Today our English listening practice topic is about depression, anti-depressants and serotonin. A recent research paper says serotonin has little or nothing to do with depression! So wait a minute, the primary treatment we have to help people with depression targets serotonin, and serotonin has little or nothing to do with depression. How could we possibly take so long to discover something this fundamental? With so many people taking these pills, there is a lot to talk about.
Anti-depression medication affects the people who take it. Otherwise, why prescribe the drugs to so many people and for such long periods of time? People will tell you that anti-depressant pills have helped them, but whatever is going on medically is now being questioned by some heavyweight medical research from University College London. Of course, this ignores the elephant in the room, and that is the side effects of taking this type of mind-altering drug over long periods of time.
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When I say a lot of people take these pills, I mean millions of people in Britain alone! The Lancet published data from NHS Digital showing that 70.9 million prescriptions for antidepressants were given out in England in 2018, compared with 36 million in 2008. No wonder the anti-depression pill market is booming. The global antidepressant drugs market in 2020 had a value of 15.6 Billion USD and they project it will reach 21 Billion USD by 2030. It’s a substantial business if you are one of the 5 major players that dominates this market.
Since I was 16, I've felt a black cloud hangs over me. Since then, I have taken pills for depression.
⭐ Amy Winehouse, UK Singer
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Imbalance Chemical Heavyweight Antidepressants Psychiatry Depression Hallelujah Psychotherapist Biochemical Withdrawal
Hi there. Today I'm going to talk about a topic that I feel passionate about. It's related to a piece of research, which was published recently, which has been in the news, certainly in the UK and probably in other countries around the world. We know our Adept English audience love it when we do podcasts on neuroscience and psychology, the brain and the mind.
So it's one of those. I hope you find this topic as fascinating as I did. And while you're busy being interested in the topic, your brain will be learning some fantastic English language. So do your English language listening practice with Adept English and learn something interesting at the same time.
Hello, I’m Hilary, and you’re listening to Adept English. We will help you to speak English fluently. All you have to do is listen. So start listening now and find out how it works.
Last week a report was published by UCL in London, that's University College London, one of our top universities. And the headline of this research? 'There is little evidence that chemical imbalance causes depression, UCL scientists find'. I'll say that again.
'There is little evidence that chemical imbalance causes depression, UCL scientists find'. And 'Researchers question the use of antidepressants which are prescribed to one in six adults in the UK.' 'One in six adults'? Okay. Well, when I heard about the report and when I read it, I said, 'Hallelujah!' 'Hallelujah!' I say to this news. That word is not one I use often and yes, it has a religious connotation, but I'm not using it in that way here.
'Hallelujah!' here just means sheer joy! At last! Something sensible is being said. We've waited a long time. So hallelujah is my expression of joy that this insight is starting to be mainstream. That depression is not about low serotonin levels. The brain chemical theory of depression is at last being challenged. Also being challenged - the huge amount of antidepressant prescribing that goes on in the UK, even to children. It goes on around the world too, especially in the US.
Psychotherapists like me on the whole will be rejoicing at this news. We are really happy at this news. This is the level of feeling about it. At last, someone is talking sense about depression and the reasons behind it.
If you ask psychotherapists like me about depression, it's no mystery. We know what kinds of things cause depression. It's not something that's badly understood. It's just, we're not really listened to in mainstream medicine because strictly speaking, we're not scientists. I have an MSc, but if you're a psychotherapist, you're not counted as a scientist.
Let me give you some vocabulary and background on this one. So, 'hallelujah', I think I've covered - that's H A L L E L U J A H. And it means 'What joy to hear this!' And what is depression? So that's D E P R E S S I O N. Well, it's a situation where someone feels very low in mood, unhappy. It's a unpleasant feeling. They have very little joy or hope for the future. Everything seems a little bit grey or black even, if you're very depressed. Literally it's a sense of kind of being pushed down. That's 'depression'. You're being 'pressed down' by your life and by your circumstances, I guess.
As many of you know, I'm a psychotherapist. I have been in practice for 22 years. And so I've seen, and I still see a lot of people with depression. I also work with other kinds of psychological difficulties, but depression is very common.
And the theory in mainstream medicine for the whole of my practice has been that 'depression is caused by a brain chemical imbalance'. The brain chemicals are 'out of balance' and 'that's why people get depressed'.
And this is the sort of thinking and the theorising that has been the mainstream, that's in the NHS, that's in psychiatry - in the UK, in the US, in Europe and around the world. And the 'solution', therefore to depression is antidepressant pills or tablets.
So 'the circumstances of your life and your history have nothing to do with your depression - it's a brain chemical imbalance and here's a pill for it'. This mainstream viewpoint has been 'driving me nuts' for the last 22 years, so I'm really pleased that it sounds as though we're about to have a more sensible conversation about mental health.
It was reported in mainstream news by heavyweight psychiatrists in positions of influence. So what does the article actually say?
Before I do that quickly. Don't forget to make a note of this discount code so that you can get 50% off our Adept English Consonants Pronunciation Course. It's on offer at half price at the moment. So if you want to improve your English pronunciation, please go to our website and buy this course!
Back to the topic. This study was a 'meta-analysis'. So a 'meta-analysis' is a scientific report which looks at lots and lots of studies. It looks at lots and lots of data from different studies. And these types of reports, 'meta-analyses' are often the most useful because they give answers to big picture questions.
