SSRIs: Minimal Effectiveness and High Risk

Philip Hickey, PhD
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Last month (February 2017), the journal BMC Psychiatry published a study by James Christian Jakobsen et al.  The study is titled Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and Trial Sequential Analysis.

The research was a meta-analysis — i.e. it combined the findings from several earlier studies.  Here are the authors’ conclusions:

“SSRIs might have statistically significant effects on depressive symptoms, but all trials were at high risk of bias and the clinical significance seems questionable. SSRIs significantly increase the risk of both serious and non-serious adverse events. The potential small beneficial effects seem to be outweighed by harmful effects.”

The authors point out that there have been previous meta-analyses assessing “the effects of SSRIs in adults with major depressive disorder,” the general conclusions of which have been that SSRI’s have a statistically significant effect on depression.  But Jakobsen et al point out that the previous studies had a number of limitations, including one or more of the following:

  • failure to use predefined Cochrane methodology in the selection of studies;
  • only including subgroups of depressed individuals;
  • failure to search all relevant databases;
  • failure to systematically assess harmful effects;
  • failure to systematically assess risk of bias in the source studies.

The authors’ objective was:

“…to conduct a comprehensive systematic review assessing the beneficial and harmful effects of SSRIs versus placebo, ‘active’ placebo, or no intervention in adult participants with major depressive disorder using our eight-step procedure for assessing evidence in systematic reviews.”

The authors’ protocol, detailing the methodology to be used, was published in advance, and can be seen here.  “The methodology was not changed after the analysis of the review results began.”

. . . . . . . . . . . . . . . .

Here are some quotes from the article, interspersed with my comments/observations.

“Independent investigators searched for eligible trials published before January 2016 in The Cochrane Library’s CENTRAL, PubMed, EMBASE, PsychLIT, PsycINFO, clinicaltrials.gov., and Science Citation Index Expanded…Trials were included irrespective of language, publication status, publication year, and publication type. To identify unpublished trials, we searched clinical trial registers of Europe and USA, websites of pharmaceutical companies, websites of U.S. Food and Drug Administration (FDA) and European Medicines Agency, and we requested the  U.S. Food and Drug Administration (FDA) to provide all publicly releasable information about relevant clinical trials of SSRIs that were submitted for marketing approval.

Participants had to be 18 years or older and have a primary diagnosis of major depressive disorder based on standardised criteria, such as DSM III, DSM III-R, DSM IV, DSM V, or ICD 10.”

Obviously this was a very comprehensive search for source studies.

“Primary outcomes

  • Depressive symptoms measured on the 17-item or 21-item Hamilton Depression Rating Scale (HDRS), the Montgomery-Asberg Depression Rating Scale (MADRS), or the Beck’s Depression Inventory (BDI).
  • Remission (Hamilton <8 points; BDI <10 points; MADRS <10 points).
  • Adverse events during the intervention period which were classified as serious and non-serious adverse events. Serious adverse events were defined as medical events that were life threatening, resulted in death, disability, or significant loss of function, or caused hospital admission or prolonged hospitalization. The remaining events were classified as non-serious adverse events.

Secondary outcomes

  • Suicides, suicide attempts, and suicide ideation during the intervention period.
  • Quality of life (scale used by the trialists).

The time point of primary interest was end of treatment (defined by trialist). We also planned to report results assessed at maximum follow-up.”

. . . . . . . . . . . . . . . .

“Using our strict inclusion and exclusion criteria, a total of 195 publications/unpublished trials were identified and included. Due to multiple publications of single trials and lack of useful data, only 131 randomised clinical trials enrolling a total of 27,422 participants were included in our analyses.”

. . . . . . . . . . . . . . . .

“Estimating a meaningful threshold for clinical significance is difficult and an assessment of clinical significance should ideally not only include a threshold on an assessment scale.  Major depressive disorder affects daily functioning, increases the risk of suicidal behaviour, and decreases quality of life. Some adverse events might therefore be acceptable if SSRIs have clinically significant beneficial effects. We therefore both predefined a threshold for clinical significance and assessed the balance between beneficial and harmful effects.

As threshold for clinical significance, we chose a drug-placebo difference of 3 points on the 17-item HDRS (ranging from 0 to 52 points) or an effect size of 0.50 standardised mean difference. This has been recommended by the National Institute for Clinical Excellence (NICE) in England and has been chosen in other reviews. Nevertheless, these recommendations are not universally accepted and have been questioned. Others have suggested the following ‘rules of thumb’ regarding the standardised mean difference: 0.2 a small effect, 0.5 a moderate effect, and 0.8 a large effect. One study has shown that a SSRI-placebo mean difference of up to three points on the HDRS corresponds to ‘no clinical change’ [186]. Another valid study has shown that a SSRI-placebo difference of 3 points is undetectable by clinicians, and that a mean difference of 7 HDRS points, or a standardized mean effect size of 0.875, is required to correspond to a rating of ‘minimal improvement’[187]”

In studies of this kind, it is necessary to distinguish clinical significance from statistical significance.  This is well illustrated with a simple analogy.  Imagine a coin that has a 1% bias in favor of heads.  What this means essentially is that if one conducts a very large number of trials, each of 200 tosses, the average result per trial will be 101 heads and 99 tails: a discrepancy of 2 per 200, or 1%.  In ordinary practice, however, this coin could be considered fair for use in sporting events and other simple decision-making situations.  The 1% discrepancy is statistically significant (as opposed to a random fluctuation) but not practically significant.

Similarly, in clinical trails involving a large number of participants, a treatment effect might be statistically significant (i.e., probably not a random fluctuation), but may nevertheless be so small that it has no clinical significance.

For the purposes of the present meta-analysis, Jakobsen et al chose a 3-point difference on the 17-item Hamilton Depression Rating Scale as the threshold for clinical significance.  Their discussion of this in the above quote is self-explanatory.  Reference 187 in the above quote is to a 2015 paper by Joanna Moncrieff and Irving Kirsch.  The paper is a discussion of a 2013 study by Leucht et al, What does the HAMD mean?, which is reference 186 in the above quote.

The Leucht et al study was a meta-analysis embracing 7131 participants.  The methodology used was to compare the improvement scores that people obtained on the HDRS questionnaire with their improvement scores on the Clinical Global Impression scale (CGI-I).  The CGI is a rating scale based on a face-to-face interview and is used frequently by psychiatrists and other mental health workers in clinical and research settings to assess client improvement or deterioration.  Leucht et al found:

“The results were consistent for all assessment points examined.  A CGI-I score of 4 (‘no change’) corresponds with a slight reduction on the HAMD-17 of up to 3 points.” [Note:  the HAM-D and the HDRS are the same questionnaire.]

What this means essentially is that trained psychiatrists and other clinicians, conducting face-to-face assessments, could not detect an improvement of 3 points on the HDRS.  People who achieved an improvement of 3 points on the HDRS questionnaire were rated as “no change” on the face-to-face CGI-I.

Incidentally, five of the six authors of Leucht et al report close links to pharma.

