Psychiatry Gone Astray

Editorial note: We follow up the Guilty post last week with a piece written by Peter Gotzsche that has caused a stir in Denmark and provoked some of the Danish professors he critiques to respond.  

At the Nordic Cochrane Centre, we have researched antidepressants for several years and I have long wondered why leading professors of psychiatry base their practice on a number of erroneous myths. These myths are harmful to patients. Many psychiatrists are well aware that the myths do not hold and have told me so, but they don’t dare deviate from the official positions because of career concerns.

Being a specialist in internal medicince, I don’t risk ruining my career by incurring the professors’ wrath and I shall try here to come to the rescue of the many conscientious but oppressed psychiatrists and patients by listing the worst myths and explain why they are harmful.

 Myth 1: Your disease is caused by a chemical imbalance in the brain

Most patients are told this but it is completely wrong. We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. The truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract.

This means that you get worse when you try to stop the medication. An alcoholic also gets worse when there is no more alcohol but this doesn’t mean that he lacked alcohol in the brain when he started drinking.

The vast majority of doctors harm their patients further by telling them that the withdrawal symptoms mean that they are still sick and still need the mediciation. In this way, the doctors turn people into chronic patients, including those who would have been fine even without any treatment at all. This is one of the main reasons that the number of patients with mental disorders is increasing, and that the number of patients who never come back into the labour market also increases. This is largely due to the drugs and not the disease.

Myth 2: It’s no problem to stop treatment with antidepressants

A Danish professor of psychiatry said this at a recent meeting for psychiatrists, just after I had explained that it was difficult for patients to quit. Fortunately, he was contradicted by two foreign professors also at the meeting. One of them had done a trial with patients suffering from panic disorder and agoraphobia and half of them found it difficult to stop even though they were slowly tapering off. It cannot be because the depression came back, as the patients were not depressed to begin with. The withdrawal symptoms are primarily due to the antidepressants and not the disease.

Myth 3: Psychotropic Drugs for Mental Illness are like Insulin for Diabetes

Most patients with depression or schizophrenia have heard this falsehood over and over again, almost like a mantra, in TV, radio and newspapers. When you give insulin to a patient with diabetes, you give something the patient lacks, namely insulin. Since we’ve never been able to demonstrate that a patient with a mental disorder lacks something that people who are not sick don’t lack, it is wrong to use this analogy.

Patients with depression don’t lack serotonin, and there are actually drugs that work for depression although they lower serotonin. Moreover, in contrast to insulin, which just replaces what the patient is short of, and does nothing else, psychotropic drugs have a very wide range of effects throughout the body, many of which are harmful. So, also for this reason, the insulin analogy is extremely misleading.

Myth 4: Psychotropic drugs reduce the number of chronically ill patients

This is probably the worst myth of them all. US science journalist Robert Whitaker demonstrates convincingly in “Anatomy of an Epidemic” that the increasing use of drugs not only keeps patients stuck in the sick role, but also turns many problems that would have been transient into chronic diseases.

If there had been any truth in the insulin myth, we would have expected to see fewer patients who could not fend for themselves. However, the reverse has happened. The clearest evidence of this is also the most tragic, namely the fate of our children after we started treating them with drugs. In the United States, psychiatrists collect more money from drug makers than doctors in any other specialty and those who take most money tend to prescribe antipsychotics to children most often. This raises a suspicion of corruption of the academic judgement.

The consequences are damning. In 1987, just before the newer antidepressants (SSRIs or happy pills) came on the market, very few children in the United States were mentally disabled. Twenty years later it was over 500,000, which represents a 35-fold increase. The number of disabled mentally ill has exploded in all Western countries. One of the worst consequences is that the treatment with ADHD medications and happy pills has created an entirely new disease in about 10% of those treated – namely bipolar disorder – which we previously called manic depressive illness.

Leading psychiatrist have claimed that it is “very rare” that patients on antidepressants become bipolar. That’s not true. The number of children with bipolar increased 35-fold in the United States, which is a serious development, as we use antipsychotic drugs for this disorder. Antipsychotic drugs are very dangerous and one of the main reasons why patients with schizophrenia live 20 years shorter than others. I have estimated in my book, ‘Deadly Medicine and Organized Crime’, that just one of the many preparations, Zyprexa (olanzapine), has killed 200,000 patients worldwide.

Myth 5: Happy pills do not cause suicide in children and adolescents

Some professors are willing to admit that happy pills increase the incidence of suicidal behavior while denying that this necessarily leads to more suicides, although it is well documented that the two are closely related. Lundbeck’s CEO, Ulf Wiinberg, went even further in a radio programme in 2011 where he claimed that happy pills reduce the rate of suicide in children and adolescents. When the stunned reporter asked him why there then was a warning against this in the package inserts, he replied that he expected the leaflets would be changed by the authorities!

Suicides in healthy people, triggered by happy pills, have also been reported. The companies and the psychiatrists have consistently blamed the disease when patients commit suicide. It is true that depression increases the risk of suicide, but happy pills increase it even more, at least up to about age 40, according to a meta-analysis of 100,000 patients in randomized trials performed by the US Food and Drug Administration.

Myth 6: Happy pills have no side effects

At an international meeting on psychiatry in 2008, I criticized psychiatrists for wanting to screen many healthy people for depression. The recommended screening tests are so poor that one in three healthy people will be wrongly diagnosed as depressed. A professor replied that it didn’t matter that healthy people were treated as happy pills have no side effects!

