Extreme research bias: It is not placebo, it is acute withdrawal.



Imagine that you are going to take part in a randomized controlled trial for a new antidepressant. (You will remember the points better if you personalize it like this)

You are already on an antidepressant, but like the majority on these drugs, you feel it is not really working.


On day one you have an interview with a nice doctor, and feel like a VIP. You get a pill and you are instructed to take this every morning for the next 8 weeks. You are told that you might feel a bit strange in the beginning, especially that you may feel a bit anxious.


From day one you feel bad, but you expect it since the doctor told you so. No pain , no gain, it gets worse before it gets better, you think. As the days go on, you feel worse and worse. The other participants that you meet in the waiting room say the same thing: they really feel a lot worse.


After 10 days, you notice that some of the others are getting a lot better, quite suddenly. This seems like a mystery to you. It seems like half of you are still feeling really bad, worse every day, and the others are really getting back to their old selves. They said that they got a really bad score on the depression tests right before they got better though.


What has happened?

You have taken part in a standard drug trial, sponsored by the producer, where you have been given a so-called placebo washout treatment for 10 days. They gave you placebos for these 10 days, and then tested all of you right before they gave an antidepressant to some of the others, while you got to continue on the placebo.


They noted all the side effects you got from going cold turkey, and compared that to the side effects of those who got back a drug very similar to the one they were taking before. If you, on cold turkey, e.g. felt anxious or suicidal , this was compared to how anxious/suicidal people back on the drug felt. If they did not feel worse than you, the side effect would not be mentioned.


It may sound incredible that this is how drug research is conducted. Companies are not testing if the drug works for relieving a psychological problem. They are testing how well the drug relieves abstinence from a similar drug.


This is especially bad for suicide calculations. I you stop a so-called antidepressant drug abruptly, you may become very suicidal, even according to the info from the drug company and FDA. If you, on cold turley,  are then compared to a person comfortably back on a similar drug, one would expect that you were more suicidal.


Actually the ones back on the drug may be up to 6 times as suicidal as you. And you are already much more suicidal than most people since you are going cold turkey of the drug. If you and your fellow cold turkiers are 3 times as suicidal as never drugged people, than the hightened suicide risk is 1800%  (18 times the risk) for those who get back the drug.


We have no idea how high the risk is or people who take the drug for the first time, because this is not tested. People often tell about 8 horrible weeks before the drug kicks in, the first time they take it. So the suicide risk may be increased more than 18 times. In research projects the “ 8 weeks before it kicks in” is never seen. Another proof that the drugs are tested on previous users.


The scary conclusion to this is: we cannot trust any of the drug research. Not only are the drug companies their own judge and jury, but they are only testing the effect of relieving cold turkey withdrawal.


And even then, drugs are not really better. You have and equal chance of getting better even if you were in the cold turkey placebo group. In other words: cold turkey is as good as getting back on a similar drug. Cold turkey is still not recommended, but imagine how well the population might be if all drugs were withdrawn very slowly, one month taper per year of use.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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