“HF, MK and AS work full-time for Merck & Co, parent company of Organon, which provided the data for this study.  AS is also a shareholder with Merck & Co.  SL has received honoraria for consulting/advisory boards from Alkermes, Bristol-Myers Squibb, Eli Lilly, Janssen, Johnson & Johnson, Lundbeck, Medavante, Roche, lecture honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Essex Pharma, Janssen, Johnson & Johnson, Lundbeck Institute, Pfizer, Sanofi-Aventis, and Eli Lilly has provided medication for a trial with SL as the primary investigator.  PL has received honoraria for educational talks on medical ethics from AstraZeneca and Eli Lilly.”

So it seems unlikely that they would be biased towards downplaying the efficacy of antidepressant drugs.

Also incidentally, here’s an interesting quote from a general discussion of this matter in the Moncrieff and Kirsch paper:

“The small differences detected between antidepressants and placebo may represent drug-induced mental alterations (such as sedation or emotional blunting) or amplified placebo effects rather than specific ‘antidepressant’ effects.”

. . . . . . . . . . . . . . . .

Primary Outcomes

“…meta-analysis of the results of all 92 trials [that used the HDRS] showed that SSRIs versus placebo significantly reduced the HDRS score (mean difference −2.25 points…).”

In other words, there was a statistically significant reduction in average depressive “symptoms” as measured by the HDRS, but the reduction was only 2.25 points, which as discussed above, is of no clinical significance, i.e., would be rated as “no change” on the CGI-I scale.

Risk of Bias

“All trials were at high risk of bias per several bias risk domains and especially the risk of incomplete outcome data, selective outcome reporting, and insufficient blinding bias may bias our review results. Our GRADE assessments show that due to the high risks of bias the quality of the evidence must be regarded as very low. The high risks of bias question the validity of our meta-analysis results as high risk of bias trials tend to overestimate benefits and underestimate harms.  The ‘true’ effect of SSRIs might not even be statistically significant.”

In other words, the small, but statistically significant results found in the meta-analysis may simply reflect various biases that were present in the source studies, and which would inevitably bias the results of the meta-analysis.

GRADE is a protocol developed by Cochrane Training for assessing the quality of a body of evidence.  Grading of Recommendations, Assessment, Development and Evaluation.

Incomplete outcome reporting is a particularly important source of bias in these kinds of trials.  Consider a drug vs. placebo trial in which the authors have gathered ten different pieces of outcome data on each participant.  Let’s say that four of these outcome measures favor the drug and six favor the placebo.  It is very tempting for the researchers, particularly those who have a vested interest in the drug, to report the four drug-favorable measures and omit the other six.

I leave it to the reader to decide whether psychiatric research might be prone to this kind of selective reporting.

Subgroup Analyses

In trials involving people with relatively higher levels of depression (HDRS score higher than 23 points), the improvement with SSRI’s was higher than in the trials involving lower levels of depression (less than or equal to 23 points).  The mean difference was 2.69 points for the SSRI group vs. 1.29 points for the placebo group, neither of which cross the threshold for clinical significance (3 points).

Other tests for sub-group differences showed no significant differences.  These tests were:

  • comparison of different SSRI’s
  • older vs. younger participants
  • trials with washout period vs. those without
  • trials with drug/alcohol dependent participants vs. those without
  • short “treatment” period (less than 8 weeks) vs. other trials
  • dose of SSRI, below median vs. equal to or above median

Long-term Follow-up

Only six of the 131 trials reported long-term follow-up results.  The meta-analysis of all six trials showed a mean difference of 1.30 HDRS points in favor of the SSRI participants.  This is a marginally significant result statistically.  The probability that it could have been a chance fluctuation is 7%.  Additionally it is considerably below the threshold for clinical significance.

The fact that the mean difference in long-term follow-up is lower than the short-term results suggests that whatever tenuous benefits came from the SSRIs were short-lived.  It is also interesting that only 6 of 131 trials pursued any kind of long-term follow-up.

Remission and No Response

Thirty-four of the 131 trials assessed participants for remission, and 70 trials assessed for no response.  Remission was usually defined as achieving a score below 8 on the HDRS.  Response was usually defined as a 50% reduction of HDRS score.  On each of these measures, the SSRI group had a better outcome.

Jakobsen et al, however, point out that the results on remission and response need to be interpreted cautiously for the following reasons:

“1) the assessments of remission and response were primarily based on single HDRS scores and it is questionable whether single HDRS scores are indications of full remission or adequate response to the intervention; 2) information is lost when continuous data are transformed to dichotomous data and the analysis results can be greatly influenced by the distribution of data and the choice of an arbitrary cut-point; 3) even though a larger proportion of participants cross the arbitrary cut-point in the SSRI group compared with the control group (often HDRS below 8 for remission and 50% HDRS reduction for response), the effect measured on HDRS might still be limited to a few HDRS points (e.g., 3 HDRS points) or less; 4) by only focusing on how many patients cross a certain line for benefit, investigators ignore how many patients are deteriorating at the same time. If results, e.g., show relatively large beneficial effects of SSRIs when remission and response are assessed but very small averaged effects (as our results show) — then it must be because similar proportions of the participants are harmed (increase on the HDRS compared to placebo) by SSRIs. Otherwise the averaged effect would not show small or no difference in effect. The clinical significance of our results on ‘no remission’ and ‘no response’ should therefore be questioned.”

Serious Adverse Events

Forty-four trials reported data on serious adverse events.  The meta-analysis odds ratio for the SSRI vs. the placebo group was 1.37.  What this means is that “31 per 1000 SSRI participants will experience a serious adverse event compared to 22 per 1000” in the placebo group:  an excess of about eleven serious adverse events per 1000 SSRI users.  And it should be stressed that in this study, serious adverse events were defined as “…medical events that were life threatening, resulted in death, disability, or significant loss of function, or caused hospital admission or prolonged hospitalisation.”

It should also be remembered that the great majority of the trials collected no long-term data.  The eleven-per-thousand excess serious adverse events occurred during the relatively brief period of “treatment” duration, and it is reasonable to suspect that such events would be more frequent with long-term use.

It is also noteworthy that only 44 of the 131 trials reported data on serious adverse events.

Non-Serious Adverse Events

“Meta-analyses showed that the participants randomized to SSRIs versus placebo had a significantly increased risk of several [non-serious] adverse events.”

These included:  abnormal ejaculation, tremor, anorexia, nausea, somnolence, sweating, asthenia, diarrhea, constipation, insomnia, dizziness, dry mouth, libido decreased, sexual dysfunction, appetite decreased, fatigue, vomiting or upset stomach, flu syndrome, drowsiness, blurred/abnormal vision or dry eyes, nervousness, headache, dyspepsia, weight loss, central or peripheral nervous system problems, lightheadedness/faint feeling, agitation, impotence, taste perversion, etc..

Suicides, Suicide Attempts, and Suicide Ideation

“There were almost no data on suicidal behaviour, quality of life, and long-term effects.”

The limited amount of information on these matters showed no significant differences between participants randomized to SSRI’s vs. placebo on number of suicides, number of suicide attempts, or suicidal ideation.  This is particularly noteworthy in that the prescription of antidepressants is routinely defended on the grounds that they provide protection against suicide.

