In this weeks Scrubbing Up health column Dr Joanna Moncrieff, argues that taking tablets to treat conditions like depression and schizophrenia may not be a straightforward solution.
Dr Moncrieff says that although taking a pill to treat these conditions is widely believed to work by reversing a chemical imbalance in the brain, they actually put people into "drug-induced states".
BBC News website readers have been writing in with their reaction to the latest Scrubbing Up column.
Well-meant article perhaps, but seems an awful lot like it's shifting the responsibility for care back onto the patient, and one wonders if people with mental health problems are in the best position to take on that responsibility.
While someone with depression might welcome the opportunity to alleviate it with drugs, someone hearing voices that tell them to kill might not. Regardless of how it works, if it prevents people from harming themselves or others, by all means continue to prescribe drugs, and in the meantime do more research until we understand these issues properly. But don't give potentially dangerous people more information than they may be able to handle: it's just asking for trouble.
Rob, London, UK
This is an interesting article, as it highlights a definite difference not just of taking the 'magic bullet' but in terms of what is really required for an individual. I have a number of friends for one reason or another that have had to have some form of medication to resolve mental health issues.
Interestingly there was a family history of mental illness in both cases; one had the self awareness to start taking some medication when the situation escalated, the other was at the mercy of a 'pill pusher', and tried to mortally injure himself.
Of course mental health is never about direct comparisons, but I am sure many people need therapy (this could be exercise, a voluntary job with animals, talking to someone who cares) before pharmacology. Promote self awareness? Like looking for fairness and decency in a world asleep.
My ex is diagnosed as having bipolar disorder and has to take a pill in the morning and one in the evening. She's never liked taking them and always complained that they just left her very tired. I've always been of the opinion that she didn't actually need them, but it's easier for the doctors to stick her on pills and dumb her down than it is to try and help her gain full control of herself.
I saw her recently and she said she'd been off the pills for a while and was fine, but then had a bout of depression and rather than being worked through her problems, she was stuck straight back on the pills, surprise surprise she's feeling tired all the time again.
I agree they're certainly not a catch all cure. A lot of people diagnosed with these problems in my opinion just need some help working through issues, sure the other end of the scale where someone is a danger to themselves and those around them these pills have a place, but not the way they're being dealt out like smarties as they currently are.
I've always wondered how the serotonin deficiency theory was quantified. People can be unhappy for legitimate reasons, what are the measures for determining when the physiological brain responses are abnormal? Who has a right to say that these brain processes are deficient and their way of thinking is not "normal"? What controls are there to say whether a lack of serotonin is a cause or an effect?
I've been on Cilapram, since December 2008. I started off on 20mg and increased the dosage to 40mg two months ago, as my problems seemed to return again. The doubling the dosage has worked and I feel fine, just hate the side effects. Tiredness and lack of sex drive.
In my condition the drugs are working, I know what I was like before I saw my doctor and I don't want to get back in that situation. I don't think the chemical cure is a myth. It has proved to me that these tablets work. I have gone from a jibbering wreck who wanted to kill himself, to a happy relaxed and calm person, who is now enjoying life - a life I could all to easily have ended last year.
As someone who has been prescribed medication for mental health issues, I find this one-sided article frightening rather than enlightening.
Is Dr Moncrieff saying I should bin the medication I have and 'go it alone'? Am I a complete idiot for trusting the medical profession and simply walking round off my head thanks to the drugs I am prescribed? This is a staggeringly irresponsible piece that will leave many vulnerable people confused and scared about their medications. Where is the other side to this, the doctor or mental health expert speaking in favour or defence of drug use? I know this is a column, rather than article, but a little balance within it would have gone a long way.
I have been told for years that I have a "chemical imbalance" and been prescribed a succession of antidepressants. The early ones induced a zomboid state of pharmacology bondage (which was fine for those around me who wanted me more "normal").
Depression is like trying to walk through a mire in the fog - the early antidepressants simply made me feel I was sleep walking and did nothing to mitigate the theft of my life that depression implies. Since then I have been on a succession of serotonin uptake inhibitors (SSRIs) the (sometimes terrifying) side effects of which were either not known or certainly not disclosed to me. The benefits have been variable and contradictory.
Dr. Moncrieff is right, if only in the conclusion that can be drawn that insufficient research has been done. We and the government purchasers of mental health treatments are in the hands and in thrall of the big pharmaceutical companies who have huge research budgets and marketing muscle.
Far too few resources are devoted to research into unpatentable products like St. John's Wort (an ancient but unproven treatment for mild depression) and talking therapies such as psychoanalysis and psychotherapy. Pills are simply cheaper and doctors think from their wrists as they write prescription after prescription.
Too many people are "parked" (clamped) on antidepressants not realising they are being robbed of their potential to be more economically and socially productive people. Mental health is a Cinderella of the health system - she is bloated and housebound with no fairy godmother coming to her rescue.
Charles McFadyen, Devon
I am stunned yet again by the magnitude and irresponsible manner our society allows itself to operate within. These powerful drugs are freely available and so many of us have been mislead over the years. I think the government have a serious obligation here. In short we have been covering up psychological problems by way of poisoning the mind to think and feel differently. This is very different to re-dressing a natural chemical imbalance. I for one would like to know who is responsible if the Dr is indeed correct.
