Challenging the New Hype About Antidepressants

Joanna Moncrieff, MD
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The extraordinary media hype over the latest meta-analysis of antidepressants puts the discussion of these drugs back years. Despite the fact that 9% of the UK population are taking antidepressants,1 and rates of prescribing have doubled over the last decade,2 the authors of the analysis are calling for yet more prescribing. John Geddes suggested in The Sun newspaper that only 1 in 6 people are receiving adequate treatment for depression in high income countries. In The Guardian he estimates that 1 million more people require treatment with antidepressants in the UK, but by my maths, if 9% are already taking them and they only represent 1 in 6 of those who need them, then 54% of the population should be taking them. I make that another 27 million people!

The coverage was almost universally uncritical, and said little about the terrible adverse effects that some people can suffer while taking antidepressants, or while trying to get off them. The Guardian even claimed that the new “groundbreaking” study will “put to rest doubts” about antidepressants.

But there is nothing ground-breaking about this latest meta-analysis. It simply repeats the errors of previous analyses. Although I have written about these many times before, I will quickly summarise relevant points.

The analysis consists of comparing ‘response’ rates between people on antidepressants and those on placebo. But ‘response’ is an artificial category that has been arbitrarily constructed out of the data actually collected, which consists of scores on depression rating scales, like the commonly used Hamilton rating Scale for Depression (HRSD). Analysing categories inflates differences.3 When the actual scores are compared, differences are trivial, amounting to around 2 points on the HRSD which has a maximum score of 54. These differences are unlikely to be clinically relevant, as I have explained before. Research comparing HRSD scores with scores on a global rating of improvement suggest that such a difference would not even be noticed, and you would need a difference of at least 8 points to register ‘mild improvement’.

Moreover, even these small differences are easily accounted for by the fact that antidepressants produce more or less subtle mental and physical alterations (e.g. nausea, dry mouth, drowsiness and emotional blunting) irrespective of whether or not they treat depression. These alterations enable participants to guess whether they have been allocated to antidepressant or placebo better than would be expected by chance.4 Participants receiving the active drugs may therefore experience amplified placebo effects by virtue of knowing they are taking an active drug rather than an inactive placebo. This may explain why antidepressants that cause the most noticeable alterations, such as amitriptyline, appeared to be the most effective in the recent analysis.

Antidepressant trials often include people who are already on antidepressants. Such people may experience withdrawal symptoms if they are randomised to placebo, which, given that almost no antidepressant trial pays the slightest attention to the problems of dependence on antidepressants, are highly likely to be classified as relapse.

The analysis only looks at data for eight weeks of treatment, whereas in real life people often take antidepressants for months or even years. Few randomised, placebo-controlled trials have investigated long-term effects, but ‘real world’ studies of people treated with antidepressants show that the proportion of people who stick to recommended treatment, recover and don’t relapse within a year is staggeringly low (108 out of the 3110 people who enrolled in the STAR-D study and satisfied inclusion criteria).5 Moreover, several studies have found that the outcomes of people treated with antidepressants are worse than the outcomes of people with depression who are not treated with antidepressants,67 even in one case after controlling for the severity of the depression (as far as possible).8 The huge increase in prescribing of antidepressants over the last three decades has been accompanied by a substantial rise in the numbers of people who are in receipt of long-term disability benefits due to depression and related disorders in the UK, and this is at a time when benefits for other disorders, like back pain, have been reducing.9

Calling for antidepressants to be more widely prescribed will do nothing to address the problem of depression and will only increase the harms these drugs produce. Adverse effects of the most commonly used SSRI antidepressants include sexual dysfunction, which in rare cases seems to persist after discontinuation of the drug,10 agitation, suicidal and aggressive behaviour among younger users,11 prolonged and severe withdrawal effects12 and foetal abnormalities13 with some drugs. Thankfully the more severe effects are probably rare, but they will become a more significant problem if prescribing rates increase further. The harm caused by encouraging people to consider themselves as having a disease requiring long-term medical treatment is difficult to quantify.

As the debate around the coverage highlighted, many people feel they have been helped by antidepressants, and some are happy to consider themselves as having some sort of brain disease that antidepressants put right. These ideas can be reassuring. If people have had access to balanced information and decided this view suits them, then that is fine. But in order for people to make up their own minds about the value or otherwise of antidepressants and the understanding of depression that comes in their wake, they need to be aware that the story the doctor might have told them about the chemical imbalance in their brain and the pills that put it right is not backed up by science, and that the evidence that these pills are more effective than dummy tablets is pretty slim.

