems around SSRIs. You criticise Big Pharma at your peril, and the backlash she experienced was as predictable as it is appalling.
Ever more profits are generated by antidepressants as normal life experiences such as stress and unhappiness are medicalised as 'anxiety' and 'depression', and then medicated, and this is why I don't believe there is a mental health crisis. Late capitalism makes life intolerable for many, who are told there's nothing wrong with the system, it's their brains that are malfunctioning, thus adding insult to injury. So people are drugged into compliance, and the rich get even more obscenely rich. For more on this, see also 'Sedated: How Modern Capitalism Created Our Mental Health Crisis' by James Davies.
Joanna Moncrieff's book is impassioned and articulate. It's both easy and hard to read: easy because her writing style is clear and flowing, and hard because you are likely to get very very angry with Big Pharma and the medical professionals who allow themselves to be seduced (i.e. bribed and corrupted) by Big Pharma.
For more info on how medical trials are used and abused see also 'I Think You'll Find It's a Bit More Complicated Than That' by Ben Goldacre.
July 24, 2025
While I understand that this book is likely to be inherently biased due to the author’s very public stance on this issue, I thought that this book would at least try to fairly present the opposing view. Unfortunately, I was wrong, and that is one of my main criticisms. Moncrieff recounts the stories of several people who have taken antidepressants which, for whatever reason, has not helped them; she presents NO stories from people whom antidepressants have helped.
Another significant drawback would be the sensationalist tone that the author takes for much of the book, which takes away from its (and her) credibility. Although a lot of the research presented is very interesting — and does indeed lend credit to the view that the chemical imbalance theory of depression may not be correct — this is overshadowed by Moncrieff’s own opinions.
Thirdly, the book does not really provide any theories as to the cause of depression, if it is not caused by defective serotonin signalling. It very briefly outlines a few theories, but doesn’t explore them in depth. This is frustrating as there is a large amount of recent interesting literature pinpointing other molecules in the pathophysiology of depression, such as BDNF (brain-derived neurotrophic factor).
Overall, Chemically Imbalanced gives a good overview of the evidence suggesting depression is not caused by neurotransmitter dysfunction, albeit a very one-sided one. Anyone reading this should 1. take it with a pinch of salt, and, more importantly, 2. DO YOUR OWN RESEARCH.
Another significant drawback would be the sensationalist tone that the author takes for much of the book, which takes away from its (and her) credibility. Although a lot of the research presented is very interesting — and does indeed lend credit to the view that the chemical imbalance theory of depression may not be correct — this is overshadowed by Moncrieff’s own opinions.
Thirdly, the book does not really provide any theories as to the cause of depression, if it is not caused by defective serotonin signalling. It very briefly outlines a few theories, but doesn’t explore them in depth. This is frustrating as there is a large amount of recent interesting literature pinpointing other molecules in the pathophysiology of depression, such as BDNF (brain-derived neurotrophic factor).
Overall, Chemically Imbalanced gives a good overview of the evidence suggesting depression is not caused by neurotransmitter dysfunction, albeit a very one-sided one. Anyone reading this should 1. take it with a pinch of salt, and, more importantly, 2. DO YOUR OWN RESEARCH.
April 28, 2025
I think this book is very accessible and will benefit those new to the subject most of all.
It is well researched and covers the history and development of the public consumption of SSRI's very well indeed.
My only insignificant gripe is that it can be a tad repetitive in places.
It is a subject i have strong views about given the job i have, the medicalisation of the emotions that make us human is touched upon here. I remember when the study that prompted the writing of this book was published. The results were of no particular surprise, they did however grant the opportunity to have this very important phenomenon discussed more broadly in the public sphere.
I bought this book thinking it would tell me something new on the subject, but it seems to be more of an introduction and a brief history on it. This is not to denigrate the book at all. It will give those curious to know more about the chemical imbalance theory of depression a great insight.
It is well researched and covers the history and development of the public consumption of SSRI's very well indeed.
My only insignificant gripe is that it can be a tad repetitive in places.
It is a subject i have strong views about given the job i have, the medicalisation of the emotions that make us human is touched upon here. I remember when the study that prompted the writing of this book was published. The results were of no particular surprise, they did however grant the opportunity to have this very important phenomenon discussed more broadly in the public sphere.
I bought this book thinking it would tell me something new on the subject, but it seems to be more of an introduction and a brief history on it. This is not to denigrate the book at all. It will give those curious to know more about the chemical imbalance theory of depression a great insight.
February 11, 2025
This book seems to have been written by a high school student, full of inconsistencies and contradictions. It repeats what every thinking being knows and Thomas Szasz mentioned decades ago, psychiatry (and I would add psychology as well) is a crude farce. DON'T BUY
Este libro parece escrito por un estudiante de escuela secundaria, lleno de inconcistencias y contradicciones. Repite lo que todo ser pensante sabe li dijo Thomas Szansz hace décadas, psiquiatria ( y yo agrego tambien psicologia), son una burda farsa. NO COMPRES ESTO
Este libro parece escrito por un estudiante de escuela secundaria, lleno de inconcistencias y contradicciones. Repite lo que todo ser pensante sabe li dijo Thomas Szansz hace décadas, psiquiatria ( y yo agrego tambien psicologia), son una burda farsa. NO COMPRES ESTO
June 22, 2025
I found this book eye opening and insightful. It’s staggering how much of the population are taking anti depressants (20% or 1 in 5) and the medicalisation of depression due to a serotonin chemical imbalance (largely driven by skewed research and profit). Book was accessible to me despite not having a medical background. A brave and bold book and feel more informed about my well-being and mental health choices. A real eye opener!
January 5, 2026
Brilliant, Essential, and Accessible!
Dr. Moncrieff deserves the highest honors the fields of medicine and science offer. This book will save lives, help others recover lost hopes and dreams, and - I hope - inspire all of us to build a world more conducive to more people flourishing.
Dr. Moncrieff deserves the highest honors the fields of medicine and science offer. This book will save lives, help others recover lost hopes and dreams, and - I hope - inspire all of us to build a world more conducive to more people flourishing.
November 25, 2025
very interesting. hard to get through but that’s on me as I don’t love non fiction. so thought provoking tho I think I want to come off my antidepressants
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