Readers may find this no-difference­ result puzzling, given the accumulation of anecdotal information linking SSRI use to suicides and even murder-suicides.  But it has to be borne in mind that, compared to the enormous numbers of people taking SSRIs, suicide is still a very rare event and is unlikely to occur in sufficient numbers in short studies of this kind to provide useful comparative information.

General Points

“All trials used placebo as control intervention and due to the large number of adverse events, some patients might have figured out if they received an ‘active’ intervention or not, which might question the blinding of the trials.”

“Multiple previous reviews and meta-analyses have, as mentioned in our Background, assessed the effects of SSRIs and have generally concluded that SSRIs have significant effects on depressive symptoms. However, the estimated results (and not the conclusions the review authors made) of these reviews and meta-analyses actually are in agreement with our present results and show that SSRIs do not seem to benefit patients more than a few HDRS points. This increases the validity of our present results. Furthermore, we assessed in detail the risks of serious adverse events and of non-serious adverse events and found that both were significantly increased by SSRIs.”

“Our HDRS mean differences were averaged effects. Hence, it cannot be concluded that SSRIs do not have clinically significant effects on all depressed participants. E.g., certain severely depressed patients compared with lightly depressed patients… might benefit from SSRIs even though there is no evidence backing this hypothesis. However, any clinical research result will have this ‘limitation’. Specific patients might benefit from any given intervention even though valid research results have shown that this intervention ‘on average’ is ineffective or even harmful.”

In addition, it needs to be recognized that there is no way to identify in advance which individuals will be harmed by these drugs.  So, in prescribing these drugs, psychiatrists are effectively playing Russian Roulette with one essential difference:  they’re pointing the gun at someone else’s head.

“SSRIs versus placebo seem to have statistically significant effects on depressive symptoms, but the clinical significance of these effects seems questionable and all trials were at high risk of bias. Furthermore, SSRIs versus placebo significantly increase the risk of both serious and non-serious adverse events. Our results show that the harmful effects of SSRIs versus placebo for major depressive disorder seem to outweigh any potentially small beneficial effects.”

“Per our results, we now believe that there is valid evidence for a public concern regarding the effects of SSRIs. We agree with Andrews et al. that antidepressants seem to do more harm than good. We have clearly shown that SSRIs significantly increase the risks of both serious and several non-serious adverse events. The observed harmful effects seem to outweigh the potential small beneficial clinical effects of SSRIs, if they exist. Our results confirm the findings from other studies questioning the effects of SSRIs, but are in contrast to the results of other reviews concluding that SSRIs are effective interventions for depression. However, our present analyses represent the most comprehensive systematic review on the topic and we hope it may guide clinical practice.” [Hyperlink added]

. . . . . . . . . . . . . . . .

 DISCUSSION

If psychiatry were a bona fide medical field, a meta-analysis of this quality yielding these results would send Richter 9 shock waves through the profession.  The prescription of SSRIs for depression is probably the single most frequent activity performed by psychiatrists in their day-to-day work.  The unambiguous revelation that this activity is doing more harm than good should be generating enormous concern for psychiatry’s leadership and for the rank and file.

But the publication of this study on February 8 generated no discernible concern within the profession.  This is because psychiatry has very little interest in the scientific assessment of its “treatments.”  Psychiatry is drug-pushing, pure and simple.  The primary criteria of success are customer retention, and volume of product sold.  As long as the “patients” keep coming back for more, psychiatrists can convince themselves that they are doing good.

The fact that the “patients” have been duped by unsubstantiated assertions of chemical imbalances, and are, in many cases, addicted to the pills, are inconvenient truths that can readily be eclipsed by self-deception and in-group mutual reassurance.

. . . . . . . . . . . . . . . .

AN INTERESTING “REBUTTAL”

On February 21, 2017, Emil Karlsson, who describes himself as “a debunker of pseudoscience and steamroller of miscellaneous nonsense”, critiqued the Jakobsen et al paper on the grounds that the HDRS 3-point cut-off for clinical significance is arbitrary and excessively high.  But in fact, as we saw earlier, the threshold is based on the empirical findings that a “minimal improvement” on the Clinical Global Impression scale corresponds to an improvement of about 7 on the HDRS, and a CGI rating of “no change” corresponds to a 3-point HDRS shift.  So the threshold of 3 points, far from being too high, is actually excessively generous.  Nevertheless, the average HDRS improvement in the trials reviewed by Jakobsen et al was only 2.25 points, and the improvement in those trials that contained long-term follow-up was only 1.30 points.

FUNDING

“The work was supported by The Copenhagen Trial Unit, Centre for Clinical Intervention Research, in Denmark.”

 

 

 

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93 COMMENTS

  1. Reminds me of the old joke, ‘How many shrinks does it take to change a lightbulb? Answer: Only one, but the lightbulb has got to really want to change.’ Except the shrinks here are the studies, and the lightbulb here is the field of psychiatry. And psychiatry really, really does not want to change.

    Liz Sydney

    • Hello Dr. Hickey ,
      As I have responded to you in the past I doubt my comment will make into a general discussion .As there is little need for a mental patient who has gone thru the system with a BS in business and minor in physch and/or a sibling with a PHD from a top 20 doctorate program .
      Beliefs other than ones promoted by main stream mental health complex are not allowed , so I will keep it short as not to waste both are times .
      My 15 year prescriptions of SSRIs is an absolute joke . When I had my 2005 break , I was given Lexapro , wellubutrin , paxil , depoke , serequel and 10 other type of SSRIs with absolutely nothing , I ended up in Miami behavioral in a fog , extremely fuctional till this expisode and never previous was on any depressions meds or past history , I was found divorced , in a strange culture , and no known friends , family , job , or money .
      At first I was thrown a cocktail of drugs to quickly get me on my feet , as a had a manic wife now in south beach doing party drugs and hanging around the wealthy and beautiful people , if I didn’t get on my feet quickly she would surely wipe me out ..which eventually did happen anyway .
      After an suicidal episode of an adverse reaction to a high dose of Librium , then following hospitalization , I was in a 6 month voluntary start program .I was the only one there not court ordered or wasn’t a drug addict or violent criminal doing there easy time vs jail .
      As the only educated nonviolent patient I was involved with a type of class president and was a go between in patient care and doctors , as if this was good for me or not I will not go into .but I got to talk to the once a month doctor assigning medicines to a variety of patients , ages , sexes , dominations , etc . He was overwhelmed and even admitted to this , he didn’t really know how the medicines worked or didn’t , his job was handling the patients , keeping the violent ones as non drugged as possible and keeping the others just from hurting others or then selves , quality of life was not a real concern . I ended up talking and communicating with this old Freudian type Hispanic/Cuban doctor .He was overwhelmed and just tring his best with not much to work with , he said his cure rate was basically Zero , he just was happy or qualified as a positive treatment was no deaths or violence . The multiple of SSRIS only worked in minor or mild mental health cases . True violent of those seeing and or hearing things typical drugs halodol , thorizen , and other tranquilizers where used , sorry about my spelling ! If one was violent they didn’t up the SSRIS and wait 6 weeks to 2 months , that of course is crazy , but saying to someone in deep depression , take 2 and call me in two months if your still alive is lol .
      We have gone from talk health , to lobotomies , to drugs to EST to SSRIS back to Special-K or Ketamine ..back to heir freud and cocaine , sure it makes somebody depressed low on energy to a club rave dancer is possible , like lobotomy , he is smiling but still is in pain . So we went from SSRIS that basically did little or nothing , with tremendous badly hospital health confirmed side effects to Special-K break out , well there are going to be a lot of new middle to upper middle class teens going to the doctor to get help now lol ..this new break thru only exposes the real weaknesses of our current anti-depressants …it is not because of the real success of SSRI but there failure off them that even brings on the thought of a Ketamine break thru , sure it works , as did cocaine in the 1900s as a medical advance , but if we haven’t learned anything is to call a narcotic , rave cat tranquilizer the next big break thru in mental health , well hell bring back Coca-Cola and speak easies , cheaper and atleast the people will die with a tune in there head versus a bullet …anyways doubt this will ever get by the censors , none have so far ! think before deleting !

