The Dr Louise Newson Podcast - 47 - Rethinking mental health and antidepressant prescribing

Episode Date: February 17, 2026

Content advisory: this episode contains themes of metal health and suicidalityIn this episode, Dr Louise Newson is joined by Dr MarkHorowitz, who is a psychiatrist, researcher and world-leading expert in psychiatric medication withdrawal and deprescribing. Mark is also the lead author of the Maudsley Deprescribing Guidelines and co-founder of Outro Health, the only virtual clinic in the United States offering a clinically validated antidepressant tapering service.Together, they explore how antidepressants,gabapentinoids and other psychoactive medications became so widely prescribed and why stopping them is often far more difficult than starting them. Thediscussion looks closely at what the evidence actually shows about effectiveness, long-term risks, withdrawal effects and suicidality, particularly for women and younger people.The conversation also examines how hormonal changes, life stressors and social factors are frequently overlooked, leading to the medicalisation of distress that may be a normal response to difficultcircumstances. Want more from the podcast? Sign up to my premium offer: https://www.drlouisenewson.co.uk/premium-podcastsLET'S CONNECT  Subscribe here 👉 https://www.youtube.com/@menopause_doctor Website 👉 https://www.drlouisenewson.co.uk/Instagram 👉  /@drlouisenewsonpodcast  Download balance app 👉 / https://www.balance-menopause.com/balance-app/ LinkedIn👉 /https://www.linkedin.com/in/drlouisenewson/ TikTok 👉   https://www.tiktok.com/@drlouisenewson Spotify 👉 https://open.spotify.com/show/7dCctfyI9bODGDaFnjfKhg  LEARN MORE Download my balance app 👉 https://www.balance-menopause.com/balance-app/Get tickets for my new theatre tour, Breaking the Cycle 👉 https://www.nlp-ltd.com/dr-louise-newson-breaking-the-cycle/ Find out more about Dr. MarkHorowitz's work 👉  https://markhorowitz.org/Find out more about Outro Health's virtual tapering clinic (US) 👉  https://www.outro.com/ 

Mark Horowitz is on my podcast today, and this is actually going to blow your mind. You might have to listen to it more than once. We talk about antidepressants, we talk about benzodiazepines, we talk about gabapentinin, progabalin, these highly addictive drugs that are prescribed more commonly than HRT and have more risks with them. We need to be thinking differently about mental health, and his perspective on things, including his research, is really interesting. and I just hope it makes you think of it differently. So Mark, this is great that you've come in today. I know it's going to be a very interesting podcast that's going to resonate with a lot of people. People might be wondering why I'm holding such a big, heavy book

that I've slugged across London, but it's the Maudsley-prescribing guidelines, antidepressants, benzodiazepines, gabapentinoids, which is gabapentin and progabalin, and Zed drugs, which are the sort of Zopoclone, sleeping tablets and you are a co-author of this and you've written so many papers. Your knowledge is huge and I just wanted to get as much out of your lovely brain for the next half an hour. So just before we start though, just explain a bit about your background if you don't mind, Mark.

Thanks have me on and if the book is heavy to carry, imagine how hard it was to write. So thank you. So I'm Mark Horowitz. I'm a training psychiatrist and researcher. I'm an associate professor Psychiatry at Adelaide University, and I'm a visiting lecturer in psychopharmacology at King's College, London. And I run a deprescribing clinic that specialises in helping people to stop antidepressants, penesopines, all the drugs you mentioned in the NHS in northeast London. And I also work with outro health in America that does similar things to help people come off antidepressants safely. And I've done a lot of work exactly dealing with half of psychiatry, I think, which is how to safely stop medications because so much of psychiatry is about how to start them.

