Largest Survey of Antidepressants Finds High Rates of Adverse Emotional and Interpersonal Effects

John Read
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Not long back in Melbourne after the ISPS conference in New York City. As a longstanding member of the ISPS Exec and editor of ISPS’s scientific journal ‘Psychosis’ I am obviously biased,  but it was pretty cool to be among 750 kindred spirits for five days. Have a look at the two thoughtful reviews of the conference by MIA writers Noel Hunter and Sandra Steingard – and then consider joining us in ISPS. Ok; advertising over!

Rather than write about my usual main focus of psychosis, I thought it timely to talk a bit about depression and antidepressants. My undergrad lectures on depression start with ‘This will be a short lecture. Depression is caused by depressing things happening – end of story.’ Of course I go on to talk about the various factors that make one person only a bit depressed and another very depressed after the same depressing thing has happened. (Including, of course,  the number of other depressing things that have happened prior to the latest depressing thing).

I try to get across the basic idea that there is not something called ‘depression’ or ‘major depressive disorder’ or ‘depressive illness’ inside people that causes them to feel depressed – the mistake that so many mental health professionals, encouraged by big pharma reps, seem to make. My favourite example of this silliness is research showing that suicide is caused by something called depression and that therefore the way to reduce suicide rates is to identify and treat (with drugs of course) people with this thing – rather than identifying depressing things and doing something about them.

Anyway, I thought I would make a small contribution to the discussion about how  coverage of the recent airline tragedy focuses so much on the supposed  ‘mental illness’ of the pilot and not so much on the possible role of antidepressants.  Of course we will never know the answer to these questions but it is important, I think, to combat the simplistic nonsense wheeled out after most such tragedies, the nonsense that says the person had an illness that made them do awful things.

So, just to confirm what many recipients of antidepressants, clinicians and researchers have been saying for a long time, especially the prolific David Healy, here are some findings from our recent New Zealand survey of over 1,800 people taking anti-depressants,1 which we think is the largest survey to date.

Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Agitation 47%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39%, and Feeling Aggressive – 28%.   If one had to imagine a combination of feelings most likely to increase the chances of a tragedy involving the loss of multiple lives it would be hard to do better than emotional numbing, agitation, aggression, suicidality and caring less about others.

Although we cannot know whether these findings are relevant to the recent tragedy it certainly seems that antidepressants do have a broad array of adverse emotional and interpersonal effects and that these effects are far more common than previously thought.  Of course an online survey runs the risk of attracting people with an axe to grind – but 82% of the respondents also thought that the medication had reduced their depression.

Given that recent reviews have found that these drugs are no more effective than placebo for the majority of recipients, we also tried to enhance our understanding of the placebo effect by  investigating which psycho-social variables were related to whether respondents thought the drugs had worked.2  We found that perceived effectiveness was significantly related to a range of non-pharmacological variables, including: the quality of the relationship with the prescriber, being fully informed about anti-depressants by the prescriber, holding fewer social causal beliefs about depression, not having lost a loved one in the two months prior to prescription, and – somewhat paradoxically perhaps –  belief in ‘chemical’ rather than ‘placebo’ effects.

It is worth mentioning that even a group of people who had accepted a biological treatment for their difficulties and had (mostly) found it helpful, did not unquestioningly swallow the ‘chemical imbalance’ theory of depression (and everything else) espoused by biological psychiatry and the drug industry.3  The most strongly endorsed causes were:  Family stress (90.8% ‘agreed’ or ‘strongly agreed’), Relationship problems (89.9%), Loss of loved one (87.5%), Financial problems (86.9%, Isolation (86.3%),  and Abuse or neglect in childhood (85.4%), with Chemical imbalance (84.8%) coming in 7thHeredity 12th, and Disorder of the brain 13th.

Finally, we gave participants ten possible reasons that prescription rates of antidepressants are so high (in 2013 the number of prescriptions in England – 53 million – surpassed the total population – 52.6 million). Among the more commonly endorsed  explanations were:  ‘Drug companies have successfully marketed their drugs’ (61%), ‘Drug companies have successfully promoted a medical illness view of depression’ (57%),  ‘GPs don’t have enough time to talk with patients’ (59%), and ‘Other types of treatments are not funded or are too expensive’ (56%). The least endorsed explanation for high prescribing rates was ‘Anti-depressants are the best treatment‘ (20%).

* * * * *

References:

1. Read, J., Cartwright, C., Gibson, K. (2014). Adverse emotional and interpersonal effects reported by 1,829 New Zealanders while taking antidepressants. Psychiatry Research 216, 67-73

2. Read, J., Gibson, K., Cartwright, C., Shiels, C., Dowrick, C., Gabbay, M. (2015). The non-pharmacological correlates of self-reported efficacy of antidepressantsActa Psychiatrica Scandinavica. doi: 10.1111/acps.12390

3. Read, J., Cartwright, C., Gibson, K., Shiels, C., Haslam, N. (2014). Beliefs of people taking antidepressants about causes of depression and reasons for increased prescribing rates. Journal of Affective Disorders, 168, 236-242.

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161 COMMENTS

  1. What I do not understand is if there is a biological cause for depression why don’t we have a blood test for it? Why don’t we know what a normal serotonin range is and then measure depressed people to see if they really are below normal? The blood test would then show if the drugs increase serotonin levels.

    I am not a biologist but I do know that serotonin is found in blood platelets so why is there no test?

    Also if you look at the side affects of anti-depressions you’d think you were looking at a list of depression symptoms.

    The only thing I really do know is that my congressman Tim Murphy wants to lock me up and forcibly medicate me because I’m depressed. Check out his house bill H.R.3717

    https://www.congress.gov/bill/113th-congress/house-bill/3717

      • That is SUCH EXCELLENT information – I am not being sarcastic, sorry, just a huge ‘click’ as to a possible connection (that is verifiable and legitimate) between chronic fatigue syndrome (leaky gut huge in that massive mess of an illness, now called ME by advocates) and mood states that is NOT ever looked at by physicians, except ENVIRONMENTAL ILLNESS doctors – amazing scientists that they are.

        It makes sense and will not cure everyone (healing gut, diet changes, etc.) of depression or mood imbalances but can be a huge beginning step on path to feeling better and as important – STAYING WELL.

        If you know that healing nutritional imbalances, clearing out candida and other gut infections (with medications, diet changes, nutritional supplements) helped make you better then anyone who is sane – as most are when in a feel good normal state – will maintain a healthy lifestyle to keep feeling good and staying well.

    • Well there is no test for it simply because neurotransmitters in the brain are hard to measure. For example, the closest thing you would have for a blood test of brain neurotransmitters is a spinal tap and looking at the cerebral spinal fluid. The only with that is the Blood brain barrier, which separates the cerebral spinal fluid with blood in the brain, obviously.

      Neurotransmitters cannot cross the blood brain barrier directly, mostly procurers like amino acids can. This is why the urine tests for neurotransmitters are inaccurate for measuring them in the brain.

      Then you are looking at different receptor sites and neurotransmitters do other things, outside of brain function. Like Histamine is used by the immune system by mast cells and whatnot.

      This is why you have side effects with the medications, because neurotransmitters are doing other things in the body too.

      • Excellent and thanks for that LoganBerman, trying to ‘catch up’ after years out of this quagmire. Had to, I am BP-1 and it was insane trying to understand, find natural or pharmacological aids to help when dealing with severe mood swings and mixed states.

        Lucky I survived, hope I have something to add to all this continued mess of a conversation and debate.

      • So how do you explain that rodent, which are deficient in serotonin signalling are perfectly normal in terms of “depressive” behaviours? Or the fact that creating animal models of depression is based on introducing persistent environmental stress combined with inability of the animal to escape it (learned helplessness) and not by giving drugs to reduce serotonin levels?

        That totally agrees with the psycho- and socio- explanations of depression, not with the “chemical imbalance” bs. Btw, there are no credible scientists who believe in serotonin theory. I happen to be a neuroscientist and though this is not my area of study I do go to conferences and know what people doing basic science know and think and this pharma propaganda is not even being mentioned. In fact many people are fed up with doing research based on the DSM and medical model because they do lead nowhere.

          • Yes, and she’s either not a good one or she’s really dumbing it down for the audience in that interview. Most of what she’s saying are hypothesis at best and the “chemical imbalance” is just straight bullshit. Also the stuff she says about drugs is just pure speculation based mostly on pharma PR.

            As far as I can see she’s not a specialist in mood research:
            http://carasantamaria.com/publications/
            In fact she never finished her PhD and is working as a science communicator so claims for being a neuroscientist are a bit, well, exaggerated.

            On FENS there are practicing neuroscientists who present the results of their work and even then by no means you should take it for granted (I’ve seen some talks that made me wonder how did this moron get to be a head of a lab). Still, the field as a whole is waking up to the fact that bio-psychiatry can’t inform neuroscience and is in fact a big obstacle.

      • You’re catching on! This is payback to Big Pharma who is a MAJOR supporter of DR. Tim Murphy. They gave him millions for his campaign and who knows how much in kick-backs when he was in private practice. I’d vote against him but he always runs unopposed!

        • What a monster! He has the almost comical audacity to claim to want to reduce stigma (How? By spending money in “educating” people.) when he does nothing but defame and stigmatize those he considers damaged.

          I believe there is an especially hot place in Hell for that creep where demons will put him in five point restraint and give him infinite administrations of ECT and put him on an endless IV drip of Haldol. For eternity. Yay!