  2. Philip – you make very important points and we keep asking ourselves ‘how can this be?’

    I have come to see for myself that prescribing family doctors (especially) are being actively misled to mis-diagnose side-effects, adverse effects, withdrawal and/or long-term effects of antidepressants (and other psych meds) as ‘medically unexplained symptoms’ (MUS)/somatic system disorders. This MUS diagnosis seems to be a very convenient hiding-place for all manner of neurological dysfunctions/damage of unknown origin …. and a way to divert attention and ‘re-attribute’ very serious patient suffering to yet another DSM/ICD ‘diagnosis’. Patients are being made ill/disabled and then having their credibility completely undermined. The more that they try to draw attention that something is terribly wrong – the more that they find themselves labelled as ‘difficult’ ‘attention-seeking’ ‘heart-sink’ patients demonstrating ‘excessive health anxiety’.

    I do not know where psychiatrists, neurologists, healthcare providers, politicians and insurance providers etc. sit in all this, but I do know that patients are being very seriously harmed. And every single day countless more unsuspecting people are starting on these medicines …

    I have been writing about this recently, trying specifically to reach UK family doctor readership:
    http://bjgp.org/content/67/656/99/tab-e-letters#do-no-harm—a-serious-concern

    Perhaps I can share this too – as a wry look at what is going on, largely below the radar, and not only in UK! https://recoverynet.ca/2017/03/06/m-u-d-d/

  3. So these are non-serious?
    abnormal ejaculation – ask a guy with PSSD about “abnormal” ejaculation. Pleasureless? Too soon? Not at all?
    tremor – many can’t do their jobs with a tremor in their hands, makes one appear to be weak or ill
    anorexia – leads to weakness, fatigue, syncope, and head injuries
    nausea – worse than pain, leads to vomiting, which is fun at work
    somnolence – mess up at work, school or caring for others
    sweating – give a presentation with nine-inch dark circles on your shirt, seem nervous when not
    asthenia – (abnormal weakness/lack of energy) sounds like severe depression
    diarrhea – dehydration (potentially serious), fatigue, fun at work
    constipation – pain, discomfort
    insomnia – fatigue
    dizziness – falling, head injury
    dry mouth – aversive, unappealing
    libido decreased – joyless life, unhappy partners, divorce, despair
    sexual dysfunction – see previous
    appetite decreased – see anorexia
    fatigue, vomiting or upset stomach, flu syndrome, drowsiness,
    blurred/abnormal vision or dry eyes – can’t perform job functions, drive, enjoy visual arts
    nervousness – highly aversive and crippling at times, causes irritability and harms relationships
    headache – day-wrecker, week-wrecker, etc
    dyspepsia – day-wrecker
    weight loss – not always desirable, impedes women’s fertility (which is just as well given the harm to developing babies and withdrawal after they’re born)
    central or peripheral nervous system problems – please specify
    lightheadedness/faint feeling – falls, head injury
    agitation – akathisia, perhaps? Pure hell.
    impotence – devastating
    taste perversion – loss of another great pleasure in life
    etc ???

    Anything on the nature and prevalence of withdrawal and post-withdrawal syndromes?

  4. Thank you for a very good article as usual, Phillip, but the situation is much worse than minimal efficacy. The placebo reaches the same level on the rating scales just a few days after the drug, even in heavily industry sponsored trials like Gibbons et al (2012).
    This is actually quite amazing since the placebo group in almost all studies is a completely abrupt cold turkey withdrawal group. Patients are withdrawn from their previous drug and given placebo for a washout period of about a week. This makes all patients a lot worse naturally. Just read stories about patients missing only one dose of Paroxetine. So by the end of the week all patients are typically doing a lot worse than when the trial started , they are all in cold turkey withdrawal, and very prone to suicide, akathisia etc.
    Then half of the group receive an antidepressant very similar to the one they were on before, and the other half, the placebo group get to continue in free fall cold turkey withdrawal. One would think the drug group would feel much better than the placebo group right away, but it seems from the data that even stopping abruptly from an antidepressant, is just 3 points worse on the Ham-D, not noticeable either by patients or professionals, and they reach the same level as the drug group a few days later.

    So antidepressant research is not testing the effect of antidepressants in depression, but only how well they relieve withdrawal symptoms from cold turkeying the previous drug. The severely depressed just had higher doses of the previous drug or longer exposure and therefore got a heavier cold turkey reaction that was then somewhat ameliorated by the next drug.

    We could get extremely good results if we tested alcohol like this. It would look like a fantastic effect, having the placebo group in delirium while the drug group had their alcohol back.

    A clear sign of the harmfulness and unethical nature of this design is that there were 22 serious events pr 1000 on placebo, compared to 31 on drug. How can a sugar pill create serious life threatening medical events? Cold turkey could definitely do that.

    The suicide numbers are totally misleading since we know that abrupt changes in dose increase the risk of suicide significantly. So since researchers have put the placebo group into maximum risk for suicide with cold turkey, it makes no sense to compare this to the drug group, which actually should experience a relief of e.g. akathisia, because they are pulled out of the abstinence. Even with this design FDA found a doubling of suicide risk on the drugs, and some studies of paroxetine found a 600% increase over the cold turkey group.

    It wouldn’t be surprising if the cold turkey increased suicide risk 10 times, so suicide risk on Paroxetine may then be 60 times higher than for non drugged patients. Peter Goetzshe writes about how suicides are directly hidden or moved to the placebo group, to try to hide the increased suicidality.
    So all the fine points about noticeable effects drown in the sea of withdrawal. The studies are not testing drug vs something remotely neutral, it is drug compared to being plunged into the hell of withdrawal, as described by many patients.
    This research actually only shows us that doctors are willing to give a drug that may increase suicide risk 60 fold to patients and the only benefit is that they reach a certain depression score a few days before the cold turkey group catches up with them.
    However, it is actually quite reassuring that the cold turkey group is doing that well. The research gives some hope that withdrawal, even cold turkey, may go very well for most patients.

  5. The level of deception and misleading intra-group reassurance within the psychiatric establishment is startling and stunning… or perhaps not so much when we think back to how staunchly tobacco execs resisted acknowledging the harms of their immensely profitable product decades ago. Profit over people.

