Prozac was approved in 1987 in the US, and launched in early 1988, followed by a clutch of other SSRIs. Twenty-five years later, we now have one prescription for an antidepressant for every single person in the West per year.
Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder – melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.
No one knows how many new cases of depression there are per year partly because modern depression is a creation of the marketing of Prozac. Until recently what is now called depression was called anxiety, nerves or a nervous breakdown. SSRIs can help some cases of nerves but they are of no use for depression proper – melancholia. But the money for companies lies in treating nerves not melancholia – and as a result any of us with severe depression is likely to get worse treatment now than we once did. We’ve gone backwards.
By 1999 the number of us taking SSRIs chronically equaled the number starting an SSRI each year. By 2003, over 6 million Americans were taking an antidepressant semi-permanently – along with over 6 million Europeans.
The number of prescriptions for antidepressants is increasing by 5-10% each year, while the figure for people starting each year remains the same. This means that there is an increase of 5% to 10% in the number of people hooked to antidepressants each year.
There is no research evidence to suggest that anyone’s life is saved by taking an antidepressant but if there are lives saved the research makes it clear that for every life saved there must be another lost. There are probably something between 1000-1500 extra suicides in the US each year, triggered by an antidepressant – an extra 2000 -2500 in Europe.
The data is similar for violence. There are probably between 1000- 1500 extra episodes of violence in the US each year that would not have happened without antidepressant input and between 2000-2500 extra episodes in Europe. Some of these will include school or other mass shootings which were unheard of twenty-five years ago.
About 4000 families in the US have children born with major birth defects each year because of antidepressants taken in pregnancy. Up to 20,000 women per year have a miscarriage because of these drugs and a large number have voluntary terminations linked to antidepressants. Miscarriages are among the biggest single predictors of later mental illness and substance misuse in women. In Europe these figures likely run at an extra 6000+ birth defects, 30,000+ miscarriages, and who knows how many extra voluntary terminations.
Most children born to mothers who have been on these drugs do not have obvious birth defects. But it increasingly looks as though these children may show cognitive delay and other autistic spectrum features.
Perhaps the greatest casualty of Prozac has been holistic medicine. Imagine you have numbness in an arm or pain in a shoulder. If referred to an orthopedic or neurology department you will have every conceivable scan or test to pinpoint the problem. Chances are the clinic will find abnormalities and attempt to put things right – abnormalities that are not the source of your problem. A good generalist, who knows your circumstances, relationships, difficulties at work and the community from which you come, can spot when aches and numbness stem from strain or tension – they see you rather than bits of you.
Prozac has killed Generalism. It did so by focusing attention on mood in the way neurologists hyper-focus on nerves. Psychiatrists have become the doctors who deal in heroic combinations and doses of pills rather than doctors who, like generalists, step back and take a broader view.
Prozac has also killed therapy – just like Prozac CBT has a hyper-focus on thoughts rather than the big picture. CBT has also become a conduit into antidepressant prescribing as therapists regularly suggest softening up a depression with pills.
Many see or saw psychiatry as a medical backwater with grim, overcrowded hospitals, and a dim understanding of the disorders it treats. In fact it was the first branch of medicine to have specialist hospitals and journals, the first to discover the bases for and eliminate several serious disorders, the first to adopt rating scales and controlled trials. And with Freud’s son-in-law, Edward Bernays, it was the first to step into public relations.
Twenty-five years ago, no one could have imagined that the bulk of the treatment literature would be ghostwritten, that negative trials could be portrayed as glowingly positive studies of a drug, that controlled trials could have been transformed into a gold-standard method to hide adverse events, or that dead bodies could have been hidden from medical academics so easily. Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants could have been brought on the market and that almost as a matter of national policy people would be encouraged to take it for life.Share this:
Copyright © Data Based Medicine Americas Ltd.
Dr Healy, SSRI’s brought about a change in my behaviour and depression that no amount of CBT could have achieved. Dont throw the baby out with the bathwater. SSRI’s have a place for some. The problem is that many take the easy fix of an SSRI over the more onerous task of CBT. Regards, damien
Damien – not throwing the baby out with the bathwater just trying to say this baby is no prettier than benzos or stimulants or opiates. The problem is thinking that what’s on prescription is more effective and safe than street or other drugs. The best bet is to keep as many people out of the health system as possible – CBT comes with its own side effects. D
Dear Professor Healy,
You wrote: “Just trying to say this baby is no prettier than benzos or stimulants or opiates. The problem is thinking that what’s on prescription is more effective and safe than street or other drugs.”
Utter nonsense. I am astonished by your lack of insight here. Firstly, benzodiazapines, stimulants and opiates are EXTREMELY addictive. I used to suffer from substance misuse and I know from experience that SSRIs have ZERO abuse potential, whereas benzodiazapines, stimulants and opiates have an extremely high abuse potential. Secondly, SSRIs (with the exception of citalopram/escitalopram) are practically non-toxic in overdose.
In essence, SSRIs have a MASSIVE advantage over prescription benzodiazapines, stimulants and opiates, both in terms of overall safety and efficacy (and that is before taking into consideration the extreme dangers of impure street drugs).
I strongly suggest that you re-evaluate your motives here. What exactly are you trying to achieve by proliferating these ridiculous opinions? Quite frankly, it makes you seem emotionally immature and exceptionally unprofessional; I’ve certainly lost the respect that I once had for you.
“Utter nonsense. I am astonished by your lack of insight here. Firstly, benzodiazapines, stimulants and opiates are EXTREMELY addictive. I used to suffer from substance misuse and I know from experience that SSRIs have ZERO abuse potential, whereas benzodiazapines, stimulants and opiates have an extremely high abuse potential.”
Your logic here is absolutely flawed, Lee. Addiction doesn’t equal abuse, and here in your comment, you seem to imply they are equal. There are many drugs that have potential for addiction, but absolutely zero chance for abuse. Research cetirizine , brand name Zyrtec, for seasonal allergies. I took Zyrtec (and its generics) 1 pill a day almost everyday for over 5 years. Just one a day. I didn’t feel a thing from cetirizine except that it prevents post-nasal drip and sneezing fits from common allergens. No potential for abuse. But, whenever I would miss a day, my allergies would come back stronger than ever, and I would go into episodes of CVS (Cyclic Vomiting Syndrome). The CVS was debilitating, and I believed that the cetirizine was preventing the CVS. It turned out I was having withdrawals. I was physically dependent on cetirizine. I went to several doctors who suggested I keep taking cetirizine everyday throughout my 5+ years of taking it, and would even prescribe me more powerful versions of the drug. These doctors knew NOTHING about what was wrong with me, yet I still paid them for their “professional” advice. A lot of them tried to prescribe more varieties of pills. That’s what doctors in the US do now. They are liaisons for the most powerful drug dealers.
How did I come to discontinue cetirizine? A very serious long term effect that I wasn’t aware of until I was confronted by friends and family. I had developed amnesia ( but I didn’t realize it until I was told how strange I was acting). Turns out a side-effect of long term use of cetirizine is amnesia! No doctor told me that, and it was never included in the drug label’s list of side-effects.
I have also known people who could simply not discontinue taking SSRI’s, or even being able to ween off of them due to psychological and physical distress. That, my friend, is addiction without the potential of abuse. Text-book.
Doctors don’t look for root causes anymore, they just push pills on their clients (not patients anymore), charge them tons of money, and get incentives from drug companies to do this. It’s criminal.
How many people in your country are hooked on caffeine? Have you ever read “Caffeine Blues” by Stephen Cherniske? I used to have pretty bad and chronic depression. I discontinued caffeine after ingesting it for as long as I can remember (set. 27 years), and had the worst withdrawal, severe suicidal depression that lasted for months! Now, that’s all in the past, and I am happier than I have ever been with energy levels higher than when I consumed caffeine. I cured my depression by discontinuing a drug that was causing my depression, and in the process, and saving tons of money by not purchasing coffee. How many, who are on SSRI’s, consume a large amount of caffeine everyday, or even have an allergy/sensitivity to caffeine? Caffeine is a drug, plain and simple. The coffee lobbyists suppress this info because it will cost them their precious profits. There is nobody on this world now who can convince me that caffeine is “good for me” because through personal experience, I proved that wrong. I know beyond a shadow of a doubt, that caffeine use is detrimental to one’s personal happiness. I am now 10 months free of caffeine, happier, more energetic, and more clear-headed than I can remember. SSRI’s (though for some people, may help) for most people are probably unnecessary, and just counteracting the side-effects from chronic caffeine use.
Thank you, Dr. Healy, for being an honest doctor in a time where that can be a difficult stance to take. Standing up to powerful drug companies. “David vs. Goliath”
The difficulty with people like you is that because you have had a miraculous “natural” cure, you conclude that everybody else with your problems has the same root problem and could be cured the same way. If you had ever seen people addicted to benzodiazepines, stimulants or opiates you would understand why those substances are potentially far worse than antidepressants. Just because a certain cure worked for your depression and other symptoms doesn’t mean that it would solve other people’s problem’s. Moreover, despite your beliefs, most doctors try to do right by their patients–they are not greedy profiteering amoral individuals as you seem to have characterized them. Most patients come to doctors demanding an easy fix–“give me a prescription”–they don’t want to participate in lifestyle changes that would involve pain or discomfort or hard work. You can blame doctors for colluding with patients in this dance, but then doctors are no worse than their patients. Doctors know that if they refuse to provide a simple fix the vast majority of patients will simply go elsewhere.
In response to jt:
“The difficulty with people like you is that because you have had a miraculous “natural” cure, you conclude that everybody else with your problems has the same root problem and could be cured the same way. If you had ever seen people addicted to benzodiazepines, stimulants or opiates you would understand why those substances are potentially far worse than antidepressants. Just because a certain cure worked for your depression and other symptoms doesn’t mean that it would solve other people’s problem’s.”
Ok, fair enough. Except for one very important aspect that if something is wrong with you, but you don’t know exactly what is causing the problem, the most intelligent thing to do would be to discontinue all mind/body altering substances before any real judgements can be made. If you already know what the root of the problem is, then that is good. If you don’t, then you need to wipe the slate clean just to see if it is this drug you are taking that is causing your illness. Take ADHD or depression for example. What is the root cause of ADHD or depression? They’ll tell you it is a chemical imbalance in the brain. Ok, but what brought about that chemical imbalance? It could very well be your morning cup of coffee, and you won’t know until you discontinue using it for a long period of time. You have to get through the withdrawals which the majority of people just have an incredibly difficult time doing. That is because it is so extraordinarily difficult to keep faith while going through long periods of withdrawal. One may very well be taking SSRI’s because they are fighting the additional effects (the term side-effects is very misleading) of other drugs one may be putting in their body. This isn’t a “miraculous cure” as you stated, but was an experiment to see if the causes of my depression and anxiety were from drugs, and it turns out I was 100% right about that. No miracles required, and until one tries this, they’ll never know. They may just keep adding prescriptions to counter the additional, unexpected effects of all of the drugs they may be currently using currently using.