          Btw, I’m writing a dystopian story in which the central villain is named Murphy. Just a coincidence of course. 🙂

  2. I believe depression has far more to do with one’s past, present, and future prospects of his/her life situation and with self-esteem than with any “chemical imbalance” in the brain.

    I’d also like to point out how Big Pharma claims their antidepressants need to be taken for 4 to 8 weeks before they become effective. What they fail to mention is that many people who began taking the drugs did so because they were in the midst of some type of crisis. After 4 to 8 weeks, the feelings of being in crisis may well have subsided on their own, or by having made positive changes, or through helpful actions such as receiving counseling.

    Furthermore, many of the immediate physical side effects that occur upon initiating antidepressants (headaches, nausea, dizziness, stomach problems, nightmares, etc.) tend to go into remission after 4 to 8 weeks, thus giving the patient a psychological boost from being relieved that his/her physical health is improving.

    • Furthermore, many of the immediate physical side effects that occur upon initiating antidepressants (headaches, nausea, dizziness, stomach problems, nightmares, etc.) tend to go into remission after 4 to 8 weeks, thus giving the patient a psychological boost from being relieved that his/her physical health is improving.

      That is defiantly not true for the majority of people though. Not to be offensive but it doesn’t sound like you have ever taken one of these medications before. It is not like, hey my stomach feels better, therefore I feel better, it is more like in a month, hey I feel better because I don’t feel like killing myself anymore.

      • a) you should get yourself acquainted with an old Jewish joke about a man with too big a family, a rabi and a animals:
        http://www.beliefnet.com/Love-Family/Parenting/2000/10/Teaching-Tales-The-Way-You-Like-It.aspx?p=1

        I’d go with old wisdom on that one.

        b) the so-called “anti-depressants” do not prevent suicide (actually they do the exact reverse) so “hey I feel better because I don’t feel like killing myself anymore” is totally incorrect.

        c) have you ever taken SSRIs?

        • The story is quite true, B. The clergy want to cover up child abuse, so they have the psychiatrists deny the real problem, defame and torture the person with massive amounts of their antipsychotics. But, the medical evidence of the real problem continues to exist, even after the egregious miss medication ends. Plus, 6 children in the neighborhood end up committing suicide, due to the psychiatrists keeping the child molesters on the streets, and defaming and drugging the victims instead. Perhaps, it is wiser to treat the real problem, rather than just covering it up?

    • You’ve obviously never dealt with depression. While some people do have it short term to help them deal with a trauma in their life (death of a parent, divorce, etc), there are those of us who have been fighting depression for many, many years. I’ve been mostly on Effexor XR since 2002, with no long-term side effects. I was on Cymbalta for a year that made me feel kind of numb, and another (Abilify, I think), that made me feel worse than when I am trying to deal with depression on my own, with no medicine at all. It IS a chemical imbalance… that problem does exist. Don’t be dismissive of something just because you don’t understand it.

      • Are you kidding?

        Some of us a long term users who fought tooth and nail to get off of these brain disabling drugs because of the physical and mental havoc they wreaked on us.

        This is an advocacy site for us. Lately I’ve seen a good number of pro-pharma people post here and I have to wonder, who is behind this? Why are people here to push a pro-drug, pro “chemical imbalance” agenda?

          • What argument?

            There is no chemical imbalance. No proof that a chemical imbalance is behind depression, none, or that playing around with serotonin improves mood.

            Meanwhile, pill takers are taking huge risks with their health by taking drugs that alter brain function, sometimes permanently.

            But have at it.

          • Serotonin defiantly has an effect on mood, what are you talking about sir? People who take MDMA take 5 HTP after to avoid a crash they feel afterwards. Granted Serotonin does other things too.

          • I’m glad you can function without medication.
            Seriously though

            “Seriously though” implying that the preceding comment was intended to be humorous?

      • Oh dear, Isloan, you tried one drug for a year and it made you feel numb and another that that made you feel worse. I hope you got an apology from your Dr.

        I know of no research that has proved a chemical imbalance that cuases depression. I know of two experiments that prove serotonin levels are not related to depression. In one the level of sertonin metabolites in spinal fluid were measured and no relationshiop to levels of depression were found. In another a drug that lowers sertonin levels, the opposite to what SSRI’s do, were prescribed to people with depression and they had they were as effective as anti-depressants. So that debunks the sertonin imbalance theory.

        I can’t be bothered to look up the studies. I’ll leave that to someone who is more dedicated than me.

        Some people get depressed after recent traumas like divorce etc and some who have been depressed for years might have suffered things from a long time ago that they might not have thought about for a long time or connected it to how they are feeling. My favourite writer on depression is Dorothy Rowe who says that depression comes from the Just World Fallacy, believe that good things happen to good people and bad things happen to bad people and then wait until something bad happens…. Believing everything is your fault and that only bad things will happen in the future and only bad things have happened in the past are core believes of depression and the core believes that result in it can come from events in childhood and be supported by those around us. http://www.dorothyrowe.com.au/books/item/282-depression-the-way-out-of-your-prison-3rd-ed-2003

        Please do not be dismissive just because you do not understand. I won’t if you wont.
        Pax

        • Clinical depression isn’t something that can be cured with talk therapy alone. There usually needs to be medication intervention. I know people who have tried different medicationsand they find the one (s) that work for them. When they go off of them that’s where the illness takes hold of them again. Stress is the culprit.

          • Depressing situations, whether they are called clinical depression or not, can be cure with talk therapy alone in some situations. It’s too simplistic to say it can not (ever) be cured with talk therapy alone. One has to look at the degree of the problem and the quality/degree of the interpersonal resources available to help, of which talk therapy is just one option.
            Likewise, some people go off medications and do very well. They improve their interpersonal situation, titrate off the pills, and the dreaded “illness” does not ensnare them again!

          • Kay, that is simply a restatement of the rhetoric we’ve all been exposed to. There is no solid evidence to support this viewpoint. If you look at the DSM criteria for “Major Depressive Episode” or “Major Depressive Disorder,” there is no distinction between “clinical depression” and any other kind of depression.

            As to depressive symptoms returning when someone goes off an antidepressant, you really need to read Anatomy of an Epidemic. There is a well-understood physiological mechanism from research into addiction that explains why “symptoms” that a psychoactive drug suppresses will return with a vengeance when they are discontinued, called neurological up- and down-regulation.

            I do agree that stress is the culprit, but there are many, many things an individual can do to reduce his/her unresolved stress and feel more in control of his/her life. I used to work at a crisis line and talked to hundreds of depressed and suicidal people. The number that I could not help through communication to get to a better place I could count on one hand. Genuine human communication, whether through therapy or some other means, that is focused on helping a person regain a sense of personal agency and control in his/her life is healing and leads to a more permanent solution. Labeling and medication, on the other hand, seems in my observation to lead many people in the opposite direction – feeling that the depression is inherent in them, rather than related to how they are living their lives and what has happened to them, and feeling that there is nothing they can do about it (after all, it’s all in my brain) except wait around for the drugs to make them feel better. I recall speaking to one woman who had been trying different antidepressants for over a year without result and was positively frantic about her prospects for a productive future. I asked her if anyone had told her there might be other things she could do besides medication. She was silent for a moment and then said, “No,” in a much calmer voice. She was stunned at all the alternatives I was able to suggest.

            “Clinical depression” is a cultural construct. It has no real definition and no actual scientific basis in reality. While many people report finding their antidepressants helpful, this does not mean that there was something wrong with their brains. It just means that the drugs make them feel better. More power to them, but using drugs to make us feel better is an action as old as humanity and does not qualify as medical care. I believe folks deserve more and better than a label and a prescription, and for the most part, they are not receiving it.

            Stress is a real issue that can be addressed and changed. This is the key to recovery from depression or any other condition – resuming responsibility and control for a larger and larger portion of our lives. This is not to blame the victim – our society places a lot of barriers in the way of feeling in control of our way of living. But it is those barriers that constitute the real problem, not the individual’s brain, IMHO. And my opinion is backed by years of clinical success stories. Depression can almost always be reduced by effective and loving communication.

            — Steve

          • When they “go off” of them, they are likely suffering from discontinuation or withdrawal syndromes which have nothing to do with the original “illness.”

            The drugs alter the brain…it takes time for the brain to re-wire itself, so to speak. If it ever does.

          • “Clinical depression isn’t something that can be cured with talk therapy alone.”

            It’s not true. It can be “cured” with psychoatherapy. It can be cured with yoga or leaving your bf or changing a job. It can be cured by doing nothing at all. It depends.

            “When they go off of them that’s where the illness takes hold of them again.”

            Also known as withdrawal. People going off heroin also feel horrible for a while.

          • False. You are ignoring the valuable testimonial evidence, at the very least. When I stopped believing depression was like you say, I started reversing its effects on purpose. Beyond that, in full recovery, something might have happened to initiate intense and sudden relapse, but I could just review the facts and admit that although originating with an external event, it immediately becomes only how I am making myself feel, as with any other emotional state. Nothing like one level or variety or approximate degree of stress ever gets measured, either, in some instrumental and scientific manner. It’s quality words that describe depression, not numbers on a scale. The problem with theories of emotion we have and responsibility for your own that comes from behavioral healthcare seeming medical, involves logical inconsistency. Psychiatry errs here, for profit and extra-judicial authority, like in everything. Psychology joins in to take a load off and retain the benefit of associating with power. Someone is mincing their words to you….

