Joanna Moncrieff

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Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network. She is a prominent critic of the modern 'psychopharmacological' model of mental disorder and drug treatment, and the role of the pharmaceutical industry. She has written papers, [1] books and blogs on the use and over-use of drug treatment for mental health problems, the mechanism of action of psychiatric drugs, [2] their subjective and psychoactive effects, the history of drug treatment, and the evidence for its benefits and harms. She also writes on the history and politics of psychiatry more generally. Her best known books are The Myth of the Chemical Cure [3] and The Bitterest Pills. [4]

Contents

Career

Moncrieff qualified in medicine from the University of Newcastle upon Tyne in 1989. She trained in psychiatry in London and southeast England during the 1990s, becoming an MRCPsych in 1994. In 2001 she received an MD (in the United Kingdom, an advanced research doctorate) from the University of London. From 2001 for 10 years she was the consultant for a psychiatric rehabilitation unit for people with severe and enduring mental disorders. [5] She works as a consultant in adult community psychiatry at the North East London NHS Foundation Trust, [6] and she is Professor of Critical and Social Psychiatry at University College London, having previously been a senior lecturer in the Division of Psychiatry. [7] She is also currently the Principal Investigator for the NIHR-funded RADAR (Research into Antipsychotic Discontinuation And Reduction) study. [8] Dr Moncrieff is a founding member and the co-chairperson of the Critical Psychiatry Network. [9] This is a group of psychiatrists from around the world who are sceptical of the idea that mental disorders are simply brain diseases and who campaign to reduce the influence of the pharmaceutical industry and find alternatives to narrow, medical model based practice.

Professor Moncrieff stood in the Ingatestone, Fryerning and Mountnessing: Brentwood council election in 2021 and 2022 as the Labour Party candidate, but was not elected. [10]

Research and writing

The role of drugs in modern psychiatry

Moncrieff's work challenges the idea that drugs or medications have specific effects on underlying diseases or abnormalities. She is known for challenging the theory that mental disorders are caused by chemical imbalances. [11] She shows that there is little evidence for serotonin abnormalities in depression, [12] or dopamine abnormalities in psychosis or schizophrenia. [13] She traces the history of the idea that psychiatric drugs are magic bullets and she explores the role of the pharmaceutical industry, the psychiatric professional and the state in fostering this model. She has documented the increasing rates of prescriptions of psychiatric drugs over the last decade, [14] and analysed the way the pharmaceutical industry has created conditions like adult ADHD [15] [16] and the ‘new bipolar disorder’ to help market these drugs. [17]

Models of drug action

Moncrieff is not completely opposed to the use of drugs for mental health problems, but believes that the action of drugs in these situations is misunderstood. Moncrieff developed two alternative 'models' for understanding what drugs might be doing when they are prescribed to people with mental health problems. The current mainstream understanding of psychiatric drug action is based on a 'disease-centred' model that suggests that drugs work by rectifying the underlying abnormality that is presumed to lead to the symptoms of the disorder in question. Moncrieff contrast this with an alternative 'drug centred' model, which suggests that since psychiatric drugs are psychoactive substances, they work because they change the way people think, feel and behave. According to this model, psychiatric drugs have no specific biological effects in people with a mental disorder, and they produce their characteristic effects in everyone who takes them. The changes induced by some sorts of drugs may, however, lead to the suppression of the manifestations (symptoms) of some mental disorders. [18] The Myth of the Chemical Cure traces the emergence and development of the disease-centred model from the 1950s onwards. It highlights the lack of evidence for the disease-centred model of drug action for every major class of psychiatric drug. It also explores the commercial, professional and political interests behind the disease-centred model. [3] [ page needed ]

Antidepressants

Moncrieff has written several papers criticising the methodology of antidepressant research. [19] She did a Cochrane meta-analysis of the small group of trials of antidepressants that compared them with an 'active' placebo containing a drug used to mimic some of the side effects of the antidepressants used. [20] She has published one of the few papers that describes the psychoactive effects of modern antidepressants and their association with suicidal ideation, and with physical effects. [21]

Together with Dr. Mark Horowitz, Moncrieff in 2022 conducted the first systematic umbrella review of the evidence for the serotonin "chemical imbalance" theory of depression, which suggests that the evidence does not support the hypothesis. [22] [23]