Happy pills have many side effects. They remove both the top and the bottom of the emotions, which, according to some patients, feels like living under a cheese-dish cover. Patients care less about the consequences of their actions, lose empathy towards others, and can become very aggressive. In school shootings in the United States and elsewhere a striking number of people have been on antidepressants.

The companies tell us that only 5% get sexual problems with happy pills, but that’s not true. In a study designed to look at this problem, sexual disturbances developed in 59% of 1,022 patients who all had a normal sex life before they started an antidepressant. The symptoms include decreased libido, delayed or no orgasm or ejaculation, and erectile dysfunction, all at a high rate, and with a low tolerance among 40% of the patients. Happy pills should therefore not have been marketed for depression where the effect is rather small, but as pills that destroy your sex life.

 Myth 7: Happy pills are not addictive

They surely are and it is no wonder because they are chemically related to and act like amphetamine. Happy pills are a kind of narcotic on prescription. The worst argument I have heard about the pills not causing dependency is that patients do not require higher doses. Shall we then also believe that cigarettes are not addictive? The vast majority of smokers consume the same number of cigarettes for years.

 Myth 8: The prevalence of depression has increased a lot

A professor argued in a TV debate that the large consumption of happy pills wasn’t a problem because the incidence of depression had increased greatly in the last 50 years. I replied it was impossible to say much about this because the criteria for making the diagnosis had been lowered markedly during this period. If you wish to count elephants in Africa, you don’t lower the criteria for what constitutes an elephant and count all the wildebeest, too.

Myth 9: The main problem is not overtreatment, but undertreatment

Again, leading psychiatrists are completely out of touch with reality. In a 2007 survey, 51% of the 108 psychiatrists said that they used too much medicine and only 4 % said they used too little. In 2001–2003, 20% of the US population aged 18–54 years received treatment for emotional problems, and sales of happy pills are so high in Denmark that every one of us could be in treatment for 6 years of our lives. That is sick.

 Myth 10: Antipsychotics prevent brain damage

Some professors say that schizophrenia causes brain damage and that it is therefore important to use antipsychotics. However, antipsychotics lead to shrinkage of the brain, and this effect is directly related to the dose and duration of the treatment. There is other good evidence to suggest that one should use antipsychotics as little as possible, as the patients then fare better in the long term. Indeed, one may completely avoid using antipsychotics in most patients with schizophrenia, which would significantly increase the chances that they will become healthy, and also increase life expectancy, as antipsychotics kill many patients.

How should we use psychotropic drugs?

I am not against using drugs, provided we know what we are doing and only use them in situations where they do more good than harm. Psychiatric drugs can be useful sometimes for some patients, especially in short-term treatment, in acute situations. But my studies in this area lead me to a very uncomfortable conclusion:

Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good. Psychiatrists should therefore do everything they can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs.


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You and your meds. Give the real story. Get the real story.

Pharmageddon

Pharmaceutical companies have hijacked healthcare in America, and the results are life-threatening.

 

Dr. David Healy documents a riveting and terrifying story that affects us all.

 

University of California Press (2012)

 

Available on Amazon.com

 

Comments

  1. Thanks so much for posting this. A clear, concise refutation of the myths associated with psychiatric drugs which is easily understood by lay people is immensely valuable. I will be circulating it throughout my networks and particularly to the families I work with who are so often given antidepressants to deal with the grief they experience as a result of losing a loved one to suicide.

    • I will copy it for our GP who prescribed an SSRI for my daughter. Her grasp of the myths exactly matches those in Dr Healy’s post. My daughter’s suicide at 20 was “caused by depression not the medication”

  2. Waiting for Godot?

    Waiting for Godot is a play which “has achieved a theoretical impossibility—a play in which nothing happens, that yet keeps audiences glued to their seats. What’s more, since the second act is a subtly different reprise of the first, he has written a play in which nothing happens, twice.” (Irish Times)

  3. Doctor Healy: I would very much like to know how I might gain your authorization to cross-post a link to this BLOG entry to DxSummit.org, the Global Summit for Diagnostic Alternatives, sponsored by the Society for Humanistic Psychology. It seems to me that your piece is one of the more cogent arguments I have seen, against the mythologies routinely spouted by proponents for the medicalization of daily life.

    I am also very interested to learn of your views concerning other bits of gross malpractice that have found their way into the Diagnostic and Statistical Manual. High on that list in my view would be psychosomatic medicine as a field, with its assertion of the self-evident nonsense that emotional distress can be “converted” into otherwise unexplainable medical symptoms.

    I have talked with hundreds of medical patients who have been substantively harmed by such assertions, by being denied appropriate medical investigation and care after being labeled as having “somatoform” mental health disorders. There is also evidence that just by applying a label of “psychogenic pain”, a doctor will more than double the risk of suicide in patients whose medical symptoms have not otherwise been diagnosed and treated.

    Sincerely,
    Richard A. Lawhern, Ph.D.
    Resident Research Analyst

  4. Marnie Woodcock says:

    A refreshing stance to see more psychiatrists willing to speak out about abuse and corruption which has hampered the psychiatric industry for a very long time and left millions of victims in its wake.

    Question is- when will any government take the bull by the horns on this and many other abuses and make this public knowledge. My experience in the UK is that being labelled with a psychiatric condition, has become an alternative route to dis-crediting and silencing people, especially when they’ve blown the whistle regarding severe abuse and failings across several sectors.