Many people will be wondering why on earth we are reacting to the increasing burden of human misery in this way. Why are we not asking why it is that so many people in the modern world feel miserable and stressed? What are the pressures that people are under that make coping with life difficult? I could name many: insecure or inadequate employment, finances and housing, loneliness, increasing pressure to perform and reach ever higher targets at work and school and the disappearing nature of community in many areas. These are the things we need to focus on to stem the ‘epidemic of depression’ — not doling out ever more placebos with side effects!

Show 13 footnotes

  1.  Lewer D, O’Reilly C, Mojtabai R, Evans-Lacko S. Antidepressant use in 27 European countries: associations with sociodemographic, cultural and economic factors. Br J Psychiatry 2015 Sep;207(3):221-6.
  2.  NHS Digital. Antidepressants were the area with largest increase in prescription items in 2016. Cited 2018 Feb 23; Available from: URL: http://content.digital.nhs.uk/article/7756/Antidepressants-were-the-area-with-largest-increase-in-prescription-items-in-2016
  3.  Kirsch I, Moncrieff J. Clinical trials and the response rate illusion. Contemp Clin Trials 2007;28:348-51.
  4. Fisher S, Greenberg RP. How sound is the double-blind design for evaluating psychotropic drugs? J Nerv Ment Dis 1993 Jun;181(6):345-50.
  5.  Pigott HE, Leventhal AM, Alter GS, Boren JJ. Efficacy and effectiveness of antidepressants: current status of research. Psychother Psychosom 2010;79(5):267-79.
  6. Ronalds C, Creed F, Stone K, Webb S, Tomenson B. Outcome of anxiety and depressive disorders in primary care. Br J Psychiatry 1997 Nov;171:427-33.
  7. Dewa CS, Hoch JS, Lin E, Paterson M, Goering P. Pattern of antidepressant use and duration of depression-related absence from work. Br J Psychiatry 2003 Dec;183:507-13.
  8. Brugha TS, Bebbington PE, MacCarthy B, Sturt E, Wykes T. Antidepressants may not assist recovery in practice: a naturalistic prospective survey. Acta Psychiatr Scand 1992 Jul;86(1):5-11.
  9.  Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016;2:18-24.
  10. Farnsworth KD, Dinsmore WW. Persistent sexual dysfunction in genitourinary medicine clinic attendees induced by selective serotonin reuptake inhibitors. Int J STD AIDS 2009 Jan;20(1):68-9.
  11. Sharma T, Guski LS, Freund N, Gotzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016 Jan 27;352:i65.
  12. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom 2015 Feb 21;84(2):72-81.
  13. Reefhuis J, Devine O, Friedman JM, Louik C, Honein MA. Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ 2015;351:h3190.

63 COMMENTS

  1. I can only conclude that this is in response to the Florida shooting in which he had obtained mental health services and people are once questioning the validity of these services. We in the US have been inundated with news about Mental Health, stigma and how there is no correlation on mental health and violence. It’s an all out media blitz. I’m also assuming that some are pulling back on mental health services. This I can only assume given the PR. We had a major study out published by The Lancet of all organizations:

    https://www.cbsnews.com/news/antidepressants-really-work-study-confirms-some-better-than-others/

    Of course they don’t have a link to the original study, that would show how shoddy the statistics or methods are.

    • No, according to the media “mental health” doesn’t cause violence. Mentally ill people do! The solution? More drugs!

      Drugging 25% of the population hasn’t solved violent shootings. There are more shootings now than 25 years ago when most of these drugs weren’t invented.

      The obvious solution? Drug more people than ever!!!! That’s a (literal) no brainer. 😀

    • The whole article is here.
      http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

      It is so short I thought it was the abstract. The whole article is quite strange.
      Here is a quote: “We contacted all the pharmaceutical companies marketing antidepressants and asked for supplemental unpublished information about both premarketing and post-marketing studies, with a specific focus on second-generation antidepressants. We also contacted study authors and drug manufacturers to supplement incomplete reports of the original papers or provide data for unpublished studies.”
      That means the drug companies could provide any data they wanted and exclude whatever was not in their favor.
      Another problem is that all these studies rely on patients who are taking antidepressants before the study and stop taking the drug cold turkey. Then, after 10 days half of them get back a drug very similar to what they were taking. The placebo group continues their cold turkey withdrawal. It is quite obvious that people feel a lot better when they get back a similar drug compared to being in withdrawal.
      So all of these studies are not testing if antidepressants work, they are just showing the obvious: that getting back a drug is more pleasant than abrupt cold turkey withdrawal.
      In addition, the placebo group reaches the same level as the drug group one week later. Why not wait?

