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Holding Psychiatry Accountable - excellent and important work from Joanna Moncrieff, Mark Horowitz, Benjamin Ang


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It is so gratifying to see psychiatry held accountable. Thank you Ang, Horowitz, and Moncrieff for not letting psychiatry off the hook! 




Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the scientific literature


by Benjamin Ang, Mark Horowitz, Joanna Moncrieff


Received 23 November 2021, Revised 26 March 2022, Accepted 9 April 2022, Available online 18 April 2022, Version of Record 25 April 2022.


Link to full article, available for free:







The theory that depression is caused by a serotonin abnormality or other chemical imbalance has become widely accepted by the public and is one prominent justification for the use of antidepressants. However, it has been increasingly questioned and there is little evidence it has empirical support. In response, leading psychiatrists suggested it was an ‘urban legend’ that was never taken seriously by the psychiatric profession. To interrogate these claims, we examined the coverage of the serotonin theory of depression in a sample of highly cited and influential academic literature from 1990, when the theory started to be popularized, to 2010 when these responses were articulated. We analysed 30 highly cited reviews of the aetiology of depression in general, 30 highly cited papers on depression and serotonin specifically and a sample of influential textbooks. The majority of the aetiology reviews supported the hypothesis, including some that were entirely devoted to describing research on the serotonin system, and those that reviewed the aetiology of depression more broadly. Research papers on the serotonin system in depression were highly cited and most of them strongly supported the serotonin theory. All textbooks supported the theory, at least in some sections, and devoted substantial coverage to it, although some also acknowledged it remained provisional. The findings suggest that the serotonin theory was endorsed by the professional and academic community. The theory is compared to an exhausted Kuhnian paradigm with professional equivocation about it acting as a means of defending it against encroaching criticism. The analysis suggests that, despite protestations to the contrary, the profession bears some responsibility for the propagation of a theory that has little empirical support and the mass antidepressant prescribing it has inspired.





1996-2018 - misc. polypharmacy, incl. SSRIs, SNRIs, neuroleptics, lithium, benzos, stimulants, antihistamines, etc. (approx. 30+ drugs)

2012-2018 - 10mg lexapro/escitalopram (20mg?)    Jan. 2018 - 10mg -> 5mg, then from 5mg -> 2.5mg, then 0mg  -->  July 2018 - 0mg

2017(?)-2020 - vyvanse/lisdexamfetamine 60-70mg    2020-2021 - 70mg down to 0mg  -->  July 2021 - 0mg

March-April 2021 - vortioxetine 5-10mg (approx. 7 weeks total; CT)  -->  April 28th, 2021 - 0mg

supplements: magnesium powder (dissolved in water) as needed throughout the day; 1 tsp fish oil w/ morning meal; 2mg melatonin 

August 1, 2022 - 1 mg melatonin


Courage is fear that has said its prayers.  - Karle Wilson Baker

love and justice are not two. without inner change, there can be no outer change; without collective change, no change matters.  - Rev. angel Kyodo williams

Holding multiple truths. Knowing that everyone has their own accurate view of the way things are.  - text on homemade banner at Afiya house


I am not a medical professional; this is not medical advice. 

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  • 3 weeks later...

Hi @Ariel, this used to be a post posted in the wrong place, because I had a couple of SA-windows open. See https://www.survivingantidepressants.org/topic/27577-websites-that-claim-low-serotonin-depression-or-chemical-imbalance-please-add/







2004: (apr): Citalopram 20 mg, June 60 mg., dec 20 mg

2004 (dec): Mirtazapine 15 mg.

2014 (Jun): Citalopram stop cold turkey. Began 10 mg Vortioxetine

2017: (dec): Mirtazapine 15 mg ->30 mg (after three day stint on psych ward)

2020: (aug): Vortioxetine 10 mg stopped cold turkey. 

2020 (dec): Mirtazapine 30 mg -> 15 mg (GPs instructions)

2021 (feb): Mirtazapine reinstatement 26,25 mg

2022 (Jan): Mirtazapine (5% taper): 14. Jan 24,9 mg, 6. feb 23,7 mg, 1. marts 22,5 mg, 15. marts 21,3 mg, 2. april 20 mg, 26. april 19. mg, 25. may 18.1 mg, 26 jun 17 mg.


Have always taken fish oil capsules. Do not drink alcohol when tapering. 1 multivitamin pill a day. Try to eat healthy, but impossible on mirtazapine.

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