  5. Anne O'Beirne says:

    Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability creates more harm than good. Psychiatrists should therefore do everything they can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs” ~ Wow! Fairly profound coming from a Psychiatrist.

    There have been times when I found major tranquilizers that I can tolerate or minor tranquilizers useful. But I never needed them long term and no one explained that to me in 2008! As a result I ended up heavily drugged for 3 yrs which was completely unnecessary. Not forgetting that my major issues started while on an SSRI (Citalopram). It led to extremes of “highs” and “lows” and a diagnosis of “Bipolar Affective Disorder”. I had to figure it out for myself. Now I spend time trying to create awareness for others even though I meet resistance. And it is great to have your work to refer to.

    I am now at the stage of no drug use and do Yoga almost every day. I also listen to relaxation CDs, try to do mindfulness and sometimes do meditation. This requires daily work. I have also given up alcohol and try to watch my diet. As well as walking. Bibliotherapy is also something I find useful. And the idea of WRAP (Wellness Recovery Action Plan). The 5 key concepts of RECOVERY are: Hope, Personal Responsibility, Self-advocacy and Support. And also having good, honest doctors to refer to. Thank you.

    My symptoms are slowly subsiding and going away. Officially losing the label may be that bit trickier. But that is the plan. The last thing left to come back is a full night’s sleep. Working on that.

    • Anne O'Beirne says:

      Correction ~ The 5 key concepts of RECOVERY are: Hope, Personal Responsibility, Education, Self-advocacy and Support.

  6. Dr Healy I applaud you for this article.
    Thankyou.
    Millions worldwide including myself have been totally hoodwinked by so called academic giants (ie doctors) calling black white.

  7. A great, direct summary of important themes. I think that the withdrawal point made under the “chemical imbalance” myth cannot be overemphasized. Dr. Gotzsche writes that “The vast majority of doctors harm their patients further by telling them that the withdrawal symptoms mean that they are still sick”. That is true, but the situation is even worse than that.
    Symptoms that appear when psychoactive drugs are taken are interpreted as having “unmasked” inherent conditions, rather than being counted as the side effects they clearly are. The press enthusiastically blames acts of violence, that look a lot like withdrawal from SSRIs or other drugs when one reads the facts, on the failure of the perpetrator to take his meds.
    This tendency to blame people for drug effects may be the single factor most responsible for perpetuating all the myths. Everyone sees the same situation, but psychiatrists too often add to the harm they have done by offering misleading, corrupt interpretations, which the public and the press accept.
    Excellent blog, I would like SSRIstories to reference it.

  8. As a parent of a 23 year old with schizoaffective disorder, we are very conflicted re. antipsychotics. We believe his disorder was triggered by heavy cannabis use.

    After the first break, risperidone was tapered to zero after 10 weeks. We read Whittaker’s book at this time. Things settled, but after a “little” cannabis six months later, there was another break. Because of side effects, quetiapine was used. Things leveled out and after 6 months use, a very gradual (many months) taper was done.

    The third break occurred 2 months later. Because the hospitalizations were so inhumane, we tried letting things run their course. The levels of psychosis varied from mild to moderate over a 10 month period. Eventually he was forcibly taken to the hospital from his university (not by our choice). He is now on olanzapine.

    My point here is simple… if a person goes psychotic, there are no effective or accessible services to help families, even if you can afford to self-pay. There is no alternative for supportive professionals working in the home, this aint Finland! Second, the antipsychotics, for whatever reason, do eventually moderate the most overt symptoms. Lastly, mental health hospitals are little more than lock-down facilities that provide little more than medication in deplorable conditions.

    While everyone involved recognizes the risks of long term antipsychotic use, there simply is not a well-developed body of literature or practitioners to guide families and patients through difficult times. After the first break, his doctor was Peter Breggin, the dean of anti-medication and he disowned our son as a patient when he came to the office in a psychotic state. What is a family to do?

    Answers please, not a statement of problems and myths, Dr. Healy.

    • Dear GS – Trying to find humane & effective help can be a tough slog especially in the USA! I don’t think either David Healy or Peter Gotzsche would say never touch antipsychotics – just use the smallest dose for the shortest time possible.

      I’m encouraged that your son was even allowed to taper off – most “shrinks” round my way insist the drugs have to be lifelong. He and you might enjoy a look at this online hub: http://www.madinamerica.com

      Lots of good people searching for answers like yourself. MindFreedom also has some good resources. There’s also a network of “voice hearers” groups that seek to understand & live with their symptoms (some use meds, many don’t): http://www.hearingvoicesusa.org

  9. Dr. Healy, thanks for going against the prevailing attitude in the medical profession and posting this. I went through a period of pretty severe depression several years ago at the same time I was being diagnosed with and going through a terrible period of Crohn’s Disease. I was prescribed antidepressants and filled the prescription but never could bring myself to take them. I read that there appeared to be a connection between Crohn’s and depression, and thought that maybe if my Crohn’s symptoms diminished that perhaps the depression would as well. I was concerned about messing around with my brain chemistry and wondering how I would ever get off antidepressants once I started them, particularly if they impaired my judgment. Thankfully, over 12-18 months my Crohn’s gradually went into remission and I came out of the depression. I have remained in remission on the Crohn’s and have had no episodes of depression in the several years since.

    I suspect you could write largely the same article about statins which are overprescribed based on the successful lobbying efforts of the pharmaceutical industry to repeatedly lower the levels of cholesterol at which they’re prescribed. My father took these for years and became very weak with muscle fatigue in his 60′s. I suspect the statins played a role in that.

