By Chimnonso Onyekwelu, Meleni Aldridge and Melissa Smith

According to the World Health Organization, mental health conditions are one of the biggest health challenges globally, affecting over 450 million people worldwide. Depression and anxiety being the most common, impacting nearly 30% of adolescents worldwide and ranking as the 13th and 24th leading causes of disability respectively.

In today's medical system, antidepressants (ADs) are still the primary treatment for depression and anxiety, making up 75% of all prescriptions for these conditions. While AD dispensing was already on the rise, the COVID-19 pandemic brought about an even greater increase. Between January 2016 and December 2022, research shows a 66.3% increase in monthly antidepressant dispensing rates.

Today, despite growing concerns about their safety, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine (noradrenaline) reuptake inhibitors (SNRIs)—such as Citalopram, Fluoxetine, Sertraline, and Mirtazapine—continue to be widely prescribed across all age groups. This raises important questions about their long-term impact and whether the medical model that prioritises medication is truly the best approach.

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The benefits and risks of antidepressants

ADs have helped many people, especially those with severe depression and anxiety. But their widespread use raises concerns about the masking of symptoms instead of addressing the root causes. Plus, the adverse effects and long-term risks make it important to explore other solutions.

Common adverse effects include insomnia, weight gain, nausea, headaches, drowsiness, vomiting, and sexual dysfunction, which affects nearly half of all SSRI users. Most severe effects include anxiety, agitation, hallucinations, and palpitations. In extreme cases, ADs have been linked to violent behaviour and suicidal thoughts. A Swedish study of over 850,000 patients found that SSRIs increased violent crime rates by 43% among individuals aged 15–24. Recent research also indicates an increased risk of suicide attempts, particularly among children and young adults.

Alarmingly, these risks were known during clinical trials but were often concealed by pharmaceutical companies. For example, the US Food and Drug Administration (FDA) received 39,000 complaints about Prozac within its first nine years on the market, yet evidence of violence and suicide risks was downplayed.

Another major concern is the addictive nature of ADs. SSRIs create significant physiological dependence, often after just weeks of use. Many users experience severe withdrawal symptoms like anxiety, dizziness, and cognitive impairment when they try to stop taking them. Despite growing evidence of these risks, regulatory oversight remains weak, and discussions about the potential dangers of ADs continue to be suppressed. This raises huge ethical concerns about the pharmaceutical industry's influence on psychiatric treatment. 

Is depression a medical, metabolic or social issue?

The antidepressant industry has long promoted the idea that depression is caused by a chemical imbalance in the brain, specifically a lack of serotonin. Whilst it found a willing partner in mainstream medicine, research—including a major study by Moncrieff et al—has debunked this theory, finding no clear link between serotonin levels and depression. This challenges the entire foundation on which ADs have been marketed and prescribed.

A blind eye has also been turned to the now undeniable link between metabolic and mitochondrial dysfunction and depression. When there is insufficient energy to power the body, when resources are scarce and funnelled into survival, depression is a natural outcome. It’s the body’s way of conserving energy through ‘sickness behaviour’, which explains the hallmarks of depression, headlined by loss of interest, fatigue and negative rumination. Left unaddressed at the metabolic (energy) level, it can explain why depression is also associated with higher morbidity, mortality and disability.

Historically, depression was seen as a social problem. Stories from ancient texts, such as the Bible and Greek literature, describe sadness and despair as natural responses to life’s hardships rather than medical conditions. Cross-cultural studies also show that sadness and grief are normal reactions to life events, not inherent disorders.

The shift toward viewing depression as a medical disorder began in 1980 with the introduction of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). This new system introduced a symptom-based criteria for diagnosing depression, blurring the line between people’s normal response to external issues and chronic dysfunctions. As a result, rates of depression skyrocketed from 2–3% of the population to the widespread levels seen today.

Many experts argue that depression is more of a social issue than a medical one. Psychologist Michael Yapko suggests that depression is often rooted in social factors like poor coping skills, lack of support, and stressful environments. However, we now know that difficult life circumstances and living with challenges linked to poor socio-economic status take an enormous toll on our metabolic health given the insidious impact of stress. Researcher Irving Kirsch further argues that depression is frequently "a normal reaction to a terrible situation," emphasising its social causes.

While some people do benefit from medication, two-thirds of patients experience so-called treatment-resistant depression, meaning standard antidepressants don’t work for them. Depression is conventionally labelled as a single disorder— but looking through another lens and recognising that depressive behaviour is an evolutionary strategy for survival, then a magic drug bullet approach is rarely going to work. Rather than a single disorder, depression can be more accurately described as a mix of multiple factors that are unique to each person, hence requiring highly personalised treatment approaches. Over-medicalising normal emotions risks turning everyday struggles into diseases, taking focus away from real social issues that contribute to mental distress and disempowering individuals. A balanced approach, recognising metabolic, medical, evolutionary and social factors can be the only way to ensure effective treatment.