And I, you know, sometimes I think it's a little bit like having cars without brakes on the, on the road that I'm looking at how to safely stop these things. It's really interesting actually. So I was reflecting a lot coming here today because I qualified in 1994. Antidepressants, the SSRIs were just sort of coming out really. Before that we had antidepressants like amyptylene, dothypine, but they had more side effects. so we were a bit more careful. And they were quite immediate side effects people had,

you know, the dry mouth, sometimes blurred vision. So when they came out, I remember because when I did my training in general practice, there were more drugs than when I did my psychiatry training, if that makes sense. The adverts were very, oh, it's very easy, it's very safe, it's very low, and low risk just prescribed them. And, you know, as a doctor, we don't really get trained much about lifestyle medicine at all. So when you've got someone in front of you with 10 minutes, it can be really difficult to tease out, firstly, whether they are clinically depressed or whether they're reacting to a dreadful situation or whether there's something else going on. But also, like, how do you take responsibility? How do you manage them?

And it's, there's a lot, quite a lot of pressure as a GP. So I do feel bad for lots of reasons, but I've prescribed a lot of these drugs. I've prescribed a lot of sleeping tablets to a lot of women thinking back who really couldn't sleep. And I was just on this sort of hamster wheel like a lot of people are because they thought what I was doing was right.

And I think it was at the time. But there's a couple of things really. One thing is, obviously now I know about the world of hormones in the brain. And when I think back to the women who I've prescribed to, I didn't ask about their periods. I didn't ask if they had any change throughout their cycle. I didn't ask about postnatal depression, which is often a sort of sign that they might have worsening mental health when hormones changes their age. And now, obviously I prescribe hormones, but I deprescribe a lot of these drugs. I'm constantly thinking, how can these people come off those drugs? Because

there are harms with them, there are long-term risks, and I'm thinking so much more about how to not prescribe them in the first place than the last six, eight years probably, I haven't prescribed any of those drugs. And I would say my patients that I look after now are healthier than my patients I've had before. Yeah, I mean, I guess there's a lot to dig into there. I mean, number one, I think it does impose on GP's a very big pressure that I think is, you know, people have all sorts of problems,

physical health problems, social, psychological problems, and GPs are there with eight to ten minutes to try to solve them. I think there's a lot of pressure on them to deal with that. We know that most people's low mood is because of their life circumstances. Study after study shows the number of stressful life events you experience in a year correlates very strongly with whether you're depressed or not. The sort of things that before the kind of biomedical era, people would have said causes depression.

Job loss, divorce, death of a loved one, And those are the big risk factors. We have hugely medicalised these conditions over the last few years where everything has now has capital letters. It's major depressive disorder, generalized anxiety disorder. But these things are responses to our lives. Lots of people get better naturally. We know that after the process of natural recovery is very efficient.

Most people who are depressed, six months later will not be depressed because things change in people's lives. we have this sort of intervene quickly mentality. So GPs, you know, with, you know, want to do something useful. They want to be helpful. That's part of their training. They want to get in there and do something. But we know that people that are not prescribed antidepressants

have the same sort of outcomes as people that are prescribed antidepressants. So there's not huge evidence for their effectiveness, especially in the long term. So a lot of studies on these drugs are done for a few weeks. There's very small differences. You need a sort of magnifying glass. to see it on these studies, and there are very few studies on long-term effects. So I think a lot of people are being prescribed these drugs too quickly for too long

without reference to the long-term consequences, which we can talk about, including how hard it is to stop these drugs. Yeah, and some people really do feel worse when they take the drugs. And I know looking at some of the studies, people were saying, well, it's because these people have mental health issues anyway, so there's suicidal thoughts or whatever that happens. are not because of the drug, they're because of how they are, but there has been increasing evidence that there is a cohort of people

whose mental health has viral doubt of control on these drugs, which is a concern, isn't it? So I find that very irritating when people blame the underlying condition because it's very clear. The FDA did a very big meta-analysis now 15 years ago. They looked at double-blind, randomised control trials. That means that the people in both arms of these trials have the same mental health conditions. So you can't blame the mental health condition.

whole point of doing these trials. In the group of people given antidepressants, there was more suicidality than the group given placebo. That was particularly true for young people. And that's why in America, antidepressants come with a black box warning that under the age of 25, these drugs will increase, can increase your risk of suicidal thoughts and acts. There's been a lot of shifting round of words by the MHRA in different drug companies to make it sound like it's because of the underlying condition. But that is just not true. Allblind studies show that it's the antidepressants that are causing that increase in suicidality.