    After much reading on these type of topics and understanding the incentives of the pharmaceutical industry and the medical community, my default position is to refuse a drug or medical screening unless there is an extremely compelling argument for it when considering the risks and potential benefits under both scenarios. And while I will consider the physician’s advice, I will also do my own research.

  10. Thanks for sharing this Dr. Healy,

  11. My son suffered from fairly severe school-related anxiety when he was very young. Every doctor insisted that I start him on Paxil or Prozac or Zoloft. I politely declined.

    But it got to a point that I couldn’t get a doctor in our area to see him for treatable issues that he had. (He had extraordinarily MILD cerebral palsy–or something that mimicked very, very mild C.P.) I was labeled as non-compliant–and I guess I was “non-compliant.” I didn’t trust the medication; I thought it was a bad idea for my kid.

    Meanwhile, I was very tired, I was gaining weight, easily fatigued, pale, out-of-breath during exercise, spent lots of time sitting and laying on our couch. So, every doctor I saw diagnosed me with depression and wrote me a prescription for Prozac, Paxil, or Zoloft. But I knew I wasn’t depressed. I didn’t TEND TOWARD depression–I was a generally happy person. Sorta born that way, I think. So I never filled the prescriptions for myself, either.

    One day, I decided I would compromise. I decided I would get one of my prescriptions filled and see what effect the medication had on me.

    I was given, supposedly a “baby dose,” and only took half of one one day.

    I woke up the next morning with the worst sense of impending doom than I can describe. It was like a dark drapery was pulled down on my entire life. For the very first time in my life I felt deep, inexplicable sadness–I experienced utter despair. Out of nowhere!

    This was 24 hours after having taken one half of one pill!

    It terrified me that this medication was given to children and adolescents who may not make the connection between THAT pill and THAT feeling.

    I became a member of 23andme and begged them to start asking their members if they had had any similar experiences. 23andme is currently studying this. Perhaps it is a medication that certain genetic profiles respond well to, and others do not.

    (Sort of like statin meds, @DP–same experience with my dad and my husband following statin medication. Same medication–same symptoms. Symptoms that never relented.)

    Anyway, I have met people who feel they have received a benefit from anti-depression medications–but they tend to be people who always tended toward depression.

    But I think anti-depressant medication can be downright dangerous (particularly to children and adolescents) who do not tend toward depression; indeed I think it can trigger depression!

    By the way–my fatigue, lack of energy, etc.,–I was severely, severely anemic, as it turns out. I wasn’t “depressed.”

    I appreciate parents who are at the ends of their rope, and I am not saying that all such medication is bad for all children. But my child’s anxiety cleared up without medication. I was fortunate enough to be able to home school him until he seemed ready to overcome the anxiety for the payoff of spending time with peers. (About 5th-6th grade.) He’s a great kid, and a great student–4th year pre-med at UCLA. (Neuroscience major, ironically.) To this day–he’s never been medicated with a psychotropic medication.

    I am just so relieved to see this issue discussed. And I am so relieved that I was an adult when I tried my one-half of a “baby dose” of Prozac.

  12. C. S. Herrman says:

    Apart from what most of us know — that the psychiatric profession has been unforthcoming as to necessary facts or accountability, that the pharmaceutical companies exert entirely too much influence, and that too many doctors are more or less incompetent — the issue remains that you, too, Dr. Healy, are in at least one regard just as incompetent as those you imply to be. To be specific:

    The impression you leave, and doubtless intend to leave (presuming you have an IQ worth mentioning), is that your morals and competence veer between the Scylla of Peter Duesberg of HIV denialist fame, and Thomas Szasz of pharmocological denialism fame. I suspect the latter is but a bipolar humbug in no mood to allow an empirical rational for his moods and exaggerations and embellishments. Fortunately they are more irritating than harmful. The former, however, is easily a medium for hundreds if not thousands of HIV deaths. And the reason you are keeping their delightful company is this — you suppose that because we do not have the Mack-truck-in-your-face evidence, you can feel free to idiotically assert that mental illness is mainly iatrogenic in the way Duesberg claims HIV is owing to drugs, recreational and therapeutic.

    Now allow me to set you aright, Sir. When anti-retrovirals came to be statistically (at p < .001) associated with lowered viral loads and the latter, by the same significance with decreased symptomatology, it doesn't require anyone but a full-blown bipolar with an agenda to pronounce the antithesis to what is rational to all normals. Dr. Healy, you are expected as a professional to know these things very well, and yet you deliberately exaggerate, embellish and employ hyperbole to light tinder rather than educate minds.

    How else to account for so ribald a denial of scientific orthodoxy? While you allow drugs in acute cases, the vast majority of mental illness that causes unemployment, poverty, vagrancy, belligerency, family destruction, and etc., are the result of chronic, not acute symptomatology, which you would have the reader believe are collectively, and in all likelihood, not requiring of treatment. Reread the thoughtful comment of GS. That person know what they were talking about.

    You can't have it both ways, doctor. Get a grip and rewrite that article before reposting elsewhere.