        • The efficacy of ZOLOFT as a treatment for major depressive disorder was established in two placebo-controlled studies in adult outpatients meeting DSM-III criteria for major depressive disorder. Study 1 was an 8-week study with flexible dosing of ZOLOFT in a range of 50 to 200 mg/day; the mean dose for completers was 145 mg/day. Study 2 was a 6-week fixed-dose study, including ZOLOFT doses of 50, 100, and 200 mg/day. Overall, these studies demonstrated ZOLOFT to be superior to placebo on the Hamilton Depression Rating Scale and the Clinical Global Impression Severity and Improvement scales. Study 2 was not readily interpretable regarding a dose response relationship for effectiveness.
          Study 3 involved depressed outpatients who had responded by the end of an initial 8-week open treatment phase on ZOLOFT 50–200 mg/day. These patients (N=295) were randomized to continuation for 44 weeks on double-blind ZOLOFT 50–200 mg/day or placebo. A statistically significantly lower relapse rate was observed for patients taking ZOLOFT compared to those on placebo. The mean dose for completers was 70 mg/day.

          • Zoloft gave me cardiac arrhythmia. When I told my psychiatrist about it, she said, “I’ve never heard THAT one before.” She completely dismissed my complaint. Didn’t take notes, didn’t report it. So I quit taking it and never went back to see her. I wonder how often complaints of adverse effects are treated this way.

          • So in essence, what we’ve proven is that some people feel somewhat better taking Zoloft than they do when taking a sugar pill. It is also true that some people feel somewhat better when drinking alcohol or smoking marijuana or even taking heroin than similar people taking a sugar pill. Using drugs to modify consciousness is not a new idea, and “symptom reduction” in a short term study proves nothing about the causes or ultimate outcomes for people who are depressed for whatever reason. Common sense suggests that people are depressed for a wide range of reasons, some of which are interpersonal, some social, some financial, ans some physiological. Lumping them all together and giving someone a drug to make them feel better is a stupid plan in the first place.

            Reality is that depression (and anxiety and anger, etc.) is an evolutionary survival mechanism that comes into play when the body feels it is necessary. It is not a disease, not ever. There are diseases that might CAUSE a person to feel depressed, and we should screen for those, but to think that ALL depressed people are depressed for the same reason and need the same kind of help is scientific reductionism of the worst sort. (And it’s even contravened by the introduction of the DSM itself!).

            Pharmaceutical companies and organized psychiatry have chosen to focus all research on symptom reduction rather than longer term outcomes, mostly because that’s what drugs do and they will almost always be superior if you use that measurement. However, when we look at long-term outcomes like employment, education, intimate relationships, and community involvement, it’s clear that the label-and-drug model is not successful. If Nigeria and Brazil are beating the crap out of the US and the UK in terms of schizophrenia outcomes, it’s time we ate a slice of humble pie and started questioning our own paradigms.

            Symptom reduction by drugs can be perceived as helpful, but so can going to the bar after work. The real deal is improving lives long-term, and I defy you to find a Zoloft study that shows it improves that kind of outcome.

            You really should read “Anatomy of an Epidemic”. If you really believe in science, it will blow your mind.

            — Steve

          • I agree Steve, except for one point: it’s not even that sure that they really do better than a sugar pill and if so it is really slightly better and may not be better at all if the sugar pill was an active placebo (given the side effect of the drugs it’s hard to make a real double blind study).

          • “She completely dismissed my complaint. Didn’t take notes, didn’t report it. So I quit taking it and never went back to see her. I wonder how often complaints of adverse effects are treated this way.”

            In my experience – in 4/4 cases (that would be 100%). Each time I changed the psychiatrist just to find out that the next one was just as bad or worse.

          • Great. First of all could you link to these studies? Also, a few questions:

            – did the authors of these studies have conflicts of interest? were these studies pre-registered? The problems with pharma sponsored research are many and include outright fraud, ghost writing, data manipulation, ignoring patients dropping out because of inefficacy and/or intolerable side effects, suicides etc.

            – do we know how many studies were performed on this drug but not published due to the negative outcomes (also known as publication bias)?

            – I understand the superiority of the drugs was assessed using p-values. It’s all good and fine but how does this translate into clinical efficacy in terms of how much better people actually are? Improvement on average of 1-2 points can be statistically significant but it won’t be clinically significant especially if the side effects are an issue.

            – was there any follow up? 1-2 month studies are extremely short and are unlikely to show if the effect of the drug is persistent (and these drugs are used over long-term) as well as what side effects and tolerance/dependence issues may arise)

          • I actually had a neurologist / psychiatrist put me on various combinations of six drugs, all with major drug interactions warning they’d cause anticholinergic intoxication syndrome, to cover up a medically confessed “Foul up” with Risperdal by a prior psychiatrist. No doubt, complaints of adverse effects to the psychiatric drugs are being covered up by even subsequent psychiatrists all the time.

          • All of these studies that you are trying to use to support the usefulness of SSRI’s as more than just placebos are actually very short studies. True scientific studies will always go for longer than six to eight weeks. These dare studies done by the drug companies to push their products so that they can make more profit than they already are making.

          • Tatiana, it’s a long answer.

            There really is no treatment that can safely relieve the physical, cognitive, and emotional problems. It’s just a matter of gritting your teeth and piecing together your own recovery.

            If you join survivingantidepressants.org, or already belong, just post your questions in your “intro thread” and let the members know what’s going on with your health.

            You will find every trick in the book for getting through discontinuation in their pages, as well as empathy and online companionship.

      • lsloan

        There is absolutely not real scientific studies (studies not done by psychiatry or the drug companies) which prove that there is a chemical imbalance in the brain that causes depression. This is all hogwash that the drug companies promote to further their huge profits every year. There is nothing of scientific value that prove low serotonin in the brain causes depression. In fact, they’ve lowered the serotonin levels in peoples’ brains and they didn’t get depressed so how do you explain that? You need to back up what you say with scientific studies and the fact is, you can’t.

        • LoganBerman how big an improvement on the Hamilton Depression Scale? And what does this translate into in common everyday language? Is it a bit perkier but still misrable as sin? Or is it feeling super human as if you had never been depressed?

          According to Irving Krirsh the studies do show an improvement on the Hamilton Depression Scale but not so much as to write home about in most cases and what is more there are other things, safer things that are just as effective. https://www.youtube.com/watch?v=ISptt3CRAqc

          • The problem with that is he is talking about the placebo effect in that book, and I have read it.
            He is a psychologist, he is not a medical doctor, pharmacologist. The placebo effect does work but saying that the drugs are no better than it is wrong.

          • The Hamilton Depression Rating Scale is pretty weird, anyway. Look for it online and see if you think it is a valid measure of depression. It has one question about mood, three about insomnia, and one about weight loss, but nothing about weight gain.

            Here’s a study that is cited to show ADs work, but look at the finding.

            “virtually no difference at moderate levels of initial depression to a relatively small difference for patients with very severe depression, reaching conventional criteria for clinical significance only for patients at the upper end of the very severely depressed category. ”

            Then see the chart…the green area shows the studies that showed “clinically significant effect.”
            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2253608/figure/pmed-0050045-g002/

            How does that justify the claim that the drugs work, when none of the other studies showed anything useful was done by the drugs?

          • “He is a psychologist, he is not a medical doctor, pharmacologist.”

            Oh, I love arguments from authority so much. Mr Kirsch has published peer reviewed papers on a topic so as far as I care he can be a truck driver by education – he’s work has made it to scientifc journals so you can feel free to criticize it on a merit if you want but not on what kind of letter he may or may not have before his name. I happen to know some people with no formal education in their fields who have successful careers because they are smart people who put hard work and brain power into learning and research. In fact being multidisciplinary is a thing in bio-medical sciences (with people educated in computer science, maths or physics entering biology and chemistry for instance).

  3. I think the issue is that people need to understand that if people could feel better they would. Its so easy to say don’t stress and worry about life situations but look at who people judge you on life situations. Its so hard to say you have mentally ill today and not have people judge you and make you feel uneasy about it.

    I do think counseling helps alot but some people need medication, and you and your doctor have to find what works for you as a person. I look at it like this, if you were a diabetic you would take your medications and not all medications work for everyone you cant just give up. I guess this is coming from a depressed person. America needs to accept the fact that mental illness is a serious issue and we need not be so quick to judge, try to be more positive about it maybe more people will be able to accept it and get the treatment they need.

    • I understand what you’re saying, but I don’t think that anyone is saying “don’t stress and worry about life situations” here. I hear that a lot, as if there are only two options, either ignoring the impact of stress, or somehow minimizing the person’s suffering by implying they should “get over it.” Those are not the only options.

      I doubt there is a person here who doesn’t understand how debilitating and exhausting and hopeless it can feel to be in a deep depression, and I doubt equally that anyone believes you should just “pull yourself up by your bootstraps.” I think the author’s intent is to say that understanding and acknowledging the role that current and historical stress and trauma has on our current mood leads to a much better understanding of how to help. The author is certainly not judging a person for being depressed about really depressing things happening to him/her!

      As for the diabetes analogy, I am afraid that one has been thoroughly discredited. Diabetes is something you can objectively test for and observe – the body is not making sufficient insulin. It is also something you can objectively treat and observe if the treatment works – if the medication is effective, blood sugar levels will stabilize. It it isn’t, they won’t. Whereas there is no way to measure if someone’s brain chemicals are “imbalanced” (not to mention the fact that no particular “imbalance” is consistently associated with depression – the low serotonin theory was discredited back in the 1980s). As a result, there is also no way to figure out if the chemicals are now “correctly balanced,” since we don’t know what a “correct balance” really is. In truth, the chemistry of the brain is constantly changing, depending on the environment and the needs of the moment, so the idea that there is a “correct balance” may be completely wrong.