Now, on the doctors, you’ve swayed me. Nice job. You are exactly right. If they don’t offer a quick fix, patients will go elsewhere, and those doctors could go out of business. Then it does all come back to the patient who doesn’t want to put the hard-work and discomfort into lifestyle changes, just as you said. This helps my original point about how the best thing to do for yourself in order to figure out the root cause of your illness (unless you already know it beyond doubt Example: it’s hereditary, environmental, etc) is to discontinue the use of all drugs whether they are legal, illegal, or widely socially accepted.
Additionally, I did not say, or even remotely imply even once, that SSRI’s are worse than other drugs. My response was to prove the original poster’s synonymous use of the terms “addiction” and “abuse” as a fallacy. I understand if you didn’t fully comprehend what was being said. No hard feelings here, and thank you for taking the time to respond.
As for ADHD, true ADHD, by definition, begins in childhood, long before any child (usually) is ever exposed to caffeine or any other mind-altering drug, so one cannot blame caffeine for the cause of this disorder. It has been long known that excessive intake of caffeine can cause anxiety disorders and anxiety is highly correlated to depression. However, having one or probably even a few cups of coffee has not been reliably shown to be related to depression. There are, of course, always exceptions. And herein lies the dilemma for doctors. Should doctors tell everyone who suffers from depression to stop using caffeine even if those who use normal amounts let’s say have only a 1/5000 chance of improving? The reality is that trying to induce such behavior change is so monumental that it is too frustrating to make the yield worthwhile for the doctor. Same with trying to implement better dietary habits. Exercise, which has been shown to be as effective as antidepressants is probably the single best thing a doctor can prescribe but how many patients are likely to follow through, particularly when they lack motivation to do much of anything? Which again highlights the basic dilemma of depression: how do you get someone to make positive changes in their life when they often have barely the motivation to get out of bed?
“As for ADHD, true ADHD, by definition, begins in childhood, long before any child (usually) is ever exposed to caffeine or any other mind-altering drug, so one cannot blame caffeine for the cause of this disorder.”
This is absolutely not true. Statistics show that children do consume caffeine at early stages of development in doses that rival adult consumption. This is due to the fact that dosage is relative to size of the subject. In other words, it is measured in mg of caffeine/kg of weight of individual. Children are smaller people, and thus require less of the drug for the same effect.
“However, having one or probably even a few cups of coffee has not been reliably shown to be related to depression.”
This is also simply untrue. There are unbiased (not funded by Big Coffee) studies that show there is an undeniable connection.
“Should doctors tell everyone who suffers from depression to stop using caffeine even if those who use normal amounts let’s say have only a 1/5000 chance of improving?”
Yes and no. Those suffering from depression will have a greater chance of attempting suicide due to long term caffeine withdrawal, but it should be tested (with extreme care) to see if the dilemma is indeed drug induced. Remember, the depression caused by caffeine withdrawal can last months, even a year depending on history of use. The “9 day withdrawal” period that is touted by so many has mostly to do with the physical symptoms of withdrawal, and after those are over (with depression lingering), people think they are detoxed and go right back to caffeine, and that is due to the depressive effects of the withdrawal.
Yes, exercise is fundamental to a healthy lifestyle. Caffeine helps to rid the body of essential nutrients thereby nullifying a percentage of the positive results of exercise.
Be aware that there is a boat-load of misinformation out there on the positives of caffeine because most of the studies performed on the effects of caffeine on the human body are inherently biased towards inflating the positive effects of caffeine, if any. These studies biased studies are all paid for with funding from coffee companies. Starbucks has paid millions of dollars toward “research” on the positive effects of caffeine. You can believe them if you want, but I choose to use my critical thinking faculties to conclude that they are just trying to make more money off of public health. They say that coffee drinkers are less likely to get cancer. This conclusion is biased and unfounded. Cancer is a degenerative disease, with the exception of cancer causing viruses. The longer you are alive, the greater your chances of developing cancer because you essentially become a copy of a copy of a copy of a copy, etc of yourself. This is why you age, grow old and die. The two biggest reasons more cancer has been found in recent history are the fact that medical tech has become more advanced, and because people are living longer (which is a derivative of the former). Now perhaps those who drink the most coffee end up dying of say, heart disease, before reaching a stage of developing cancer. That would suggest the possibility that coffee drinkers actually die sooner. I am not saying that this is definitely the case, but the point is that you can make a study suggest whatever you want it to suggest. Most studies on caffeine use are biased in this nature. My point is that it is a drug. A drug is a drug is a drug, and chronic or daily use of a normal recommended dosage will have long term effects on normal body chemistry.
“how do you get someone to make positive changes in their life when they often have barely the motivation to get out of bed?”
It is a fact that regular coffee drinkers lack morning motivation until they et their first cup of coffee. This is physical and psychological drug dependence. By the time that first cup has brewed, it is already too late for most people to exercise and not be late for work which may certainly be a desk job. If they didn’t have this dependence, they may be able to fit in a routine 30 minute workout session that would invigorate them even more than caffeine intake would. And it should be noted that caffeine doesn’t actually give you energy. Exercise does, caffeine doesn’t. Caffeine gives you stress, not energy, which keeps you alert and awake. It overstimulates the adrenals making you feel as if you are being chased by a tiger who will rip you to shreds every time you drink a cup. This is called the “Fight or Flight” response, and it happens with every dose of caffeine until your adrenals are squeezed dry. This is the infamous “caffeine crash.” This type of frequent stress on the body is quite damaging to both body and mind and the logical conclusion that caffeine does more harm than good literally begs to be realized.
I was prepared to buy and read Caffeine Blues until I read some of the critical reviews. It appears that the author has a mail order degree and conveniently has a pyramid company that sells non-caffeienated supplements. You might say that doesn’t discredit his message, but he sounds like a snake-oil salesman. How can one trust a person like that? Here’s a summary of some of the better critiques:
This book is typical of many one-issue health and nutrition books. It “seems” to be an ample resource for information about the effects and potential dangers of caffeine intake. The book is intelligently written and the endnotes add some weight (no, I didn’t actually review the sources, but I presume they would not be there if they weren’t supportive to some degree).
After reading the book I felt I learned a number of things and that it’s probably a good idea to limit caffeine use. However, as I’ve read more and newer research, I’ve now come to doubt that caffeine is really a hazard unless you’re an individual who reacts badly to it. (I am not.)
Indeed, the author does make his point too zealously. The book opens with a testimonial about the devastating effect caffeine had on the author until he gave it up and turned around his life. Is this sort of personal, I-saw-the-light-now-I’m spreading-it involvement with a supposedly scientific presentation really supposed to make it more, rather than less, credible?
Furthermore, the book not only presents the possible dangers of caffeine (without always adequately acknowledging the difference between the possible and the probable), but uses ad hominem argument to attempt to discredit those who disagree, e.g., media reports on caffeine are presumed to be biased because reporters are presumed to drink a lot of coffee. And here do seem to be many who do disagree.
I also learned through a web search that the author had or has a company called the Oasis Wellness Network that uses pyramid techniques to peddle, hmm . . . caffeine-free coffee substitutes! And then there are the author’s credentials. The book cover boasts in large type of Mr. Cherniske’s M.S., but it appeared to me from the author’s on-line bio that his master’s in nutrition was “earned” from Columbia Pacific University. Columbia Pacific University was a correspondence “university” that California ordered to close permanently and refund students’ money for, among other things, failing to employ qualified faculty.
This book was written by a man who knew next to nothing about caffeine but who had a very fixed agenda: To say bad things about caffeine and scare people who might have otherwise benefited from and enjoyed using it.
It was written decades ago and was dated and inaccurate then. Today, it’s a relic of scientismic nonsense. Anyone who is tricked into relying on this book for information is being swindled.
If you want to read the REAL caffeine story, try getting The World of Caffeine: The Science and Culture of the World’s Most Popular Drug or The Caffeine Advantage, both of which were written by caffeine experts Bennett Alan Weinberg and Bonnie K. Bealer. These books have been praised by the most prestigious reviewers in the world, including those from The New England Journal of Medicine, The Washington Post, The Wall Street Journal, New Scientist, etc., etc., etc., and have been translated into Italian, Japanese, and Spanish. These are the books that tell the accurate, true, and fascinating story of caffeine!
He is NOT a doctor. The only degree he has is from a unaccredited CORRESPONDENCE school!!! It was shut down by court order in 2001. He paid $72 for his “degree”. He is now involved in Oasis Life Sciences, a MLM selling junk.
This book is full of extremely alarming information about the dangers of caffeine, and unfortunately the author misuses scientific studies to prove the point he is trying to make. Many of the studies are misrepresented, and others have since been shown to be faulty. If you are interested in the effect of caffeine on the body, find another book or read the numerous medical journal articles (by actual physicians and PhDs from accredited universities) on this topic yourself–this uncredentialed author can’t be trusted.
This book is junk science. The author doesn’t know anything about caffeine. For example, he claims that caffeine ages you because it is dehydrating. Caffeine is NOT dehydrating– that is proven by every scientific study! And, in fact, caffeine is a strong anti-oxidant, so it actually prevents aging. If you want to read serious, well-researched book about caffeine, read The World of Caffeine, by Weinberg and Bealer. If you want to read a great self-help book about how to use caffeine safely to get benefits for your mind and body, read The Caffeine Advantage by the same authors.
By the way, it’s funny, but Cherniske, the big anti-caffeine man, admits that he uses caffeine regularly and that it makes him feel great!!
This book will scare the coffee right out of you — at first. Maybe growing up around Mormons made me always a bit suspicious of coffee, and drinking the strong brew served in Tokyo certainly confirmed that you can overdose on it.
But Caffeine Blues laid more crimes to the body at the door of the Bean than there are Kennedy conspiracy theories. Except for regular strident comments about the medical profession ignoring caffeine (I have certainly seen plenty of warnings), he makes a logical case that caffeine induces stress-like reactions in the body, which long term, are bad for the body. Enough said for me to give it a go.
The disappointment sets in with his Off the Bean program which includes good advice about easing off coffee and adding exercise and sleep, but also suggests taking half a dozen supplements that I would need to read a dozen books to feel safe with. Precious little is said about them.
It turns out he is president of a company that makes stuff to make you better. And the FDA did make him sign a consent agreement to stop over-promising about his fountain of youth consumables and tests. (Search Findlaw under his name). So I worry he has overstated some of the research referred to related to caffeine.
But he has raised enough points about caffeine, and done it in a reasonable enough tone, that I will go without for a while.
Interesting read, but maybe to be taken with a grain of salt.
Amazing. I have been taking Certirizine every day for years. I know SSRIs have triggered allergies and I take the antihistamine to combat that. But if it inhibits my efforts to come off the SSRIs then its like a catch 22!