    • To CS Herrmann.
      I would like to add to the list:
      - All psychotropic drugs (including antidepressants) have a chemical structure and an influence on neurotransmitter pathways similar to illegal drugs. It’s a myth that they are different. Consequently, addiction and side effect reported on psychotropic drugs are similar to illicit drug users.
      - Pharmaceutical clinical trials include only small population and usually ‘trouble’ cases are excluded by participant selection criteria. That’s why only post-marketing surveillance can reveal all adverse effects. However the post-marketing results are very rare reach doctors.
      - It is only a THEORY that depression is the consequence of neurotransmitters imbalance. We only know that SSRIs block the reuptake of the neurotransmitter serotonin in the brain. The result is an increased availability of serotonin in the synaptic space, which cause the decrease of specific transporters . Is this imbalance helps to ‘balance’ the brain function? In another words we only hypothesize that it helps to control depression. In my opinion, it’s brain cells that ‘adapt’ to long prescription of SSRI s and rebalance itself to norm. Changing the balance of serotonin SEEMS TO help brain cells send and receive chemical messages ( no clear evidence provided by research).
      - What is norm and what is not in brain biochemistry? We all react differently to drugs. It is a known fact, however, data produced by pharmacogenetics, for example, are openly denied by majority of medical practitioners. In opposite, facts based on ‘SEEMS TO’ theory is embraced.
      Dr Gotzsche is not denying requirement to treatment , he is raising awareness of adverse drug reaction on SSRIs and drug overuse. Ignoring the fact that any drug (including SSRI) can cause side effect is also leads to life-threatening situations for thousands of patients (deterioration of HIV patients is just quicker). You are obviously moved by losses because of HIV denial and Dr Gotzsche is also concerned about the health and well-being of mental patients due to the denial of drug safety knowledge.
      Thanks for this brave post!

      • Thank you.

        • Deirdre Oliver says:

          ANDREA – You are an inspiration to us all. Your strength and wisdom belies your age. The world is a better place because of people like you. There is a development in the UK, via Dr Lucy Johnstone, a style of `therapy’ called `psychological formulation’. There is an interview with her on Facebook. An idea. Thank you. Deirdre.

      • C. S. Herrman says:

        I appreciate your points, Iskander. But I also represent the commonsense understanding that science and experience together create and support, namely, that psychotropic drugs WORK on the vast array of mental illness.

        As I said in my post at the very top, I am aware of the deficiencies of medical and psychiatric practice. It goes without saying that mistakes are rife, dangerous and indeed culpable of misery, debility and death.

        But two points remain relevant by way of perspective. First, practically nobody who has any experience with mental illness or the health professions is unaware of all the issues surrounding SSRIs. It’s old hat. Period. What is at risk is that constant harping on the obvious risks losing track of the relevant fact that the drugs WORK. Second, people being people, those with agendas take advantage of others’ desire to place trust in experts. This means that readers are necessarily in adverse reliance, and must hope, without recourse to knowledge, that the experts will not abuse their trust. The two folks responsible for this cavalcade of overblown hyperbole are playing on natural instincts to question all of authority when only parts of it are problematic. Overstressing these errors, while independently necessary (but already done sufficiently) serves only to cause normals and patients alike to question exactly what is most dangerous to question — the efficacy of these drugs to greatly reduce infirmity. I am thousands of others are the proof of that.

        So, again, while we require to know the whole truth, we must understand that overplaying our hand can do its own kind of damage. Think how many are refusing treatment for serious mental illness because they have taken literally all of these warnings of the two who sponsor this column and others. Were it not for the constant barrage of fear-mongering parading as innocent warnings there would be far less reason to worry over the continuing specter of mass killings. See my article Alice in a Mass Killer’s Wonderland either at OpEdNews or on ResearchGATE.

        • David_Healy says:

          We disagree on this point. First the data show rating scale changes rather than real benefits. Second RCTs are necessarily focussed on a primary outcome – one effect – and close to hypnotize doctors from noticing the 99 other things a drug does. On a numerical basis there are more people being injured than harmed. The drugs are risky. The risks may be worth taking if the condition warrants it – but most people being given SSRIs do not warrant such risks and are ill-informed as to the risks. Most of the Antidepressants currently being consumed in Western settings are being administered chronically – close to 10% of the population – and this likely reflects dependence.

          DH

        • C.S. Hermann says: “First, practically nobody who has any experience with mental illness or the health professions is unaware of all the issues surrounding SSRIs.”

          I challenge that assumption. I wonder what your evidence might be.

          Here are more than 1,000 current case reports demonstrating clear patterns of clinician error in misdiagnosing common adverse reactions, overprescribing, not knowing the basics of tapering, and not recognizing withdrawal symptoms http://tinyurl.com/3o4k3j5

          It’s very, very obvious that many doctors all over the world, including psychiatrists, are completely unaware of the risks of antidepressants.

          • C. S. Herrman says:

            Oh, I hear you loud and clear. But recall what I actually said, that which you excerpted. I referenced those outside of the profession, not within. And I also, I say now for the third time in these comments, that the professions has been horrifically bad in many regards, and you are mentioning one of them, to which i can hardly offer complaint for being in full agreement.

            But now note the larger perspective here. Patients MUST learn to be their own advocates when they cannot find others. And nmy advocates I DO NOT mean those whose counsel implies a denial of the basics: 1) mental illness is a reaction to stress and is due to the organism’s over-reactions that become generic and hard-wired, whence requiring more than talk therapy; 2) the drugs work. Not universally, but nearly enough so as to be a well taken fact of existence that is only foolish and worse to deny or ignore.

            Ergo, when it comes to anti-depressants and SSRI in particular, ptirnets have to question openly thier doctors’ choices and explanatipons. They need to bring in copies of scholarly articles increasingly available for free on the internet (Elsevier especially good) — and I do NOT include in that category the off-hand half-truths of the two authors of this post series.