So you're quite right. It's something to be concerned about. When you talk about older adults, between the ages of 25 and 65, there is more debate. Some analyses show that antidepressants increase suicidality. Some show they have no effect, but no studies show they decrease suicidality. So when people say that these drugs are life-saving, it really is a marketing line because, you know, that has not been shown in any studies. People might say that about the drugs that they take,

but people might say that about anything they do in their lives, but looking at the evidence, as we have to as doctors, the objective evidence doesn't show that these drugs reduce suicidality. That's not what the studies show. And that's really important, I think, for people to know. When they first came out, we could prescribe them to children. They're still prescribed to children. And they are still prescribed, but not so much as from GPs.

But because mental health services are so stretched, There's more owners then on the GP. If you've got someone in front of you that's got mental health issues and you know it's a really long wait for CAMs or for a referral, and you see these people, it's really hard. I was very fortunate. I had a really good trainer when I was a GP. And he kept saying to me, Louise, you can't change people's home circumstances,

but what you can do is change the way they think about them. And so he did quite a lot of cognitive behavioural therapeutically. and it was quite a lot about what you can accept and what you can change and it's the mindset and it can take a bit of time you can't just do it all in 10 minutes but I was very fortunate because where I worked as a GPI

really got to know my patients and their families so you knew like sometimes it was a breakup of a relationship and then next time they'll be with someone else or something would happen or it might be an abusive partner and it's working how you remove yourself from the violence or something rather than being medicalised for it. Exactly.

I think, I mean, you know, this is what happens with medicalisation. You swap problems. So you're talking about all sorts of domestic abuse, relationship problems, job issues. You know, the way to solve those problems, you might need. Social workers, you might need to change,

you know, financial services. There might need to be things that are changed. If you turn it into an issue with chemicals in someone's brain, then you're thinking about which drug works and side effects and doing research on brain chemistry. I think you're missing the problem. You can't.

So I think, that's what, you know, medicalising has done is it's confused people. I remember reading in articles saying there's rates of depression that are rising in teenagers because of bullying and financial stresses. And what we want to do is do more research into the brains of these people to work out why it's happening. It's such an absurd response. If the issues are bullying and financial pressures, then of course the solutions are school dynamics and redistribution support of people with low incomes, not looking at what goes wrong in their brains. But because we live in such a sort of technophilic age where understanding how brains work is the answer. We've forgotten the

sort of basic social factors that push these things. I think it's hard for a GP because sitting there, as your trainer said, how can you change people's lives? It's very hard, which is why I don't think it's best seen as a medical problem because GP's are very good at managing blood pressure and diabetes. But when you're talking about social problems, they may not be the most appropriate people to deal with these things. But medicalising it has put it in their laps, which puts them in a very difficult position, which is why it's so easy to prescribe a medication because you can do that in eight minutes. Yeah. And the thing is also with psychiatric diagnosis, there's all this DSM criterion. And as doctors, we like to make a diagnosis because it helps dictate treatment.

And also it can be, not always, I think, but it can be validating for a patient to know they have a condition. You know, if you were feeling really tired and lost weight and I did your blood sugar level and your glucose level was really high and I told you had type 1 diabetes, you'd be quite relieved with a diagnosis and a treatment that was effective. But some of these criteria are firstly very rigid. Secondly, you can talk about some of the politics maybe behind them,

but then as soon as you've got that, then it triggers their medical treatment, doesn't it? So exactly, I think the root into medicalisation of these conditions is diagnosis. And as you've alluded to, diagnoses, When you talk about type 2 diabetes, you talk about blood sugar levels, you talk about insulin responses, there's biochemical findings. Talking about mental health conditions, of course, there are no biochemical findings.