And I would also like to add, it is currently a rough allergy season this year. I am smack in the middle of it with no air conditioning (pets and all), and somehow…no allergy attacks whatsoever. None. All my life, I dreaded allergy season as it would literally almost debilitate me, even while taking Zyrtec, and definitely before Zyrtec. This could possibly be linked to my cessation of caffeine. More research NEEDS to be done to test this hypothesis. Could be a break-through allergy and depression treatment.
And one more thing, I promise. I also used to be a smoker, now I am 4 years without a cigarette and no desire to have one at all, ever! In my experience, quitting cigarettes was much easier than quitting caffeine.
Lee, I have to (respectfully) disagree with your comparison of SSRIs to “street” drugs. I agree, SSRIs are not “addictive* in a craving sense, but when the brain senses their absence, it reacts…….badly! This isn’t exclusive to drugs even: for example, a “hot flash” in women is a result of dropping estradiol levels at menopause. Obviously, children have low hormone levels and don’t have hot flashes, but after the advent of puberty when sex hormones skyrocket, any abrupt change years down the road will cause withdrawal symptoms.
Biology lessons aside, I have a diagnosis of obsessive compulsive disorder (without concomitant depression) and have been on one SSRI or another for 15 years, until one month ago. I took Paxil for the first 4 years — 10 days after starting it (in 1999), I had an amnesic/depersonalization episode that lasted only a few moments, but was nevertheless scary. My doctor had the gaul to dismiss it as residual effect from anesthesia two months earlier for wisdom teeth removal. In 2003, I began Celexa — that caused bruxism, two cracked molars, WORSE anxiety, and two episodes of syncope. I have a heart murmur and later learned that Celexa can lead to arrhythmia. In November 2013, I began Zoloft, 50 mg. When I upped it to 100 mg 5 months ago, I developed persistent, 5x/daily diarrhea that caused me to lose 20+ lbs. My doctor took me off cold turkey and wrote me a script for Buspar for nerves. HIS actions nearly cost me my sanity…..and my life. I developed akathisia: low, dysphoric mood; agitated restlessness; sleepwalking; violent nightmares; thoughts of death (I felt like a magnet was PULLING me to the edge of death and I had to consciously walk 20+ feet away from the curb because I was afraid I was going to walk into oncoming traffic). I even had to restrain my left arm from throwing a bottle at a waitress who annoyed me. I won’t even *begin* to ask you to try to understand such a phenomenon, because it’s impossible………until you experience it! Think of there being no phone line between thoughts, emotions, and your limbic system. It is like coming face to face with your own version of “Satan”, which I consider to be one’s own unique anti-ego that seeks to destroy you. That may sound like fanciful verbiage, it isn’t meant to. It’s the only way to describe the feeling. I can honestly say, that I have WALKED in the shoes of SSRI victims who were not as lucky as I.
Do I think SSRIs are “bad” and that no one should ever take them? No. After all, Zoloft was the only med I’ve taken that led to this side effect. But SSRIs are not lifesaving miracle cure-alls. There are risks, and there is also no long term clinical trial data for patients like myself who’ve ingested these pills for more than a decade.
I just finished reading “Endocrine Psychiatry” by Shorter and Fink. The book shows how psychiatry indeed has moved backward with the lumping of all types of depression into the DSM-IV “major depression” heading. It discusses the fact that psychiatrists indeed had a fairly reliable test called the “dexamethesone suppression test” which could distinguish between melancholia depression and other types. For that type patients responded very well to ECT and TCA’s and could achieve remission.
Psychiatry in the US mandates “the newest med is prescribed first” but often the newest approved med is not the most effective med for that illness. MAOI’s like Parnate, Marplan and Nardil are more effective antidepressants than the newer SSRI’s or SNRI’s. Yet these effective meds of the late 50’s are rarely prescribed. Lithium has a 55% good response rate in bipolar patients yet anti-psychotics are often the first to be prescribed. There is great research on L-gated calcium channel blockers like nimodipine on depression and bipolar disorder in the 80’s and 90’s yet they can’t be patented and no one can make money from them.
The problem with MAO-Is is the significant dietary restrictions, such as aged cheeses and salami as well as drug interactions. If a patient eats the wrong food or takes the wrong medication he can have a serious, even fatal reaction. For this reason, the MAO-Is have fallen out of favor and are used primarily in treatment-resistant depressions. Unfortunately they are so little used that clinicians have almost forgotten about them or are so unfamiliar with them that they don’t know how to properly use them or they’re afraid of them. I don’t know where you got the idea that lithium is the drug of second choice these days in Bipolar Disorder, but it is still considered the gold standard for classic Bipolar Disorder. Some clinicians may favor antipsychotics because they are easier to use; lithium requires careful blood monitoring to maintain a therapeutic level and this is not necessary with antipsychotics. The reasons calcium channel blockers are not used much is because, despite their promise, they just have not proven to be effective, not because of financial reasons. Along those lines, lithium is still widely used and it’s not on patent (and I’m not sure if it ever was).
Thank you for this eloquent summary of the 25 year story of SSRIs which I will share with everyone I can.
A small point: I do think it a bit unfair that you take a swipe at CBT as part of the story. For most qualified and accredited therapists the B is at least as important as the C. Although thoughts are important because of their effect on mood (both positive and negative) with skilled questioning they can quickly lead to underlying beliefs which dictate unhelpful and self damaging behaviours. The therapy is holistic, except in its most basic form, as the patient’s behaviour cannot be seen as in a vacuum but must always be located within their environment which includes relationships at work and home as well as financial and other practical problems.
I have a question for you: I have several times in the past 10 years as a therapist had to send patients back to their GP to have their medication reviewed because they were simply incapable of taking an active part in psychotherapy with me because of their worsening symptoms.
What are we to do when faced with a highly distressed patient – either floridly anxious or deeply depressed – who cannot engage with anyone or anything let alone reflect insightfully on their dysfunctional beliefs and behaviours and plan ways to change?
Angela – part of the problem is SSRIs and CBT get used because they supposedly work. They can both be helpful but neither SSRIs or CBT are suitable for everyone and neither work the way an antibiotic does. Both come with serious side effects and both are delivered in settings that have a serious power imbalance. By how much have we actually advanced in the last 25 years – could we have gone backwards?
i have been reading the pharmacological as well as the psychotherapeutic aspects of this post.
patients themselves are interested in what goes into them, using both methods of treatment, and come back with questions and ideas after their own research, given today’s easy access to the internet.
seems to me, we professionals would benefit from listening to them too. i largely use cbt in my interventions with depression patients, and there are limitations, which are helped or hampered by the usage of prescription medicines.
i have sadly observed many doctors do prescribe medicines in high doses where none are required, and patients reduce their adherence due to the side effects of the medicines, and in the process, lose their faith in the entire treatment. there is a definite loss of holistic approach to the illness and the person as a whole.
I am curious to know whether you have done any studies on patients who have attempted to reverse the negative effects/ damages done by unnecessarily prescribed psychiatric medications by chemical or other means. If so, I’d be quite interested in your results. Thank you and have a great day.
Once you’ve been treated you cannot be untreated. Treating and stopping is not the same as not treating.
Since no one has actually scientifically proven any irreversible biological or physical or psychological damage due to SSRIs (and I stress scientific, because there are lots of anecdotal reports that are not scientific), it would be impossible to prove a treatment can “undo” any damage.
You bring up the notion of power imbalance. All of medicine is, for most people, a situation of such imbalance. There are probably more people today who are less impressed with the power of the doctor but for a majority, I believe there is an almost pathetic trust that the doctor has one’s best interests at heart and is sufficiently skilled and honest to formulate the best treatment for one’s malady. From the doctor’s side of the equation, it’s difficult to maintain a therapeutic boundary while still being attentive to the patient and her needs, being honest about all aspects of treatment and being prepared to defend one’s decision when the best treatment is no treatment. Too often the patient’s trust is assumed rather than earned. When I was teaching medical students, I had a test for those who would become surgeons vs those who didn’t believe a little tincture of steel cures everything. I would start talking about “clients” rather than “patients” and see who jumped in which direction. The willingness of people to ingest whatever the doctor orders, meekly and without question, is frightening, almost as frightening as the zeal with which GPs are handing out dangerous drugs for non-diseases.
This is key. Psychiatrists and therapists both need to realise that the majority of these people are not suffering from a disease. My wasn’t ill at all, and antidepressants were really the last thing she needed.
If antidepressants were used for the 1 in 10000, or even 1 in 1000 instead of 1 in 10, then the safety and effiacy of these drugs would be much less of an issue, the ‘this is all we have’ agrument would hold some weight… lives would be saved not lost. In my humble opinion, the science behind the illness is way worse than the science behind the medicine.
I very much enjoyed your post. I was directed to it from 1boringoldman, you two seem to have much in common and I appreciate your viewpoints. I hoped you could provide me with references re: SSRIs and mortality and SSRIs and the estimates you provided for their leading to suicide. There’s this guy Robert Gibbons coming to give a lecture where I work on his paper last year in the AGP re: SSRIs and suicidal ideation. I’d like to be well informed for his presentation. Thanks much.
Scott – the data/publications you want can all be accessed from the articles section in the publications slot on davidhealy.org. Re RG – see an earlier post May Fool’s Day
Link to an article in which people might be interested;
(Lisa Cosgrove & Emily E. Wheeler, `Industry’s colonization of psychiatry: Ethical & practical implications of financial conflicts of interest in the DSM-5)
I was somewhat taken aback by your statement that CBT comes with ‘serious side effects’. I’m assuming you are not confusing it with psychoanalytic or psychodynamic therapies which can use demonstrably risky techniques such as regression. If you are not, I have to assume that you are using the same intellectual rigour in making this statement as in those you make about the use and abuse of SSRI’s. In my wide reading in this and related subjects, and in my practice as an academic and CB therapist over the last 15 years the only side effect for people undertaking CBT is a possible and short-term increase in anxiety during the term of the therapy. Have I missed something?
Angela – Just as with CBT, using SSRIs should come with a decent holistic assessment, but in both this is likely more honoured in the breach than the observance. There is a worry that a decent holistic assessment in the case of CBT will lead to engagement with recovered memories – certainly many of those who argued that recovered memories pointed to abuse in the 1990s would have described themselves as CBT therapists.
SSRIs suit some people but not all and one of the criticisms of the pharmaceutical industry is that they have not done enough to pinpoint who will be helped and who should avoid. In the same CBT likely suits some temperaments – introverts but not extraverts – CBT refuses to concede this and has done little to chase who the treatment suits.
The data supporting CBT is about as weak or strong as the data supporting SSRIs – slightly better than placebo – and as with the SSRIs one of the problems is that there are a large number of negative studies left unpublished.
The comparisons could be pushed further but at bottom CBT functions as something like a brand and as with all brands the marketing isn’t interested to sully the product.
