BBC 5 live — the most listened-to BBC radio station in the UK — ran a piece on rising antidepressant prescriptions last Sunday. In short, it aimed to explore why such prescriptions have doubled in the last ten years, and why, in England alone, there were over 63 million prescriptions issued in 2015.
At home I listened to the radio discussion with interest, as earlier that week the producers had called me to discuss possible themes the programme could explore. I do applaud the programme for airing an interview with James Moore, who discussed with passion and clarity some of the harmful side and withdrawal effects of antidepressants. But unfortunately, as I continued listening, it became gradually clear that none of the points I had raised earlier that week (about industry-backed diagnostic inflation and the lax regulation of medicines) were going to be aired as drivers of our prescribing epidemic.
Instead, we heard a very confident GP referring to depression as a “chronic condition” while stating that antidepressants in many instances are “life-saving.” And we heard the President of the Royal College of Psychiatrists alluding to the ‘fact’ that antidepressants are not over- but under-prescribed. Such unsupported claims simply made my head spin, but I shall not test your patience by rehearsing the rebuttals here — I trust you have these already at hand.
What I will do, though, is tell you what I told the producers before the programme was aired, because if they were unable to put these points on record, then I would certainly like to:
“While it is true that vaulting antidepressant prescriptions are partly driven by poor provision for alternative interventions in the NHS,” I told them, “and while it is also true that people are now on these medications for 50% longer than they were some years ago (often because doctors misinterpret withdrawal effects as evidence the original problem has returned, thus reinstating medication), none of this explains why these drugs came to market in the first place, and how they have managed, like i-pads and bubble-gum, to spread rapidly across nations. That kind of contagion needs investment, symbolic capital and powerful patronage. And that’s the story you should tell.”
As our exchange meandered back and forth I was finally asked for a specific example of such patronage — one that applies to the NHS.
The example I chose concerns two of the most powerful questionnaires in the NHS, called PHQ9 and GAD7. Their power is due to their having being used throughout primary care for the last 15 years to enable all GPs to assess whether a person has depression or anxiety and, if so, how severely.
Now, here comes the troubling bit: The major criticism of PHQ9 and GAD7 is that they set a very low bar for what constitutes having a form of depression or anxiety for which a drug should be prescribed. And yet, what the tens of millions of people who have filled in these questionnaires over the last 15 years almost certainly didn’t know is that their NHS distribution was paid for by, their copyright was owned by and their development was undertaken by — Pfizer Pharmaceuticals. Which, incidentally, makes two of the most prescribed anti-anxiety and anti-depression drugs in the UK.
So here we have a company setting the bar very low for receiving such drugs, while at the same time making and selling those drugs — and this has been going on unchecked for fifteen years.
After making these points, the producers seemed genuinely concerned and wanted to know more. And so I continued discussing the facts until they finally declared that a special programme solely on this issue warranted commissioning.
While I certainly agreed with the proposal, my fear of course is that despite good intentions, that probably won’t ever happen. What is more likely to happen, at least in the near future, is that the drivers of our epidemic will continue to be misrepresented by interested parties, misunderstood by a misled public, and roundly miskicked by those guild organisations for whom truth feels like an ‘own goal.’
In an attempt therefore to give voice to what gets little hearing, I have, like so many contributors to Mad in America, been busy with colleagues doing what I can — this time editing a new book on this very topic: the causes and harms of our prescribing epidemic. In conjunction with the Council for Evidence-based Psychiatry, we’ve assembled a team of leading authors (including Peter Breggin, Peter Gøtzsche, Peter Kinderman, Joanna Moncrieff, Sami Timimi and Robert Whitaker) who argue that the primary drivers of this epidemic have little to do with the clinical success of these drugs in rectifying the problems they purport to treat.
Rather, this epidemic has been driven by powerful processes of pharmaceutical sponsorship and marketing, the manipulation and burying of negative clinical trials data, strong financial allegiances between industry and psychiatry, lax and conflicted regulation of medicines, increased diagnostic inflation, poor provision for non-medical alternatives, misused and misleading bio-medical language, and public health policies that increasingly privilege abstract economic and occupational outcomes (such as back-to-work indices) in their framing and management of emotional discontent.