      To summarize, the author is not trying to say that depression isn’t real, that people don’t suffer, or that they should just “buck up” and get over it. He is saying that the depression is almost always a normal response to abnormal conditions, and that we’d do a lot better to focus on alleviating the stressful conditions rather than essentially “blaming the victim” by pathologizing the person who happens to feel depressed. As an example, I work with foster kids who have been abused and/or by their parents and removed forcibly from their homes. They don’t know where they are going to grow up, they have conflicting feelings of loyalty and anger at their parents, and they are totally confused about why all of this is happening to them. It seems very understandable that they’d be depressed about all this, especially when they have had to endure multiple foster placements and separation from siblings while in care. Why would we assume that they are depressed due to a brain malfunction? Wouldn’t it make more sense to try and help them make sense of what’s happened and help them achieve a greater sense of certainty and control of their future lives?

      There is a lot of propaganda out there about “depression,” but John Read is cutting through it with this piece. People are almost always depressed because they’ve had depressing things happen to them. That doesn’t mean they aren’t suffering or that they should get over it. It means that we should compassionately listen to their stories and try to help them find a way to put some meaning and perspective onto their suffering. Counseling is one way to do that, but there are many others. While medication may help some people deal with the pain they’re experiencing in the moment, they will never help anyone to process and digest either the problems in their current life or their historical trauma. The analogy is not insulin for diabetes. It’s more like opiates for a broken arm. They’ll take the pain away temporarily, but you’d be foolish not so look for the actual cause of the ongoing pain and try to fix it more permanently.

      —- Steve

      • Steve McCrea wrote: “To summarize, the author … is saying that the depression is almost always a normal response to abnormal conditions, and that we’d do a lot better to focus on alleviating the stressful conditions rather than essentially “blaming the victim” by pathologizing the person who happens to feel depressed.”

        I agree with you, and I wish it were that simple. But unfortunately sometimes it’s impossible to alleviate stressful conditions, and sometimes a situation that wouldn’t stress out most people stresses out someone who has endured difficult things in the past. So I have to “make do” with medication despite knowing the detrimental effects on my physical health and wondering about the effects on my emotional health.

        I am NOT a pro-pharma troll, I am just a person with chronic depressive disorder and general anxiety disorder who is probably on too many psychotropic meds. Without them I cannot function: I cry ALL of the time, I can’t sleep, and I have panic attacks. With them I am currently holding down 2 temporary half-time jobs as a junior Web developer. I’ve been on at least 2 different psychotropic meds for almost 20 years, and at this point I’m on 4.

        I truly wish I didn’t have to take so many meds, and I desperately wish someone could alleviate my stressful situations. But there’s no changing the past and there’s no way to become younger (and thus more desirable to employers), so I’ve got to do the best with what I have, which includes prescribed psychotropic medications. I’m somewhat better now that I am working again after MANY years of under- and unemployment, from the perspectives of having something absorbing with which to occupy my time and having more money.

        While not working is horribly stressful, working is also stressful, and I’ve had to increase the frequency of my anti-anxiety med at times to keep from having panic attacks when I discover I’ve made a bad mistake or when I’ve gotten a “talking to” from a manager. I was an abused child, and when an interaction, even just a potential interaction, with an authority figure feels threatening, I get very – probably unduly – stressed out. The anti-anxiety med controls the stress enough to keep me from sobbing or panicking, reactions that are NOT well tolerated in the working world.

        I’m just a temporary employee (times 2) who could be let go on any given day so I’ve GOT to keep it under control as well as I can. Last week, one of my managers told me I stressed him out when I got stressed out when he gave me a bunch of changes to make in a short period of time. I told him that I was simply concerned about the tight timeframe, in part due to the stress of juggling 2 demanding half-time jobs, and apologized for overreacting. I didn’t have the courage to tell him the truth, that I thought I had handled the situation pretty well because I didn’t cry or scream or do anything at all inappropriate. He’s a good guy and I realize he was trying to help me feel less stressed, but unfortunately it had the opposite result because I have nothing resembling job security. A full-time, permanent job would do a lot to alleviate my stress in this area, but I was turned down for the last 4 jobs for which I applied, so I am grateful for any employment at all!

        I had an excellent talk therapist who significantly helped me between 15 and 19 years ago, but she retired, and since then I’ve been unsuccessful at finding a good therapist that I can afford. (My therapy attempts ended in frustration after 1-1/2 years, 2-1/2 years, and 3 months respectively, and the last was the worst.) My health insurance changed, and now it won’t pay for more than 10 sessions of talk therapy while it will happily pay for the meds my psychiatrist prescribes ad infinitum.

        My psychiatrist has been acknowledged as one of the best in the city where I live. He told me long ago that I would be on antidepressants for the rest of my life, but he’s not happy I’m still on an anti-anxiety med, and he strictly limits it and my sleeping pills. He and I have both learned the hard way that changing a drug “cocktail” that is working for me is likely to have severe consequences, including my ending up in an emergency room, so we’re both disinclined to “rock the boat”. He wants me to be actively engaged in talk therapy but he recognizes the restrictions of my health insurance and the expense of a private-pay therapist.

        So please realize that while I would dearly love to have my stressful conditions alleviated and be freed from my psychotropic medication burden, it’s simply not possible given the circumstances of my life, and I can’t foresee any circumstances under which it would be possible. Professor Read is absolutely correct that “Depression is caused by depressing things happening,” but my life has been and is depressing and anxiety-inducing. Even though I hate it, medication keeps me out of the psych ward and allows me to be a reasonably functional member of society.

        • Justme2, do you mind saying whether you had the crying, insomnia, and panic attacks before starting on the prescriptions in the first place? If so, to the same degree?

          Either way, I wish you well and am glad you are able to work.

        • I am so sorry to hear of your difficult circumstances! Like I said, it’s not as simple as “pull yourself up by your bootstraps.” People who have been through the wars like you do experience chronic depression and anxiety, and I’ve never been inclined to criticize anyone in your situation for doing whatever you think works.

          That being said, I am a counselor by trade and have spent a lot of time working with trauma victims, especially childhood abuse victims and domestic abuse victims. I don’t believe that there is nothing that can be done, and my biggest objection to the psychiatric paradigm is not the drugs, but the basic message that you have to accept that you’re disabled for life because your brain is broken! It appears to me you’re doing a courageous job fighting that message, but I still think it is inherent in the label-and-drug approach that ignores the impact of trauma on a person’s life.

          Of course, I don’t know you and can’t presume to suggest what might or might not work. You have your own path to walk, and I admire your courage for pushing forward despite the challenges. My only thought is that you may find more help in actually getting to a better place in the long haul by hooking up with other survivors of abuse and with therapists who really understand this kind of trauma and what it does to you. Most therapists I encounter nowadays are quite shallow in their conception of what therapy should look like – they tend to be very present-focused and skill-based but don’t really take a look at the impact of historical trauma. And psychiatrists are generally far worse – their only nod to trauma is “your brain got wrecked by all those bad things that happened and that’s why you need to stay on your meds.”

          I wish I had something more than my compassion to offer, but I do feel for you and hope you’re able to find a better path forward. You shouldn’t have to suffer because someone else was an asshole in your past. I wish I could take your suffering and send it to the perpetrators, who are the ones who really deserve to feel that pain.

          Take care and thanks again for sharing your story!

          —- Steve

    • Here we go with the “it’s just like diabetes” meme from the pro-med, pro Big Pharma front.

      No, it’s NOT “just like diabetes.” Not even close.

      Diabetes is diagnosed with laboratory testing…show me ONE mental illness that is diagnosed with a laboratory test.

      Where are all these pro-pharma people coming from? They all keep reading from the same script.

      • Where are all these pro-pharma people coming from? They all keep reading from the same script.

        A recurrent characteristic of organized attempts to manipulate a narrative (usually accompanied by plausible deniability). So congrats folks, looks like we’ve got their attention!

    • Please stop comparing “depression” to diabetes, it’s making me sick. It’s comparing apples to clockwork orange.

      If you’d believe at all in so-called “evidence based medicine” (and I know there are good reasons to be skeptical) then you would have to agree there is little evidence that “anti-depressants” are anything more than rather toxic placebos. Plus emotional numbing is not the same as “making better” though maybe some people feel (especially while on the drugs) that it is.

        • Insulin is used to treat juvenile (type I) diabetes which is caused by autoimmune death of beta islands in the pancreas which normally contain insulin producing cells.

          Type II diabetes is a different animal – people produce normal or even elevated amounts of insulin but the body cannot response to it (hence it’s other name – insulin resistant diabetes). And you’re right – this one is largely caused by bad nutrition and lack of exercise.

  4. Given the fact that recent reviews have found that these anti-depression drugs are no more effective than placebo for the majority of recipients, should physicians put the current priority to identify what is his or her self-assurance in each particular patient with depression and individualistically treat him (or her) with something associated with this confidence?

  5. “Eight of the 20 adverse effects studied were reported by over half the participants; most frequently Sexual Difficulties (62%) and Feeling Emotionally Numb (60%). Percentages for other effects included: Feeling Not Like Myself – 52%, Agitation 47%, Reduction In Positive Feelings – 42%, Caring Less About Others – 39%, Suicidality – 39%, and Feeling Aggressive – 28%.”