I was curious as well about “side effects” from CBT, especially the idea of it having any common roots with recovered-memory therapy. At least as I’ve seen it practiced here, CBT seems to involve a relentless focus on the here-and-now. More in common with Norman Vincent Peale than “The Courage to Heal”, with the only side effects being discouragement and frustration. (In fairness to Angela and others, there is quite a bit of wisdom in CBT. And I’ve gotta assume it can do much more when practiced skilfully and with attention to the individual in front of you.)
The real problem, I think, is that both researchers and insurance companies seem to have fallen in love with CBT just because it lends itself to standardization. So it can be studied! Measured! Just like a pill! Hooray! Workbooks, scripts and protocols, take-home tests, and a dream that someday the therapist herself will be no more of a factor than, well … the shrink who hands you the Prozac.
Of course the more rigidly scripted the interaction gets, the less effective it probably is. It’s perfectly insane thinking … use this, not because it seems to work but because we can measure if it works. It’s like asking all your depressed patients: “Please stop brooding about your failures in life, and start having psychomotor retardation instead. Here, I’ll show you how it’s done … It’s much easier to measure, you see, so this way we’ll be able to tell whether we’re helping you.” Other promising techniques like “mindfulness” or dialectical behavior therapy are at risk of being squeezed into this idiot box as well.
Hi Dr Healy, I read your article with interest as Ive just been prescribed Prozac and today will be day 3 of taking it. A couple of months ago my brain went into a tale spin after months of stress and seems to have completely short circuited. I now have no auto pilot whatsoever and all that works are my senses and the overwhelming depression, anxiety and panic i was experiencing before is augmented by the distress that this causes. My GP has been brilliant but my first referral to a psychiatrist was refused, so he got me to write a summary of what lifes like for me which took a month because i can concentrate for only about 10mins per day. Last week i passed it to him and he passed me the Prozac prescription! I feel like a zombie on it! But it’s nice not to feel so much. I still can’t concentrate or manage to do much but the prozac is making me care about that a lot less which is a welcome relief. What’s very scary though, and the reason your article resonated so much with me, is that Im already thinking what would happen without it?
Excuse for my English. I Have a probleme stress-post-traumatique and me is necessary see a psychiatrist for my paying insurance. Pressure of the company insurance is huge if you are sick you must take pillules. Otherwise you am not sick. Medecin refuse to look at determinant social. Therefore, a lot woman give in on pressure.
Excusez pour mon anglais. J’Ai un probleme stress-post-traumatique et je doit voir un psychiatre pour mes payer assurance. La pression des compagnie assurance est énorme si tu es malade tu doit prendre des pillules. Sinon tu n’est pas malade. Les medecin refuse de regarder les determinant social. Donc, beaucoup de femme cède sur la pression. Bonne journée
I am saddened by the relentlessly negative comments about CBT which lead me to wonder whether anyone really understands both the theory and the practice of this therapy. It is clearly much easier to criticise than to praise. Everything and everyone are open to criticism but it’s not the only, or indeed the best, way to understanding.
What really concerns me, though, is what happens when you take hope away from people who are suffering. CBT is little better than placebo and anti-depressants make you ill. So would someone, anyone, tell me what people with disabling levels of emotional disorder are supposed to do?
Should I perhaps have turned away the literally hundreds of people I have treated over the last 15 years saying ‘Sorry, this treatment is little better than placebo andI don’t know enough about who benefits the most from this approach?’ Incidentally, none of these recovered false or genuine memories of childhood sexual abuse.
Perhaps the fact that most of these people got better, and to my knowledge, haven’t relapsed is entirely due to the fact that they paid someone to listen to them for 1 hour a week over a few months i.e. skills, training, reading, thinking and rigorous clinical supervision count for nothing. All you need is someone to listen to you for an hour a week – anyone would do really.
So, colleagues, fellow sufferers et al – how are we going to help people when they come to us asking for help? What should we be asking for when we ourselves are in a desperate state and need help?
Angela – its not meant to be relentlessly negative. Its applying the same rules to CBT as to drugs. CBT has powerful lobbies behind as does Prozac etc – neither suit everyone. The only way people are going to get the right treatment for them is if those delivering both ADs and CBT recognize that both treatments can cause problems.
In North America therapists practicing CBT have become a conduit to ADs – if the patient doesn’t respond to CBT it is suggested they also have an antidepressant.
And just as doctors buy into the hype around prescription only and the discrediting of remarkably similar but over the counter or cheaper drugs like St John’s wort or chlorpheniramine, so also CBT therapists have you hint in one of your earlier comments have been party to the marginalizing of Behavior Therapy – the over the counter version of CBT.
Re turning people away, I think people have a right to make up their own minds – this means have something like the equivalent of a DBM position paper on ADs for CBT also.
Its not about turning people away – its about recognizing that a great deal of the benefit comes from a therapist rather than a specific treatment modality whether CBT or Prozac and that often engagement with the therapist is all that is needed and both parties can be more relaxed if there are other modalities to fall back on
As a therapist who has also written critique of CBT as the `treatment of [therapy] choice’ in liberal democratic societies which have become rampantly commercialist and in which `thinking’ is privileged over `feeling’ more generally, I agree with David’s most recent comment. Many things could of course be said about the almost default elevation of CBT over other therapeutic modalities. But certainly agree with the need for a wide range of effective psychotherapeutic options.
I have practiced a variety of techniques as a therapist for over 20 years. I utilize many CBT techniques, and many of the tools developed by David Burns.
They’re natural, and empowers the client to assume most of the credit for recovery.
I have read most of David Healy’s early studies, and although I think he’s brilliant and admirable for exposing the ridiculous SSRI’s, I stand firm on my successful use of CBT.
The answer to Charlie’s question is that there is nothing available to alleviate anxiety apart from ssris, benzos and CBT.
Three choices offered.
People asking for help are not offered much and not offered what they want.
I am sure Charlie would have liked more than his ten minute slot with his doctor to explain problems of depression, anxiety and panic.
If Charlie’s problems are as serious as they sound, then a plan of action should be put into action, immediately.
They never are.
If I had not been offered a pill, what would I have done?
I would have changed my life.
Being sedated for two years held me back from life changing decisions that I should have made, I realise that now, and so, Charlie, face the demons and do everything in your power to make any decision that would make you more content with your lot in life….
Do you want someone to talk to…….there are many, many sympathetic phone lines run by charities who are available to talk you through anything you want to talk about. Freely, uncritically and enormously friendly.
The NHS…..no help services…….is not the place to go for acute anxiety……..
It is now the case of the people helping the people and doctors and psychiatrists are bringing upon themselves their own demise, in the field of mental health…….
The current system fails us all…………………………
Re talk therapy, my daughter had a form of counselling at 16 years of age. She was offered 6 or so sessions – a one size fits all approach. I was not involved apart from some confirmation of details at the start and a questionnaire type meeting at the end. (A far as I could see boxes were being ticked ) I was asked whether or not I thought the sessions had been helpful. I didn’t think so and said so. My daughter was not happy having to change counsellors part way through the course. I was not impressed that I had no involvement apart from being the taxi.
S’il vous plait, avez-vous la droit de choisir quel pillules, quel drogue? Le medicin, a-t-il expliquer les effets, les dangers, le but de ce traitement? Ou habitez vous?
Angela, I apologize if I sounded overly cynical about CBT as a technique. There is a lot of wisdom embodied in it. My comments were just based on my experiences with the twelve-session, assembly-line, workbook-driven junk version, which is also just as ideologically loaded as the Think and Grow Rich courses offered to salesmen etc. Unfortunately the stuff is out there, and I’m sure it would give any thoughtful CBT oriented therapist hives. I hope there is less of it in the UK than over here. (My personal favorite was the therapist who sat down to do the math with me and figured out that at my current rate of careful saving and frugal living I could have $36K saved by the time I retired. And she thought that was a Positive Thought that could help me stop worrying! Now whose reality testing is a bit out of kilter there?)
I would never say that simply talking to “somebody” for an hour is enough, and the years of study, practice, training are meaningless. However, your question caused me to reflect that over the years I’ve learned far more from my fellow screwups in Alcoholics Anonymous than from any therapist. Even while hospitalized a quarter century ago (for which I am grudgingly grateful; I needed to be there) I got more from the company of fellow patients than the (relatively good) staff — including even from the woman who thought she had seven personalities! Hey, she had her strengths and weaknesses; I had mine.
The mental health professions, and society as a whole, need to think far more about fostering this kind of mutual support, and beginning to undo some of the poisonous social isolation and fragmentation that’s growing so fast in our dog-eat-dog culture. That’s what gives me hope. And yeah, we do need some very well-educated and wise people to help facilitate the process, most often it does not just happen. Sorry for the rant — and thanks for the comments!
OK. This is my last blast to address some of the issues raised in this discussion.
CBT is most emphatically not just about thoughts or just positive-thinking. Briefly, it is about helping individuals to understand the interaction between their thoughts, emotions, physical responses and behaviour, and how this interaction may be maintaining their distress. Relapse prevention is planned almost from the first session.
Re the power imbalance: I cannot think of a situation in which one person is asking for help from another which does not have an inbuilt power imbalance. I am acutely aware of this in my relationship with the people I see and discuss it with them and minimise it as far as possible. I practice as openly as possible and share all correspondence with them.
CBT aims to help people learn the skills they need to make choices in their lives that promote good mental health. I record every session and provide them with a copy to listen and reflect on and discuss in the next session. This is very effective in helping them to become their own therapist. I do not know another therapy where the patient is encouraged and supported to take responsibility for their lives and not become dependent on the person or treatment they are being offered. CBT is rarely about giving advice but, recognises that the person, being the best expert on themselves, will find the best solutions within themselves. This is why socratic questioning is so central to the practice of CBT.
Johanna – thank you for your comments. In every helping profession there are people who are incompetent and, sometimes dangerous. CBT is not a protected title so literally anyone without a minute of training can call themselves a CBT practitioner. This is a systemic problem and is no reason for not seeking our therapists who are regulated and responsible. BABCP are the body that provide that in the UK.
I have suffered from depression for 25 years including 2 hospital stays of about 9 months. I came off my medication 16 months ago and suffered tremendously as a result. However, with the help of the information on this website I am beginning to find some normality. I believe my experiences have made me a better therapist and I never fail to learn from my patients. That is why I love what I do (most of the time).
Research for which I cannot recall citation: The most powerful factor in effective psychotherapy is the the therapist doing it (with consideration of the patient who is on the receiving end) with technique a distant second. I cringe when I hear “CBT” and efficacy used in same sentence. Who is using it? With whom?
I wonder if it might get more attention if one were to publicize the dangers of sudden death caused by SSRIs and other ADs. The MHRA has recently issued a warning on prolonged Q-T interval with citalopram.
The same effect has been found with TCAs http://www.ncbi.nlm.nih.gov/pubmed/19417591
It seems that this information would obviate the argument about suicide: “Well they’re depressed so they’re prone to suicide anyway.”
or haemorrhagic stroke.