These things are social constructions. They were, you know, the modern age of psychiatry was unleashed in 1980 in the northeast of America by the DSM3 committee. So, you know, I think it's worth understanding of history. Yeah. So in the 1970s, psychiatry was under attack by psychologists who said, you know, we're better at therapy and we're cheaper, what are you guys doing? And their response was, you know, we're doctors, we have medical degrees, we understand

the way the brain works, and DSM3 was the response to that. Before that, DSM 1 and DSM2 had been very psychoanalytic in orientation. They had different chapters on reactions, depressive reaction, anxious reaction, even psychotic reaction. And the reaction was to people's lives. Things that go wrong, some people respond by becoming hopeless, some people by becoming very anxious, very common responses. DSM3, those categories were changed.

Depressive reaction became major depressive disorder, capital letters. Anxious reaction became generalised anxiety disorder capital letters. Was that because of new biochemical findings, neuroimaging, epidemiological studies? No, it wasn't. It was because they wanted to enforce that these are medical conditions like anything else. And so they sat around, there are these interviews done by James Davies, where he asked the committee members, how did you come to these diagnostic criteria? And they said things like, it was a bit like a group of friends ordering, going out for dinner.

And in the end, we would vote on the right criteria. And they said things like, six criteria was too many, four was too few. So we decided on five criteria. And also they said things like, you can't put that symptom in the diagnostic criteria because I do that. It was very much shaped by their own notions of what is normal, what is abnormal based on middle-aged white men, professors of psychiatry in the 1970s. sort of famously, of course, in previous versions of DSM, homosexuality was a diagnosis that then became out of favour as social morals changed. So you can sort of see how socially determined these

things are. And so you're right, now you have this diagnostic set of criteria, a capital letter diagnosis. It sounds like diabetes and they're in the realm of the medical, where of course there are guidelines that say if they have this diagnosis, give this medication. And so now you've been shunted, you know, all these different life problems have been shunted into, you know, a diagnostic lane. The other thing to say along with this is how common depression is. People, you know, they say, oh, it happens to one in four or it's this. By the age of 45, 70% of us will meet criteria for clinical depression or anxiety. 70%. So, you know, it's the idea that there's something wrong with the brains of 70% of people is implausible. You know, it's a

sort of natural response a lot of us have to overwhelming stress, you know, or not having our emotional needs met. It's the response of a normal person to circumstances. That's what a lot of these studies show. And of course, if you do medicalize that, there's a huge market to give people medications. And I think that's what's happened over the last few years. What was considered, you know, normal has now been, is now, you know, jumped on, diagnosed and you push down a treatment path. And of course, because the antibisans are not so effective, a lot of people go through cycles of medication. They try an antidepressants. They're told this one's not for you. Try another one. It can lead people down this route of being given multiple medications because the medications,

especially, you know, if you're in a situation of domestic abuse, relationship conflict, and the issue is not being solved, but you're being medicated. These medications are not going to solve those problems. They're not particularly effective. So you end up. getting multiple cycles of medication, you're then sometimes called treatment-resistant, which then makes you eligible for further treatments that people are given pre-gabalin, quatiopine, you know, people can end up getting lithium or elective-threaty. You go down this sort of root of medical treatment to find something until it's effective. Yeah, and I see this a lot because we do see a lot of people with mental health issues.

you know, one of the commonest symptoms of hormonal change is low mood, brain fog, anxiety, irritability, poor sleep. Lots, there's a big overlap, of course, with symptoms of depression. So most people, and I was really surprised when I started my clinic several years ago, but most people I see have been either offered or given antidepressant, 68% of people come to the clinic. And I thought with time things would have improved, but actually they haven't. but I'm seeing people that are on antipsychotics like you say like quaterapine, lithium, the gabapentin progabalin for their moods, but also I have been saying increasingly people that have had electroconvulsive therapy

and ketamine infusions, which really scares me because no one's been thinking about other causes, you know, like you say some of them are social causes, but some of them are hormonal changes. And then what really sort of concerns me is that if someone's on hormones, we have a long discussion about the difference between the natural and the synthetic ones, about the risks and the perceived risks. I don't know any of my patients that anyone sat down and told them any perceived risks or problems with any of those drugs, including antidepressants.