  2. Good article. And good question: “Why are we not asking why it is that so many people in the modern world feel miserable and stressed?” One of the answers to this question that ought to be considered is how psychiatry and psychotropic drugs actually CAUSE people to feel miserable and stressed. Think of how these neurotoxins are marketed. Pharmaceutical companies try to convince everyone that there is something wrong with them. Psychiatry does the same thing. It markets madness. It medicalizes every day life. Even Joanna’s question makes it seem as though it is simply a fact that many people in the modern world feel miserable and stressed. No one is publishing articles about the masses of people who are happy and relaxed. The media doesn’t promote all the good that there is in the world, because it’s so much harder to medicate happiness and goodness. (Although I heard that the FDA approved a drug to treat people who are annoyingly cheerful: https://www.theonion.com/fda-approves-depressant-drug-for-the-annoyingly-cheerfu-1819594776)

  3. I just listened to an American interviewing a British citizen about this recent psychiatric British propaganda.

    https://www.youtube.com/watch?v=mZleMx1UOog

    The decent and ethical American Christians are trying to get the word out about the adverse effects of the psychiatric drugs, in the hopes of helping the British, and the Christians, and all people.

    Please consider commenting on that youtube video. Those of us who know of the psychopharmacology industries’ crimes against humanity shouldn’t be stuck only in an echo chamber talking to ourselves. We need to be sharing our knowledge of the psychiatric industry’s crimes against humanity with the whole world. The world is now interested.

    Thank you, Joanne, for working to be an ethical member of the psychiatric industry, pointing out the fraud of your industry, I know that takes a lot of guts.

    • I wish I knew some of these people Someone Else. Every church I attend is militantly pro-psychiatry in the hopes of appearing humane.

      People–in Christian forums–complain that they need Prozac since Jesus isn’t enough to save them. If they think Science has all the answers they should take a page from Richard Dawkins and get the Heck out of church since they have no real belief in God or souls or good and evil!

    • Hi Someone Else,

      Dr Joanna mentions the Guardian newspaper and Streetphotobeing mentions inherited vulnerability to ” drug suicide”.

      The article from the Guardian newspaper below, is about my first cousin, who died tragically in the 1980s . I honestly don’t know the details.

      https://www.theguardian.com/lifeandstyle/2017/nov/04/aisling-bea-my-fathers-death-has-given-me-a-love-of-men-of-their-vulnerability-and-tenderness

      Originally I had 6 male first cousins on my mother’s side of the family – 4 have since died in similar circumstances.

      The last time I suffered from Acute Akathisia I had to break into hospital (with the cooperation of the charge nurse); and I left in less than 48 hours.

      (- I came off the offending drugs and that was the end of my MH career ).

      But if I was exposed to offending drugs again, I could very easily behave the same way again, and according to my Irish Records .. Nobody Would Be Any the Wiser.

  4. If “antidepressants” work so well why are many people who take them on disability and not working? Why are so many horribly depressed and suicidal?

    I had depression as a kid, but learned to “talk myself out of it.” Taught myself compensatory methods that psychiatry refuses to acknowledge since they feed off learned helplessness.

    Believing I had a “brain disease” that only mind altering drugs could fix did more than make me an unwitting junkie. It tricked me into abdicating responsibility for my thoughts and feelings–even helped me rationalize acting like a jerk or lunatic. (Hey, might as well have the game as the name–as the saying goes!)

    For years shrinks lied to me. If I would take my “meds” I could hold down a job, find love and acceptance, lead a happy and productive life. Bunch of lies!

    • Yes, you raise the primary question of all. If these damned drugs are so wonderful and helpful and work so well, why is it that what they want to call depression is worse now than it has ever been???? Why isn’t their wonderful “treatment” working? In any other branch of medicine if a drug doesn’t prove its worth in dealing with the problem it’s supposed to take care of it’s rejected as less than helpful.