The claim is that the risk of stroke is low but how would we know? Is anyone keeping track of medications being taken by stroke patients? Apart from myself, I don’t think so.
Many will accept the risk of suicide if they even know of it, but few would want to suffer sudden death.
I have never suffered from depression. I have always been upbeat and articulate. I have had two instances of ‘points’ where it would have been nice to have had someone to talk to.
In each instance, I have never been offered any form of counselling.
In 1988, I found myself in a huge Glasgow hospital, when a man gave me Imipramine. I became distressed very quickly and he made a good decision to take me off it; he said that Imipramine can cause severe anxiety and he noted, wisely, that suddenly, out of nowhere, I had ‘vague suicidal’ thoughts.
The second time this happened, was when I went to the surgery with upset about my partner’s drink driving charge.
No counselling was offered.
A psychiatrist was contacted from the nearby mental hospital.
He put me on Seroxat almost straight away.
When the gp ignored his advice to switch to Fluoxetine, and vague ‘suicidal thoughts’ became real ‘suicide’, then I had a problem.
My ‘normal brain’ had been shat on twice because psychiatry did not know what to do with me, apart from give me pills.
After all this, it was suggested that maybe a ‘behavioural approach’ should be approached. I was so traumatised, so catatonic with distress, that someone thought, maybe, I should have someone to talk to.
A young woman screamed into my driveway, a few months later, and I told her that drugs had caused me to almost take my life, twice. In my lovely house, with a lovely daughter and a partner flying air ambulance and scheduled flights to the Outer Hebrides, she snapped her book shut and said ‘I can’t help you.’
I never saw her again.
So, the lesson today is, don’t ever, ever, ever discuss your private life with ‘grey suits’. I have a wonderful letter from the MHRA, when I told them all about all this.
I could not accept two instances of nearly being destroyed by ‘suits’ and drugs and my UK regulator’s letter was so naive, so stupid, so full of denial, that it left me reeling with abject disgust.
It was said we have gone back twenty-five years.
My life is now private. Never again, will I share any thoughts that were important to me with anyone, ever again….. I am now my own person, I have learnt the lesson, do not discuss… And chuck all pills in the loch where they deserve to be.
“The triumph of marketing over science”, according to one researcher, is what the popularity of SSRI anti-depressants represents. Dr. Healy, your book is not the first to reveal the duplicity of the pharmaceutical industry. At one time, selling placebos and misrepresenting their efficacy would have been a huge scandal. Isn’t the job of the FDA to deal with the marketing of placebos as anti-depressants in the US?
Yes this is `common factors’ research (Miller, Hubble et al). Technique or particular modality has been found to be less significant than the quality of the therapeutic alliance (and other `extra therapeutic’ factors).
If only they were placebos. They’re not. To a significant degree, they’re poison. They are well aware of the suicide issue – black box warnings etc.- but the physical toxicity causing death by pulmonary embolus, prolonged Q-T interval, haemhorrhagic stroke, malnutrition and dehydration especially in the elderly are written off as “natural” causes of death.
Poison is perhaps somewhat of an exaggeration. We give rat poison to people all the time, and botolinium toxin occasionally, as examples, so in the sense of ‘poisonous to some’ while ‘possibly beneficial to others’, perhaps. If it’s meant as ‘evil beyond evil’, I don’t know.
I rarely start SSRIs, I continue or restart PER PT REQUEST, but I have two patients with psychotic depression I just started on an SSRI and an atypical. One in particular is suffering tremendously. I’m contemplating whether to think about ECT, but do you feel I’m poisoning this person? I believe SSRIs do have benefit in severe MDD, isn’t that what the studies show? I asked and never got an answer what is the truth beyond all the hype, but I believe in this scenario this is the correct thing to so. It’s a very serious condition and difficult to treat and if some genius can come up with a magic solution, please do. I’m following accepted practice and trying to help suffering people, not ‘poisoning’ anyone. I don’t think we need such inflammatory language.
On the issue of how to treat psychotic depression, companies making SSRIs had concluded in the 1980s that these drugs did not work for melancholia or psychotic depression. In trials for severe depression TCAs like clomipramine or amitriptyline beat SSRIs every time. In any depression with raised cortisol SSRIs are likely to be ineffective.
The “studies” have not shown SSRIs are good for severe depression. These marketing exercises recruited mild to moderately ill people but excluded severe depression for the most part. No specific effect for SSRIs could be shown at the milder end of this mild to moderate spectrum. It was at the less mild end that some effect could be shown.
As regards the word poison, we desperately need to be able to recapture this word and make sure everyone realizes that all drugs are poisons, especially prescription drugs which are on prescription because we have every reason to believe they will turn out to be riskier than alcohol or nicotine etc.
See We need to talk about doctdors. Saying avoid the word poison plays right into Pharma’s hands. In an expert report if I used the words every drug is a poison, lawyers for the company will go out of their way to get this struck off as prejudicial against their client.
A quick response to DH and the doctor he’s replying to: I had severe depression with psychotic features in 2008. It wasn’t touched by Citalopram or Sertraline, and it was 2011 before I was well recovered. And I’m still stuck on the bloody Sertraline which knackers many aspects of my life (on my psychiatrist’s advice, I switched to Duloxetine for its better side-effect profile; I was horribly ill on it — having stopped it suddely on Saturday [it was an emergency] I really don’t know what I do now). I think that what made the difference in terms of recovery, actually, was my wife’s determination that I should recover, my friends’ and colleagues’ very real kindness, and the help of some really focused, intelligent, thoughtful, honorable and well-trained therapists. In retrospect, I wish I could have had somewhere safe to go to be looked after for a bit, and a high enough dose of a TCA to get a decent remission on a sensible timetable (like within 9 months, not 2 and a half years).
I think a critical mistake is happening here.
Ssris are not placebo.
We swallow a chemical compound, and I don’t know what’s in it. Is the recipe available for us to look at?
We, perhaps, think that swallowing this pill is doing us some good.
We go on swallowing this capsule for months, years, thinking that this is a good thing to take because we have been persuaded to do so.
But on, ceasing to take it. the placebo rears it’s ugly head and up to fifty extraordinary imbalances start to take place. Not slowly, not one after another, but all together and I defy anyone to maintain a life with up to fifty factors going on that make normal behaviour untenable.
Placebo is the current buzzword.
A silent and deadly transformation is taking place within your mind and/or body. It is insidious, it is hardly recognisable, but deep in your brain/gut a disease is operating which has been planted
The disease is put there by the drug. We are ingesting a compound, then a serum, and we have no idea what is in it.
It’s a bit like Lymes disease. Bitten by a tick, and all is well, until all bodily functions shut down and mental faculties disassemble.
This is then an emergency. There is a tropical disease hospital for Lymes disease.
There is not a hospital for ssri withdrawal syndrome……..planted in our bodies, which has no means of recognition……
Ticks are prevalent, in Argyll, I am always crawling with them, off the bracken, off the dog, but a similar substance put into my body, which duplicates the same odious and nasty and almost fatal reaction, is only worse because ticks were not invented.
GSK have never said their drug was a placebo, and for once, I agree with them….
Far more sinister……….
Tick juice is natural, a bloodsucking, monster of insects…..Seroxat serum was invented by humans. There is a big difference…..I ingested it, I was fatally wounded. I know that 0 – 6 weeks with a rope around my neck was created by humans……..placebo is unnacceptable psychiatric bull..cause and effect..simple…
Get the bite…..dead in weeks….simple…..
So. While we are all waiting around for the evidence base for which therapeutic approach is better than placebo, what do we do with the distressed, possibly frantic, person who finds their way to this site hoping for something to help them get through their medically induced problems? Someone brave enough to question the medical orthodoxy and start to try and find their own way to health. We can all discuss how many angels can dance on a pinhead or some other pleasingly abstract concept. That will be about as useful as discussing all the uncontrollable variables involved in doing research on two people who are unique interacting with each other in a unique interaction in which one is seeking help and the other is trying to provide it. Of course, if you make that the only way such interactions can be judged (RCT’s) then you can spend your whole life (and several more if you’re Buddhist) avoiding committing to one therapeutic approach or another. In the meantime the hapless visitor to this discussion will be helped not at all and may even go away discouraged and stop seeking the help they need. Result!
I think you just do your really difficult, important job, as a professional and a human being. Different things will work for different people. CBT-based therapy works wonders sometimes. So does most every other kind of therapy I’ve ever heard of. I can’t get too worked up about controlled studies comparing one therapy with another, because once you reduce a therapy to a standardized “intervention” that is Exactly The Same no matter who is in the room, you have probably killed it off.
At a certain point long ago, “Haphazard Eclectic Therapy” literally saved my life. It included a few philosophies and a grab-bag of drugs, some OK, some lousy. Ordinary caring and common sense probably played a much bigger role than most doctors would dare admit. So, “HET” might not do much for me nowadays, but I would never, ever knock it. Why not? Because I’m still here, and grateful.
In the same way, every drug mentioned on this blog, even Paxil/Seroxat, has been seen as a lifesaver by somebody somewhere, and the magic words are probably “especially at first.” My hunch is probably none of them should be taken for life or your body will find a way to resist the effects. And eventually, maybe, to resist happiness itself. But if someone is taking them short-term in a crisis and they help buy some time, it’s not for me to judge.
For those of us struggling with the fallout from years of psychiatric chemotherapy, there are no easy answers. I think unfortunately David is right that once treated you can’t be untreated; or as they say in AA, once you’ve been pickled, you can’t go back to being a cucumber. Like you, I feel the pressure to find solutions, for myself and everyone else. The various internet boards are jumping with all kinds of ideas, from yoga, to running, to fifty different herbs, amino acids and what have you, some of which might actually work, to “temporary” use of a whole range of prescription drugs to help you wean yourself off other prescription drugs.
God, I wish someone had solid answers I could trust! One of my hopes for RxISK.org is that we can start to find some answers … or at least some hunches that are well-supported enough that someone can test them out in an organized way. In the meantime, I’d much rather deal with a concerned person who says “I don’t know … let’s try XYZ,” than with someone who has a “blockbuster” cure they insist will work for everyone.
In the meantime, we got a few things to say to the Frantic Person: It’s not your imagination. It’s not your fault. You are not alone. Believe yourself, because we believe you. Those count for something.