One lesson I have learned from editing this volume, and the sheer power of the chapters included, is that we must keep telling this story, not just because the credibility and integrity of its supporting facts compel us to do so, but because of the social and individual harms this epidemic is continuing to inflict. Indeed, this narrative is a complex one; indeed, it will take more time to unravel than most shows are able or willing to commit — but we must never deter from its telling, for the price of doing so would just be too great.
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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Excellent article James… good to see a the case laid out cogently and clearly like this, about what is really going on behind the scenes with the drug prescribing epidemic.
Selling and buying, who is selling and who is buying?
Looking at the research, Iceland has the largest consumption of antidepressants , nearly 1 in to 10 people.
Figure 10.11 http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/health-at-a-glance-2015_health_glance-2015-en#page186
Exploiting peoples hope for a cure, just like when they sold https://en.wikipedia.org/wiki/Snake_oil
“quacks had fake cures for real diseases; now, they claim…” Szasz
There was a survey a few decades back showing that Icelanders were the happiest people on earth. If they keep popping those SSRI pills I guess that will change soon.
Thank you for telling the truth about the overprescribing of the psych drugs, especially by the GPs, where one did not used to expect to be given psychotropic drugs under the guise of “safe … meds.”
I will mention the censoring war against truthful information in medicine is in full force online now. The Natural News website, an alternative medicine website, was taken down by Google yesterday.
Ironically the Natural News website has gained more supporters as a result of such obvious censorship. This may bite that search engine in the butt. No one googles something in hopes of getting false info.
I’m switching to Gogoduck. Not quite as fast, but more reliable. And it won’t collect data on users without their consent.
I meant Duckduckgo.
“No one googles something in hopes of getting false info.” So true, nor do people want only part of the common wisdom that the Internet provides. Guess it’s time I switch, too.
I’m glad to hear Natural News got more supporters due to the obvious censorship. It seems the self proclaimed “elite” are freaking out after their candidate supposedly lost the Presidential election, and now that their appalling sins are being exposed for the world to see online.
I will admit that I am not familiar with the Natural News site. However, I question if the “self proclaimed ‘elite’ … freaking out after their candidate supposedly lost the Presidential election, and now that their appalling sins are being exposed for the world online.” It is true that no one is without sin and the other old line about “he throws the first stone.” I think as far as our cause goes; their has probably been an unsaid or unwritten complicity by some in the former administration. One of the problems with our government is that it can be so insular, the real truths are hidden from the main people. Sometimes, those in power are not really those in power. However, if you think the present “administration” is without sin or Rebecca of Sunnybrook Farm; I beg you to read a book of poems Called “Desolate Country” an Art Uprising anthology or a “Blessed are the Weird” by Jacob Nordby. Both are available through Amazon.
You will see that although our cause is great and needed, their is a cause greater than ours. I also believe about the “elite” that there is no “elite” but the “power” we give them. It is unfortunate that Google took down that site. In the end, I am not sure who to blame or if blaming would do any good. I think, that not only, “should” we speak up and be educated about as many things as we can and especially in this area; the most important thing to our “cause” and our “healing” is to accept who we are and be who each one of us; even in face of all opposition. I am not encouraged that the present “administration” appreciates those of us who are different; “artistic” “creative” “intelligent” etc. But, that should never stop us from being who each one of us is meant to be. .. . never.
Thank you for your Brilliant Article,
I see the SSRI epidemic as a type of (publicly funded) money laundering scheme. It’s been successful because all the people and agencies we might trust have (one way or another) fallen under influence.
The present situation is that these drugs are now out of patent and no longer earning any real money. But an epidemic of very expensive SSRI induced disability continues.
Yes – I think that sums it up!
James – Did you see the BBC TV documentary “The Doctor Who Gave up Drugs” last year? The whole 2 episodes are excellent and worth watching, but your article has just brought to mind the bit where Dr Chris van Tulleken completed the PHQ-9 himself and was surprised to discover that he was “very likely” to be suffering from “some form of depression”. The clip in question is at 19mins 40 seconds on Episode 2. Here’s the link… https://www.youtube.com/watch?v=iFIlGODWM2E
Thank you James Davies (for the excellent new book and for this article) – and James Moore for speaking on Radio 5-live!
Many other people had contacted the programme with their stories and other input too… so it will be interesting to see if they do put together a further programme on the topic.