            Admittedly, this is hardly an ideal solution. But there are no other better ones until we manage to reform medical education, especially the residency programs in psychiatry. We should also seriously consider giving better training to clinical psychologists and have them enabled to work hand-in-hand with physicians. More can be done. But again, it is NOT good policy to spread so much venom through half-truths that people are led away from the essentials. That is my undying belief and I will never waver in it, for my own experience and that of everyone I have counseled supports it.

          • I can assure you through personal experience as well as 1,000 case reports that it is very, very difficult for patients to educate doctors by offering them scholarly articles, no matter how well chosen.

            Physicians are fairly impervious to information, no matter how well documented, coming from a patient. They would rather function on the basis of their own belief systems, something they learned from a drug company, or word-of-mouth from a friend at a conference.

            You say: “1) mental illness is a reaction to stress and is due to the organism’s over-reactions that become generic and hard-wired, whence requiring more than talk therapy; 2) the drugs work. Not universally, but nearly enough so as to be a well taken fact of existence that is only foolish and worse to deny or ignore.”

            Both of those assertions are debatable. The first, out of biological psychiatry, is strongly contested by the psychotherapy community as well as psychiatry reformers. The foundations for the second — that the drugs undeniably work — have been shown to be riddled with all kinds of error: jiggered clinical trial results, conflict of interest, observer bias, etc. You may recall the huge uproar over Irving Kirsch’s findings? Plus, you have the testimony of patients — but who wants to hear from them?

            Given the huge 30% dropout rates from clinical trials, mostly due to intolerable side effects, clinical trials reveal that about a third find antidepressants intolerable, a third get no beneficial effect, and a third supposedly benefit. This is what you’d expect from drugs that are no more effective than placebo.

            I agree patients need to be their own advocates. In fact, I call this defensive medicine — you defend yourself against your doctors. The facts about antidepressants have been so thoroughly distorted, the general public needs strong corrective messages for its own good.

            With the excessive overprescription of antidepressants in the developed world (example: the US http://www.cdc.gov/nchs/data/databriefs/db76.htm), it’s hard to believe the truth should be suppressed lest potential customers get scared off: Given the risks, antidepressants should be used only as a last resort in extreme cases.

            Clearly, overprescription to millions is a public health issue that needs to be addressed. Waving the bloody shirt of dire consequences such as suicide serves no one but the psychiatry industry. Obviously, 11% of the US population doesn’t need to be taking antidepressants to reduce the .01% suicide rate.

          • Miss Diagnosed says:

            Well said. The what I have come to learn is (both from experience and my own extensive research into patient testimonials) is the worsening of both mental and physical health issues, that go dismissed by Doctors for being adverse reactions/side effects because not listed by Pharma.
            The symptoms and ADRs instead believed as other ailments and thus also drugged to treat, these range from physical problems (bowel/skin/headaches/eye strain etc) to that of believed more aggressive mental health issues (Bipolar/Unipolar/Manic Depression)

            Take a look at the Effexor petition itself, there are no less than 30.000 signatures asking Wyeth to list the full list and extremities of the ADRs and symptomatic reactions.

            Are 30.000 people really that wrong? Is it not actual scientific evidence that 30.000 people are suffering as opposed to benefittng?

            I truly believe common sense speaks for itself – A business needs customers, repeat customers to ever be successful – Pharma is indeed a business (one of the most powerful and successful businesses on the planet.

            A patient cured is a customer lost – Nuff said.

            Furthermore – Only now, years on I have come to learn terminology needs inspecting on every scientific study – Please note even the leaflets accompanying the antidepressant states how the drug is `believed` to work. there is no definitive actuality of how it works.

            My further research has led to other studies claiming drugs and methods as `suggested` , `assumed`, inclined to, `indicating`, Nothing is proven as solid fact.

            The people advocating these drugs based on pharma` marketing is scary – I do not wish ill on the anyone but, in this case, experience outweighs text book knowledge and I invite any advocate to have a taste of their own medicine (pun intended)

  13. Thank you Dr. Gotzsche for this breath of fresh air! If I had a dollar for every time I’ve been handed the “insulin story”, I could retire rich. One of the story’s selling points (especially among those who know it’s not good science) is the promise that it will reduce stigma attached to mental illness. Yet there’s considerable evidence that people who see psych diagnoses as caused by a “broken brain” are actually less likely to accept those diagnosed as neighbors, and more likely to fear them.

    There’s also real evidence that this narrative of a “lifelong brain illness” especially when given to young people experiencing a first mental or emotional crisis, produces demoralizing hopelessness and helplessness. And it’s often reinforced by mental health professionals who tell them to relinquish their goals and accept a future built around their meds and their chronic illness.

    MindFreedom USA conducted a survey of “Hope in Mental Health” interviewing 390 people, most of whom rated themselves as either fully or substantially recovered. Yet almost two-thirds reported being told their illness was lifelong and that symptom management was the best they could expect. Three-fourths were told at some point that they would be on medication for the rest of their life, and 49% were urged to give up a cherished life goal such as a career, a family or a home of their own.

    http://www.madinamerica.com/2012/12/messages-of-hopelessness/

    The story archive itself is a real treat – and they’re still accepting new stories:

    http://igotbetter.org/stories

  14. was given these ssri drugs for panic attacks.I was given all the drivel of chemical imbalance etc etc, I took them for 8 years after being told I would need to take them for life, because I need them like a diabetic needs insulin.I became emotionally numb , gained a lot of weight and my love life disappeared.
    So I stopped taking them, tapering over 3 months as instructed by my Gp, the withdrawl was horrendous I had the most horrid depression, suicidal thoughts, head shocks, head pains, stomach & bowel problems, balance problems, tinnitus, head pressure, lost over 2 stone below my normal weight, had anxiety, akathesia, and much more, These symptoms lingered for years and after 8 years off some still remain. I started with Panic attacks and ended up with a cocktail of awful symptoms I never had prior to these drugs!