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you can make informed choices about your health and your treatment. and you can advocate for yourself when you speak to healthcare professionals. If you want clear, trustworthy information without the noise or the misinformation, then download my balance app today. It's there to educate, support and help you take back control of your hormone health. There's so many things to say. I think number one, even before we talk about side effects is how these drugs work. I think that's also worth talking about because people who have presented these drugs

as sort of solutions to their problems. and I think they're anything but. You know, there's the work of John Moncrief is a professor of psychiatry, I think, who makes these things very clear, which is, you know, there's two ways to think about psychiatric drugs. One is what she calls a disease-centered model

where these drugs, where drugs can reverse the underlying cause of a condition. So, for example, an antibiotic is a good example, a valid example. You've got a pneumonia, you're coughing up blood, you feel terrible, antibiotics go in, they kill the bug, and you're coughing and your fever go away.

You know, fantastic solution. People present psychiatric drugs as if they're similar. You know, even the word antidepressant sounds a bit like antibiotic. I'm just going to go in there, get the depression, kill it, and you'll come out the other side. And these sort of explanations are often based around this idea of a chemical imbalance. People's depression is caused by a neurotransmitter imbalance in their brain. And antidepressants will fix it.

They'll increase serotonin, is the drug, is the transmitter most talked about. People will feel better. And that sounds like a very neat solution. you know, who wouldn't take a transmitter that you're lacking. It sounds very plausible and safe. But of course, you know, that explanation is not based in good evidence. We don't have evidence that says that depressed people have low serotonin in their brains or in anxiety.

It was really an idea. It was put forward by scientists 60 years ago amplified by drug companies. So it's sort of, you know, everybody in the street thinks that. But there is not evidence for it. So there's another way of thinking about how to psychiatric. drugs work, which I think makes a lot more sense, which she calls the drug-centered model. Antidepressants, pre-gabalin, gabapentin, antipsychotics are psychoactive chemicals. They cross the blood-brain barrier.

They affect the way that you think and feel. And that means that those effects are superimposed on whatever you're feeling. An analogy would be to alcohol. If you're an anxious person and you don't like parties and you drink alcohol, you feel less inhibited, more calm. Nobody would say that social anxiety is caused by an alcohol deficiency, you know, all that everyone understands that alcohol is being superimposed on whatever anxieties you have. And also, when you stop alcohol, it'll leave your blood, your anxiety will come back. And if you use alcohol in the long term, you'll become tolerant to it. It'll have less and

effect on your body, or you'll need more and more. And also, alcohol's going to have toxic effects on your liver, on your brain. And it might be very hard to stop. You'll get withdrawal. effects. If you think about psychiatric drugs through that lens, everything makes much more sense. You know, what do antidepressants do, for example? When you ask most people on the drugs, they say they feel numbed. Yes, so easy. And what they're saying is the range of their emotions from very positive to very negative has been compressed into the middle. And if you're very panicked or anxious, you know, or low in mood, having the volume turned down from a 10 to a 4 can be a relief. But it's not the same thing as fixing the underlying problem. And you have to expect all

the issues that come with psychoactive drugs, you're going to get tolerance effects over time. It'll wear off. There's going to be toxic effects, which we can talk about in a second. When you try to stop them, you'll get withdrawal effects because your body gets used to it. We try to stop it, it's sort of scribbing out for it. And we now know that antidepressants and pre-gabalin and gabapentin and quatipine, and all of these drugs can have severe withdrawal effects that can last for some people for months or even years. You know, not just a week or two that would be a kind of, you know, small hiccup, but serious problems. And then talking about all the side effects of the drugs. I'll start with antidepressants then talk about pre-gallin and quatyapine. Or there's a lot of overlap.