And then there is the off-label prescribing of antidepressants – as featured in a new BMJ editorial this week and which is most alarming too.
I have contributed a rapid response – others may wish to as well?
Prescription drugs work pretty much the same way as street drugs. So if we want to fight against one, we need to also fight against the other. We need people who work to fight injustice, not those who want to ‘recovery’, ‘heal’, or just plain escape from it.
“But unfortunately, as I continued listening, it became gradually clear that none of the points I had raised earlier that week (about industry-backed diagnostic inflation and the lax regulation of medicines) were going to be aired as drivers of our prescribing epidemic.”
The driver of the prescribing epidemic is the chemical imbalance myth more then anything else. Most of the public still believes that bull manure that “low serotonin” causes depression ect. And then wants pills to ‘correct’ it.
“There are a thousand hacking at the branches of evil to one who is striking at the root.” – Henry David Thoreau
Strike the root ! > https://www.madinamerica.com/2012/01/psychiatrys-grand-confession/
The_cat, very well put!
But also the_Cat, what sets one up to fall prey to the Mental Health System and their ~Brain Chemical Imbalance~ theory? Would you agree that it is social marginalization, and that the most common source of this is The Family?
Abusive families often do lead to emotional distress called “mental illness” in certain members.
This is not always the case; it wasn’t what led to my mad episode or “MI” label. My parents have done their best to support me. Unfortunately they’re misinformed and lack necessary tools to help me now.
My dad lost his job when I was 14. We lost our home and all monetary support for 2 months. Luckily we had my grandparents to stay with.
At the new school I was subjected to sexual harassment and other forms of bullying. This led to intense anxiety, depression, and poor self image.
In college, though I wasn’t bullied, my emotional problems continued. In an evil hour I ignorantly went to see a psychiatrist.
Sometimes I feel I deserved what happened to me because I’m weak and too sensitive. By which I mean how the Psych System treated me. If I were emotionally strong and less sensitive–like my younger siblings–none of the horrible stuff would have happened to me with the druggings and stigmatizing labels.
Feelin’Discouraged, Please never ever think you deserved what happened to you for any reason. You did not deserve it! I, too, got trapped into the abusiveness of the current “psych” system. In college, I first went to student counselors in the Counseling and Guidance Department through the College Counseling “System.” They were on the up and up. No toxic drugs were involved and we did serious work on dealing with my “issues” at the time.
But, years later, when I first looking for a career that would give me joy and then when I moved and was out of work I ended up in the State Vocational Rehabilitation Office. From there, I ended up in the mental illness system. From there, it started with Tegretol, which I could not take and then Lithium. A few years later I moved and was able to disassociate myself from them and was drug-free for a few years; until my best friend and sister was diagnosed with cancer. A few years after that, you could say I “got off the wagon.” I saw several of these drug pushers and then one ditched me saying I couldn’t afford her because of my insurance policy. She had the kindness of heart to drop it to me when I was trying to make another appointment; but, she left me holding the bucket as I was still taking the drugs.
Then my sister passed away. VR then guided me back into the mental illness peoples. This time, the toxic drugs got more and more. I was determined to be “seriously and pervasively mentally ill.” I have very scant memories of my life from about 2004 until about 2013. They decided I was “schizophrenic.” I spent eleven days in a mental hospital; came out and they couldn’t wake me up for days. I ended up in a real hospital with a “false” diagnosis. They abruptly took me all the drugs with no tapered withdrawal; except lithium. They lied to me and other stuff. I finally got tired of it and due to some family things, I moved. I started out in my new place seeing the psychs, etc. They messed with my drugs; “browbeat” me if I complained about them; threatened to test to see if I was taking them. In the meantime, I read “Anatomy of an Epidemic.” Also, I was so sick I couldn’t eat or sleep or anything. Then, one day, I tried to take the drugs and “threw then up.” I said; “NO MORE!.” I saw an idiotic psychiatrist one more time. I told her no more drugs. She insisted that I take a low dose of risperidal or I might have a relapse. I think I tried to take it once. I never saw her or the inside off that place again! The last time I was there was May 2013. No RELAPSES YET! I have dealt with much fatigue and other issues during the withdrawal. I have actual had more complaints of the body, than the mind. I tell you my story so you know you are not the only who got “suckered.”