  15. Great article, and I can shake hands with former poster Ruth.
    I was prescribed Paxil/Seroxat in 2002 for anxiety relates issues. While it worked pretty well in suppressing my anxiety, I also did some strange and dangerous things while under the influence of the drug. I wanted to get off after 2 years but I was addicted already and got so sick from the withdrawals I saw no other choice than restarting to keep my job.
    No single explanation from my GP who ony told me that “some people needed it for life” without giving any explanation about the difference between relapse and withdrawal.
    I remained a prisoner of Seroxat for three more years with severeal horrific withdrawal attempts, cold turkey, cutting the dose in two or alternating the dose. All method only led to acute and unbearable disease.
    I finally quit in 2007, still not knowing about tapering and hoping for the best. It has become the most hellish ride of my life and almost my death.
    Now 6 years later, having lost my job due to WD a long time ago, having lost tens of thousands of bugs I am still recovering from the withdrawal of this so-called “non addictive wonder drug”.

    I reported my horrific and slmost fatal experience with Paxil/Seroxat to all involved watchdog offices in the Netherlands, only to get a 10-line answer in which I was “thanked for reporting”.
    Also I wrote a letter to manufacturer GlaxoSmithKline to confront them with my experience and with the fact that all this was already reported since 2002 and asked director Van Olden how GSK was going to conpensate me and the many other victims of this “wonder drug” and how it was possible that is was marketed as non addictive.
    In the reaction of this “doctor” Van Olden, he only stated that my files were closed “because of my anger”… Without answering any of my questions!

    These murderous malpractices really need to stop and this article is one step in the right direction. Also finally tapering strips for Paroxetine are availiable now here in the Netherlands, way too late for me but even some psychiatrists seem to slowly see the light.
    But unfortunately, we have to accept that many years of our lives have been destroyed by criminal companies pushing crinimal drugs and we just have to live with that…

    Dr. Healy thanks for your bravey and good work. Your work helps me to accept what has happend to me and many others and find the force to build a new life on the smoking ruins of my old life which was destroyed by Seroxat.

  16. daisy swadesh says:

    Thank you for this article. It’s short and very to the point–good for passing on to others. And thank you for your courage in speaking up.

    As a teenager I found I got so sleepy drinking at parties I stopped trying to drink. I was totally uninterested in street drugs. When I was given antipsychotics the adverse side-effects were immediate and severe (one affected my fine motor coordination to the point that I couldn’t dress myself). Of course I have chosen to go as drug-free as possible.

    If more doctors listened to their patients they would have discovered these and many other things long ago.

  17. Great article. I wish you would mention the benefits of psychotherapy as a treatment modality for many mental disorders; it is safe, effective, and creates lasting change. As more and more people begin to see through the claims of the pharmaceutical industry, safe alternatives to drugs need to be promoted.

  18. Dr Healey,
    If you don’t believe that mental illness is not caused by a chemical imbalance ; do you have an explanation for the pathogenesis of melancholic depression and schizophrenia ?
    Don’t you believe in mental illness?
    How do you think that these illnesses should be treated if you don’t believe in psychotropic medications ?
    Your post is very confusing;I would recommend you to talk about the ideal ways of treating rather than wasting time on myths.
    I agree that many psychological conditions can be contained by psychotherapy rather than medications and in such conditions medications cause no good than harm but tell us how genuine psychiatric illness can be treated because it not only is beneficial to the patient but also beneficial to the society as risks are minimised .

    • David_Healy says:

      Lucky

      The post was written by Peter Gotzsche. I believe mental illness is real and physical treatments can help. The chemical imbalance ideas is just marketing copy – inspired marketing copy that has led millions of people to give themselves some very real chemical imbalances that have been far worse than anything that might have been wrong in the first instance. DH

      • DH – you have never addressed my question of a month ago — how should a family deal with an overtly psychotic family member, if not with antipsychotics?

        Our son’s third break occurred in August 2012. because his two prior hospitalizations were so dreadfully bad, we promised him that WE would not take him to the hospital. In April 2013 he was hospitalized for a month — taken there by police.

        The antipsychotics brought him back to some measure or nomalcy, to the point where he could resume his university studies.

        We, as parents, are completely dissatisfied with the provision of psychiatric care. But the column’s contentions, while many are true, are not fully supported in fact or practice.

        • David_Healy says:

          Greg

          I can’t find an original email from you on my system or a note from you on the blog so I am slightly at a disadvantage here. I also don’t know if you’re referring to Peter G’s post or to something from me.

          Re use of antipychotics – I have never advocated not using them. But they do need to be used with care in that they are generic tranquilizers rather than specifically helpful for psychosis, and they come with risks of suicide, aggravation of psychosis, sudden cardiac death, a range of metabolic problems and dependence.

          Any one using them should try to ensure the person being given them is on the right drug for them – some antipsychotics may be more dysphoric for me than others – and in the right dose – the best doses are usually much lower than ordinarily given – and only continued for as long as needed.

          Is there something in this last statement you disagree with?