You know, antidepressants cause emotional numbing. You know, that's, I think that might be their main effect. But that's one of the main reasons people would come to my clinic in America, Outtro Health. And in the NHS, they say, I don't know who I am anymore. I don't know what I think about my partner or children. I used to like art, music, sport. I've lost interest. And so what might have been useful in the short term,

five years, ten years later, you know, is causing them significant problems in their life. There's sexual trouble. We know those things actually correlated, emotional numbing and sexual numbing. You know, more than half of people on antidepressants, experience, diminishment of their libido, desire, ability to ejaculate to have sexual pleasure.

We also know that some people have that even after they stop. There's a question. This is called post-SSRI sexual dysfunction. There's a question, does it come back? Some people, it can take years, but it's really a concern. Weight gain is a big issue, not in the short-term studies, in the long-term studies that comes out as a clear signal. There is daytime fatigue, trouble sleeping,

concentration problems and memory issues, even in healthy volunteers. There are not great long-term studies on the physical health consequences of the drugs, but there are cohort studies that find in all the studies they find similar, findings, people who take antidepressants are more lucky to have strokes, falls, have bleeding risks, osteoporosis, cataracts, heart disease, and in some studies they will die earlier. There's a big debate about the degree to which that is based on their depression or on the medications themselves. In studies where they try as much to control for those issues as possible, these signals still

come out. So there is a concern that we know that these drugs, for example, affect platelets. and so bleeding risks make a lot of sense as do strokes. So these are not just benign drugs. When you're talking about pre-gabalin, gabapentin, I mean, those drugs have been referred to one professional psychiatry as benzodiazepines on steroids. That's a very good description because they work on a slightly different pathway,

but you can block their effects by giving an opioid blocker, which means they're doing something similar to opioids. They're obviously a drug of abuse. They have money, they have a street value on the black market. So they are addictive substances. They cause dependence. They also cause memory and concentration issues. They cause tiredness during the day.

They can cause weight gain. They all cause withdrawal effects. So many of the issues with antidepressants are probably even worse for pre-goblin and gabapentin. And there's a sort of catch-up that happens where benzodiazepines have a fairly bad reputation, I think, appropriately amongst doctors. One, because a lot of doctors were sued a generation ago. and they don't prescribe them very well.

I think in fact GPs are quite sensible with benzodiazepines. It happened for a few days, not a solution to your problems. Then a new drug comes onto the market that has the exact same issues. In this case, it's pre-gabalin and capepa-pensin. And it takes independent researchers 20 years to catch up to say, actually these drugs that are presented as having no major issues, are addictive, do-cause dependence, can be hard to stop. Aren't that effective?

By that time, the next group of drugs are coming out. And of course we have ketamine coming out now, which is sort of even more obviously a street drug. I used an analogy to alcohol before. But now I don't need to use an analogy because ketamine is a street drug. It's a horse tranquilizer as well, isn't it? There's an issue every few weeks in the BBC. There's an article about kids using ketamine more and more. And at the same time, representing it as a medical treatment.

And of course, it's going to get some people high because that's what ketamine does. But there are all sorts of consequences. It causes your bladder as walls. stick together, ketamine bladder. The effect wears off. Some people become very disorientated by the drug. Bigger doses cause the k-hole, but even smaller doses cause disorientation. It increases the risk of car accidents, of heart troubles.