You may be sensitive; but for a very good reason. I think there may be some kind of “artist” hiding inside you. Experiment. You will realize that despite it all, you are here for a great purpose and reason. My heart goes out to you. You are stronger than you think. You have the strength of millions who never tried to walk your path.
Families can be subjected to outside stress, and this may be extremely unfair. But sometimes stress helps families pull together.
But for someone to end up voluntarily or involuntarily in the mental health system, it seems like there must be something which makes them feel that they need it, some feeling of doubt or inadequacy.
Just to try and better explain it. You could never get me into a pyramid or Ponzi scheme, because I have no interest in getting money that way.
But made to believe that a psychotherapist might have the answers to why my life has been so hard? Yes, I was susceptible to this. It was completely bogus, all the therapist could do was tell me how to let my abusers win. But I was still taken in.
The whole thing is a conspiracy to deny the child’s experience.
Stop collaborating with the Mental Health System and Recovery:
This is a great article; as true in America as it is in Britain. I think someone mentioned “street drugs.” I am no scientist; but I see no difference. In fact, I see the doctor or psychiatrist in the same manner as I see the “drug pusher” on the street. To convince you to take the drugs, they say similar things; like, “oh, this will make you feel better.” or “all your problems will go away.” The only difference is their casual mention of “side effects” but you have to pry it out of them and those little initials by their name. To “fight” this we will have to fight the whole medical, health care, drug (legal and illegal) and insurance industry; but, it is a fight worth fighting. However, like all good struggles for virtue and righteousness, the struggle begins at “home.” Get educated and stand up for yourself and when they try to force drugs on you “just say no!”
Learn to be in charge of your own health. Don’t let someone else or the doctors be in charge. You are you and you know yourself the best!
Here’s another line street-dealers and psych-dealers use: “All you’ll feel is good.” Giving us their bovine excrement about how the mind-altering drugs are non-addictive. I had a shrink once say that the only thing that made his stuff seem addictive was that you got used to feeling better.
I detest liars and hypocrites!
I’m not so sure! Realistic information on the negative effects of street drugs is freely available, most consumers are recreational users and consumption is voluntary. I don’t think this is the case with prescribed psychoactive substance.
If you mean that shrinks are more dangerous than street-dealers I agree. Due to their phony respectability and pseudo scientific lies they’re a bigger menace to our society than all the drug lords from developing countries combined.
And nothing will change until poeple start invading chemists to hang banners.
Or similar actions
Feelin Discouraged: You are absolutely right. They hide under the mask of authority, respectability, and degrees with letters beside their names. So, people think it’s alright to take these drugs. They were prescribed an M.D. But, increasingly, not only psychiatrists prescribe these drugs, but of course, pediatricians, general practitioners, internists, ob-gyn and those in other specialties prescribe these drugs. Also, nurse practitioners, physicians assistants, and anyone approved by the M.D. or signing the M.D.’s name can prescribed these drugs (depending on state laws) Additionally, a woman would not take these drugs, if pregnant. Yet, today, they get away with prescribing drugs such as antidepressants to these women with the weak argument if we did not prescribe these drugs, they might commit “suicide.”
This does make them far more dangerous than any drug lord or drug pusher. These people can kill you and get off “scot free.”
Why Council for Evidence-based Psychiatry, with such big leading authors such Peter Breggin, Peter Gøtzsche, Peter Kinderman, Joanna Moncrieff, Sami Timimi and Robert Whitaker who are so vocal about the danger of antipsychotic, Bezos and all these lethal drugs that cause deterioration of cognitive and “possibly” irreversible brain damage can’t challenge the norm and form institutions or clinics to help patient come off their meds safely – instead of leaving patients in the hands of devils. Come on guys, you have the power and resources to do such thing so help us! Pleeeeeeeeeeease
James et al
I have recently come across another questionnaire, introduced around the same time as PHQ-9 and GAD-7 and also in association with Pfizer. This is the PHQ-15, used together with the other two questionnaires to help to ‘diagnose’ medically unexplained symptoms (MUS), also known as somatic system disorders …. Here’s links to the PHQ-15 questionnaire:
(more about it wrt DSM5 in this download https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Level-2-Somatic-Symptom-Adult.pdf )
I have to say that I find this very alarming altogether – and seems to confirm my earlier observation