  6. Everybody on this website wants to make it all better and spread the truth injection campaign. In the world we live in now, there is not going to be no psychiatric medicine. This is because pharmacology helps some people. It doesn’t cure the issue, but it helps alleviate. For many people there is a biological component to the mental health challenges that are experienced. Only an utter fool would disagree with this.

    • The psychiatric medicines might be helping those who need them and hurting people who take yet don’t need them. That would be the ultimate insult and I think it’s sort of funny in a way. It’s also ironic to ay the least. They have my vote for sparing them damnation.

      The website and all the bloggers here are far worse in my opinion. It’s like 1960’s all over again when you all moved into the ghetto and damaged the infrastructure of the neighborhood, but in this case I’m the minority living in my lovely community. You’re at it again with me a guy who ha experienced severe mental health sickness. PEACE DUDE!

      • The first problem is, how would you be able to tell who “needed them” and who didn’t. The second problem is that when they DON’T work, which (looking at the data above) appears to be very frequently, are the doctors able to notice and admit that they are making people worse? My experience, and I have lots of it over 20 years working with foster kids and ten more working as a counselor, is that they don’t.

        The bloggers here appear to me for the most part to be trying to tell a story that the “mental health” industry doesn’t want told, and this article says it well – most of the time, drugs do more harm than good, and doctors are just plain incapable of being objective enough to sort out who they do and don’t work for, or to even bother to ask. The data in this study basically say that if there is a group the antidepressants work for, it is either very, very small, or thoroughly offset by an equally large group who are made worse. This is important information. I have no idea why you would not want folks to share it. Perhaps you can explain why asking these questions or sharing this data is bad?

      • ” a guy who ha experienced severe mental health sickness.”
        I got that also. But, Where did it/does it come from? and do drugs make it worse?
        Alcohol or crack do help people for a time, but the person was not lacking in alcohol or crack in their brain.

        what is the “biological component ” in plain English?

    • Or rather than a fool disagreeing, perhaps former NIMH directors Steven Hyman:

      “The underlying science remains immature…The molecular and cellular underpinnings of psychiatric disorders remain unknown… psychiatric diagnoses seem arbitrary and lack objective tests; and there are no validated biomarkers with which to judge the success of clinical trials.”

      and Thomas Insel:

      “The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

      … offer a different view on the biological side of mental health challenges.

      The fact remains that while all of our experiences are expressed in biology and epigenetics, there are no biomarkers for any DSM disorder, nor any evidence that changes in brain chemistry or epigenetics are causal for – rather than correlated with – behavioral and emotional problems that get labeled as mental illnesses.

      Perhaps you can define more clearly what you mean by “a biological component”…

    • I disagree with this statement, ” For many people there is a biological component to the mental health challenges that are experienced.”

      I do not think I am not an utter fool.

      I maybe misguided or lacking information. If you have any information that says, “For many people there is a biological component to the mental health challenges that are experienced,” Please post here so I learn something.

      If not please apologise for calling people with different viewpoints form you utter fools.

  7. Sure will! I’ll go into more detail soon. I’m waiting a while for more comment. Congratulations to you. RESPECT. All you commenters are usually so quick to bully kind females who express a diverging view. I’ve witnessed on more than one occasion where you hardcore people gang up on caring women who made amazing and thought provoking points. They were so nice and wonderfully written and wanted to help others, but it was dissident to your views. I was an empathetic listener and so I did my research so I can join in here on comment section.

    It seems you don’t have a lot to say when it’s a man who is expressing an opposing view.

  8. Matt, What do I mean by a biological component:

    1) Does the term nervous system sound familiar. It involves the nerves that go from the brain to the rest of the body. I have only a college degree in business administration, however I know that is one obvious example of how there is a strong biological component. That is just one obvious reason. A fifth grader could tell you that. Just maybe you have studied too much social work or psychology classes to see how foolish it is to disagree with that. A medical dr can surely tell you that the nerves firing from brain may be out of sync and this can cause so many things including mental health issues.

    2) After Robin Williams passed away it was obvious that mad in America bloggers are as clueless about depression as general public. I laugh hysterically when blogger/commenters praise Dr Peter Goetze with the depression is natural response to life. This destructive reasoning is also bad for other challenges like schizophrenia.

    Ok..now to Steve: Why sharing thi data i bad or asking question bad:

    1) Most here on this site were born dog eyed which is why they got entrapped in the mental heath system in first place. I was smarter from onset to run from treatment. After being put in straight jacket and hospitalized I eventually found a dr who administered the right medication and I ran far away. Anyways I don’t know about sharing the data other than there are truth , lies, and statistics. It might be ok to share this daaaattttaa.

    • Sharing the data is what people here on this website are doing.

      If you are saying you have solid evidence that SSRI anti-depressants are effective and low risk, I’d love to see it, otherwise, we’re sharing the evidence that exposes anti-depressants as less than effective and high risk. Ditto, neuroleptics, anti-psychotics so-called.

      We can’t all be happy customers of the variety that you seem to be. SSRI anti-depressants are the drugs that people have the most complaints about, and there must be reasons for this to be so. Among the reasons that have been found are 1. the drugs are hardly more effective than placebos at relieving “depression”, and 2. there are serious physical health conditions that can come of taking these drugs, given long term maintenance, without any eventual tapering off of dependence. If you’ve found some statistically significant data that says otherwise, we’d love to see it. I just don’t think that data exists, not reliable data anyway. Of course, there are drug company hacks who will tell anybody (you, for instance) what they want to hear.

      Why? Drug companies in recent years have weathered some of the largest civil suits in history. Drug research and development is way up there with prospecting for gold and drilling for oil in terms of profitability. The world is full of dupes, only, they are the ones agreeing with the drug company print outs. The drug company is out to sell a product, and if a sucker buys, that’s just more money in the bank for the people selling, more or less, toxic chemicals.

    • Well, depression can be a response to very traumatic things in life, which can be events, losses or actions perpetrated by a human(s) on another. And of course, since there is no “mind” without a brain, all feelings and thoughts have biological mediators.

      Also, I take a low dose SSRI. That’s personal drug use. But those aren’t my reasons for being here.

      However, simply modifying brain chemistry or “biological mediators” with drugs does not solve problems in living.

      A man beaten up on a day to day basis, may get relief from an opiod or an anaesthetic (which work on the biological mediators). But in the long run, he must stop getting beaten up.

      • The beaten man was a very good analogy. It is a bit like treating a broken leg with painkillers too. The person would able to walk on the broken leg, but the damage would just increase and the painkiller dose would need to increased or changed to a stronger one. Sounds a lot like what happens with ADs. Doses are increased, and nothing is done with the original trigger

      • of course, since there is no “mind” without a brain, all feelings and thoughts have biological mediators.

        Not so fast — while I think you are correct about the brain being a mediator, I see no evidence behind the assertion that feelings and thoughts (mind) are created by the brain. This is where neurology, metaphysics, philosophy and spirituality intersect.

        • Pat, you say you believe in the Bible. According to it, we’re more than physical organisms. Why shouldn’t our psyches or souls cause us problems when we are stressed out? Since the problem is metaphysical in nature there is no pill or surgery that can help.

          If the brain is at fault, a tumor or other abnormality will show up on a CAT scan. Psychiatrists don’t use brain scans for their diagnoses.