In the original studies that they got the drugs approved on, there was more suicides in the group given ketamine because some people obviously is a very unpleasant experience. So we are giving out drugs with psychoactive properties to a whole lot of of people, older people, young people, and some people may find it pleasurable, and a lot of people will find it unpleasant. It'll wear off. It'll cause a whole lot of physical health problems for them, and it'll be very hard for many of them to stop. So I think we are handing people out medications without huge evidence of their effectiveness with significant issues down the track for long-term physical health problems and withdrawal effects without being told exactly what they're taking.

It's really scary. And people, People listening might be wondering why we're talking about progabalin and gabapentin and ketamine, but a lot of women with hormonal issues are prescribed these. And I was actually horrified the first time I read some menopause guidelines that say, they talk about non-hormonal treatments. And, you know, there are lots of non-hormonal things we can do that aren't medicalise. You know, I do a lot of yoga. That's irrelevant whether I take hormones or not. There's lots of mental health issue, you know, improvements that can occur with regular exercise or going outside or whatever, eating, all sorts of really important things. But actually in the guidelines,

it says that gabapentin and progavalin can be given for flushes and sweats. Now, firstly, flushes and sweats are not the most common, nor the most severe symptom. And actually, why would you give those highly addictive drugs? I was shocked, but we see people that have been often given them because they've been scared away from their natural hormones. It's just, you don't replace one thing for another, but nothing that has all these awful side effects and risks. I can't speak to the exact studies in menopause because I'm more aware of the studies in depression and anxiety. But the sort of approach that drug companies normally take with these sort of things is they do short-term studies. It goes for four weeks or eight weeks.

And sometimes you see a small effect. And if you see a small benefit, you don't know, there's lots of reasons why you could see a benefit. Maybe you're a little bit high. You know, maybe you're a bit euphoric because you've been given these drugs that can make people a bit high. Maybe you're a bit numbed and so you don't feel things as much as you used to. Maybe you're unblinded by the treatment. You've got side effects. That makes you think I'm on the treatment.

We know that expectation effects make people feel better. That's a very big effect in antidepressants. It's going to be an effect with pre-gallin or any other drug. And so you get these small effects and then they polish the trials and they get their drug approved and enters guidelines. But of course, people don't take drugs for eight weeks. They take drugs for years or decades. So you don't know what's going to happen down the track. And what we can see with people on these drugs long term, it's a very different story.

The drugs wear off, something like calls negative effects. You know, just using the analogy of alcohol, you might think you're quite happy on a couple of weeks of alcohol. Down the track, you know, that's not the case. People end up being miserable and anxious. I see that a lot. People getting worse on longer term treatment. Mood and pain get worse on longer term treatment because, you know, what happens in the short term isn't necessarily affected in what happens in the long term. and then all these physical health consequences build up.

And also, you're also not getting to the root cause of what's happening. You're putting a sort of sticking plaster on top of it. And so, you know, if they're doing studies in menopause, there's anything like they do it in mental health problems. They're going to be doing all these kind of tricks of the trade to make the drugs look effective in the short term, whilst ignoring long-term effects, the side effects, you know, and often how small the effects are. I had a quick look at antidepressants and menopause. You know, the effects are very minimal. I think they, you know, you can sort of, again, you need another magnifying glass.

Yes. And yet, but they sort of get over the line of statistical significance at eight weeks, and that's the trigger for getting approved. And suddenly you have a whole lot of drugs being given to a very wide grip of people based on very scat evidence. Because more women are prescribed antidepressants than they are HRT. Just tell me the stats before we finish about antidepressant use in adults. So in England and Australia and America, about one in six adults are on antidepressants. So in England this year, 9 million adults will use antidepressants.

It's more common amongst older people and women. So women are prescribed antidepressants 50% more than men. As you get older, the gradient goes up. So it means that middle-aged women, between, I think that's defined as 40 and 60, about one in three in England are on an antidepressant. So it's very high levels. One in three. I think in areas of deprivation, I think in North England it's even higher.

And it's increasing every year. So every year there's a few percent going up. in part because people are on these drugs longer and longer, probably in part because it's very hard to stop them because of withdrawal effects. So people end up getting, I think that's another issue. It's very easy to start these drugs, much harder to stop them because you get dependent on them.

