We all know that depression is caused by – or at least linked to – low serotonin levels. But is there really a solid basis for this view?
The British psychiatrist and author Joanna Moncrieff has rigorously viewed decades of research, and concludes that it lacks support in the data. Her latest book, Chemically Imbalanced – The Making and Unmaking of the Serotonin Myth (2025), is a rather unsettling account of how this highly debatable theory became so mainstream that few even question it.
She argues that the old way of looking at psychiatric drugs – that they altered your mental states (amphetamines made you active, valium made you calm), gradually gave way to a model that says that psychiatric drugs correct an underlying abnormality (e.g., serotonin deficiency).
According to Moncrieff, this shift did not come about because of new evidence, but because this model made antidepressants much easier to justify and market. After all, they weren’t substances that altered your mind, but treatments repaired an underlying imbalance, but medication that made your brain and nervous system function as normal again.
And this strategy seems to have worked. The use of anti-depressants has sky-rocketed since the nineties, and the serotonin-deficiency model has become mainstream. Even in popular culture, as the artist girl in red sings:
I'm running low on serotonin
Chemical imbalance got me twisting things
Serotonin (2021)
Moncrieffs book opens up for big, often uncomfortable questions about what depression is and what antidepressants and psychiatric drugs actually do. And how relatively unsupported scientific narratives can become cultural “truths”.
Last, but not least, it questions the biological roots of depression and other psychiatric disorders, and medication as a convenient and cheap “quick fix”.
Joanna Moncrieff is a leading voice in the Critical Psychiatry Network. She has also written The Myth of the Chemical Cure (2007) and The Bitterest Pills (2013), and is an active public commentator in the United Kingdom, with articles and interviews in outlets such as The Guardian and The Spectator.
Physician and author Gabor Maté says about Chemically Imbalanced – The Making and Unmaking of the Serotonin Myth (2025):
This essential book debunks one of the greatest misperceptions besetting current medical practice: that what we call mental illness is reducible to biological causes, divorced from people’s life experiences and traumas. Dr. Moncrieff explains both the scientific flaws and the deliberate manipulations underlying much of today’s psychiatric ideology and treatment.
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