Dr Moncrieff (Reference Moncrieff2006) attacks the pharmaceutical industry for promoting the idea that depression is ‘caused by imbalances in brain chemicals’ and berates it for the fact that people are taking more prescription drugs than ever before. She implies that because the biochemical basis of depression is not known, the promotion of antidepressants is a plot to encourage profiteering.

The history of medicine teaches us that many crucial and life-saving drugs were and still are used despite a lack of knowledge of their scientific action (e.g. the use of steroids in asthma). In fact, there are very few instances where the scientific basis of action of crucial medicines is fully understood. The history of psychiatry teaches us that before antidepressant medication there was no treatment for depression except waiting for natural recovery: frequently a long and painful process during which the patient often starved to death or ended life by suicide.

One can easily take, like Moncrieff, an extreme view of the pharmaceutical industry, emphasising how it controls research and uses advertising to influence clinicians, and I note that the current issue of the Journal has no fewer than 12 full-page colour advertisements promoting psychotropic medication. The alternative view, however, would be that the industry has helped us to move out of the dark ages when all we could offer was asylum and restraint. The reality is probably somewhere between these extremes.

As a general psychiatrist with a special interest in psychological treatments (especially cognitive-behavioural therapy) I am not proposing that medication has all the answers or is even the preferred choice in all cases. However, I have to persuade many patients on a regular basis to take antidepressant medication before improvement can occur. The ‘chemical imbalance theory’ is a useful working hypothesis for one cause for depression. There is a current climate of opinion among those who regularly surf the internet that medication is all bad, dangerous and addictive. Clinical psychiatrists like me have an uphill battle to persuade patients to take life-saving medication which articles such as those by Moncrieff, and the websites she directs us to, make even harder.