How antidepressants became the default treatment

Despite growing evidence that alternative treatments—such as psychotherapy, dietary changes, social prescribing and increasing physical activity—can be more effective and safer, these options are often overlooked in favour of drug-based 'pill-for-an-ill' approaches. Yet, pharmaceutical companies have ensured that antidepressants remain the go-to treatment.

A key tactic used by these companies is manipulating clinical trial results. Studies have exposed selective publishing practices, where negative findings—such as increased suicide risks—are suppressed. This creates a misleading picture of antidepressant safety. Pharmaceutical companies also influence academic research by ensuring that favourable studies appear in top medical journals, while research highlighting risks is pushed to lesser-known publications. One study by Plöderl et al found that accounting for missing data, the link between antidepressant use and suicide risk was much stronger than initially reported. Additionally, safety data in randomised controlled trials (RCTs) are often poorly analysed, allowing serious adverse effects to go unnoticed.

Another major factor is the financial relationship between pharmaceutical companies and psychiatrists. Over half (55.7%) of active US psychiatrists receive payments from drug manufacturers, with the top 2.8% receiving 82.6% of total payments. Companies spend millions on consulting fees, speaker events, and research funding, subtly influencing doctors to prescribe antidepressants. This financial influence creates a biased system where industry-backed prescriptions take priority over more effective alternatives.

Beyond influencing doctors and researchers, pharmaceutical companies also shape public opinion through media influence and direct-to-consumer advertising. Especially in the US, negative press about antidepressant dangers is often suppressed, keeping concerns about dependency, withdrawal, and long-term harm out of the public conversation.

Boost your mood naturally

The over-reliance on ADs highlights a pharmaceutical industry driven by profit over comprehensive mental health care. While helpful for some, ADs are not a one-size-fits-all solution and overlook the social, metabolic, evolutionary, environmental, and psychological roots of depression.

Rather than medicalising normal emotional distress, treatment should take a balanced and supportive approach, integrating medical, social, and lifestyle-based interventions. Genuine progress requires independent psychiatric research, ensuring that a person’s whole body health and wellbeing guides treatment—not corporate interests.

A shift toward evolutionary-rational, science-based, long-term solutions is crucial. This includes nutritional interventions, activity and movement, lifestyle changes, social and environmental prescribing, digital detoxes, art and music therapy, complementary medicine and a whole lot more.

The good news? There are plenty of natural ways to boost your mental well-being.

1. Eat yourself happy. It’s now widely accepted that mood is intimately linked with gut health.  Eating a diet high in ultra-processed, high calorie, high sugar, foods that are low in nutrients and fibre-rich wholefoods, effectively starves our gut bacteria thereby reducing whatever diversity is left after repeated rounds of antibiotics. Diets high in minimally processed nutrient dense foods feed your body and gut microbiome, significantly reducing symptoms of depression.
2. Reduce screen time. High levels of screen time, not just digital, but TV as well, affects everyone from children to the elderly. Make time to get out in nature with friends, family or organised groups to take advantage of free healthcare from the forest.
3. Get out and socialise. We’re inherently social creatures and we benefit hugely from direct interactions with other humans.
4. Get down and dirty in nature. Being in nature isn’t just for kids, it exposes all of us to a wide range of microbes to help build immune tolerance and resilience and improve our gut microbiome.
5. Get active, every day! Being active every day is essential. Whether it’s a walk in nature, some gardening, walking the dog (or a neighbour’s), cycling, or visiting the gym. Getting out and being active on a daily basis can really help to lift your mood.
6. Sweet dreams. Avoid TVs in bedrooms and ensure screens are not accessed at least an hour before bedtime- and definitely not after lights out- to maintain good sleep hygiene practices. Check out our sleep health hack videos here, here and here.
7. Chill pills from mother nature. There are many herbal remedies that can help alleviate anxiety and reduce feelings of depression including, ashwagandha, rhodiola, chamomile, valerian, lavender and kava kava. For more information about using herbal medicine click here.
8. Reconnect with old friends. Remember your gut–brain information superhighway. Why? Because depression — and the preceding inflammation — may be caused by direct (mis-)communication between our brain and our gut, often termed our ‘second brain’.
9. Meditate. Even 5 minutes of quiet time shutting out noisy thoughts can help rest and clear your mind, it’s even better if you can sit outside in nature. If you prefer a guided meditation, join Meleni Aldridge in her Sovereign Breath Practice.
10. Homeopathy can be helpful in dealing with stress, anxiety and depression taking into account not just the physical but mental and emotional symptoms of an individual. It’s safe to use and doesn’t come with the plethora of unwanted side effects associated with ADs.

Medical disclaimer: This content is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider regarding any medical condition or treatment.

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