    I was only ever given Paxil for depression and spent 15 on it and struggling to get off it, while constantly caught up in a catch 22 situation of going through withdrawal and going back on it to stop the horrendous side effects (which included a sudden presence of suicidal ideation not ever present in the original depression and therefore suicide attempts, a factor that caused a psychiatrist who knew me all of 5 minutes to mislabel me as BDP), which I now know were a direct result of pure addiction. As soon as I went on it, the first thing I noticed was the heightened levels of agitation and an inability to feel empathy or to empathise with family and friends. I went from being sensitive and caring for everyone to being completely dismissive of people’s emotions and feelings. Practically nothing bothered me, which fooled me into thinking I was OK, and also resulted in me being able to reinsert myself into society, but with a completely false sensation that I could bring on and literally eat the world. The newfound feelings of ELATION prevented me from considering stopping the drug, despite the fact I was seriously affected both sexually and emotionally. I can only say I was experiencing an abnormal feeling of well-being similar to that of the high people get on cocaine (though I can’t confirm or compare the similarity because I was never on it). I was no longer able to blush or feel embarrassed. (Brisdelle) Basic emotions and ability to respond accordingly were seriously cordoned off, if you will, as though it was a road block. I also noticed delayed orgasm was a major problem, and this was one of the main reasons I wanted to get off it. The emotional blunting had me inhumane and totally desensitized. I didn’t like that either. I missed my old self and caring about people. But, I was 19 and naïve. I didn’t see these sirens or alarm bells going off as warning signs to the possibility that the emotional and sexual deadening could worsen or become permanent. In 2009, I was struck down with 100% total emotional and sexual numbing while still on Paxil. I was no longer able to feel love for my partner or interest in him or in my own family. It is not just romantic love that is affected as is reported in many articles. It was not a case of a returned depression. Fatigue, lack of motivation, sexual dysfunction and apathy (or anhedonia) are symptoms that represent permanent SSRI side effects rather than residual depressive symptomatology. But even though sexual dysfunction is listed as a side effect of antidepressants on all patient information leaflets within every box, doctors and the pharmaceutical companies are playing down the fact that not only can they occur, but that they may even be permanent. Since 2009, I haven’t had one orgasm, been able to feel or express love for anyone, haven’t been able to laugh, smile or cry or show interest in anything. I never had a case of underlying schizophrenia or similar, and was only ever diagnosed with depression. Anyone who knew me before 2009 does not recognise the complete and utter stranger I have turned into. My lack of ability to express emotion on any level has me holed up in my apartment, away from society, family, friends and all the activities I once enjoyed, including the right to be employed. Since being on Paxil, I have basically turned into a write-off and now live like a house plant. I basically pump calories into myself and can’t even get enjoyment from something as basic as food. The fact that I am totally socially isolated and living like a recluse for the last four years has given to way to ludicrous, unjust, demoralizing, and downright insulting suspicions of a possible case of an out-of-the-blue case of schizophrenia, sociopathy, etc, etc. Now, if you mosey on over to Dr. David Healy’s website, RxISK, and read this, http://wp.rxisk.org/buried-alive-post-ssri-sexual-dysfunction-pssd/ you will see that not only is there a write-up about the existence of sexual anhedonia which goes hand in hand with emotional blunting caused by SSRIs, but you will also see there is a comments section where an average 0f 52 people have commented, with most of those comments reporting the exact same problems as what I have just mentioned here due to having been on an SSRI. In 1995, when I was forced to go on Paxil, there was no mention on the patient information leaflet that I could suffer sexual dysfunction, and there was certainly no warning it could be permanent. If I had known about these side effects back in 1995 and the possibility of addiction/withdrawal effects, I would NEVER have taken it. The truth was kept from me and I had a faulty product forced on me, taking away my right to decide if I wanted such a product to destroy my brain and body.

    • I’m so sorry for you. I hope you’ll be able to withdraw from these poisons safely and regain your life and your personality. There are many people here who went through similar experiences and came back to life.

      Despite not having this experience (thank god) myself I know what you’re talking about. I’ve seen this happen with another person and I know that when he stopped the drugs he turned from annoying jerk into a person you can connect and be around. He was also one of the “chronically sick with chemical imbalance”.

    • Excellent post detailing the more insidious, yet equally devastating adverse effects of these drugs.

      Lethargy, apathy, loss of empathy, other emotional blunting, loss of libido and sexual dysfunction, anhedonia, etc., are often totally overlooked. However, these reactions produce profound chain-reactions of downward consequences on the lives of those afflicted. I know first-hand. I’ve experienced them all.

    • Thanks for your post…I can relate to much of this experience during my decade on Celexa and Xanax. The denial is strong in many of the posters here. They seem to think this can never happen to them. Medication spellbinding is the term Dr. Breggin gave for that phenomenon.

  6. Yes I think dialogue is important and some of us for a wide variety of reasons come to this website having experience on both sides of the issue. I honor the radical voices and I completely understand where they are coming after my own horrific experience. However I have to be true to myself and acknowledge there are family members and others who say they get a benefit out of medication. Whether this is a result of a placebo affect or that sometimes for some people some meds do work I really don’t have the background to say.
    I think dialogue is a good first step to an evolution and revolution towards a nondrug centered approach to helping all humans in adverse situations. If we can do away with drugs great by me but I will fight for the right for those who find it helpful to stay on. We have to honor everyone’s right to individualized treatment no matter what our own personal view might be. I know some would say and I have said and thought first do no harm but talking to my kids they have made a choice that works for them. Not my call and they have made informed decisions.
    At least the trolls are now aware of the website. In my state people are still very unaware.
    So as Maurice Sendak wrote in “The Wild Things” – “let the wild rumpus begin”!

  7. I laugh at these so called experts of major mental disorders , unless you have actually experienced the effect of manic-depressive , or endless hedonistic or polar opposite of it ,you really are relying on just paper research and your own ..non-scientific experiences ! As a child I had an aunt when I was 5 years old burn up 10 feet in front of me , my dad never sick before die in my arms , lost girlfriend at young age and witnessed some horrible events .
    But yes that made me somewhat melancholy or sad ..but it didn’t put me into a horrific negative suicidal spiral like I have experienced in the last 15 years of my life .
    Sure there are people who fathers or mothers didn’t love them and they need a little fraudian jump start …but those of us with extreme depression are mentally wired wrong .I played football and had 10s upon tens of concussions .Each one more debilitating than the last . I was a 96% student athlete in a college town .From my freshman year I felt feelings I never felt before my concussions , like trouble studding , loose of positive feelings , feelings of I called being in a fog or bell-jar thoughts , loose of surrondings ..I forgot how to get home one day like a azlheimers patient like my mom became .
    Don’t tell me a happy gp lucky 3.8 GPA all county athlete that I am SAD.Thats like telling an herion addict the its just a placebo .
    When my beautiful wife with everthing going for her got in a car accident and had a TBI her whole personality changed ..I quess that was just her having depresstion , when I moved to Miami and did the south beach thing and talked to professional athlete who had millions , beautiful women , houses , indorsements , and 100s of friends ..quess what ..they commited suicide .
    Depression is very much REAL,, you treat it like they treated epilepsy in the evil ages ..you are the devil and possession has taken you over .
    Half of TBI dont show up on MRI ..does that mean they went from perfectly functioning people to having trouble walking ,urinating , hearing , seeing ..of course not ..there brain activity is altered somehow .
    How do we explain the supper mentally ill , that see and hear things and jump off buildings to get away from what they think they see ….just having an off day .
    Then there is all this off-label phsych-medicines being given out without anyone really knowing how they work or who they work on ..The real ..no scared of being sued doctors ,or the ones who dont know all the answers ..or as I call the god fixaction ones ..they will tell you try this and if you have any new idealation of suicide or anyother bad sideeffect stop !
    the others dont have the time or warnings to say anything ..I call that dont blame me doctors ..I went 10 years to school and I not losing my license over you .
    I have been given lithium by one doctor and in 24 hours had become like that pilot , just determined to end it all and take out as many of my so called enimies at the time .
    What saved me and others is my Christian faith pounded into me from early childhood , do not take anothers life randomly ….so even though the lithium made me suicidal and homicidal ,which I have never experienced since …I dint act on it because of faith ….and dont underestimate faith when it comes to healing and mental illness .Maybe if the suicidal pilot had faith he wouldn’t have killed himself and others but have gone to a clergy or doctor first .I literally was there myself after the lithium episode ,I wanted to kill myself and as many as I could with me ..something about this type of illness the more you bring with you the better ,like a club for angels .doesn’t make sensce to the average mind but extremely to the sick mind .
    So dont say there is no serious depression , that is insensitive and hurtful to the people who deal with this demon on a minute by minute ,hour by hour ,week by week ,month by month occurrence .At first I thought I was a coward by not killing myself , I was ding 100 paper cuts ,but then I realized it was much tuffer fighting the fight of mental Illiness and just surviving one day at a time ,hoping for some ,yes made breaktthru or therapy or a nano cure .
    But dont ever say people like me and others dont have a real problem , then you become the disease and not the cure !!!!There are some medicines that some patients tolerate well , then there are some with terrible sideeffects , if not for my upbringing and catholism I would certaintly be dead with others ….but there is a definite brain malfunction in most of us , just like diabitus or luekimia or HIV.
    Robin Williams didn’t commit suicide because one of his jokes didn’t go over well , nor did the all pro linebacker ..the basis for a large portion of mental illness is a brain chemical or nuerlogical misfiring we haven’t fiquered out yet ..and yes do sometimes placebos and faith help ..yes of course , just like a POW or somebody in solitary confinement ..you have to believe in some higher power because you cant see the forrest thru the trees .

