How Approval Hinges on Small Positive Trials

Is depression really caused by a chemical imbalance — or is that one of the most enduring myths in modern psychiatry?

For decades, the serotonin theory of depression has shaped how mental health is explained, treated, and marketed to the public. But what does the science actually show — and why does evidence that challenges this narrative provoke such intense reactions?

In this provocative episode, our host Bruce Wampold sits down with Joanna Moncrieff, M.D., professor of critical and social psychiatry at University College London and a founding member of the Critical Psychiatry Network. Joanna has spent more than 30 years researching psychiatric diagnosis, antidepressant medications, and the sociocultural forces that shape modern mental health care. She is the author of well over 60 academic articles and several books, including her newest release, Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth.

Together, Bruce and Joanna discuss:

• What the scientific evidence does, and does not, reveal about the connection between serotonin and depression

• What antidepressant trials really show about efficacy and placebo effects

• Emotional numbing, clinical significance, and real-world prescribing practices

• The social, political, and professional forces that influence psychiatric research and practice

• Why challenges to the chemical imbalance narrative have been so controversial

• What it means to understand depression as a human response to life, rather than a brain disease

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Bruce Wampold, Ph.D. | Emeritus Professor, University of Wisconsin–Madison; author of The Great Psychotherapy Debate; one of the most influential psychotherapy researchers alive today.

Joanna Moncrieff, M.D. | Professor of Critical and Social Psychiatry at University College London; leading figure in the Critical Psychiatry Network; author of Chemically Imbalanced and multiple prior books examining antidepressants and psychiatric theory.

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This episode was produced and edited by Geissy Araújo, Ph.D. and Kevin Riordan.

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The Making Therapy Better podcast is brought to you by CarePaths EHR, an electronic health record system designed to help you improve therapy outcomes. [https://www.carepaths.com](https://www.carepaths.com)

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00:00 Introduction 00:45 Meet Dr. Joanna Moncrieff

02:10 The serotonin myth: Unpacking the evidence

09:57 Antidepressants and the placebo effect

18:40 The sociology of psychiatry and antidepressants

31:06 Understanding depression: Biological vs. psychological perspectives

32:57 Clinical trials vs. real-world practice

35:11 The role of the human relationship in depression treatment

37:03 Evolutionary perspectives on depression

40:26 Challenging the serotonin theory of depression

47:03 Future of depression treatments: Psychedelics and beyond

54:57 Reframing depression: A human reaction to life's challenges

58:30 Conclusion and final thoughts

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#MentalHealth #Depression #Psychiatry #Antidepressants #serotonin #CriticalPsychiatry #Psychotherapy #BruceWampold #JoannaMoncrieff #MakingTherapyBetter #MentalHealthScience

Intro/outro music by Chris Haugen, free for public use.