Antipsychotics

The Bitterest Pills traces the history of antipsychotic drugs from the introduction of chlorpromazine in the 1950s. The book also looks at recent developments, including the marketing of antipsychotics through the Early Intervention movement, and the promotion of a new and expanded concept of bipolar disorder. [4] [ page needed ] Moncrieff also describes the cultural development of the new concept of bipolar disorder, which she refers to as ‘the medicalisation of "ups and downs"’. Research by Moncrieff and colleagues described and compared the subjective or psychoactive effects of different antipsychotics. [24] This included publication in the controversial and non-peer reviewed Medical Hypotheses . [25]

Lithium

In early work Moncrieff analysed the evidence for the efficacy of lithium. She claimed there was no evidence that lithium was superior to other sedatives for the treatment of acute mania, and that lithium's efficacy in preventing a relapse of manic depression was due to the adverse effects caused by the sudden withdrawal of lithium. [26] In later work she showed that studies on the outcome of lithium treatment in the real world fail to demonstrate useful or worthwhile effects, and suggest it may even worsen the outcome of manic depression. [27]

Other drugs

Moncrieff has critically reviewed the literature on the use of drug treatments like acamprosate and naltrexone for alcohol problems [28] and the use of stimulants in children. [29] [ page needed ]

History and politics of psychiatry

Moncrieff has developed a political analysis of the drivers of modern mental health theory and practice and explored the influence of neoliberalism. [30] [31] She has published papers on the historical context of the emergence of modern drug treatment, [32] the history of psychiatric thought in the 20th century [33] and of ‘rapid tranquilisation’ in psychiatry, [34] as well as her books on the history of drug treatments.

Books

Related Research Articles

<span class="mw-page-title-main">Antidepressant</span> Class of medication used to treat depression and other conditions

Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction.

<span class="mw-page-title-main">Antipsychotic</span> Class of medications

Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay together with mood stabilizers in the treatment of bipolar disorder.

<span class="mw-page-title-main">Major depressive disorder</span> Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

<span class="mw-page-title-main">Mood stabilizer</span> Psychiatric medication used to treat mood disorders

A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, such as bipolar disorder and the bipolar type of schizoaffective disorder.

<span class="mw-page-title-main">Tricyclic antidepressant</span> Class of medications

Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants, which is important for the management of depression. They are second-line drugs next to SSRIs and SNRIs. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains three rings of atoms. Tetracyclic antidepressants (TeCAs), which contain four rings of atoms, are a closely related group of antidepressant compounds.

<span class="mw-page-title-main">Psychopharmacology</span> Study of the effects of psychoactive drugs

Psychopharmacology is the scientific study of the effects drugs have on mood, sensation, thinking, behavior, judgment and evaluation, and memory. It is distinguished from neuropsychopharmacology, which emphasizes the correlation between drug-induced changes in the functioning of cells in the nervous system and changes in consciousness and behavior.

<span class="mw-page-title-main">Psychiatric medication</span> Medication used to treat mental disorders

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

<span class="mw-page-title-main">Akathisia</span> Movement disorder involving a feeling of inner restlessness

Akathisia is a movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still. Usually, the legs are most prominently affected. Those affected may fidget, rock back and forth, or pace, while some may just have an uneasy feeling in their body. The most severe cases may result in aggression, violence, and/or suicidal thoughts. Akathisia is also associated with threatening behaviour and physical aggression that is greatest in patients with mild akathisia, and diminishing with increasing severity of akathisia.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy. Depressed mood is a symptom of some mood disorders such as major depressive disorder and dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts. It can either be short term or long term.

<span class="mw-page-title-main">Imipramine</span> Antidepressant

Imipramine, sold under the brand name Tofranil, among others, is a tricyclic antidepressant (TCA) mainly used in the treatment of depression. It is also effective in treating anxiety and panic disorder. Imipramine is taken by mouth.

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behavior and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

<span class="mw-page-title-main">Chlorprothixene</span> Chemical compound

Chlorprothixene, sold under the brand name Truxal among others, is a typical antipsychotic of the thioxanthene group.

Treatment-resistant depression is a term used in psychiatry to describe people with major depressive disorder (MDD) who do not respond adequately to a course of appropriate antidepressant medication within a certain time. Definitions of treatment-resistant depression vary, and they do not include a resistance to psychological therapies. Inadequate response has most commonly been defined as less than 50% reduction in depressive symptoms following treatment with at least one antidepressant medication, although definitions vary widely. Some factors that contribute to inadequate treatment are: a history of repeated or severe adverse childhood experiences, early discontinuation of treatment, insufficient dosage of medication, patient noncompliance, misdiagnosis, cognitive impairment, low income and other socio-economic variables, and concurrent medical conditions, including comorbid psychiatric disorders. Cases of treatment-resistant depression may also be referred to by which medications people with treatment-resistant depression are resistant to. In treatment-resistant depression adding further treatments such as psychotherapy, lithium, or aripiprazole is weakly supported as of 2019.