    5

    • Somebodyhelp

      No one here would ever say that depression isn’t real and that people don’t suffer from it’s effects. What most of us do say is that this is not an illness. If people want to take drugs because they believe that the drugs help then by all means take them. But what most of us are saying here is that we should always have a choice in taking these drugs. Many of us who come to this site and post here had the psych drugs forced on us, we had no choice at all about taking them. Those drugs have caused numerous people great harm. Yes, these drugs seem to help some but for many people they’ve harmed rather than helped. What we want is freedom of choice and true informed consent; we do not want to force everyone to believe and feel the way that we do. But none of us are saying that depression and it’s effects are not real. Hang in there and keep holding onto your faith. I’m really glad that you’ve made it this far. Welcome to MIA.

  8. So glad I found this site. Just two weeks ago I went to a therapist for the first time in years. Within the first 30 minutes, he decided to prescribe Zoloft, even though I clearly told him I did not want any pharmaceuticals. I left with a prescription in hand, thinking I would explain to him went I went back that I would never fill the prescription. But the next day it hit me. This guy did not respect my wishes as I originally expressed them. No way will I ever see him again. How did I even let him get so far as to hand me the prescription? I have never taken anything for depression, and I never will. I have an adverse reaction to all pharmaceuticals. Why would an anti-depressant be any different?

    As for the “It’s the same as diabetes” argument — maybe it is. I would treat diabetes with diet and exercise, not with the Big Pharma poisons.

    • Good for you. Many people here wish they were so smart ;).
      As to “just like insulin for diabetes” – it’s a ridiculous comparison. The pathology of type I diabetes is clear – it’s cause by immune system killing insulin producing beta cells in pancreas. You can see it by monitoring the inflammation, by measuring the insulin and by measuring the sugar levels. For treatment you simply supplement what is missing and in right amounts (which is also monitored – taking too much insulin can kill you pretty fast). None of this is true of “depression” and psych drugs. There’s not a shred of evidence that abnormal serotonin levels cause depression and plenty of evidence against it. There is no way to measure this in a living, breathing human and no way to monitor if the supposed imbalance is corrected in any way. The whole “depression” is just a subjective description of moods and behaviours that can have a million different etiologies, only few of them being medical in nature and not really having much to do with the neurotransmitters.

      • I do agree that there is no test for it, or that it can’t be observed, though I do believe it has a chemical component, as well as genetic.

        For example there is a Gene, MTHFR, which half the population has a mutation in, which means people cannot convert folate easily from their diet. This gene is also responsible for neurotransmitter production as well. You can actually get a prescription for Methylfolate (Deplin) from a pharmacy and some people have reported an improvement in symptoms. It is pretty expensive though.

        So mental illness could very well be genetic, it probably is, but it is complicated because if you have a genetic mutation you could have quote lower levels of neurotransmitters than people who don’t, which in turn would be technically an “imbalance” compared to other people. Then it would be epigenetic I guess, you know?

        • When you say “mental illness could very well be genetic,” are you aware that you are talking about a huge range of issues, varying from difficulty paying attention in class to hearing voices to having flashbacks of historical trauma? How can you or anyone say “mental illness could very well be genetic” when there is such a range of things that “mental illness” is now purported to cover?

          One simple example: how and why is “ADHD” a mental illness? Even if there is some genetic variation in activity level and intensity, which there no doubt is, who gets to decide that kids all need to sit down at desks in a herd and do as they’re told for 6 hours a day, and that kids who can’t do that are “ill?”

          Or at the other end: how can PTSD be genetic, when it is clearly a reaction to a severe environmental stressor? Are you saying there is a “right” way to react to being sexually abused or seeing your mom murdered by your dad, and those who don’t respond “correctly” are mentally ill?

          It is a completely untenable proposition that “mental illness” is genetic, if only because the definitions of “mental illness” are so heterogeneous that the idea they’d all have the same or similar causes is delusional in the extreme. I really don’t understand why all this focus on genetics anyway, when that’s the one part of the equation you can’t even change? Why don’t we focus instead on changing school environments to be more responsive to kids’ needs, or stopping child abuse and domestic violence, or reducing poverty, or assuring good prenatal nutrition, or providing quality healing environments for people who have been overwhelmed by stress? Why are we always blaming the genes? Because, Logan, blaming the genes is effectively blaming the client, and lets society completely off the hook. I don’t think that is a very accurate or helpful view to take if we really want to help people avoid and/or heal from extreme mental distress.

          — Steve

          • Steve,

            The psychs zero right in on genetics because they know that the patient can’t readily disprove them due to lack of a reliable test, and they use that disinfo to keep patients cowed and “compliant.”

            I was convinced for years that I had a genetic disease, until my life fell apart on pills and I confronted my pdoc, who could not give me any answers that did not come on a prescription pad.

          • I found the the source of the 70% figure offered by LoganBerman. Not impressed.

            http://www.deplin.com/wp-content/uploads//Kelly.pdf

            Kelly et al. studied 100 people who had attended the Dept of Psychiatry at a Belfast hospital, and whose current or most recent period of illness met ICD-10 criteria* for a depressive episode. The controls were 89 people with no history of depressive episodes, recruited from local clinics.

            Basis for the study:

            The research questions for this study derive from the discredited monoamine theory of depression:

            Folate and homocysteine are thought to parallel levels of 5-methyltertahydrofolate in the CNS, which is thought to relate to monoamine neurotransmitter function.

            Kelly et al. thought MTHFR genotype would predict a) depression and b) plasma levels of levels of folate and homocysteine.

            Findings:

            1 Relationship between MTHFR genotype and depressive episode history?

            70% of the 100 recent/current depressive-episode subjects had the relevant MTHFR polymorphism.

            So did 55% of the 89 no-depressive-episodes-ever subjects.

            2 Relationship between MTHFR polymorphism and folate and homocysteine?

            In the current study, patient and control groups did not differ in levels of plasma folate or plasma homecysteine.

        • Your beliefs are not medical evidence. As you have admitted, there are no medical tests for mental illness. To suggest that it is a genetic disease implies that there are tests for same. Repeatable, verifiable tests. There are none. If there were, psychiatry would be shouting it from the rooftops.

          You are using the exact same language that my former psychiatrist used to keep me in line and taking the drugs. In fact, he insisted I had a “genetic disease” based on speaking to me for about 30 minutes. Unfortunately, at that time, I was ignorant of my own condition and desperate for help, and believed him.

          • As you have admitted, there are no medical tests for mental illness

            Nor could there be because the “mind” is not material, thus any suggestion that it could be “diseased” in any but a metaphorical sense is a blatant misuse of language which any high school English teacher should be able to point out.

            As E. Fuller Torrey pointed out before he went over to the dark side, you can no more have a sick mind than you can have a purple idea.

          • This processing deficiency is caused by the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, which is quite common among patients with depression. Up to 70% of patients with depression test positive for the polymorphism and therefore cannot convert folic acid into L-methylfolate. (9)

        • “MTHFR, which half the population has a mutation in, which means people cannot convert folate easily from their diet. This gene is also responsible for neurotransmitter production as well. (…) So mental illness could very well be genetic, it probably is, but it is complicated because if you have a genetic mutation you could have quote lower levels of neurotransmitters than people who don’t, which in turn would be technically an “imbalance” compared to other people.”

          Half of the people have a genetic brain disorder? I mean if you believe the DSM that is probably true. Which only goes to show how ridiculous the whole idea is. If a deleterious mutation causing serious mental disorders was determined by a single SNP, even with relatively low penetration, this mutation would be purged from existence by natural selection. So this SNP would be in say 0.5% of population not 50%. We have millions of SNPs and each of them can potentially increase of decrease our risk for something by some factor. It’s all fair and good and completely meaningless in practice. Also it ignores an important environmental contributor and the fact that some of the pathologized behaviours may in fact be adaptive if not for our sick society.

          • No, what I am saying is it is part of the puzzle. Their are various polymorphisms of that gene, making it less efficient. Even though about half of the gene mutation is in the population, 10 percent of those people have a 90 percent reduction of the MTHFR enzyme. The majority have about 40 to 50 percent reduction of enzyme efficiency.

          • So if a person is known to have that particular polymorphism, then THAT is the problem and THAT is what should be treated. But we’re talking about a tiny, tiny percentage of all pe0ple who have issues with depression. The vast majority of depressed people I’ve talked to (and I’m a mental health professional who has worked a suicide hotline and done involuntary detention evals, so I’ve talked to A LOT) have very good reasons to be depressed. Most appear to be helped by hearing their story and acknowledging the absolute NORMALCY of their depressed reaction to difficult circumstances. This sets the stage for an empowering discussion of what THEY can do about the situation, rather than placing the blame on their brains and the control in the hands of their doctor, in effect totally reinforcing the idea that there really IS nothing that they can do about their situation, which is why they’re depressed in the first place!