    • It seems you are confusing your own personal experience with scientific data. You may have found these drugs to be helpful, even life saving. This doesn’t mean that others have the same experience you did. The data show the likelihood that any particular person may or may not benefit, and people can make their choices based on that data. I think it is important to acknowledge that some people do report benefits, even very strong benefits, from taking antidepressants. However, it is JUST as important to acknowledge that some people have damage, even very strong damage, from taking these very same drugs. I think it should be very clear from the postings here that doctors not only don’t share this information with their clients, they go out of their way to deny it or blame their patients for not reacting the way the doctors want them to.

      The DATA say that antidepressants should not be recommended for everyone, and that each case should be treated differently. They also say that we should be very aware of the possibility of serious side effects in every case, and remove people immediately if they emerge. I’d venture to say also that the data tell us that antidepressants alone are VERY unlikely to make things better for most people, and in fact may make things worse ON THE AVERAGE over the long run. So kudos for you for finding your own path that works for you, but it feels quite disrespectful to suggest that everyone having a different experiences should shut up, especially in light of this kind of study.

      As to Robin Williams, I would suggest you study up on his childhood before you attribute his long-term depression to biological causes alone. It appears he had a miserable upbringing and used comedy as a way of coping with feelings of inadequacy that went back to his earliest childhood. I don’t want to pretend that biology doesn’t play a role, because it most likely always does, but I am saying that we DO NOT KNOW the degree to which biology affects someone’s reaction to abuse and neglect, and we DO no for sure the impact of abusive behavior on a range of behaviors and emotions. EVERY “mental health” diagnosis is correlated with early childhood trauma and abuse. And since there is nothing we can do about genetics, and there is LOTS we can do about childhood abuse, it appears the conversation has been badly, badly skewed in the direction of biological causation. This site provides the rest of the story. You can call it biased, but it is vital for you and others to understand that the standard viewpoint on “mental health” is badly biased in the other direction. It is an absolutely vital counter-narrative to the constant droning on about how it’s all biological and antidepressants are the only answer.

      I hope that clarifies things. You’re entitled to your viewpoint and experience, but I strongly urge you to remember that others have had dramatically different experiences and they are just as valid. And beyond that, I want you to respect that conveying scientific data is never wrong, even if it conflicts with your personal experience, as decisions depend on good data and everyone is entitled to it, even if it messes with the accepted “take your drugs forever” narrative.

      — Steve

      • “And since there is nothing we can do about genetics, and there is LOTS we can do about childhood abuse, it appears the conversation has been badly, badly skewed in the direction of biological causation. This site provides the rest of the story. You can call it biased, but it is vital for you and others to understand that the standard viewpoint on “mental health” is badly biased in the other direction. It is an absolutely vital counter-narrative to the constant droning on about how it’s all biological and antidepressants are the only answer.”

        Well said. I know how much harassment, trauma and gaslighting I endured from by sociopathic biological father. The man never entered psychiatry, but I did (and I ended up heavily psychiatrising my own life and viewed everything from the view point of the labels I had). I also ended up getting labeled bipolar due to SSRI induced mania, which I strongly protested, and which angered quite a few psychiatrists, till I eventually shut them up.

        And though the standard argument is “just because environmental factors play a role, doesn’t mean biological factors are not important”, it doesn’t pan out that way in real life practice. These things end up getting medicalised.

        Victimis (though I hate calling myself that) get re-victimised (the labels contribute to even more gaslighting). All done with the best of intentions and with kindness of course.

      • Robin Williams had DAWS, which is dopamine agonist withdrawal syndrome. I’ve only seen it mentioned three times. Once by someone here, in a comment, once by me, elsewhere, and once in a comment under his widow’s impassioned essay about their life together and his death. That comment was by the doctor who has published the most about it. Mrs, Williams is doing her best to educate herself, but she let slip that he’d been taken off mirtazapine, a dopamine agonist, and put on something like Levodopa, which despite its name does not help with DAWS. I had DAWS for two years and it was absolutely the worst hell I could ever imagine. The only reason I didn’t kill myself is that I like being alive and was too stubborn to give in…not that I had a plan for defeating it. It’s not depression in the usual sense, it’s a superficial but tenacious affliction that locks you into Misery, doom, despair, hopelessness and deep dark bottomless grief every gosh-darmed day, with especial horribleness around 4 am, and very little sleep possible. One could easily become a drug addict by self medicating with opiates or benzos. I toughed it out with beer and pot. Doctors were useless–not a single one diagnoses it, despite my history of going mad on Daytrana (transdermal methylphenidate) and then quitting it cold turkey. I think powerloading coconut oil for a couple of weeks cured me, or else it was a coincidence.

    • pathayes, you haven’t made any actual arguments nor presented any evidence with your comment.

      Of course we all have a nervous system.

      And yes, our brain chemistry changes constantly in relation to the environment.

      You said the nervous system is “a reason” – for what? Perhaps for your idea that “mental illness” has a biological component? If so you need to clarify that and explain how the nervous system can cause mental illness. You didn’t do that.

      What you haven’t presented is any evidence that changes in brain chemistry are the cause of distress, rather than the expression or correlation of interaction between organism and environment.

      Meanwhile, I presented admissions from leading American psychiatrists that DSM disorders lack validity, have no established biomarkers, and that there is not clear evidence of biogenetic causation for these problems. But you didn’t seem to acknowledge or respond to that… isn’t it more powerful when the leading people within the profession admit that lack of evidence?

      • The difficulty arises from depression being a syndrome that could be brought on by a variety of entities, a number of which are nervous system reactions to chemical effects and changes in other parts of the body, e.g. liver disease, blood sugar irregularities, chemical and food sensitivities, plus other things that can’t be treated with SSRI’s (or other antidepressants, for that matter).

  9. I can see clearly now that the world is full of dupes and you’re a genius.

    I would put in a good word to the keeper of the damned souls if in effect they happen to be those drug company hacks just for the fact that they sold this drug. I’d give my left arm to have them. I’m more thankful to the scientists who worked on them though. They don’t cure me, but they alleviate. My nerves firing to and from my brain are working strangely and I cant take it. I’m not like John Nash who can handle the pain so stoically and live on a college campus until I’m 50 and I begin to feel better. John Nash is not only a genious, but tough as iron.

    Good night. PEACE MAN.

    • You say: I’d give my left arm to have them. Doesn’t that sound a lot like what a drug addict would say? After a while, the antidepressant is the only thing that will alleviate the “strange nerve firings” that come from withdrawing. That is exactly what they are doing in the research, and why it seems like the drugs are working. They alleviate withdrawal from the previous drug.

  10. Kjetil, Well I’d say that medicine doesn’t cure, but it does alleviate. I’d also say that pharmacology is the best treatment for some people. Important words here are alleviate and some.

    I’d also say that some people’s mental health challenges like psychosis and schizophrenia are caused by the nervous system and issues with nerves firing to and from the brain. It’s not even the chemicals (dopamine and serotonin)that are causing the problem, but the actual firing of nerves in the nervous system.

    This not only accounts for psychosis, but also the emergence of spiritual connection or supernatural. Alot of the HIPPY people on this site say they are shamans and this is why only they are not shamans, but they have a things happening with nervous system.