Perhaps if I had used the word “toxic” it might have been found to be more acceptable because it is perceived as a milder, namby-pamby version of poisonous. All medications are tiny doses of poison. Given enough, all have the capacity to kill. “Tout est poison, rien n’est poison, tout est une question de dose.” Everything is poisonous, nothing is poisonous, it is all a matter of dose. — Claude Bernard, Pathologie expérimenta1e (1872)
It is distressing to me to find so many psychiatrists today who either never learned about or dismiss all of the older antidepressants that worked wonderfully for the properly chosen patient. It is almost impossible to get anyone to recognize that there is a form of melancholia that responds almost immediately to the MAOIs. Reluctance to use them is based on almost total ignorance of their supposed “catastrophic” response to tyramine, a grossly over-emphasised hazard. The TCAs, sometimes in conjunction with the MAOIs, or BZPs in small amounts, also with the MAOIs, believe it or not, can have superb effects. When I hear, “What am I to do?” my first reaction is to diagnose the patient appropriately. Are you really dealing with a depression or something else? Have you had a complete physical examination performed first? Have you spent time talking with the patient about history, family history, recent events, environment, family issues etc.? Kendell in the 1970s determined that the average psychiatrist took less than 10 minutes to reach a diagnosis. Unless someone is floridly psychotic and violent, that is a disgrace.
General medicine and psychiatry are both in need of a complete overhaul and a return to the development of clinical skills. It is difficult to accept the, “I don’t have time” excuse if one has entered a profession that, by its very nature, demands that time be spent on the patient; time longer than is required to write a prescription.
The criticisms of medicine in general and psychiatry in particular have been around for a very long time as well as the ignorance of the general public, understandable given the inaccurate pap it is fed.
“According to the estimate of a prominent advertising firm, above 90 per cent, of the earning capacity of the prominent nostrums is represented by their advertising. And all this advertising is based on the well-proven theory of the public’s pitiable ignorance and gullibility in the vitally important matter of health.”
— Samuel Hopkins Adams
‘The Fundamental Fakes’, Collier’s Weekly (17 Feb 1906). Reprinted in The Great American Fraud (1907), 55
“Dissections daily convince us of our ignorance of disease, and cause us to blush at our prescriptions. What mischief have we done under the belief of false facts and false theories! We have assisted in multiplying diseases; we have done more; we have increased their mortality. … I am pursuing Truth, and am indifferent whither I am led, if she is my only leader.”
— Benjamin Rush in Medical Reform; a Treatise on Man’s Physical Being and Disorders (1847)
Plus ça change, plus c’est la même chose.
Don’t know if others have seen or about to see `The Four Things Drug Companies Don’t Want You to Know’; am episode of the US studio audience television program `Dr Oz’ which screened in Sydney today. One of the guests was John Abramson, author of `Overdosed America’), there was reference to the initiative `Pharmed Out’ (in the spirit of David’s current text!) and `Dr Oz’ himself was EXTREMELY forthright and critical (much more than I would have thought likely or even possible under the circumstances) about the disturbing questions this multidimensional topic suggests. So much so that I wondered for a moment whether `Pharmageddon’ had been the inspiration for the program! Also a heightening fillip in light of the inertia and lack of interest which is generally so strong (and as discussed recently here).
Thank you Johanna. I agree with most of what you’ve said and the courage you have shown in saying it on this thread with so many naysayers giving their grey cells a gentle workout.
Rxisk is an essential and valuable step in collecting the evidence needed to tip the balance against the might of Pharma. My concern is that for the people seeking not only the forum to report their experience but also an authentic place to seek guidance on how to manage their medically-induced suffering, there are many more questions than answers. I realise this may not be David Healy’s aim in setting it up but, inevitably and frequently, people are going to find their way here, and they will remain mystified about the right way forward, and may end up in the hands of the very charlatans you mention.
Thank your for you article, and your book. I am a former user of Prozac. I took it for more than 10 years for OCD. After getting metabolic testing done it was discovered that I not only had severe deficiencies in Zinc and B6 but that my liver enzymes were elevated 6x higher than normal. I had a liver biopsy that showed scar tissue and damage. I started a compounded vitamin and mineral supplement and was weened off of the Prozac. It took 6 mos to get off the Prozac and it took an additional 2 mos for my liver enzymes to return to normal. I found that replacing the deficient Zinc, B-6 and taking the amino acid Methionine did as well, if not better at treating my OCD than the Prozac. I later completely recovered from OCD by retraining my brain using neuroplasticity based therapy. I am now anxiety free after 20 years. Unfortunately, after quitting the Prozac I encountered many new problems… my thyroid levels dropped, my hormone levels dropped and I encountered emotional anhedonia, genital anesthesia and complete loss of sexual libido and function. Despite being told the sexual blunting while taking the drugs would go away after quitting I wasn’t prepared for complete loss of feeling and function. Even after supplementing natural thyroid and hormones to their normal levels this has not improved. I am one of more than 3,000 know cases of what has become know as PSSD (Post SSRI Sexual Dysfunction). It has been 5 years now and I have not recovered and the MDs and drug companies unfortunately choose to believe it is not real. Visit SSRIsex@yahoogroups.com and you will find thousands of us that know that it is real and are desperate for a cure.
Dear Healy, my life was saved by SSRI’s. Your statements are wreckless and baseless. I was bed bound for 3 years, with burning pains in every joint of my body. Prozac was just being released. I could only stay awake long enough to take a shower and eat. I slept at least 18 hours a day. The joint pain was excruciating. And I cried and wanted to die every day. I would have killed myself 25 times over by now. I was so weak I could hardly hold up a paint brush. Prozac eliminated those symtoms, and I went on to get an IVY League Degrees, and became a well known artist. If I stop the SSRI, the same symptoms come back in 1 month. CBT has been touted as a cure all by those who peddle it, but the system can be learned by a dim witted chimpanzee in 30 minutes. I know, my sister sent me to one of the best centers in Connecticut USA, for a year, and I just stopped going 6 months ago. The toolbox of a CBT therapist is about the size of a matchbox. My psychiatrist would need a truck to carry his psychological tools in, and that does not include medication. Of course a misbehaving child does not need medication thrown at them, which happens all to often. Give the conspiracy theories a rest. Are way too many on SSRI’s and Ritalin? Yes. But thowing the baby out with the bath water as the other poster notes shows utterly obtuse thinking. Need money for that next grant do we?
I prescribe SSRIs and hope I have helped some people with them. But I think this is an accurate description of the last 25 years. These drugs are less effective than older antidepressants and the evidence shows more lives lost than saved on them and up to one in twenty becoming suicidal on them. Are you part of the camp that says we should have no warnings because these would deter people from taking these drugs?
Dr. Healy, how do you figure out which people to prescribe SSRIs to, if there is no evidence that they work on the more deeply depressed people? Do you prescribe them for something other than depression?
Most people who come to me are on meds to begin with so the issues are more trying to undo problems. Otherwise SSRIs are more useful for instance for OCD than for melancholia
This article is only scratching the surface. I was genotyped and discovered the very meds prescribed to me not only do not work, but can damage. We should be beyond blindly throwing chemicals at someone.
Like other posters, I also discovered that my “Psychological problems” were based in the physical. Mine were genetic variations and by working with a geneticist, I was able to discover nutrients I cannot metabolize and how to take others which compensate. I am 80% improved because the root cause was discovered.
Much harder is undoing the years of being told I was mentally ill and would be so for life. That is much harder to undo.
Dr. Healy, please continue your work.
Hallelujah! Excellent! This should be required reading for everyone contemplating using SSRIs. Thank you for this touch of reality.
I have lost count of clients who have come to me suicidal from their SSRI and told by their doc it is normal.
One also has to wonder at the number of undiscovered bipolar spectrum disorder folks who are set off on a life of real misery by being prescribed an SSRI by their family doc rather than getting their mood history of cyclical depressions that started in teens, an issue that cannot be teased out in one 7-minute appointment. Personally, I believe this is a class of drug, along with benzos, that should ONLY be prescribed by psychiatrists.
One area that would make fascinating research is how many people are prescribed SSRIs by their doc to “make them shut up and go away” because the doc doesn’t have the time to uncover what the actual issue is, or worse, thinks they are looking for attention. I am working with 2 women currently, both later middle age, who showed my their (unfilled) scrips for an SSRI. One went to 4 docs saying she thinks she has a thyroid issue, one of which was so rude to her, I suggested she report him to the administrator for unprofessional conduct. Both women had a large number of symptoms of hypothyroidism (one had gained 60 pounds in 4 months on a nearly Aktins diet) yet all the docs involved refused to test even the TSH. Upon testing, both women had wickedly high thyroid antibodies. They are now receiving proper medical care and thriving, and neither needed an SSRI to do do.
Personally, I use food, a few supplements, and targeted amino acid therapy for my clients, and sometimes suggest they get some type of talk therapy as well.
the following is interesting reading/watching:
Blog by Thomas Insel, director of NIMH on this subject:
Scientific article behind all this:
Despite your claims that antidepressants cause suicide, the evidence is lacking. There is great controversy as to whether antidepressants statistically increase the risk of suicidal ideation, let alone the risk of actual completed suicide. Your remarks about CBT are curious as this is perhaps the best scientifically studied psychotherapy. I’m not clear what you are suggesting as an alternative to CBT. Psychoanalysis? Old-school insight-oriented therapy? Or should psychiatrists just give up practicing all together? What exactly do you dole out to your patients? Herbs and fatherly advice?
If the evidence is lacking, why when asked can your drug cause suicide are companies legally obliged to say Yes. This issue is settled – if there is a controversy its like the ones whipped up by the tobacco industry.
CBT is very useful, as is EMDR and interpersonal therapy.
Personally, I wish there were more psychiatrists. I refer about 30% of my clients to one for a proper diagnosis. I know people who have to wait weeks to months to get an appointment with a psychiatrist who isn’t a pill pusher (and unfortunately too many are a medicate first, ask questions later type).
One huge issue, IMHO, is who funds mood medication studies and which results actually get reported and which results are suppressed.
For an abstract on the topic of SSRI and suicide: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC193979/
and the article
and one on Dr Felice Jacka from Australia
Speaking of “herbs and fatherly advice,” I just heard a ringing endorsement of that particular treatment. It came from a panel of four Iraq vets and one veterans counselor, himself a Vietnam vet. (Brotherly advice, from fellow vets of your own generation, earned high marks as well.) You can guess the herb. They were unanimous: it relieved their emotional pain much better than the VA’s drugs, with fewer bad side effects. Plus which, added the counselor, it gets the guy talking, which is the most important thing.
What should you offer, as a doctor, to people in some form of distress that matches the description of “depression”? All of the above, I think, depending on the individual. I am no expert in medical marijuana, and might not ever try this approach myself. But I had to admit, it makes no sense to dose these poor guys with Seroquel, Ativan, Paxil and OxyContin, then tell them marijuana is much too dangerous and not proven effective. That’s just crazy.
I think you’re being disingenuous. I doubt you believe everything contained in drug pamphlets. The FDA is notoriously cautions. Here’s a quote from Forbes:
“Since it was issued in 2004, there have been some critics of this warning. For one thing, not only did antidepressant prescriptions for young people fall after its release, but the suicide rate in kids seemed to jump. In 2007, a study was published that tracked the rate of antidepressant prescriptions and suicides in the U.S. and Netherlands, in people under 19. Antidepressant prescriptions in both countries fell by about 22%. In the Netherlands the suicide rate rose by 49% over two years. In the U.S. it increased by 14% over a one-year period, apparently the largest since the government started tracking it in the 70s. This research suggested that the FDA’s warning (or original research) might need to be reevaluated.”