      And my question is….if psychiatry never really did ever push the chemical imbalance bologna why is it that almost every one of the thirteen psychiatrists who work where I do claim that they make people take these damned drugs because they have a chemical imbalance? I know that we’re a backward state, and we’re ten years behind everywhere else in the United States, but we couldn’t be that much behind. Pies is not telling the truth. Psychiatry knew that these drugs don’t do much of anything at all for most people but they pushed them anyway. And now you have GP’s giving them out like candy to anyone and everyone. So much for people not believing in the chemical imbalance business.

  5. The obvious next step should be for the legions of professionals who know chemical imbalance theories are bullshit to stop writing for a little bit and ORGANIZE. A well-promoted demonstration by “experts” directed specifically at this officially promoted myth could do wonders to put this into the public conversation.

    And what’s with the damn underlining?

  6. This is reminiscent of how the slave traders remained in business for so many years, when the abolition movement got going the traders organised a media campaign, they paid writers to promote slavery and printed many thousands of pamphlets describing how each happy slave family had “a snug little house and garden, and plenty of pigs and poultry”, they also gave tons of money to newspapers to print pro slavery articles and to promote the health benefits of sugar.

  7. As you mentioned, they used response rates, not absolute changes in score per se. If it’s more likely that with the drug you end up getting >50% decrease on your Hamilton score it really doesn’t matter if on placebo there’s just simply more people that get for instance 48% or 49% decrease. So this methodology just fades out the fact that the decrease on Hamilton score compared to placebo is not clinically relevant and which I think more important, not patients own evaluation.

    However, what I find more interesting is that the study revealed that there was usage of benzodiazepine in 36% of the clinical trials (for adverse reactions?) The researchers also mention: “We also observed that drugs tended to show a better efficacy profile when they were novel and used as experimental treatments than when they had become old.” That tells you something.

  8. “Thankfully the more severe effects are probably rare”

    I do not believe akathisia is rare Joanna. It is just not diagnosed, simply because GP’s and psychiatrists can in no way face up to what they have done. There is no such thing as a – fit all – correct dose in the context of pharmacogenetics… we all have different metabolising enzyme phenotypes, we all eat different foods but have some of those foods in common which inhibit the enzymes such as black tea…

    http://www.todaysdietitian.com/newarchives/121610p26.shtml

    “Plenty of research suggests that drinking tea is healthful, but research also shows that black tea can have powerful inhibitory effects on the P450 drug-metabolizing system. In a laboratory study performed by Canadian researchers, black tea was found to be a more powerful inhibitor of the enzymes than single-ingredient herbal teas such as St. John’s wort, goldenseal, feverfew, or cat’s claw.5 Herbal tea blends were second only to black tea in their inhibitory effects. While the researchers said it is difficult to extrapolate the findings and precisely apply them to humans, they do believe the study accurately identified products for low or high levels of drug interactions.”

    It is common for people with these conditions (anxiety,depression) to have sleep disturbance to the point that they look for alternatives to sleeping tablets, most of these natural alternatives have valerian which out right blocks the enzymes, casuing akathisia.

    Plus, because of the long term ‘treatment’, Chapter Four in Grace Jackson’s Drug induced dementia shows clinical studies demonstrating the harm done by SSRI’s including reduction in serotonin by sertraline and fluoxetine, anatomic deformities which compares to Parkinson’s disease, frontal lobe dementia and lewy body dementia pg 108 onwards.

    Having said that well done on you.

    My take on this is that a fight back was expected, we can expect more of a clamp down, but the public are now learning not to trust their GP’s. For me the guardian’s efforts are an expression of desperation. This was shown in the comments section… more and more of my reference based comments are removed as are others who go against psychiatry. The guardian got into bed with Gates and will be pushing forced vaccinations and the use of drugs that reduce libido, that is his game.

    The key is to give people an alternative to treating anxiety based on what the true biology says.

    Andy Murray is a great tennis player and the brits like to bash him. Big mistake! he is one of the worlds greatest counterpunchers. That is what you have to do… counterpunch!

    plz excuse any mistakes, I do not have time to check.

    • They say that mania is the doorway to akathesia and if that is true the figures are frightening. The latest figures from the New York Times is that it happens between 4-65%. Dr Breggin has thrown out the figure that 80% of bipolar patients experienced mania on an antidepressant. A patient will never tell a doctor, they are too condescending and blame it on the illness. The patient simply stops taking the drug or continues the prescription and then enters and exits the “revolving door” so many doctors speak of, in their lectures.