    Thats what I think.

      • drugs are substances that alter the function of the body. Most drugs are from natural plants. Some like cocaine are used for recreational use. Medicines are drugs extracted from plants and put in a pill form. Science has found other ways by using chemistry and combination of substances to create new drugs.

        • If the drug comes from a doctor(prescription+pharmacist) it magically becomes a medicine.
          I as a “schizophrenic” must take a fictional cure, (a medicine to the doctor, a poison from my perspective) , for my fictional illness if authority deems it necessary.
          “Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic. Thomas Szasz”
          __________________
          A drug is a luxury you don’t truly need to live.
          A medicine is a necessary treatment for a real (physical) disease.

          A medicine has a start and finish date, a drug does not have a finish date.

          A good clue that it is a drug , is if they give free samples.

          Just like the old dope peddler.
          “He gives the kids free samples
          Because he knows full well
          That today’s young innocent faces
          Will be tomorrow’s clientele”

    • Medicine doesn’t cure the incurable. If you’re out to suggest that you have some kind of incurable “mental illness”, I’m very much a skeptic on the subject.

      Alleviate usually concerns pain, unless your pain is psychological. You don’t, in other words, alleviate wrong thinking, you correct it.

      Some people call “mental illnesses” disruptions of the thought process, you know, that thing behind those firing neurons. If the problem is with the thought process, clarity of thought couldn’t hurt.

      Your analysis, pathayes, is tainted with cynicism. I would prefer to be the master of my fate rather than have my fate master me if you get my drift. I don’t think people are fated to be “mentally ill”, mental health service consumers, or whatever. I think if you’re on a cul de sac, you can always turn around, and get back on the road that leads somewhere.

      I know that there are many people selling this idea of “chronic mental illness” today, and the drugs that go along with it, however, I personally don’t think anybody need pursue a career as mental patient if they don’t want to do so. Ditto, mental patient sitter. I don’t see the mental health treatment bubble as ‘the real world’ that exists just beyond it, and that’s where that bubble become so vulnerable. If ‘the real world’ doesn’t ‘break in’, people should seriously consider ‘breaking out’ in order to reach it.

    • I’m glad that you came back. I think you are the person who was posting Youtube videos that were not appropriate for what was being discussed. Am I correct or do I have you mixed up with someone else? It’s interesting that if you are that person today you are actually interacting with us and I think that’s a good thing. You’re obviously familiar with us since you site having watched us supposedly beat up on poor women who posted here.

      You have theories about what causes psychological and emotional distress and being out of touch with consensus reality. I’m not so sure that I agree with them but that’s not the point. We don’t have to agree about everything. I support people taking the drugs as long as they know what they’re doing by taking them. I myself will not take anything; but that doesn’t mean that we can’t discuss things here on this forum. Some people seem to get benefits from using psychiatric drugs; no one seems to understand why this is. You may be one of those people. But, there are many, many people for who the drugs are detrimental, detrimental in ways that even lead to death. Far too many people are forced to take the drugs, unlike you. You seem to have a lot of choice about whether or not you take them.

      I hope you continue to come here to discuss.

    • If that’s the case, how do folks like John Nash or Elenor Longden or Will Hall recover without any drug interventions, in your view? Why do their nerves suddenly start firing differently? Could it have something to do with how they respond to their situations? Do we as human beings have the ability to alter how our nerves fire?

    • pathayes,

      If you have actual data beyond opinion which explains how misfiring nerves cause schizophrenia, please present it here. I think most readers know that that data doesn’t exist, which is one reason why the diagnosis of schizophrenia lacks validity – being a label under which two people can have no symptoms in common, but still receive the same “diagnosis.”

  11. I’ll respond to Frank first. Franks says, “I personally don’t think anybody need pursue a career as mental patient if they don’t want to do so.” Here in Illinois I only have a few friends and they are people accusing mental health services and actually many of them are people who go to the center everyday. Excuse me for wanting to say something back to you all because I see them when you write some of the stuff you write.

    I’m on your turf here on mad in America. You want me off your lawn, but I have to say you and many of the BLOGGERS here could be profiting from the messages you send as well. Your messages attract people and you get more by being rude. Some people think many of you on this website such as social workers, psychiatrists, ect profit from being so anti psychiatry. You know how many books and websites are promoted on mad in America.

    • Keyword: personally. Generally there are a lot of people selling mental health services, but I don’t happen to be one of them. Also, there was a difference in the past when you were left alone, relatively speaking, after discharge from an institution. People are less likely to be freed from the institution unconditionally these days. Crazy happens. I would legalize/decriminalize/(demedicalize) it. I’m not for locking people up who have broken no laws, under medical pretenses, and thus violating their rights as citizens and human beings. Outpatient treatment is like an afterthought of inpatient incarceration that has gotten way out of control. Again, I don’t think anybody need spend a lifetime in the mental health system. I’m not in outpatient treatment even, and I don’t have a problem with that. I don’t think introduction into the mental health system at the tender age of 14, earlier, or even later, at 20 or 21, should of necessity lead to mental health treatment for the same individual at the age of 54, 64, or what have you. Recovered, past tense, in other words, for me, is at a far remove from currently popular “in recovery”.

      Who is “you”? I’m not a member of the MIA board. The same holds true for a great number of people who visit this website regularly. MIA is not an anti-psychiatry website although there are people with anti-psychiatry views who use the site. When it comes to rudeness, as in your case, it is not restricted to the people who have some kind of sympathy for MIA. Anti-psychiatry is much less profitable venture than psychiatry, psychology, social work, pharmacology, etc. I’m pretty sure that if you followed the money you’d find out that it wasn’t going into anti-psychiatry, however, one person’s anti-psychiatry is another person’s psychiatry. Countering the damage, there’s a tab to that, and an industry in it, too. I don’t think the people on this website, as a rule, though, have been making fortunes off the pharmaceutical industry, and that can’t be said of all mental health workers. What am I saying? If you’re looking for the most corrupt people in the “mental health” business, you are not likely to find them here on MIA. There is plenty of bunk in the “mental health” literature, you apparently have absorbed some of it.

    • “You know how many books and websites are promoted on mad in America.”
      So its bad if someone is trying to sell a book against selling drugs-for-life, but it is okay that the drugs make billions in revenue for Pharma company. Right.

      Dr. Allen Frances stated 39 Billion dollars being made a year by Pharma Companies.
      Mad in America Film Festival Panel. Running time 48:04. The time of speaking is at 5:55. Date (video) Published on Oct 24, 2014 . https://www.youtube.com/watch?v=DcqWa2r6bOA&feature=youtu.be&t=5m55s

      $18 Billion dollars a year in antipsychotics. Source (I disagree with forcing physically healthy people to consume drugs, but the link states billion dollar numbers) http://www.nytimes.com/2012/09/25/health/a-call-for-caution-in-the-use-of-antipsychotic-drugs.html

      $11 Billion dollars a year in antidepressants. http://www.apa.org/monitor/2012/06/prescribing.aspx

      $10 Billion dollars a year in stimulant drugs. http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?pagewanted=all

      Including tranquilizer drugs benzodiazepines/klonopin/diazepam/Valium/Xanax, its higher.