My now ex-wife suffered from bouts of depression and getting her away from taking what I now see as needlessly prescribed addictive and foreign chemicals which had no positive effects, angers me. Any drug that is responsible for emotional alteration might have offered a similar effect, so why have we been forced these. I thank Dr Joanna Moncrieff and would like to see a public inquiry.
I've got friends who use medication to "manage" their depression and I just don't see it working. Long term use seems to turn them paranoid and sloth-like. I think depression could be far better managed with pattern-changing techniques and other alternative behaviour therapies which produce confidence and vitality in people. I have a friend who was asked to leave his job because he refused to recommend various drug-therapies for his bi-polar clients. Surely we could teach people to train their minds to ignore the voices, for instance?
Jane Jarvis, Devon, UK
Without wanting to offend Dr Moncrieff, but isn't that whole article stating the obvious? Antidepressants are not a magic bullet and never have been. However they are excellent for changing how a patient feels very slightly so that they then feel better equipped to deal with their problems themselves or with the support of other therapies. The problem is not that people have been mislead about their power, it is that the NHS has disinvested in mental health services so all that is left for most people as an option is medication.
All I know is that without a combination of drug treatment and therapy I might not be here today. Many of my thoughts and feelings were (and still are at times) unbearably painful and if suppression of these makes life worth living then I'm all for it! As to the fact that the drugs are psychoactive and would affect even those who do not have a mental disorder, is that not true of many medications?
Clare S., United Kingdom
My dad had a mental break down three-years-ago, he's never recovered, though he is a lot better, through love and supporting him. He is the same both on medication and off, there's no point filling him up with chemicals if they have no use.
I have had several bouts of severe depression for the past 20 years. While the doctor's belief that underlying personal or emotional issues are the real problem, the fact is that there is no cure for those problems. Simply put, therapy does not work. Damage done in childhood is permanent. You can learn techniques for managing low-level distress or recognise certain damaging thought processes, but you can't stop them. They live in you. They *are* you. These things are impossible for someone who hasn't lived through them to understand. They just think that you need to work out why you feel such and such a way and it will all disappear.
The modern serotonin re-uptake inhibitors (prozac and what followed) do a good job of helping you manage better when things are very bad. They've certainly saved my life. I really don't care that I am in a "drug induced state" when taking these rather than being "cured" of some brain chemistry problem.
The point of doctor's article seems to be some conservative anti-drugs agenda where we're all supposed to feel bad if we take things that make us feel differently. We should all tackle our underlying emotional problems instead! There! That was easy wasn't it! Incredibly naive and patronising. She should walk a mile in someone else's shoes before she gives condescending 'advice' such as this.
David, Newcastle, UK
In my experience of mental health - as a carer, as a support worker, and as a service user at different times in my life - psychoactive drugs only mask deeper underlying issues, and indeed sometimes make it even more difficult for someone to look at those issues perhaps because that person is then "in an altered state" as suggested in this article. This can make it more difficult to connect with the issues that may need resolving.
I was always struck as a carer of people in psychosis that - to me at least - it always seemed that much of the content of people's psychoses were representative of deeper underlying problems that they had faced in their lives, and that their brains seemed to have just "had enough" and shut down, but were still playing out those issues in another way.
The "voices" one client with schizophrenia heard telling him he was useless were exactly the same words I would hear his mother say to him whenever she took him home for weekends, another client with a persecution complex took 30 years to disclose the abuse she had experienced as a child - perhaps she was playing out her fear of persecution in ways that may have felt safe for her.
Another client just wanted to care for his plants during his psychosis - he had a desire to be nurtured and loved in ways he had not experienced as a child. Of course, it is not just down to childhood experiences - I do believe that all of us are capable of having these experiences; we just don't know what it is that will "tip us over the edge" enough to experience them, and most are lucky enough not to. However these and many other examples always made me question the ability of drugs to truly help people in the long term.
A lot of power has been given to both the psychiatric profession and the pharmaceutical industry which is thankfully increasingly being challenged with greater public and scientific awareness.
My mother has been on anti depressants for 10 years and her personality is unrecognisable now. Her GP is clueless and psychiatrist useless. He just gives her a repeat prescription which as far as he's concerned is for the rest of her life, she's 70 and physically quite well. What to do?
Kathy, West Midlands
I have suffered from depression for many years, or at least believed I was a depressive (it amounts to the same thing). I have been on and off many different antidepressant drugs throughout my life and they have often been a real help when things were getting really bad. However, I became aware that I was in a cycle of depression and pills and my life was drifting by with the underlying problems never being fixed, merely being masked by an artificially happy state.
I took the decision to pursue psychological treatment - I believe that if you catch it early enough, depression can be overcome. It took about 10 months wait on the NHS, and by the time I got treatment I was back on pills, but when I finally got CBT it pretty much completely sorted me out. Who knows, maybe I will have to take pills again sometime in the future, but the biggest thing that happened was the realisation that nothing was actually wrong with me.