And so there is escalating use all throughout the world. So we need to wake up, we need to think about it. We need to think differently before we start. And when I say we, I mean us as doctors, but also we, I mean us as potential patients as well. or friends or relatives as well I think it's really important that we look at mental health

with a different lens actually and look at some of these medications and wonder what we're doing but also we just need to be thinking about other ways of managing any mental health issue I think

you know we're not talking in this podcast that everyone needs to come off their antidepressant overnight and actually please don't because I should say that if you do decide that medications are not for you. It's worth talking to your doctor and coming off your drugs quickly

is the worst possible thing you do. You get terrible withdrawal effects so do it carefully. And that's why, you know, deep ascribing guidance. That's why we have the clinic. Joking about it's very important that people do it in conjunction with people

who are experienced, you know, of deep ascribing because the response can be very different and it can take a long time but it's worth persevering. I've had some very good responses but sometimes it can take years and years. Exactly. So it's great.

This conversation is just the start of many really for people to be thinking differently and making choices really. So before I finish my, I always ask for three take-home tips. So three things that people will be listening to this and thinking, gosh, maybe I don't need that antidepressant. What are the three things that they could be doing? You mean instead of taking antidepressants? Yeah, or just in general, if they think, or maybe I need to stop. Because I think there's two things, really.

There's the de-prescribing side, but there's also, like, what to do instead as well. because the two should work in parallel. So I'll say a few things I'll try to keep it to three. I think number one, you know, even before you get to alternatives, you know, is the drug helping? Yeah. I think one, a lot of people drug, the drugs are not helping. And for some people, they're making it worse.

And so in that case, you don't even need a replacement. Just stopping something that's not helping you. Yes. Or making things worse is a good step. So I think it's worth, you know, really sitting down. I see people who think through, am I better than I was before I started all these treatments? And a lot of people conclude, actually, I think that I'm doing worse after all these treatments. I think that's the first thing to think about.

Two, you know, I think a lot of people mistake the trouble they have coming off antidepressants with the fact that they need antidepressants. So people stop. They feel terrible, anxious, low in mood, panic they think, I must need this drug. The GP reinforces that idea. So I think people should be aware these drugs cause significant withdrawal effects. They can feel like someone's condition coming back. They're often not.

We know withdrawal effects are very common. so not to fall into that trap of mistaking withdrawal for the fact that you need the drugs. I think in answers your question, there are lots of other things people can do that can help mood. I mean, I think number one, I'll rattle off all the things that the nice guidelines say. But before you get to that, the most important thing is, you know, what has caused you to be in that position? Because, you know, to say that you need a drug, there's a chemical imbalance, it's a bit

of a one-size-fits-all. You know, some people are in, you know, bad relationships. Some people are in difficult jobs. some people have physical health problems. And to sort of say it's all the same thing, we'll give all the same treatments, doesn't make sense. I think the first thing is to work out, you know, why? Is there a physical health problem?

Is there a relational problem? Doesn't mean it's easy to solve. I'm not going to be glib and say, well, then you can just, you know, wave it away with the wand. But if you don't understand what's causing, it's very hard to work out how to fix things, then to get to things like the nice guidelines, there's a whole lot of non-medication things

that are just as effective as antidepressants in the short term. some of them are more effective in the long term and they're all safer. And it includes, you know, exercise, mindfulness, various forms of therapy. And I always like to point out is Nice says the most cost-effective treatment for severe depression is problem-solving therapy, which means writing down your three most significant problems, the first step to take for each one, and report back on progress made or barriers encountered in two weeks. I think that really brings home that's people's problems that are causing their mood.

And I think we've lost side of that. So I would put that sort of in people's minds to sort of demedicalise their conditions. That's so important. Such great advice. So thank you so much for coming today. Thanks. Thanks, Louise. I've got something really exciting to share with you.

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