On 16 November, I published a paper on Mad in America that explained that our two systematic reviews from October and November 2016 showed that antidepressants increase the risk of suicide and violence at all ages, and not only in children and adolescents. The paper also noted that psychotherapy decreases the suicide risk and that the clinical benefit of antidepressants is doubtful. I concluded that antidepressants shouldn’t be used at all and that people with depression should get psychotherapy and psychosocial support, not drugs.
On 25 November, I submitted a Finnish translation of my paper to the Finnish Medical Journal (Suomen Lääkärilehti), explaining that it is incredibly important knowledge for Finnish physicians that the increased risk of suicide with antidepressants seems to have no upper age limit.
Ten days later, I was told that my paper could be published provided it was shortened, which I did. However, after another month, when the editor had consulted with the Editor-in-Chief, my paper was rejected with the excuse that it had been published elsewhere.
I asked the editor to reconsider his position. Firstly, the editor knew that my paper had been published elsewhere when he accepted it, and, according to the guidelines of the Committee on Publication Ethics (COPE), “Editors should not reverse decisions to accept submissions unless serious problems are identified with the submission.”
Secondly, the journal had published other material in Finnish that had previously been published in another language, which I did myself in 2012. I asked the editor whether the journal had recently introduced new guidelines but never received a reply to this question.
Thirdly, I pointed out that it would be a tremendous service to Finnish doctors and patients to publish my paper, as it would undoubtedly lead to a much-needed discussion about the value of antidepressants, which are massively overprescribed in Finland (as in all other western countries).
My arguments had no effect on the Editor-in-Chief, Pekka Nykänen, who merely restated that he would not publish my paper, without offering any reasons.
I kindly asked Nykänen to respond to my questions and observations. I also wrote that I would like to know to whom I might complain over the way he had handled my paper, whether the journal had an ethical board, and whether the journal was a member of COPE.
Nykänen came up with a new excuse saying that “We are not talking about scientific research publishing here” and that since my article was to be published in the “Point of View” section of the journal, my reference to COPE did not apply. He ended his mail by saying, “On our part the case is now closed.”
I asked Nykänen once again to reply to my questions and noted that he was wrong in postulating that COPE would not be interested in the case, as publication ethics does not depend on the type of article that is involved. Furthermore, I noted that what I described in my paper is research based on systematic reviews, which is science; not just an opinion. Finally, according to the journal’s instructions for authors, Point of View articles do not seem to be any less “scientific” than any other type of article in the journal.
Nykänen did not reply. I was so surprised that Nykänen did not appear to be the least concerned about editorial ethics that I asked a Finnish colleague to look up information about him. Given that Nykänen had overruled the decision about acceptance of my paper made by the medical co-editor-in-chief, Pertti Saloheimo, PhD and MD, I assumed that Nykänen had academic credentials within medicine. However, Nykänen seems to be an engineer by education, used to work at a business magazine, is a business journalist, and all his tweets are about business, technology and politics.
I cannot know what made Mr. Nykänen behave inappropriately. But the Finnish Medical Journal was represented early on in the International Committee of Medical Journal Editors whose guidelines about Integrity say that:
“Editorial decisions should be based on the relevance of a manuscript to the journal and on the manuscript’s originality, quality, and contribution to evidence about important questions. Those decisions should not be influenced by commercial interests, personal relationships or agendas, or findings that are negative or that credibly challenge accepted wisdom … Journals should clearly state their appeals process and should have a system for responding to appeals and complaints.”
Next, I appealed to the owner of the journal, the Finnish Medical Association, and argued that editorial misconduct can be equally as serious as scientific misconduct and should not be tolerated. I received a short mail from its CEO, Heikki Pälve, who did not consider my complaints and the lack of response to my highly relevant questions but replied that he respected ”the editorial freedom of the journal.”
Misconduct should be exposed, and Finnish doctors should know how dangerous antidepressants are, at all ages. I have therefore uploaded my correspondence with the journal and my shortened paper, both in Finnish and English.
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.