The emphasis of the treatment of bipolar disorder is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.

The Critical Psychiatry Network (CPN) is a psychiatric organization based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the Mental Health Act 1983. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom's National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.

<span class="mw-page-title-main">Lithium (medication)</span> Type of psychiatric medication

Certain lithium compounds, also known as lithium salts, are used as psychiatric medication, primarily for bipolar disorder and for major depressive disorder. In lower doses, other salts such as lithium citrate are known as nutritional lithium and have occasionally been used to treat ADHD. Lithium is taken orally.

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

References

  1. ↑ Over a hundred papers at the National Center for Biotechnology Information, U.S. National Library of Medicine, PubMed.gov
  2. ↑ Moncrieff, J; Cohen, D; Porter, S (2013). "The psychoactive effects of psychiatric medication: the elephant in the room". J Psychoactive Drugs. 45 (5): 409–15. doi:10.1080/02791072.2013.845328. PMC   4118946 . PMID   24592667.
  3. 1 2 Moncrieff, Joanna (2008). The Myth of the Chemical Cure: a critique of psychiatric drug treatment. Basingstoke, Hampshire, UK: Palgrave Macmillan. ISBN   978-0-230-57431-1. OCLC   184963084.
  4. 1 2 Moncrieff, Joanna (2013). The Bitterest Pills: the troubling story of antipsychotic drugs. Basingstoke, Hampshire, UK: Palgrave Macmillan. ISBN   978-1-137-27742-8. OCLC   841892791.
  5. ↑ "About". Joanna Moncrieff. 21 April 2013. Retrieved 9 May 2022.
  6. ↑ "Havering: Community recovery team: For clinicians". NELFT NHS Foundation Trust. Retrieved 24 November 2016.
  7. ↑ "Prof Joanna Moncrieff". UCL IRIS. University College London. Retrieved 8 May 2022.
  8. ↑ "Research Into Antipsychotic Discontinuation And Reduction". UCL Psychiatry. University College London. 4 February 2019. Retrieved 8 May 2022.
  9. ↑ "Joanna Moncrieff, MD". Mad in America. Mad in America Foundation. Retrieved 8 May 2022.
  10. ↑ "Joanna Margaret Moncrieff for Ingatestone, Fryerning and Mountnessing in the Brentwood local election".
  11. ↑ Moncrieff, Joanna (20 July 2022). "The serotonin theory of depression: a systematic umbrella review of the evidence". Molecular Psychiatry. doi: 10.1038/s41380-022-01661-0 . PMID   35854107 . Retrieved 6 February 2023.
  12. ↑ Moncrieff, Joanna; Cohen, David (6 June 2006). "Do Antidepressants Cure or Create Abnormal Brain States?". PLOS Medicine. 3 (7): e240. doi: 10.1371/journal.pmed.0030240 . PMC   1472553 . PMID   16724872. Open Access logo PLoS transparent.svg
  13. ↑ Moncrieff, J. (2009). "A critique of the dopamine hypothesis of schizophrenia and psychosis". Harvard Review of Psychiatry. 17 (3): 214–225. doi:10.1080/10673220902979896. PMID   19499420.
  14. ↑ Ilyas, Stephen; Moncrieff, Joanna (May 2012). "Trends in prescriptions and costs of drugs for mental disorders in England, 1998–2010". British Journal of Psychiatry. 200 (5): 393–398. doi: 10.1192/bjp.bp.111.104257 . PMID   22442100.
  15. ↑ Moncrieff, Joanna; Timimi, Sami (1 September 2011). "Critical analysis of the concept of adult attention-deficit hyperactivity disorder". The Psychiatrist. 35 (9): 334–338. doi: 10.1192/pb.bp.110.033423 .
  16. ↑ Moncrieff, J.; Rapley, M.; Timimi, S. (2011). "Construction of psychiatric diagnoses: the case of adult ADHD". Journal of Critical Psychology, Counselling and Psychotherapy. PCCS Books. 11: 16–28. ISSN   1471-7646.
  17. ↑ Nesbitt Falomir, C (October 1976). "[Epidemiological picture of a pediatrician in Chihuahua]". Gaceta Medica de Mexico. 112 (4): 315–29. PMID   1001861.