            A case in point: a young woman called me up on the crisis line, telling me she’s depressed about losing her boyfriend. She has talked to her mom and a coworker and both insist that she’s lucky to be rid of him and will soon find someone else, but she still felt depressed. I asked her how long they’d been together – 4 years. I asked how long ago they’d broken up – 4 months. My reply, “Not only do I think it’s totally normal for you to feel depressed at this point, if you weren’t a little depressed, I’d think there was something the matter with you.” She says, “Really?” I say, “Yes.” She says, “WOW! Thanks!” and hangs up the phone!

            Validation and normalization work better than labeling and drugs. Not that some people don’t find the drugs helpful, and I don’t wish to ban them, but in the long run, finding someone to understand you and help you make plans is almost always the real solution. There may be the odd exception where a genetic condition really does exist, but these have been proven over time to explain only a tiny percentage of cases. Such cases should be detected and dealt with accordingly, but assuming that ALL cases of depression (or even most) are biological in origin ignores both the evidence and basic common sense.

            —- Steve

  9. I have been unhappy with the coverage of the Germanwings story in major news media. The big papers have columns by medical experts explaining how depression caused it and urging people to get care.

    I wrote a blog post rebutting Robert Sapolsky, a would-be drug designer, whose column ran in the LATimes and elsewhere.

    It’s long, but it might help someone who is new to all this (the MIA) message see the light.

    That some people are helped and not harmed is great. But the extent of the harm is heartbreaking.

    Just read the words of some victims of side effects, and ask whether depression or drug syndromes is the more likely explanation.

    https://evidencer.wordpress.com/2015/04/05/lubitz/

  10. I agree.

    The dialogue is good.
    It’s healthy, if any of us are going to grow.

    We’ve all been “in the choir” together for so long, it rocks our world a bit when a pro-pharma person chimes in. That’s okay though. It’s a good thing.

    Things are not as black and white for yours truly as they were five years ago.
    There’s room for a more nuanced view of things in my life now (which has been a *huge* step for me).

    I say, bring it on.

    Duane

    • I think its worth noting that Robert Whitaker (science journalist, author of ‘Mad in America’ – for which this site is named) is not “anti-psychiatry.”

      In fact, he has interviewed many who say they were helped by psychiatric drugs. In this video, he talks about “selective drug use protocol” – using drugs in small amounts, limited periods of time; along with a sub-group of people who insist they were benefitted by their use indefinitely:

      https://www.youtube.com/watch?v=NDOJeQ0BJ9g

      I think we ought to focus our energies on making sure they are prescribed by informed consent, and they are not used by force.

      Duane

      • I am not totally opposed to responsible psychiatry myself, and believe reform can be very useful to discuss, but I also believe that psych drugs are behind much of the dysfunction in our modern society. I don’t believe that informed consent alone will stem the tide of broken lives that often result from years of being unnecessarily medicated.

        The damage from psych meds can be so subtle and insidious, that adverse changes can take place with nobody, including the patient, being the wiser until it’s too late.

        Do you expect any doctor to pass that info on under the banner of “informed consent?”

        • engineer,

          Good points.
          I guess what I’m trying to say is that I just don’t know anymore…

          When you tell people about the dangers of these drugs… many take them anyway; some scream at you (literally).

          Maybe the best way to warn people is to forget about describing the gory detail of injury these drugs have on the brain and body…

          Replace that warning with this one:
          These drugs will likely make you fat and asexual.

          This may stop a few folks cold in their tracks:
          You will not good nice in a swimsuit, nor will you care.

          Those might work? I dunno.

          Duane

          • That’s brilliant. I wonder if it happens in an 8-week clinical trial, and whether the subjects are weighed.

            (Not just asexual, btw, for for some, inorgasmic.)

            I noticed that the Hamilton Depression Rating Scale has an item about recent weight loss, but not weight gain. In fact, it would count weight gainas a positive. Heh. Maybe that it is why it is used, despite its other flaws.

            I can think of some great posters for this idea…

            Truly a good one. You should tell the Scientologists. They are the only ones throwing money at this.

          • I actually had problems with weight gain after tapering off..I wondered at first if long term use damaged my metabolism, but I’m more inclined to think I gained weight through comfort eating when my withdrawal was at its worst.

            The weight is coming off now, slowly, but I have an active job now, too.

        • I am not totally opposed to responsible psychiatry myself,

          A contradiction in terms, no?

          How can an institution based on a false and misleading premise (the existence of “mental illness”) ever be “responsible”? Or maybe we should ask “resposible to whom?”…

  11. Dr. Read, New Zealand, like the US, allows drug companies to advertise to consumers. I have seen a graph that showed the two countries have rates of bipolar diagnoses that are the highest in the world and well above the next contender, which I think was Columbia. (Cannot find it at the moment, and of course it might be false.)

    In any case, it might be that NZ is experiencing high bipolar rates because people ask their doctors for antidepressants, as they do in the US, and end up in mania or akathisia.

    The negativity about the drugs in the study you described might be because many in NZ were prescribed the drugs for mild depression, got worse or became delirious, wish they had not taken the drug for a tolerable complaint, and are up in arms.

  12. Professor Read You are absolutely right but I can’t focus on that right now because I have to just focus on keeping things as calm as possible for myself. I don’t have $12,000 to visit a clinic to pump me full f amino acids that I bneed in order to effectively recover from going off Paxil and klonopin. I am sure one day I will and i will use that but at this point I haveto managethe anger and agression I have with exercise and relaxation and MOST IMPOSTANTLY my spirituality-not religion. I can cure myself without the side effects of withdrawal as long as i believeand i plan to do that when I am completely settled. And when I have 12,000 for the right help. If there was free healthcare where I live i’d do it now. Also I would participate in any study offering participants a place to convalesce after going off the two drugs but I don’t know of any programs like this. WIll you please inform me of any if you hear of one. My email is in my registration and i give you permission to access it and madinamerica permission to give it to you. Please let me know. I cannot live fear based like most americans so I will choose to rise above my situation by relying on myspirituality to heal me and eating right and exercising every day and especially drinking tons of water but I can tell you I feel so much better less tired when I skip a day of the pills. But I’m soldiering on because i know that the best is always being done for me and when the right place that can really help me get off these insane drugscomes along It will be presented to me-things always happen for my benefit. besides it is mind over matter and when I do focus on my spirituality I don’t feel the side effects of these drugs so strongly.

    • Tatiana,

      Best wishes on your healing journey. Keep praying. I agree spirituality, regular moderate exercise, a healthy diet, and lots of water (personally I drink distilled, due to the fluoride in our water supply) are key to your recovery. And visiting MiA is actually therapeutic, too, because you’ll meet others who have already gone through what you are going through, and may be able to help you. Best wishes, and I am sorry (and remember) how difficult it was to go through what you are now, but have hope. My prayers are with you.

  13. I appreciate the author John Read’s take on psychotropic meds, or at least in this case antidepressnt medications, and the expertise he has with regards to the subject matter.

    And appreciate much his rationale for that view (in article) and then the application of his thoughts to the tragedy of the recent pilot on meds and resulting plane crash – that not taking into account the psychotropic meds the suicidal pilot was on is lacking in insight and understanding of the adverse these medications have been proven to elicit in normal folks and those suffering from mental distress.

    I recently came across this – horrifically and tragically sad – article that shows almost every mass shooting in the U.S. over the past 20 years has an agressor that was taking antidepressant medication. Most are also teenagers.

    http://www.sott.net/article/279716-Nearly-every-mass-shooting-in-the-last-20-years-shares-one-thing-in-common-and-it-isnt-weapons

    Clearly Mr. Read knows what he is talking about and this study backs up his thinking.

  14. wow!! what a read! thanks, prof john , for such a great article.

    i think it can all be broken down into simple terms, if the pro-drug people decide to be honest with themselves. if somebody has a problem, (sadness, anxiety, moody, inattentive, whatever) he needs his whole mind, a clear mind, to best solve his problem. the drugs always get in the way. ALWAYS. if you do not thing it is a good idea to be drunk or high or stoned when you must be at the top of your game then you should never take a psychotropic drug. simple as that. EVERY person of normal intelligence is capable of fixing his problems and his behaviors to allow him to lead a better life. but he needs his whole, clear mind to do so. and these horrific drugs take that away.

    healing to all

    erin

  15. Hi John Read, I thought I had sent a comment, but did forget. As usual your work inspires me and gives strenght and knowledge to keep up the work. I love the way your research involves so called ordinary people and how their knowledge (unfortunately) is far beyong knowledge in psychiatry due to how come people are not feeling good. Take care!!!

  16. Unfortunately, I don’t have a supporting link but I read somewhere one time that about only 2 to 10% adverse side effects for all meds are ever reported to the FDA. So if a physicians gives you that look when you report one, that could be the reason why.

    I also think they just don’t want to believe that a treatment they advocated can be harmful. As a result, it is easier to just discredit the patient even if it is in a subtle manner such as stating that you never heard of the drug reaction.

  17. Dear Professor Read, thanks for the fantastic article. I’ve often wondered what I would do if I ever became seriously depressed (though I’ve been treated for everything).

    This morning I woke with a problem inside my head that disturbed me. Later on, after I had moved away from the problem and revisited it again, it didnt seem to be anything special to me. When I came off depot type medication, these fears used to last a very long time, but I eventually found ways to cope and stabilise myself.

    What I realise from this is that practical psychotherapy is ideal for “serious mental illness”, because it offers the option of full longterm recovery.

  18. Something which needs to be kept in mind during any discusion of brain chemistry is that every state of mind has a unique biochemical correlation, as we are material beings, at least in this existential focus. But correlation is not causation. When we’re angry our adrenalin rises measurably. Are we then to conclude that anger is a disorder “caused” by too much adrenalin? This is the exact logic aplied to other emotional/biochemical correlations and should be seen as similarly bankrupt.

