The Observer has published an excerpt from Johann Hari’s new book challenging what we know about depression. But do his own claims and arguments stack up?

I do not know Johann Hari. We’ve never crossed paths, he’s done me no wrong that I’m aware of, I have no axe to grind with him or his work. And, in fairness, writing about mental health and how it’s treated or perceived is always a risk. It’s a major and often-debilitating issue facing a huge swathe of the population, and with many unpleasant and unhelpful stigmas attached. In recent years there have been signs that the tide is perhaps turning the right way, but a lot of work remains to be done. However, if you’re going to allow an extract from your book to be published as a standalone article for mainstream media with a title as provocative as “Is everything you know about depression wrong?”, you’d best make sure you have impeccable credentials and standards to back it up.

Let’s address the elephant in the room: Johann Hari does not have a flawless reputation. He has been absent from the spotlight for many years following a plagiarism scandal, compounded by less-than-dignified behaviour towards his critics. Admittedly, he has since shown remorse and contrition over the whole affair, but even a cursory glance online reveals he’s a long way from universal forgiveness. Logically, someone with a reputation for making false claims should be the last person making high-profile, controversial, sweeping statements about something as sensitive as mental health. And yet, here we are. It’s 2018 after all.

But let’s take the whole thing at face value and assume Hari has written this article with 100% good intentions and practices. Do his arguments and claims hold water?

Hari does make several valid points, in his defence. The claim that depression is purely a result of lowered serotonin levels is indeed one that can and should be challenged. Antidepressant use isn’t effective for everyone, and even if you’re taking them the problem they’re supposed to be addressing can often return or eventually get worse. External factors in your life can be a big part, if not the main part, of an eventual depression diagnosis. This is all true.

However, despite Hari’s prose suggesting he’s uncovered numerous revelations, pretty much everything he “reveals” is well known already.

There’s this part:

All over the world, [doctors] were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain – it is produced by low serotonin, or a natural lack of some other chemical. It’s not caused by your life – it’s caused by your broken brain.

This may strike some as odd, the idea that there’s only one accepted cause of depression, because there are several factors widely considered to be important. And that’s not based on some jargon-heavy little-known medical text: it’s according to the Wikipedia page about depression.

I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise – alongside two real biological factors (such as your genes) that can combine with these forces to make it worse.

Personally, I’d always assumed the role of life events was widely accepted, and has been for decades. In psychiatry/medicine/psychology, this is often known as the Biopsychosocial model, and any decent professional will be very aware of it. Far from being a revelation of Hari’s, it was mooted back in the 70s, and has been part of standard teaching for at least 20 years.

Hari also condemns the reliance on antidepressants, and the fact that they’re relied upon exclusively.

At the moment, we offer depressed people a menu with only one option on it.

The NHS, whose website lists several possible therapeutic options for depression, may disagree with this. Also, Ben Goldacre was addressing the problem with SSRIs and the serotonin model of antidepressants 10 years ago. And yours truly summarised the many factors and variables of antidepressants in this very section of the Guardian not too long ago.

And then there’s this unsettling element:

Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.

While this is meant as an attack on the modern absence of the “grief exception”, where grief reactions are used to rule out depressive symptoms, it’s at best a staggering exaggeration, at worst an active fabrication to support a narrative. Grief is complex and the medical community is still not agreed on how to deal with it, but the idea that you can be diagnosed with a mental health issue after showing symptoms for one minute is ludicrous. People typically require weeks of symptoms to be officially diagnosed, to suggest otherwise can only damage the perception of medical professionals.

Perhaps these criticisms (and there are many more, but I’ve only got so much space) are unfair? I’m a trained neuroscientist who’s worked teaching psychiatry for many years; what I know and what the average person knows are going to be wildly different, and Hari’s article is almost certainly aimed at the latter. You could argue that a more personal account of the issues is more helpful when communicating with those who don’t now the full facts.

I’d argue the opposite though; if you’re targeting people who don’t know the full story of depression, then it’s far more important to get it right according to the evidence, not compromise for the sake of an easy narrative. Hari’s piece repeatedly presents well-known concepts and ideas (even to those outside the medical field) as fringe ideas that he’s discovered through his own efforts.

There are alternative, and more likely, explanations. Perhaps reliance on antidepressants is due to incredible pressures of time, money and workload on medical professionals, and alternative treatments require many hours of one-on-one interaction with trained experts, rather than swallowing a few capsules a week? The majority of the medical community could do without further criticism given all they’ve had to deal with lately. But no, Hari portrays the medical/psychiatric/scientific establishment as some shadowy monolithic organisation, in thrall to the drug industry and unwilling to consider new approaches and ideas that challenge entrenched behaviours.

This is unless they’re ones that support his position though, like Irving Kirsch, who gets unwavering support from Hari, despite not getting it from the wider psychiatric community.

It’s possible Hari addresses my concerns, and many others, in the full book. I’ve not read it yet. But then, neither have the hundreds of thousands of people who’ve read the extract at this point, and so it should be addressed as standalone piece and appraised as such.

I would never dream of taking issue with Hari’s own experiences with depression. I’m sure he’s dealt with discomfort and pain that someone who’s never experienced a clinical mood disorder can only speculate about. However, everyone experiences and deals with depression differently. The very arguments Hari puts forward about the importance of life events in depression means everyone experiences different events and consequences, develops depression in their brain’s own special way, and thus it’ll need to be tackled differently from person to person too. Antidepressants are a godsend to many people, but don’t work (or actually make things worse) for others.

That’s the brain for you, no two are alike. By condemning antidepressants with such apparent enthusiasm in such a high-profile way, Hari can only risk increasing the stigma attached to those who may be taking them for all the right reasons. And that’s not something anyone needs.

Hari may have the best intentions when it comes to addressing mental health problems like depression, but this doesn’t seem like a good way to go about it. Asserting yourself as a maverick expert and backing your arguments up with suspect cherry picking of evidence and at-the-very-least exaggerated claims? Such a sensitive subject that affects millions surely requires a more thorough, thoughtful and specific approach than this?

But hey, what do I know?

Dean Burnett’s own book, The Idiot Brain is available now, in the UK and US and elsewhere. In it, he makes no claims to be able to fix anything.

• Note by readers’ editor, Paul Chadwick, added 7 February 2018: After publication, I considered a complaint relating to Guardian and Observer coverage of the book: an extract; Q&A with the author; review; this blogpost; and blogpost on 24 January. I concluded that the book’s author, Johann Hari, and his critic, Dean Burnett, were entitled to their differing views, and that the Guardian and Observer editorial standards had been met. Due to the sensitivity of the issue involved - namely, the causes and treatment of mental illness - I also concluded that it was appropriate to emphasise for readers that the author and his critic have both expressed the view that people taking anti-depressants should not stop taking their medication abruptly or without seeking professional advice.