I don’t doubt that these medications may cause some suicidal thoughts in some people, but most of the evidence suggests that they actually decrease the rate in a greater number. Every drug has risks. To demonize these drugs by focusing on a disproven “fact” is unfair to people who might benefit from these medications.
You say that “all drugs are poison” but this is so broad as to be meaningless. You also admit to prescribing SSRIs. What exactly are you advocating? Aspirin and Tylenol are poisonous if taken excessively but they do great good in the right dose. Water can and has killed people when taken in large amounts. So everything that people ingest can be poisonous. You seem to have a lot of contradictory positions. Can you clarify any of this?
Dr. Healy is pointing out the problems with just prescribing a drug without first looking at the person and doing a thorough diagnosis. Many of the symptoms of depression are also symptoms of real medical problems. The DSM actually tells psychiatrists that they should do a thorough exam of the endocrine system before prescribing these drugs.
Unfortunately, this logic is ignored by too many MD’s and psychiatrists.
Thanks for your work Doctor.
Sir William Osler: “The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.”
The older I get and the more experience I have, the truer this statement becomes. We have an armory , fairly small, of perfectly satisfactory psychotropic drugs that have been around for over fifty years. We know which type of patient they work for and for which they don’t. We know and can inform patients of their common and not so common adverse effects thereby obtaining the required informed consent from the patient. Yet we have reached a point of “flavor of the month” treatment that, in an indirect way, has brought about very poor diagnostic abilities in newer psychiatrists.
“The good physician treats the disease; the great physician treats the patient who has the disease.”
JTD asks what you dole out :Herbs and fatherly advice? Actually, in may cases herbs and motherly advice is the best medicine. The overdiagnosis of depression is beyond alarming. Many times the person is not depressed but simply going through a bad time such as we all experience as part of life’s “slings and arrows.” I have no problem in such cases suggesting chamomile tea at bedtime (or warm milk although it needn’t be warm), exercise, meditation, massage, yoga, a little self indulgence if affordable, whatever appeals to the individual. If the patient wants to try valerian or melatonin for sleep, as long as there is no medical contraindication, go ahead. All is in the context of talk therapy otherwise known as indirect advice, motherly or otherwise. The “secret” is listening carefully, diagnosing accurately and caring.
ICT, I beg to disagree with some of what you say. Most people are quite hesitant to seek out mental health treatment for a variety of reasons: the stigma, the cost, the effort, etc. Those people who do seek help usually have more than garden-variety transient problems. While depression may be misdiagnosed often, I think the research shows it is woefully underdiagnosed. Primary care physicians often want to ignore the problem or don’t know how to diagnose it. I do agree with you that alternative treatments are preferable to medication but sometimes aren’t practical as the sole treatment because of patient acceptance, insurance limitations and other factors.
I agree Irene, I do too. But if I feel it is warranted, I will also test platelet catecholamines, whole blood histamine, fatty acids, the MTFHR mutation, intracellular copper/zinc, and so on. It is amazing how much bad mood is influenced by nutrient deficiencies or imbalances. As I tell my clients: crappy food = crappy mood.
I am new to your blog. Can you point me to some information about what’s involved in stopping SSRIs after many years’ use–or evaluating whether it’s wise to try?
I am thinking of my 23-year-old son with Asperger’s and ADHD, who has been on Prozac since he was 8. I trust the experts who diagnosed him, separately, with these disorders. The Prozac was prescribed by another doctor for depression, which I wasn’t so sure of, and social anxiety, which seemed right. He also takes dexadrine, and Welbutrin to offset the sexual side effects of Prozac.
Prozac did seem to help a great deal with the meltdowns he used to have and allowed him to remain in a mainstream classroom. But now I wonder if he still needs it. He has become obese and unmotivated over the years, but obesity runs in the family and lack of motivation goes with his disorders, I think.
Jennifer – under Research papers see DBM papers on stress syndromes and stopping Antidepressants – DH
But wait, there’s more: A recent March 2013 post by saveourbones.com featured the results of a 2007 Canadian study that determined the risk factor for fracturing bones was doubled among those using SSRIs.
According to the Canadian study: “Functional serotonin receptors and the serotonin transporter have been localized to osteoblasts and osteocytes, and serotonin seems to modulate the skeletal effects of parathyroid hormone and mechanical stimulation.” Wonder drug, indeed, as in I wonder how this class of drug got FDA approval.
I should have said that of course, step one is to make sure that the patient isn’t experiencing a physiological problem. I agree with your comments and I would add a few.
To JTD: I am fortunate to live and work in Canada where every resident has the right to medical treatment at no cost – all being paid from taxes. It is, I’m glad to say, easier for people to seek and receive treatment. I have a good relationship with GPs who are able to refer with no cost to the patient. I’m not sure that I could practice in an environment that limited the individual’s ability to seek and receive medical treatment. We may also have an added advantage in that, because of the way payment is set up, no-one needs to know that the person is receiving psychiatric care, thereby avoiding the perception of stigma. Scrips for blood work etc. are not indicative of anything other than normal medical care and very strict rules of confidentiality protect the patient. I do acknowledge that nothing being perfect, the information that an individual is receiving psychiatric care can leak out, against legislative rules, but then we simply try to do our best.
Sorry; lots of problems with the piece. I have seen SSRI’s be of considerable help to the small # of pts who are in =fact= neurobiologically depressed, meaning that their autonomic tilt is stuck in parasympathetic imbalance, and the only way to get them out is to increase synaptic serotonin levels.
Likewise, short-term use (six months tops followed by =observant= de-titration) of SSRI’s can provide a platform for so-called “cognitively depressed” pts who accept the nature of their problem but cannot maintain motivation to stay in CBT or other more advanced psychotherapeutic treatments because of their learned helplessness.
I was also disappointed to see no mention of mis-diagnosing bipolars who show up in the ER or doc’s office in a temporary state of severe CNS depression. When such pts are handed a script for an SSRI and left un-assessed thereafter, many go more manic or hypomanic than they would have otherwise. Some even reach semi-permanent excitotoxicity leading to lingering — even permanent — remodeling of the limbic system and hypothalamic-pituitary-adrenal axis (the trigger for the “fight-flight-or-freeze” system in the ANS).
I really wish people would read Bruce McEwen’s, Joseph Wolpe’s and/or Hans Selye’s work on what I have noted above, or even just Daniel Siegel’s =Mindsight=. The professional often needs to be reminded of what he forgot in pre-med.
I have to say with deep respect of David’s expertise on SSRI’s and his brilliant work in Pharmageddon… but his comments on CBT seem innacurate. There is no danger on recovered memory and regression in CBT. It is an effective therapy but as anyone will tell you the single leading component in effective therapy is NOT the therapy it is the therapeutic RELATIONSHIP. Study after study has proven the latter point.
Will take issue with the totalism here. I never, ever =had= a CBT therapist. I got it all from workbooks (e.g. McKay et al, Burns, as well as gobs of DBT, ACT, MBCT and MBSR books). And it worked =well=. But my sense from observing therapeutic work is that it’s a pretty even combination of therapist-patient “fit” =and= method.
Left-hemisphere-dominated (LHD) pts. seem to do better (at least initially) with the more “wordy” REBT and CBT; right-hem-dominated (RHD) pts. with the mindfulness meditation-based therapies, though DBT is often a must for RHDs if they are emotionally overwhelmed. LHD pts. are more typically process- and method-oriented; RHD pts. are more typically in need of supportive re-mothering and “good fit” with the therapist.
In =both= cases, however, it’s about getting the =patient= a caring, compassionate, functional, empathic, patient, emotionally attuned and attuning inner parent by densifying the neural down-linkage from the pre-frontal corteces to the amygdala and other mid-brain cell bundles in =both= hemispheres. Dan Siegel, Dan Stern and Alan Schore at UCLA are the real go-to guys on all this right now.
David, I’ve just discovered your blog and am looking forward to reading your books. It is SO refreshing when someone with your experience challenges the medical system. Thank you.
I live in New Zealand.I have lived and breathed medicine for the past 30yrs. I gave up my GP practice 3yrs ago to have more time to explore what I am now doing . I am fascinated by the power of the mind. In my tool box now are mindfulness work, NLP, hypnosis etc. I always used to think of myself as a wholistic GP…open to question. I lived most of my childhood in India and many other places around the world so my mind has been opened to different ways of doing things. However, despite my wholistic approach I still dished out quite alot of fluoxetine thinking it was necessary….. my teaching being it was the combination of that & psychotherapy that did the trick. Since doing NLP and hypnosis and being challenged by one of my teachers ( Michael Yapko) Ive been working with people in a whole new way. Its exciting to see people after a 2 hr session of NLP and hypnosis come back a week later eg saying that although theyve been on 40mg fluoxetine for yrs they realise that the label of depression that they were given mearly invalided them and held them back from living . It never ceases to amaze me how after 2 hrs their label can be gone for ever ! and they can now see what they experienced as the normal ups and downs of life ! I recently worked with a woman who wouldnt get ” fixed” by NLP or hypnosis and so I worked with her with mindfulness and hey presto she is back in the driving seat of her life and no longer feels a slave to her emotions.
This approach takes alot more work on my part……….alot more effort……..however it is so rewarding. Kind Regards Caroline Wheeler.
I was given these prozac for pmt , and after 3 attempts to stop the drug I went into melt down , also made my anxiety worse , I never sufferd with any heart problems before taking prozac , then for the past 15 years I’ve suffer with arithma . It started to make my life he’ll , became house bound , couldn’t work , now been off them for 3 months and starting to have the down side
after discutinuation , have weend off this time , but I am telling you all , I have been left with a heart condision now , and may need a pace maker , I am 41 years old . And if I would of known what prozac has done to me my family and my health , I would of never takin them . I’ve got a long road ahead of me , and I took them while pregnant becouse when Tryed to stop I was ready to slit my wrists . My son was born with breathing problems . So theses drugs are not good for you and they can feel like they work , and proberly will , but after time they won’t work then you will need more and more . Then try coming off them , to say these drugs are safe to use is delusional . It’s a money making machine ,go do your reaserch on these horrid life changing pills before you take them . Becouse once your on them it will ruin your health in the long run . And they are addictive , but mr dr won’t tell you that .