    • That is the logical fallacy we’re dealing with. We are told that “all behavior arises in the brain” as if there were no agent OPERATING the brain. We decide to be angry and then we get the surge of adrenaline. True, we could probably eliminate anger by excising everyone’s adrenal glands, but is anger really the problem?

      ALL of our emotional states are survival mechanisms and are a result of our working to survive as an organism. Randomly selecting certain biological states as “disordered” is bad enough, but the current paradigm takes away the entire concept of personal agency and acts as if we are mere leaves in the wind of biological determinism and that our emotional states have no meaning or utility. I guess everyone is supposed to be mildly interested at all times and everything else needs to be medicated out of existence!

      —- Steve

  19. I found the the source of the 70% figure offered by LoganBerman. Not impressed.

    Nonetheless,this study shows a statistically significant associationbetween the presence o f t h e 6 7 ? T g e n o t y p e a n d a n i n c r e a s e dr i s k o f d e p r e s s i v ee p i s o d e s . A larger study in a properly def,rnedpopulation with depressive
    d i s o r d e r ( a c r o s s t h e a g e s p e c t r u m ) i s w a r r a n t e d –

    Here is another Study

    The second study, authored by George Papakostas, MD, Associate Professor of Psychiatry at Harvard Medical School and Director of Treatment-Resistant Depression Studies in the Department of Psychiatry of Massachusetts General Hospital in Boston, was an analysis of secondary endpoints in the multi-center double-blind, randomized trial of Deplin® in addition to an SSRI presented in 2011 at APA. The secondary endpoints evaluated the effects of specific metabolic biomarkers including inflammation, body mass index (BMI) and methlentetrahydrofolate reductase (MTHFR), a genetic defect.

    In the double-blind phase, 75 patients with SSRI-resistant MDD were enrolled in a 60-day study, divided into two, 30-day evaluation periods. Patients were randomized to receive one of three treatments: (1) Deplin® (L-methylfolate 15mg) in addition to an antidepressant for 60 days; (2) placebo in addition to a SSRI for 30 days followed by Deplin® 15 mg. in addition to an antidepressant for 30 days; or (3) placebo in addition to an antidepressant for 60 days. The SSRI doses remained constant during the double-blind phase of the study.

    Increased efficacy was observed with adjunctive Deplin® 15 mg versus SSRI therapy plus placebo. Pooled differences in mean changes on HDRS-17 and HDRS-28 (an expanded version of the Hamilton scale) were significantly different (p = 0.05 and 0.02, respectively).

    Compared to patients given adjunctive placebo, a numerically greater treatment effect was observed in patients given Deplin 15mg in addition to their SSRI who had an allelic variant in the MTHFR (methylentetrahydrofolate reductase) C677T genotype. Differences in mean changes in HDRS-28 were -3.75 for patients with a “T” allele (homozygote and heterozygote alleles combined) versus -1.99 for the patients with a “CC” allele (considered the “normal” allele) and marginally significant (p=0.087). An allele is an alternative form of a gene (one of a pair) that is located at a specific position on a specific chromosome. They determine genetic traits.

    • So you’re saying that Deplin decreases the toxic effects of SSRIs? p=0.087 is also not impressive and in my field not considered significant at all (not even marginally).

      That being said giving folate to people is widely recognized form of supplementation and yes folate has a function in the nervous system. Why one would give it together with SSRIs which have no clinical efficacy in treating depression is beyond me.

    • Still not impressed.

      LoganBerman posted selected findings from this study:

      L-METHYLFOLATE AS ADJUNCTIVE THERAPY FOR SSRI-RESISTANT DEPRESSION

      http://www.deplin.com/wp-content/uploads//Papkostas-G.pdf

      Summary

      The study reports two trials. LoganBerman reported the results of the second trial. I looked at both trials, and am summarizing results for the HAM-D scale, because it appears first on the data tables. This took quite a while, so someone else can do it for all the other outcomes measures if they question it.

      Trial 1

      The first trial supplied doses of 7.5 mg/day or 15 mg/day to the treatment groups. There were two 30-day phases. Placebo or 7.5 mg/day were supplied in Phase 1, and placebo or 7.5 mg/day or 15 mg/day were supplied to the treatment groups. Of note: Data analyses for the second phase of Trial 1 excluded all placebo-treated subjects who responded during the first phase. Of 112 placebo patients, only 33 were included in analyses of phase one data.

      They found that MTHF did not improve outcomes.

      In Trial 1’s first phase, 28% of placebo patients responded, and only 19% of MTHF patients did. Remission rate for placebo-only was 18%, and 11% for MTHF patients.

      In the second phase, with the higher dose of MTHF provided, and placebo-responders from the first phase excluded from data analyses, response to MTHF was 17%, which is slightly lower than the 19% response rate in the lower-MTHF. The placebo group size had dropped from 112 to 33 after placebo subjects who improved during phase one were excluded.

      Trial 2

      The second trial was the same as the first, but MTHF was supplied at 15 mg/day during both 30-day periods.

      MTHF subjects improved at higher rates than did placebo subjects.

      In phase 1, response rate for MTHF was 37%, and for placebo, 19%. In phase two, the rates were 28% for MTHF and 9% for placebo. As in Trial 1, placebo-responders during phase one were omitted from the data in phase two; the placebo group size dropped from 56 subjects to 21.

      Some anomalities occurred, though. Response rate in Trial 2 for MTHF in phase 1 was 36%, and dropped to 28% in phase 2. Both rates were markedly higher than those seen in Trial 1, phase 2, which supplied MTHF at 7.5 mg/day or 15 mg/day, with a response rate of 17%.

      If you look at the four phases in the two trials as a sequence (T1 p1, T1 p2, T2 p1, T2 p2), the response rates to MTHF do not make sense: 19%, 17%, 37%, 28%. The leap from 17% to 37% is quite large, considering that the increase in dose from T1 p2 to T1 p2 did not increase the response rate at all.

      This is might be because there were too few subjects in Trial 2 (19 and 18 in the phase 1 and 2 MTHF groups).

      Or it could be because Pamlab, the maker of the MTHF supplement, Deplin, funded both trials, and five of the authors take money from, consult for, and speak for Pamlab.

  20. Validation and normalization work better than labeling and drugs. Not that some people don’t find the drugs helpful, and I don’t wish to ban them, but in the long run, finding someone to understand you and help you make plans is almost always the real solution. There may be the odd exception where a genetic condition really does exist, but these have been proven over time to explain only a tiny percentage of cases. Such cases should be detected and dealt with accordingly, but assuming that ALL cases of depression (or even most) are biological in origin ignores both the evidence and basic common sense.

    I agree but you are assuming all mental distress is psychological, most of the time it is, but for some people that doesn’t seem to be the case.

    • I clearly am not assuming that if you read my full post. My issue is that the psychiatric orthodoxy assumes the contrary. MOST of the time it is psychological, and if psychiatry claims to be scientific in its approach, it must begin by recognizing that absolute fact. If there are physiological issues contributing (such as poor folate assimilation or processing), those issues should be addressed (in this case, most likely through nutritional counseling). Many physiological things like loss of sleep, sleep apnea, low iron, thyroid imbalances, chronic pain, side effects of other drugs, etc., can contribute to depression and should be addressed. The problem is lumping ALL cases of depression together and assuming ALL of them are physiological in nature and treating ALL of them with antidepressants, regardless of the context and without any reference to any valid test of what may, in fact, BE wrong physiologically. For instance, I’ve never yet seen a psychiatric evaluation that tested for anemia or low thyroid, and they often don’t even ask about sleep patterns. I’ve almost never seen a recommendation of dietary changes or working on sleep issues as a primary intervention in a case of a depressed patients. CBT and drugs are the only things offered, and often only drugs. It is, in my view, a very distorted and unhelpful paradigm of care, as it tends to do the exact opposite of what is generally experienced as helpful by the people I’ve worked with. I don’t deny the importance of taking the physiological issues into account, but psychiatrists don’t do this, either. They basically assign a diagnosis and prescribe in 90% or more of the cases I have encountered.

      And the diagnosis itself is a problem, first, because it invalidates instead of normalizing the client’s reactions to stress, and second, because it generally stops any efforts to discover a valid physiological cause, since they already “have depression” and are “under the care of a psychiatrist,” so why should we look any further for a cause?

      — Steve

      • You hit the nail right on the head.

        I do agree with most people on here that these drugs have a limited roll, especially if someone has been through trauma. Psychiatrists are really hit or miss (I have had some terrible ones) but some will sit you down and talk about health history and what not, before jumping on the medication bandwagon. The mental health facility I have been to did daily blood work on literally all the patients there to look at anything that could be wrong, I assume that is most mental health facilities. Most psychiatrists do not do this though as you stated, that defiantly should change.

        • ” The mental health facility I have been to did daily blood work on literally all the patients there to look at anything that could be wrong, I assume that is most mental health facilities.”

          They did in the hospital aka prison aka torture chamber I was in. But they didn’t care or were too stupid to actually interpret these results in any way. They were required to do this and EKG as well yet they had a guy die from heart failure while on heavy drugs and tied up to a bed (because when you make someone unconscious why would you monitor his/her breath and heart rate like a real doctor?). They are quacks and you’re much better with “doctor Google” than these bunch of morons.