          David

          • DH – I was referring to Peter G’s post, in particular in the last paragraph: “Our citizens would be far better off if we removed all the psychotropic drugs from the market”. My original post was January 22 as “GS”.

            I agree that all psychotropics are over used. I agree that they can be harmful and have all sorts of nasty side effects and result in premature death or suicide. They should be prescribed far less than they are, at lower doses and for shorter durations when possible.

            Our experience is a son with schizoaffective disorder, 3 psychotic breaks and a total of 78 days in “metal health units”. We lived with our son in the house in varying degrees of psychosis from Summer 2012 until Spring 2013. In our experience psychosis is not self-limiting, even if a person is getting psychotherapy. The antipsychotics are what brought him back to to some measure of reality.

            I agree that some drugs are “less bad” than others (all “bad” to some extent). He had terrible side effects from some including EPS, akasthesia and dystonia. Others simply didn’t do anything. Some give him a measure of normalcy.

            In the US provision of psychiatric care is terrible — even if you can afford to self pay, there simply are not the providers with either the time or experience to provide adequate guidance — psychotherapy and thoughtful and thorough psychopharmacology.

            Blanket statements like “Our citizens would be far better off if we removed all the psychotropic drugs from the market” are just as bad as forced treatment model advocated by E. Fuller Torrey.

  19. I’d like to see some comments on this blog post critiquing Dr. Gotzsche’s article above http://real-psychiatry.blogspot.com/2014/02/an-obvious-response-to-psychiatry-gone.html

  20. Miss Diagnosed says:

    I have told my story so many times – In short I had no mental illness until put on SNRI Venlafaxine

    Initially diagnosed in 2001 for `Mild Depression` which was basically my being unhappy and stressed as a young single mum being bullied by an ex – I steadily became worse and diagnosed with manic depression and suicidal tendancies.

    My research into these drugs has led me to despair that they are still on the market despite the actual evidence of both patient and medical professional testimonials alongside the death rate.

    Pharma still lies and promotes these drugs as wonder treatments and even cures. Billions in profit overriding peoples lives.

    How can these myths still be believed? Pharma`s marketing is disturbingly clever, How it has not been brought to book for false advertising and fabricated evidence God only kows

  21. daisy swadesh says:

    I won’t argue here about the existence or non-existence of mental illness. What is certain is that a vast number of people are MISdiagnosed–and that the diagnosis is never corrected. Before the inclusion of PTSD in the DSM-III (1980) many thousands of Vietnam veterans were routinely diagnosed with schizophrenia despite over half a century of awareness of “battle fatigue” and “shell shock” etc., and that PTSD had been first accurately described in 1942 (38 years before) by Dr. A. Kardiner who described the physiological aspects of an altered stress response and called it a “physio-neurosis” (see Traumatic Stress (1996?) B. van der Kolk, et al, editors).
    This is also true for survivors of severe child abuse and molestation who have endured daily interrelational trauma–but the negative effects and stress
    of long-term unhealthy relationships are ascribed to an inborn defect such as a personality disorder.
    And few PCPs take a careful history before diagnosing depression and prescribing SSRIs, and even fewer respond to problems of side-effects.

    If they would fully correct these errors–and similar ones–it would go a long way to addressing the existing problems.

  22. I applaud this article.
    I’m dealing with anxiety and emetophobia for over 4 years. I have never been prescribed medication and only did therapy for it. Even though my phobia didn’t get any better and my anxiety is at it’s tops, I would never take any medication. I’m tired, I can’t leave the house, but I wouldn’t take anything for it. Most of the people around me tried to convince me that drugs would make it easier, that I could have a normal life. Lucky me, my therapist told me: “I can give you Xanax, you will be like a vegetable and you would come to therapy twice a week for many many years. I would make a fortune out of you as you would need me and medication more and more. I can’t put anyone on Xanax. I’m human.” I was indeed lucky.
    I have friends on Xanax and they are doing worse than me with the same anxiety problems to start with. After 4 years of therapy, reading articles and meditation I still believe that anxiety and phobias are emotional imbalances. In my world you cannot treat emotional imbalances with medication. You can’t fix them like that. In best case you only avoid the symptoms and pretend you are fine when deep inside of you, the roots are still there. In therapy I’m trying to find the roots of my anxiety and phobia and heal those from the roots.
    Leaving side effects and painful withdrawals apart, does anyone think that emotional pain can be cured with medicine? Isn’t it, in fact, something very personal that has left you a scarr? How could you ever cure something emotional with meds?
    Will meds take away unfortunate experiences or memories that hurt? Will they ever take away the fact that you were abused on any level? Will they make you more confident, more aware or happier?
    I am still lucky to have the force to try. I’m still trying my best. I’m trying to go out even though my confort zone is reduced to my 4 walls and when I go out I feel sick. I’m trying to go to therapy even though I hate it and love it at the same time – it just hurts. I’m trying to do exposure, I’m obsessing with images from therapy but I’m still going forward. I’m 24, I want a family and a life. I still do.
    If I will ever go back to normal? I don’t know… But for the rest of my days I want to go to bed every night knowing that I did my best that day without any drugs.
    After 4 years I can say that anxiety thought me how to more open minded, how not to judge people, how to understand everyone better than I did before, how to care, how to love more, how to appreciate everything I have, how to love the sunshine every morning regardless of my fears. I would never give that up and I would most certanly loose them by going on drugs.
    Thank you for this article. Helped more than a lot!
    For everyone else, stay strong whever you are! All my best wishes to everyone!

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