Wow! I am eating this up. I was part of a research study at the National Institute of Health in 2006. First they had to detox me from the Paxil and the Benzos, and Ambien. I became very sick. No appetite, over the top BP and P, malaise, inability to do anything but read. I was in-patient and resided their for 3 months. When my BP hit the 200’s over 100’s I told them I could not do it anymore. Of course, they tried to get me to hang in there, but I refused citing stroke risk. Ironically, my profession was a RN with a specialty in Psychiatry. The study was regarding the treatment of Major Depression which officially has been 30+ years at that time with Ketamine which was administered IV. I believe it has been existent since childhood. I am now 63y/o. Tested Positive on the Dexamethasone Supression Test the 3x it was given to me. Now my current Psychiatrist regards me as Bipolar based on my reaction to most SSRI’s. Extreme agitation, hypomanic behaviors. I am never hypomanic off antidepresants. I am currently taking Cymbalta 20mg/day for off-label use treating musculoskelatal pain. It has not gotten rid of all my pain, but has been effective, especially shin pain. I am a small woman 5’2″ tall and 112lbs currently. I’ve been following this regimen for about 8 weeks and note some restlessness at times, but no true hypomania to date. However, I am Benzo and Ambien dependent. I worry about the effects of all these drugs as I age. How will I ever get off Clonazepam and Ambien safely? All this looms in my future. When I was working I could afford the talk therapy, but now I am limited to 15-20 minutes Medication review. Reading all this has been quite fascinating and in some respects scary to me. I was declared Medically Disabled through the NIH about 7 years ago. I believe I did best when I had the combination medication and talk therapy. I have recently found a counselor that accepts sliding scale so perhaps that will help. Thank you for letting me vent, and for this site. By the way, for 30 years I was followed by the same psychiatrist. I thought he cared. But the minute I was uninsured he refused to see me. That was a major trauma to me. I find it interesting these doctors talking about deeper testing of essential elements. I wonder what such testing would reveal about me. I do know one thing. I was advised to have ECT treatment. I was so messed up I agreed not thinking through that how in the world would ECT help me when I was on several Anti-convulsant medications. No one tried to dissuade me. I never had a effective seizure, but since I have felt blunted.
I would try to locate a psychotherapist who is certified (or at least well-versed) in one or more of the following: dialectical behavior therapy (DBT), mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), mind-body bridging therapy (MBBT), self-talk identification questioning & revision (SIQR), or acceptance & commitment therapy (ACT). There are also workbooks on most of these you can find on amazon.com.
All of them teach simple techniques that chill out the amygdalar-hypothalamic-pituitary-adrenal axis that beats on the autonomic nervous system to produce the agitated sensations of traumatic stress. There’s no real need to continue suffering is you know where to go for help. Really.
RG, Psy.D., The Beautiful Coast.
Thank you, Not Moses. However, I do not think any of these type experts would be affordable to me on fixed income. Will write these down, though and bring them up at counseling and next Psych appointment.
Will also look up book and workbooks on Amazon.
Thank you again
One thing I did not mention is that in the past two years I have developed Agoraphobia. I think that these have developed due to my not having access to some sort of skilled talk therapy. Also possibly due to the continual assault on my brain by pharmaceuticals as well as the ECT since 1979. My long-time psychiatrist 30+ years never suggested ECT. I am quite confused over what has happened to me in past few years.
I’m not surprised to hear about the medicinally induced confusion. One of the great things the mindfulness-based therapies do is provide a mechanism the pt can use to re-remodel the brain subsequent to drug induced remodeling. The workbooks are quite inexpensive. Sherri van Dijk’s =Calming the Emotional Storm= is an easy-to-understand place to start into it all. Stan & Carolyn Block’s, Thomas Marra’s, Sheela Rajah’s and Stahl & Goldstein’s workbooks are likewise easy to understand and highly effective. It’s up to you.
Thank you, again, Not Moses…you may not be Moses, but you are very wise. Will look up and order.
[…] Prozac and SSRIs: Twenty-fifth Anniversary […]
[…] Prozac and SSRIs: Twenty-fifth Anniversary […]
Prozac started it all the mainstream myth of serotonin imbalance.based solely on the fact that they noticed a increase in a few people’s moods from increased levels of serotonin,then concluded low levels caused depression.since it is impossible to test accurate basal levels of neurotransmitters in the brain who’s to argue.here is one of the problems lie every persons chemistry is diffrent higher serotonin lower dopamine and vise versa,and anywhere in between which makes us who we are as individuals.there has also been trials where they increased and decreased serotonin both increased positive mood.these systems should not be artificially manipulated with man made toxins the ammino acid precursors use is self regulated.made in the body and provided by your diet.The real problem lies in hpa axis dysregulation this causes disruptions in many body systems.you say i need an ssri causr my serotonin is out of wack funny dont remember taking any test just pure speculation.how about my adrenals or thyroid.more likely but no test thete either.The way the work is very damaging. disrupting reuptake with these poisons should not even be considered.neurotransmitters are keyed to be received by its corresponding synapse brain imaging has shown dramatic increase in firing at these sites causing premature death of nerve cells.to much serotonin can stimulate the hpa axis to push adrenaline and cortisol production this is your”placebo effect”if you feel energetic or an elevated positive mood within days of start of the meds thats what’s really going on.the brain tries to restore homeostasis to this false increase in serotonin by downregulating serotogenic messangers.the real culprit is dysregulation in the hpa axis to much toxic exposure to chemicals nervous systems overstimmulation over long periods of time.chronic high cortisol not a good thing man.
I was put on this stuff as a teenager, and off and on it for over 30 years. I finally read the book. The Emperors new drugs and stopped the medicines, all of them,2 years ago. Surprisingly it was not that difficult. I feel better. The CBT really helped me over the years, but the MD attributed nearly everything to medications.
I took AD when I was pregnant, and now I wonder if this is why I had to hold my son back in school. He’s now okay, but he’s in middle school, and finally doing well after getting a speech therapy. I sometimes have unexplained restlessness, esp. when driving. I feel as if I can’t stay still in the car while in traffic. My blood sugars come out consistently pre diabetic. I have no history of diabetes in the family, and have never been over weight. I wonder if it was the pills. Anyway, there’s nothing I can do now. I really think, overall, these pills do not do much good anyway, and maybe should only be rarely prescribed, if at all.
I wonder what you make you make of CAMH ($CAMH!) now. For valid criticism they fired you, while their “science” looks increasingly like drug and hardware-based quackery pimped by Dentsu-driven propaganda. There’s no real evidence for rtms but Daskalakis implies it might have prevented Gernanwings. Ivan Silver’s “education” department draws up highly technical letters advocating it, for members of the public to sign and mail in. This seems fraudulent. And your old pal David Goldbloom has just written a piece of narcissistic crap based on a week in his wonderful life in which he describes a depressed patient’s suicide principally in terms of his (Goldbloom’s) reaction – with a lot of speculation about serotonin, spinal fluid and spinal taps. The patient suddenly leapt to his death off his balcony. Was he on Prozac (c)?! Keep it up!
Very dangerous drugs. It was the biggest mistake of my life. For anyone taking these drugs who’s lucky enough not to have the serious side effects be warned. It could happen at any time and it will feel like being blindsided by a truck. I’m in my 3rd year off the poison pills and I’m still trying to recover. Akathisia/Rage/massive headaches /sleep disturbances/insomnia/body temperature dysregulation /weakness /numbness /vertigo/GI disturbances… All this in an intense form. I just had normal anxiety before being put on this poison. Good luck to the world. For those of you defending SSRI’s you just don’t know this can happen. Maybe your on them or came off them without issues. But it’s truly like Russian Roulette and each time is a huge risk. Dr Healy knows what he’s taking about.
Dr. Healy I have depression, OCD and anxiety and many other low serotonin symptoms (why I think it’s low serotonin symptoms? becouse drugs that increase it help with this symptoms -stronger the drug work on serotonin better the effects) like cold, pain sensitivity, irritability, no positive emotions to other people, low energy, sleepiness – all of this symptoms and OCD improve with serotonin drugs – the best of them was paroxetine. My depression is not in full remission on this drugs but I think SSRI’s are the safest drugs in long term (many people with OCD and depression must be on drugs for life – it’s sad but it’s true). I have tried many of other antidepressants – bupropion, tianeptine, agomelatine, doxepine, opipramol, etc. amitritpyline was the worst of all – many side effects and bad cardiovasular effects after only 2 weeks of use. I don’t imagine to be on this drug for life. SSRI’s not perfect but very helpful to many people and I’m glad that I live in this time when we have SSRI’s.
I continue to be distressed that so many patients and psychiatrists have come to believe that the SSRIs are the only medications available. Anything that comes with a strong warning of suicide should be regarded with suspicion. So few have ever tried the MAOIs that for specific types of depression are miraculous and effective within days. The fears about dietary issues are, for the most part, nonsense. There are very few items to be avoided and these are not typical of most peoples’ diet e.g. Stilton cheese, limburger, broad beans, Marmite, anchovies, certain drinks such as fortified wines. Even pizza with double cheese is fine. And they never came with a black box warning when they first appeared in the 1950s. I find it close to malpractice that so few psychiatrists even consider them.In over 30 years’ practice, I have not had one patient on MAOIs experience a hypertensive episode. Reported cases result from the addition of inappropriate drugs such as Demerol, not food or drink.
I have a few questions.
” No one knows how many new cases of depression there are per year partly because modern depression is a creation of the marketing of Prozac.”
Isn’t there a diagnostic criteria for depression? What does this mean?
You mentioned that suicide is triggered by SSRIs, but offer no data to back up this claim.
” There are probably something between 1000-1500 extra suicides in the US each year, triggered by an antidepressant – an extra 2000 -2500 in Europe.”
Sounds more like a guess than actual data.
Again a guess.
“There are probably between 1000- 1500 extra episodes of violence in the US each year that would not have happened without antidepressant input ”
Correlation does not equal causation. Do you have data to back this guess up?
“Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants ”
Can you elaborate on how SSRI’s are less effective than alcohol?
Diagnostic criteria are meaningless. They function rather like saying because you eat Fish of Friday you must be Catholic.
The post is not self-contained. If you’re prepared to do a little leg word you will see that the RCT data shows more suicidal acts, suicides and completed suicides on active treatment than on placebo. If you extrapolate by the numbers who have taken these medications you will likely figure that that the numbers I cite are an under-estimate.
The prime reason SSRIs get used is they are prescribed by doctors. If available over the counter for nerves they would likely not be used remotely as often as alcohol for nerves. Alcohol is a much more effective short term treatment for nerves than SSRIs. And SSRIs have no evidence for effectiveness in the longer term other than the evidence they mitigate the nerves caused by dependence and withdrawal. The key word here is effectiveness – not efficacy.
Almac Diagnostics is a member of the Almac Group, an established contract development and manufacturing organisation that provides an extensive range of integrated services globally to companies within the pharmaceutical and biotech sectors. The services range from R&D, biomarker discovery and development, API manufacture, formulation development, clinical trial supply, IXRS® technology (IVRS/IWRS) through to commercial-scale manufacture and companion diagnostic development.
We are a privately owned organisation that has organically grown over 40 years and now employs in excess of 5000 highly skilled personnel. Almac is headquartered in Craigavon, Northern Ireland with operations in the UK, Ireland, across the US (Pennsylvania, North Carolina and California) and in Asia (Singapore and Tokyo).