CBT and Antidepressants – Rethinking Mental Health Care: Beyond Pills and Protocols
When it comes to treating depression and anxiety in the UK, two approaches dominate: CBT and antidepressants. Both are evidence-based and widely used. But are they enough?
CBT gives people practical tools to reframe unhelpful thoughts and build resilience. It’s powerful, but it demands energy and insight, things often in short supply when someone is at their lowest. Antidepressants can offer faster relief, especially in crisis, but their long-term impact is debated and side effects are common.
The bigger issue? Management.
CBT delivered as a tick-box exercise quickly loses impact. Antidepressants prescribed without regular reviews can quietly become a lifelong prescription. Meanwhile, NHS data show prescriptions climbing year after year, therapy dropout rates staying high, and access gaps persisting for people from marginalised communities.
So why do we lean so heavily on medication?
Short GP appointments, long therapy waiting lists, and outdated beliefs about the “chemical imbalance” theory all play a role. Psychiatrist Joanna Moncrieff, in her recent book ‘Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth’ (2025), is blunt:
“The fact is the theory that depression is caused by low serotonin is not supported by reliable evidence. Put simply, the emperor has no clothes, and this matters, because our widespread use of antidepressants for mental health problems is grounded in this myth.”
Her critique challenges us to rethink a system that leans too heavily on pills, not always because they’re the best option, but because they’re the fastest and most convenient.
Thankfully, other approaches are gaining ground:
🌿 Somatic therapies- (yoga, breathwork, polyvagal work) support nervous system regulation, especially for trauma.
🌱 Nature-based practices - reconnect us with grounding, restorative environments.
🎨 Creative therapies- help people express emotions words can’t reach.
🧘 Spiritual and contemplative practices- foster meaning and resilience.
🍄 Psychedelic-assisted therapy- though not widely available in the UK, is showing remarkable promise in research (see Robin Carhart-Harris).
Always consult your Dr for clinical management when making changes to prescribed medication.
Further Reading
✨ If you’d like to dig deeper, here are some powerful books that challenge conventional thinking about mental health care:
Joanna Moncrieff – Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth (2025)
A bold dismantling of the “chemical imbalance” theory and its influence on prescribing culture.
Bessel van der Kolk – The Body Keeps the Score(2014)
A groundbreaking exploration of trauma and why the body must be part of healing.
Irving Kirsch – The Emperor’s New Drugs: Exploding the Antidepressant Myth (2010)
A deep dive into placebo effects and the limitations of antidepressants.
Mark Rapley, Joanna Moncrieff & Jacqui Dillon (eds.) - De-Medicalizing Misery (2011)
A critical look at psychiatry, psychology, and the medicalisation of human suffering.