  9. Instead of “the final answer” that “puts to bed” the idea that AD’s don’t work, their conclusions should have been as follows: “Antidepressants on average don’t work any better than placebos, but if (and only if) you are in the 15-20% for whom placebos seem to to really make a difference, then your chances of striking it lucky are significantly increased on antidepressant, by as much as twofold, probably because it’s an active placebo. There are other non-harmful supplements you could try also that might be placebo or might do something good, and activities such as family time, exercise, music, art and socialising that are probably beneficial for depression and certainly highly beneficial in other ways.”.

  10. Thank you for your Article Dr Moncrieff.

    It seems to me that “Mental Health” is wide open to any type of “uselessness”.

    I had a my first hospitalization in Ireland in 1980; and a series of further suicidal hospitalizations which ended with me in 1984 stopping strong medication to make full recovery. In 1980 the Admitting doctor at Ireland (Dr Fadel) considered me to be quite Well – but by 1984 I was considered completely “hopeless”.

    In 1986 when I came to the UK I wrote to doctors at Ireland asking them to send over Adverse Drug Reaction Warning to doctors in the UK regarding the drugs that had caused the problems. In this letter I described the drug effects of:-
    1. Extreme Restlessness,
    2. At times Unpredictable behavior
    3. The experience being the worst of my life (Akathisia).
    4. My fears of drug re exposure

    (This 1986 letter was at the very back of my FOI requested Irish notes, which I applied for in 2012)

    At the time (1986) Irish doctors in Response sent over an Irish Record Summary to doctors in the UK deliberately OMITTING Adverse Drug Reaction Warning.

    My Mental Health History between 1980 and 1984 had been changed around, to hide my main problem and to represent me in the negative. I also received a letter at the time from my MH Doctor in Ireland reassuring me that my request had been looked after.

    MY PRESENT DAY PROBLEM IS:
    That my GP Surgery, Newton Medical Centre, in Central London seem to think that it is their Job to :-

    1. Hide the Dr Shipman Type Medical Behavior from Ireland.

    2. Hide the fact that I have not suffered any Mental Illness; Mental Illness Disability, or Mental Illness Cost, in my 30 plus years in the UK.

    3. Hide the fact that my Mental Health History is more than 30 years out of date and from a different country (Southern Ireland).

    UK MENTAL HEALTH DEATHS
    I think doctors behaving like Psychopaths in Mental Health – is what’s causing the high Death Rates in Mental Health.

      • I sent Attachment Documentary Evidence + My (above) Commentary to my MP. I did receive acknowledgement from her Office. But I doubt very much if she got to see the information.

        From: ME
        Sent: 01 March 2018 08:35
        To: BUCK, Karen
        Subject: For The Attention of MP Karen Buck (only): Concerning – Dangerous Mental Health Behaviour.

        Dear Karen (Buck MP)

        Please find Attached, documentary evidence supporting the (serious) allegations that I have made. Please let me know if you get the Attachments:-

        1. Admitting Doctor Dr Fadels impression of me “on Presentation” at Galway 17 November 1980

        2. Pgs 1, 8, 9 of the 8 November 1986 Adverse Drug Reaction WARNING Request Letter

        3. The 24 November 1986 Irish Record Summary (2 pgs) deliberately OMITTING Adverse Drug Reaction Warning

        4. The November 18 1986 Dr Donlon Kenny False Reassurance Letter

        5. A copy of my January 13, 2012 Statement Of Psychiatric Experience to Galway University

        6. A September 15 1986 Employment Reference

        7. A September 15 1986 Character Reference

        8. A Professional Interpretation of “Akathisia”

        My GP Surgery has been promoting Present Day Severe Mental Illness with me on account of the 30 + year old, 1986 Irish Record Summary; with complete confidence (and full knowledge of the issues).

        Yours Sincerely, (ME)

  11. I will say a simple thing. People have used drugs since time immemorial to feel a certain way. There are drugs we deem illegal (cocaine, heroin etc.), drugs which are legal (alcohol,nicotine, marijuana [in some places]), and drugs which are legal only by prescription (many psychiatric drugs).

    The fundamental purpose of all drugs (whether they are legal, illegal, or legal-by-prescription) is the same. People ingest them to feel a certain way, or they are forced onto people with the hope that they behave in a certain way. This fundamental principle is irrespective of the nature of drugs or their effects.