  18. ↑ Moncrieff, J.; Cohen, D. (April 2005). "Rethinking models of psychotropic drug action". Psychotherapy and Psychosomatics. 74 (3): 145–153. doi:10.1159/000083999. PMID   15832065. S2CID   6917144.
  19. ↑ Moncrieff, J. (May 2001). "Are antidepressants overrated? A review of methodological problems in antidepressant trials". Journal of Nervous and Mental Disease. 189 (5): 288–295. doi:10.1097/00005053-200105000-00003. PMID   11379971.
  20. ↑ Moncrieff, J.; Wessely, S.; Hardy, R. (2004). "Active placebos versus antidepressants for depression". The Cochrane Database of Systematic Reviews. 2012 (1): CD003012. doi:10.1002/14651858.CD003012.pub2. ISSN   1469-493X. PMC   8407353 . PMID   14974002.
  21. ↑ Goldsmith, Lucy; Moncrieff, Joanna (April 2011). "The psychoactive effects of antidepressants and their association with suicidality" (PDF). Current Drug Safety. 6 (2): 115–121. doi:10.2174/157488611795684622. PMID   21375477.
  22. ↑ Moncrieff, Joanna; Horowitz, Mark. "Depression is probably not caused by a chemical imbalance in the brain – new study". The Conversation. Retrieved 21 July 2022.
  23. ↑ Moncrieff, Joanna; Cooper, Ruth E.; Stockmann, Tom; Amendola, Simone; Hengartner, Michael P.; Horowitz, Mark A. (20 July 2022). "The serotonin theory of depression: a systematic umbrella review of the evidence". Molecular Psychiatry: 1–14. doi: 10.1038/s41380-022-01661-0 . ISSN   1476-5578. PMID   35854107. S2CID   250646781.
  24. ↑ Moncrieff, J.; Cohen, D.; Mason, J.P. (August 2009). "The subjective experience of taking antipsychotic drugs: a content analysis of Internet data". Acta Psychiatrica Scandinavica. 120 (2): 102–111. doi:10.1111/j.1600-0447.2009.01356.x. PMID   19222405. S2CID   8520041.
  25. ↑ Moncrieff, Joanna (2006). "Why is it so difficult to stop psychiatric drug treatment? It may be nothing to do with the original problem". Med Hypotheses. 67 (3): 517–23. doi:10.1016/j.mehy.2006.03.009. PMID   16632226.
  26. ↑ Moncrieff, Joanna (August 1997). "Lithium: evidence reconsidered". British Journal of Psychiatry. 171 (2): 113–119. doi:10.1192/bjp.171.2.113. PMID   9337944. S2CID   29442516.
  27. ↑ Moncrieff, Joanna (2016). The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Springer. pp. 187–203. ISBN   978-0-230-58944-5.
  28. ↑ Moncrieff, Joanna; Drummond, D. Colin (August 1997). "New drug treatments for alcohol problems: a critical appraisal". Addiction. 92 (8): 939–947. doi:10.1111/j.1360-0443.1997.tb02966.x. PMID   9376777.
  29. ↑ Moncrieff, Joanna (2009). A Straight Talking Introduction to Psychiatric Drugs. Straight Talking Introductions. Ross-on-Wye: PCCS Books. ISBN   978-1-906254-17-9. OCLC   351325544.
  30. ↑ Moncrieff, Joanna (Summer 1997). "Psychiatric Imperialism: The medicalisation of modern living" (PDF). Soundings (6): 63–72.
  31. ↑ Moncrieff, J. (2008). "Neoliberalism and biopsychiatry: a marriage of convenience". In Cohen, Carl I.; Timimi, Sammi (eds.). Liberatory Psychiatry: Philosophy, Politics and Mental Health . Cambridge, UK: Cambridge University Press. pp.  235–257. ISBN   978-0-521-68981-6. OCLC   174449800.
  32. ↑ Moncrieff, Joanna (October 1999). "An investigation into the precedents of modern drug treatment in psychiatry". History of Psychiatry. 10 (40): 475–490. doi:10.1177/0957154X9901004004. PMID   11624330. S2CID   7724748.
  33. ↑ Moncrieff, J; Crawford, MJ (August 2001). "British psychiatry in the 20th century—observations from a psychiatric journal". Social Science & Medicine. 53 (3): 349–356. doi:10.1016/S0277-9536(00)00338-5. PMID   11439818.
  34. ↑ Allison, Laura; Moncrieff, Joanna (March 2014). "'Rapid tranquillisation': an historical perspective on its emergence in the context of the development of antipsychotic medications". History of Psychiatry. 25 (1): 57–69. doi:10.1177/0957154X13512573. PMID   24594821. S2CID   43376169.
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