Often a piece of research is answering a very narrow and much less meaningful question. So meta-analyses are good. In this report, the Professor of Psychiatry at UCL, Joanna Moncrieff says, and I quote,
'There is no clear evidence that low serotonin levels are responsible for depression.' Serotonin, that's S E R O T O N I N. That's the brain chemical that we all naturally generate. In different quantities maybe, but we all make serotonin naturally. Our bodies take something called tryptophan from our food - it's in meat and potatoes, for example. And there are a number of chemical stages that happen mainly in your gut before it's made into serotonin.
A photograph the chemical model of serotonin. English listening practice: UCL research says serotonin is important for brain health. It does not play a role in how people respond to antidepressants.
So a little bit of serotonin is in your brain, most of it is in your stomach.
There is some evidence, I think, that serotonin makes you a nicer person to be around, a pleasanter person. It makes you affable, kind, friendly, considerate, and empathic to other people.
That's what serotonin seems to do for people. And the lack of serotonin? Well, it makes you the opposite of these things. But people's serotonin levels vary naturally - they are different. And it turns out that this is not the primary factor in depression and low mood, as has been believed for so long. I think it's quite likely it may determine something of your personality in part, but not whether your mood is high or low.
And what do antidepressants do? Well, they raise serotonin levels and actually usually only temporarily. They do that at the start of taking them. But the effect tails off. Often people need to be prescribed a bigger dose to maintain the effect.
Many people take antidepressants for years. Antidepressants come in a variety of forms. So they have names like - you might be familiar with these - Prozac, Fluoxetine. They're the same thing. Sertraline and Zoloft - they're the same. Citalopram or Cipramil. Paroxetine, Paxil, Seroxat. Escitalpram or Lexapro. They tend to have different brand names, depending whether you're in the US or the UK. And they also have generic names as well. There's also Venlafaxine, which has a slightly different way of working. That's an S N R I rather than S S R I for those who know what that means.
Professor of Psychiatry, Joanna Moncrieff, again says
'Many people take antidepressants because they have been led to believe that their depression has a biochemical cause. But this new research suggests that this belief is not grounded in evidence. It's always difficult to prove a negative, but I think we can safely say that after a vast amount of research, conducted over several decades, there is no convincing evidence that depression is caused by serotonin abnormalities, particularly by lower levels or reduced activity of serotonin.'
So what does this mean? It means that the public has been misled. This has been clear to people who work in my profession, colleagues of mine, as well as me for many years. So it's great to hear it being talked about in the mainstream news. It's estimated that about 85 to 90% of the general public believe this theory of 'brain chemical imbalance'.
So what about all of those people who've been taking antidepressant medication? Joanna Moncrieff is great. I think her English is easy to understand, so I will quote her again directly. She goes on to say,
'Thousands of people suffer the side effects from antidepressants.' ('Side effects' are the effects of a medication that you actually don't want.) 'These include severe withdrawal effects that can occur when people try to stop them. Yet prescription rates continue to rise. We believe this situation has been driven partly by the false belief that depression is due to a chemical imbalance. It is high time to inform the public that this belief is not grounded in science.
So it's not just that antidepressants don't work, but they potentially do people harm. They have quite severe side effects, which often aren't discussed. And the problem comes when people try to stop taking them. We are now allowed to talk about 'antidepressant withdrawal'. That's quite new that we're allowed to label it that. 'Withdrawal', so that's W I T H D R A W A L - that's what happens when you stop taking a drug that your body has become dependent upon. So we're familiar with 'withdrawal' if someone has to use morphine medically or with heroin or opium. All of those drugs have 'withdrawal effects', albeit of a different kind. The 'withdrawal symptoms' for antidepressants are largely psychological ones rather than physical ones, but it can be both.
Other findings from this study. There was no difference in serotonin level between depressed people and people who didn't have depression. Other studies artificially lowered serotonin levels in hundreds of people. This did not result in depression. What was related to levels of depression was stressful life events. The more stressful life events a person had had, the more likely they were to have depression.
This isn't exactly news to people like me. The relationship that depression has to your life circumstances past and present. Well, that's a whole different area. And, yes in case you aren't sure, there is rather a strong correlation there and that is scientifically proven.
Other studies found that long-term antidepressant use could actually change the serotonin system resulting in lower serotonin in the long term.
So precisely the opposite effect of what was intended and in effect, creating a problem where probably none previously existed. Worth thinking about!
Another researcher on the project, Dr michael Bloomfield, Consultant Psychiatrist and Research Fellow at University College London said,
'Many of us know that taking paracetamol for headaches can be helpful, but I don't think that anyone thinks that headaches are caused by not enough paracetamol'. Fair comment!
What the researchers did make clear, and I will reiterate this too - despite this breakthrough, despite this insight, don't stop taking your antidepressants if you're on them. To stop taking an antidepressant suddenly is the very worst thing you can do. Pretty much everybody agrees on that one. If you do want to come off, talk to your prescriber, talk to your doctor and do it very, very slowly. It's called 'tapering'. 'To taper', T A P E R in English means to go very, very slowly down on your medication.
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It feels like this is a public information broadcast, but I am just so overjoyed to hear this discussion happening in mainstream news, by senior psychologists*, in an academic and esteemed university in the UK.
- that was meant to say 'psychiatrists' not psychologists!
I'm just so happy about that. We do get nearer, through this, to solving our mental health crisis. It's a big breakthrough!
I could talk for hours about this one. This is supremely interesting to me, but let me know if you've questions or you want more podcasts on this sort of topic. We'd love to hear from you.
Enough for now. Have a lovely day. Speak to you again soon. Goodbye.
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- UCL Study
- News Article
- Types of anti depressants
- The Lancet
- Anti depressant prescriptions double in 10 years
- Size of global anti-depressant market
- 6 million British take anti depressants
- NHS still promoting them
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