    SSRIs for instance, in a subset of people who take them, produce one particular effect, a stimulant effect, a feeling of energy and vitality, with other effects like tremors, stomach upsets, sexual dysfunction etc. But, I also know other people, who take the same drugs, and feel no difference or those who actually feel even more depressed.

    Other drugs produced a “stoned” like effect; sleepiness, vivid dreams, hunger etc.

    It is silly to say that any of these drugs “treat” X or Y “disorder” except in the sense that they produce a unique mild altering effect or a “high”. That’s all there is to it.

    This is a crucial point that people who end up on these drugs must know.

  12. Joanna, thank you so much for this elegant and reasoned critique of what have been here in the UK, frankly alarming levels of sensationalism around this study. I stress that this is purely my personal view, but it feels like this study is being used as a weapon, rather than evidence-based science, designed to firmly establish the superiority of antidepressant treatment and to disempower and undermine the critics. The line about “ending the debate about antidepressant efficacy” was repeated in many major UK newspapers with only slight variation in wording. It was clear from the breadth of the coverage, that the announcement of this study via the media was planned with military precision and was partly in response to the wide coverage of Johann Hari’s book Lost Connections (this was even mentioned specifically by psychiatrists tweeting about the study). Of course, when you dig into the detail as Joanna has done, it is clear that the results of the study are not strong enough to justify such a statement. Joanna and many of her colleagues have put great effort into countering the sensational claims, for which I am truly grateful. I couldn’t see the study listed above, apologies if it is already there, but here is a link to the full open access paper should anyone be interested:

    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

    • James said… “I stress that this is purely my personal view, but it feels like this study is being used as a weapon, rather than evidence-based science, designed to firmly establish the superiority of antidepressant treatment and to disempower and undermine the critics.”

      Go with your instincts, James. When the BBC is spoonfed this headline…

      “A major study of antidepressants has concluded that they work, and many more people should take them.”

      …you know something stinks. I awoke on Thursday to those exact words, and I heard it repeated several times throughout the day. My immediate thought was “sounds like a Science Media Centre* job.” Sure enough, http://www.sciencemediacentre.org/expert-reaction-to-largest-review-of-antidepressants/

      So, a broadside launched by The Royal College of Psychiatrists, but what provoked it? Andre Tomlin at The Mental Elf provides the answer…

      “It’s been a rough few months for people taking antidepressants. We’ve been bombarded with information that insists our medication is ineffective and harmful, that any benefit we gain from taking these pills is simply a placebo effect, and that by accepting a prescription of antidepressants we are joining an ever-growing zombified mass of morons.

      From Peter Gøtzsche’s ‘evidence’ that antidepressants don’t just have side-effects but actually kill the people who take them, to the BBC Panorama programme “A Prescription for Murder?” which linked taking antidepressants to violent crime, to Johan Hari’s recent book questioning everything about depression “Lost Connections”, the anti-antidepressants voices have really hit the mainstream.”

      This made me smile. Confirmation that our “voices have really hit the mainstream”. Happy day!

      *The SMC is a UK registered charity, which makes it untouchable. Professor Sir Simon Wessely is a trustee. Here’s a cartoon about how they operate: http://www.auntiepsychiatry.com/red.aspx?ha=smc

  13. Thank you Joanna for the clear explanation! I am begging you to please publish these objections as a comment on the Cipriani paper at PubMed.gov or in the journal itself.

    To the list of psychological causes of depression that you provided, I would add an unhealthy lifestyle. Already two studies showed that healthier nutrition benefits depressed patients:
    http://pubmed.gov/29215971
    http://pubmed.gov/28137247

    and there are countless studies showing that physical exercise is a valid treatment of depression:
    http://pubmed.gov/27611903
    http://pubmed.gov/28088704

    There are also free and inexpensive online versions of cognitive behavioral therapy:
    http://psycheducation.org/treatment/psychotherapy-for-bipolar-disorder/free-online-computerized-cbtcognitive-behavioral-therapy-for-depression/
    https://moodgym.com.au

    In my opinion, depression is a complicated problem that cannot be solved by a single treatment; it can be solved by a combination of several lifestyle changes and psychotherapy. I disagree with people who believe that mental disorders (such as depression) do not exist.