      In the 1970’s it was barely a 1 Billion dollar market. https://books.google.ca/books?id=2DFLI2ib-1oC&lpg=PA43&ots=HEQREreIFM&dq=sales%20of%20tranquilizer%20drugs&pg=PA43#v=onepage&q=sales%20of%20tranquilizer%20drugs&f=false

    • News to me! Still living on SSI.

      Robert Whitaker makes some money with speaking engagements and won the Booker Award (he didn’t expect that) but he still has to keep his day job.

      If earning big money is Bob Whitaker’s obsession, he’s going about it wrong. He needs lessons from T.D. Jaffe on how to earn 6 digits writing ad copy for pharmaceutical companies. Few of the folks published on MIA earn anything at all.

  12. Steve you say, “If that’s the case, how do folks like John Nash or Elenor Longden or Will Hall recover without any drug interventions, in your view?”

    When I wrote that thee is a strong biological component to schizophrenia I meant that I think schizophrenia can be caused by the central nervous system and the chemistry with the firing of nerves to and from the brain. The can account for psychosis and in addition can be how individuals have strong spiritual connection or experience supernatural phenonomon. The central nervous system chemistry causes both in actuality. I was showing a direct link to make the point about a biological component.

    I would say that John Nash, Elanor Longdren, and Will Hall might have a completely different experience. I may not be the cause of nerves firing and the central nervous system. I wasn’t saying my viewpoint was an all or nothing thing, but wanted to illustrate how there is a strong biological component to schizophrenia.

    Eleanor and Will recovered quite young and John was quite old so there is a difference in their experiences. They would be the best ones to share their own unique experience and and give an explanation. I listen to Will and Eleanor every opportunity I can get and their messages are POWERFUL!! They are national and international leaders just like Steve Harrington.

    • I do not think you have prooved anything.

      You have a theory that, “schizophrenia can be caused by the central nervous system and the chemistry with the firing of nerves to and from the brain.”

      Until you offer some proof, preferably from peer reviewed journals, you have prooved nothing.

      Proof would be observations of those phenonema in those who have a diagnosis of schizophrenia and those without. You have not offered any studies on that. Therefore you have prooved nothing.

      You have a theory that is no more scientifically valid that that of demonic posession.

    • You didn’t answer my last question, though. Is it possible that a human being has a significant level of control over how and what fires in the brain? Is not the simple expedient of breathing slowly and deeply universally understood to alter pulse and blood pressure and to calm the body and reduce anxiety? There is also excellent evidence that long-term Buddhist monks, when their brains are studied, have built up certain regions of the brain associated with calmness and focus through their meditative practice – they can change the actual PHYSICAL STRUCTURE of the brain through meditation!

      Everything human has a “biological component.” That doesn’t leave us in a situation where we are dependent on chemical or physiological interventions to alter our psyches. A smart man once drew the analogy of hardware and software – a computer is totally dependent on its electrical structure, but without a program it’s totally useless. The programs have an “electrical component,” but if you try to solve a software problem by altering the hardware, you’ll be in big trouble.

      So far, there is neither proof of any specific hardware problem, nor any specific universally effective solution, for ANY of the so-called “mental illnesses.” It seems to me that psychiatry would do very well to be a hell of a lot more humble about their pronouncements, especially as they are completely and utterly unable to explain the John Nashes or Elanor Longdens of this world.

      So sure, drugs may “work” for some people by creating what they consider positive effects, but that’s a long, long way from your claim that schizophrenia (and what is that, really) or any other “mental illness” is caused by misfiring neurons. I think we have a lot more to say about which neurons fire or don’t fire than you’re giving us credit for.

      —- Steve

      • Maybe he can’t, Matt. About the only biological theories that makes sense are anathema to mainstream psychiatry. Since you’ll want to know about them, here they are: certain of the neurochemicals will break down to oxidized variants sometimes known as chromes, when under stressed conditions, and these chromes are hallucinogenic. The one I’m most familiar with is adrenochrome, a breakdown metabolite of adrenaline, which has to be metabolized fast when you get wired. It, and its sister chemical, adrenolutin are very long-acting hallucinogens, but not psychedelics, and adrenochrome has been found in the body. You could get the most detail about them from the ancient (1967) volume, The Hallucinogens, by Hoffer and Osmond. Good luck finding it, because it’s out of print and I won’t let you take mine- maybe the Library of Congress has one.

  13. I don’t want to post a citation because after a night drinking vodka outside on my back porch I began to believe this theory. At the moment I’m doing more research on all of this. If I post my work it will be to a masters or doctoral program.

    All I can elaborate on right now is that I get weekly massages and it has virtually saved my life. With the massage treatment and the appropriate pharmacology I am doing well.

    • Matt,

      Schizophrenia is a label that refers to many different illnesses. The bodily system of the central nervous system is CASUAL, but the endocrine system can be contributing component to schizophrenia as well.

      The above is a good reason why the prognosis for people that have the diagnostic label of schizophrenia varies. The treatments are best if they are individualized and centered on specific person.

      • “Schizophrenia is a label that refers to many different illnesses.”

        So runs a recent theory put forward by some psychiatrists, but there is no proof to support it over any other theory. Sure, uh huh. This shape-shifting of illnesses can’t be just one illness alone, and so it must be many illnesses.

        Check your common sense at the door, and you can have it back when you leave.

        “The treatments are best if they are individualized and centered on specific person.”

        Of course, this snow-flaking of approaches appeals to snowflakes. One size doesn’t fit all, and your rights are less than those of a chimpanzee if, perchance, you should choose to die with your rights off.

        When you are selling “treatments”, it helps to be flexible about who you are selling those “treatments” to. The idea, after all, is to make a sale.

        There is an earlier sale involved here really. If you are going to “treat” a person for having a “disease”, first you have to sell them on the idea that they have a “disease”. It goes along with the “treatment”. “Undiagnosing” people, unselling them, well, that’s a much more tricky business. It’s the kind of business that might interfere with business were it attempted.

      • Ok, again you made an assertion, “The bodily system of the central nervous system is CASUAL, but the endocrine system can be contributing component to schizophrenia as well.” – but you give no data, no links to studies, no evidence or explanation for these opinions.

        Why should people believe you if you cannot back up your assertions?

        And perhaps you meant “causal”, not casual.

  14. Psychiatry dosent have to be this way , the middle finger , it has developed this why like Mental health /big pharma /govt industrial complex as Ike warned us after WW11 that the culture with take us on a cost spending spiral that will end consuming assets but not towards the needs of the mental health patients ..SPEND SPEND SPEND to build beautiful buildings , cafateria , expensive new drugs and more administration personal .
    Like school system the more we put in the less we get out , the system doesn’t listen to the patients , the hold educational staff meetings using someones last done thesis to the newest phychology today article or a new head administrator ideas . None are proven methods , each flawed , studies fulfil there questions with premeditated answers , no real truth in findings .Many bad drugs are leveled on doctors prematurely and without real health benefits and many side effects . The recent FDA has been in bed with the last administration in passing drugs , to much lobbing and not enough testing , winners are chosen based on politics not science ..The system is busted , no real answers but lots of paper work for the govt to make points for medicade/medicare !