    • wallenfan——excellent post…no one pays attention to lifestyle changes….they would rather blame something or somebody than get down to treating this complicated problem…thank you very much…
      I would add another name here ….dr Robert lustig and his book the HACKING OF THE AMERICAN MIND….sugar is very dangerous and we love it…

      • That’s the sad part about the whole DSM-based worldview – it encourages individuals, professionals, and society at large NOT to take responsibility for environmental and lifestyle impacts, but instead to blame the brain of the person suffering from those impacts. As a person who used to be chronically depressed/anxious and sometimes suicidal, I can honestly say that good therapeutic support plus improved living strategies have almost completely changed how I feel and interact with the world. The thing is, it takes YEARS of hard work and a willingness to become aware of some painful things we’d all like to keep under wraps. Labeling someone with “Major Depressive Disorder” or “Bipolar” or “Anxiety Disorder” makes it seem like it’s all in your brain, you just HAVE this “disorder” and there is nothing you can do about it. It also makes it easy for professionals to blame YOU when their interventions don’t actually work for you. I mean, would you take your car back to a mechanic who said your car isn’t working because it has “repair-resistant fuel injectors?” I hate the DSM, not because I don’t believe people suffer from depression or anxiety, but because it removes power and agency from the person having those experiences.

      • littleturtle, you’re welcome. The book sounds interesting. I will definitely watch this guy’s videos.

        Steve, nice to see you. I don’t mind psychiatric labels if they are associated with effective treatments that really address the cause of the problem. If a label serves the purpose of “awareness” about psychiatric drugs and helps to put the sufferer on those drugs for life, thus generating an income stream for corporations, then yes, we have a problem.

        • I somewhat agree, though I believe the labeling process in itself is unnecessary and disempowering to many if not most who receive them. But I am interested to note which of the DSM disorders you see as being capable of guiding one to effective treatment? My experience is that almost all guide only to blaming the victim and ineffective and disingenuous drug “treatments,” and those that don’t (like personality disorders) lead instead to condescension and shaming. I am also unaware of ANY psychiatric “disorder” per the DSM that has a known cause. I’d truly be interested if you have any information to the contrary, but as far as my experience goes, anything that can be done with a DSM label that is actually helpful can be done just as or more effectively without the label, other than getting insurance reimbursement.

          • Exactly. The notion that these labels “aid in treatment” is a continuous and consistent myth and a poor excuse to keep labelling individuals and rob away their truth (of course, this is not the intention of the labellers).

            Steve, all behaviours have causal factors. But they vary from individual to individual. The notion that these labels do any such thing as to remotely go into the “cause” in specific individuals who are everyday people getting involved in psychiatry (and not some research subjects) is utterly misleading.

            I think we have all also seen how these labels actually result in medical mistakes rather than any sort of healing.

          • Wallenfan, of course, there are such conditions, but why call them “mental disorders,” rather than “bad reaction to prescription drugs” or “physiological damage from street drug use” or “hallucinations secondary to stage 3 syphilis infection?” To me, it’s kind of like calling a rash a “disorder”. Well sure, there’s a rash, and you want it to go away, but the real “disorder” is what’s causing the rash – the rash is just the indication that you ate something you’re allergic to, or rubbed your hand in poison ivy, or have the measles. A rash isn’t a disease, it’s a sign. Same with depression. It’s usually a sign of something wrong, but calling it the problem is like diagnosing “pain” when your hand is on a burner. Pain isn’t the problem. It’s the hand on the burner that’s the problem.

            RFS, of course, I agree 100%. The big problem with these DSM labels, beyond blaming the victim so effectively, is that they don’t differentiate cause at all, or even attempt to. They assume that all depressed people are depressed for the same reason and need the same kind of help. This is, of course, nonsense, but for some reason, it sells big time with people who are too lazy or too scared to look deeper for the real reasons. It also keeps our leaders from having to look too hard at our institutions, like schools and churches and government programs, and see how they might be causing or perpetuating anxiety and distress, because that would be too inconvenient for our elite to have to deal with, and might cost them some money, which is the ultimate sin.

  14. Over 60,000 detentions in a year. Yet I could only see the CQC report getting a mention in the Mirror and the Huffington Post, while for the anti-depressants it was a case of “hold the front page – someone has done a meta-analysis”. As John Naish said, you would think they had won a Nobel Prize. The CQC report did get some discussion in Parliament though.

  15. Sorry to bang on about the statistical sleight of hand in the statements released about this paper by the researchers, Royal College etc.

    But are we really saying a Standard Mean Difference of 0.3 is the final answer that proves antidepressants work?

    There is a great site to interpret SMD here:
    http://rpsychologist.com/d3/cohend/

    From which you get “the final answer” lol:
    https://ibb.co/kxXS3H

    So how did they apparently prove something? Well, look at the right hand end of that graph, its easy to show a difference in the two distributions there isn’t it? That’s what they did, they used the so-called response rate, which only looks at data from that end of the chart, where there is a rather amazing 50% reduction in symptoms. This doesn’t feel like science.

  16. I notice that there’s a News Update on this story, but it is not open for comments…

    https://www.madinamerica.com/2018/02/royal-college-psychiatrists-challenged-potentially-burying-inconvenient-antidepressant-data/

    To fill people in, this letter came about as a result of an exchange between James Moore and Wendy Burn on Twitter. There is an excellent account of what happened on Bob Fiddaman’s blog here:

    https://fiddaman.blogspot.co.uk/2018/02/rcp-remove-damning-antidepressant.html#.WpgI1ujFKUk

    • Hi Auntie Psychiatry, thank you, I just wanted to reassure everyone that this is a story we will be following very closely and people will get to comment as the situation develops. Meanwhile, I would love to know what a cartoon anteater makes of all this! Thanks.

      • James, glad you asked! The letter is fantastic – I’d love to think there’s a chance they might ‘publicly retract, explain and apologise for the statement,’ but this Never Happens.

        Good job you saved the “Coming off Antidepressants” leaflet.
        Have you seen the youtube animation “Coming off antidepressants”? It’s quite something. I guess since they withdrew the leaflet, this is currently the RCPsych official guidance on the matter. I won’t spoil it for you, but watch out for the bit about “How long do symptoms last?” at 1 minute. By “symptoms” they mean “withdrawal”. The comments underneath are also revealing.

        Here’s the link: https://www.youtube.com/watch?v=ZJo3Ur4zB9E

        • Hi Auntie, thank you, I’m now looking at my iPad embedded in the wall! Most people…some people…utter bilge, as you say, the commenters don’t hold back. This deserves a parody, “some people find their psychiatrist knows diddly squat about withdrawal, while most people find more sense on Facebook”.

        • Always shocked at how naive people are. “Ask your doctor to take you off your ‘meds.'” Uh huh.

          Would you advise a battered wife to ask her creepy husband to help her pack and look for a new apartment? I don’t think so.

          Once they have you “diagnosed” they own your soul. And they know it.

          • Spot on! Body and soul – they even took away this poor guy’s legs! I listened again to the voice-over to count how many euphemisms for “withdrawal” the RCPsych has squeezed in.
            1. Uncomfortable symptoms
            2. Depression returns (x3)
            3. Troublesome side effects (Anxiety, Stomach upsets, Flu-like symptoms, Dizziness, Vivid dreams)
            4. Physical symptoms

            Of course, ‘depression returns’ carries the subtext that you are still ‘ill’ and in need of more ‘treatment’.

          • With my bipolar label–an SMI–they would have locked me up before you can say “Sigmund Freud” if they had known what I was about.

            Oddly no one saw any difference. This happens a lot–probably because people have preconceived notions of how “non-compliant” mental patients will act. When we don’t they assume we are “good;” even experts are easily fooled.

            I continued going to the Mental Illness Center and having sessions with my clueless therapist for a few months. She talked about how I should only date my own kind (other “bipolars”) and regaled me with cautionary tales about The Naughty Patient Who Lacked Insight, Quit His Meds and Decompensated Ever After.

            I realized the truth behind these anecdotes: a guy feels worse on his drugs than before, cold turkeys without researching, has horrible DTs, gets locked up where his original drugs are doubled and tripled so he’s more disabled than before. As Paul Harvey used to say, “And now you know the rest of the story.”

  17. “New Study Proves it – Antidepressants Work”,

    (Psychiatrist) Patricia Casey,

    March 6 2018 2:30 AM,

    (from The Irish Independent Newspaper)

    https://m.independent.ie/life/health-wellbeing/new-study-proves-it-antidepressants-work-36661883.html

    “..In tandem with their increased use, they generated controversy. The most significant of these was the possibility that these drugs could trigger suicidal thoughts and behaviour in some people. This led to expensive litigation particularly in the US. But a more fundamental one was the claim that these and older antidepressants had limited effect on depressive illness and that they were little better than placebos (dummy look-alike medicines). This was the opinion of a group of psychiatrists in Britain and Ireland who belonged to the Critical Psychiatry Network (CPN). In the US the Church of Scientology provided huge financial support to similar groups…”