A response to the recent article “The war on antidepressants: What we can, and can’t conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read” written by Doctor Sameer Jauhar and Doctor Joseph Hayes and published in the journal Addictive Behaviours, January 2019.
The belligerent title “the war on antidepressants” is interesting in itself, because it was borrowed from a piece recently published by Jauhar and Hayes,1 two UK-based psychiatrists. It illustrates well that the controversy surrounding the use of antidepressants has now turned into a heated dispute. This is a sad and very unfortunate state of affairs because by fighting we have never really solved the problem. This article will retell why two psychiatrists might declare that there is a war on psychiatry’s best-selling drug, what this has to do with antidepressant withdrawal and how a debate unfolded into a “war.” Because this issue has become political and contentious, I will start by honestly revealing that I also eventually entered this dispute by responding to a fierce critique from Jauhar and Hayes. Although some may allege I am biased for taking sides, my clear aim here, as it was before, is to stick to the scientific evidence. So let us start from the beginning.
In my opinion the events that led to this “war” started to escalate on 24 February 2018, when the Professors Wendy Burn and David Baldwin, the president and chair of the psychopharmacology committee of the Royal College of Psychiatrists (RCP), wrote, in a letter to The Times, that “[for] the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment”. Their letter obviously was an attempt to defend the widespread use of antidepressants, which has been previously criticised by experts like Prof. Kirsch, Dr. Moncrieff and Prof. Gotzsche. The two-week claim in the Times letter was opposed by a group of patients, academics and psychiatrists, who formally complained that the UK Royal College of Psychiatrists (RCP) had misled the public over antidepressant safety.2 Among the signatories of this letter were Dr. James Davies and Prof. John Read. The complaint states that, according to the scientific literature, withdrawal reactions concern many more than only a small minority and that quite often withdrawal lasts far longer than merely two weeks. Interestingly, the RCP had previously conducted its own survey on antidepressant withdrawal and its findings clearly contradicted the claim made by Burn and Baldwin in The Times (the study found that 63% of patients experience withdrawal and that it generally lasted up to 6 weeks, whereas anxiety lasted more than 12 weeks in a quarter). However, that document was removed from the RCP website within 48 hours of publishing the letter in The Times where Burn and Baldwin claimed that withdrawal effects do not last longer than 2 weeks in the vast majority of patients. For a detailed account, see this MIA blog.3
The media largely failed to notice this dispute until Davies and Read published a systematic review on antidepressant withdrawal on 4 September 2018 in the scientific journal Addictive Behaviors.4 This review estimated that, based on clinical trials, naturalistic studies and patient surveys, around half of antidepressant users experience withdrawal reactions, and that, exclusively based on patient surveys (the other study designs did not assess severity), just under half of the people concerned describe their withdrawal as severe. They also reported that, according to several studies, the mean duration of withdrawal reactions was much longer than merely two weeks. These findings stand in stark contrast to the information given in official treatment guidelines, which all corroborate the claim made by Burn and Baldwin (minor symptoms that resolve within 2 weeks in the vast majority). Thus, the alarming findings of the Davies and Read review understandably attracted much media attention and many newspapers were concerned about the massive numbers of people apparently suffering severe and protracted withdrawal effects (see for instance this report in The Guardian5). Given that the biomedical treatment approach constitutes the foundation of modern psychiatry, it was not further surprising that challenging the long-term safety of antidepressants caused discomfort (and, in my view, also disbelief and even denial) within academic psychiatry. I will return to this issue later. But for now, this was the moment when the psychiatrists Doctors Hayes and Jauhar entered the scene. In a blog post for the Mental Elf dated 18 October 2018, they made serious charges against Davies and Read, criticising their work as severely flawed. According to Hayes and Jauhar, the selection of studies was biased, the data extraction and analysis was biased, and both the presentation and interpretation of results were biased.6 Their blog concluded that “the non-systematic way in which the review is written, with errors in data extraction and interpretation, make it difficult to accept the findings with any confidence.” On 5 November 2018, Davies and Read responded comprehensively to the Mental Elf critique on the website of the Council for Evidence-Based Psychiatry.7 I will discuss the most important issues below, as they were later re-addressed in even more detail in a journal publication.
On 23 January 2019, Jauhar and Hayes eventually published their extensive critique of the Davies and Read review from the Mental Elf blog as a research paper in Addictive Behaviors. Their paper was entitled “The war on antidepressants: What we can, and can’t conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read.” But why is it that a scientific debate became a war? In my view, and based on emotionally charged exchanges between Read, Jauhar and Hayes on Twitter, it appears that the psychiatrists (Jauhar and Hayes) perceived the withdrawal review as an attack from psychologists (Davies and Read) on the field of psychiatry. The Twitter controversy was carried on in an increasingly aggressive tone with ad hominem attacks and criticism aimed at entire professional groups (admittedly, from both sides). Unfortunately, there appears to be a lot of tension and disagreement between psychology and psychiatry when it comes to the risk-benefit ratio of antidepressants. What started as a scientific dispute was, as I perceive it, blown up to a clash between mental health professions. While on one side (mostly psychologists) there was a desire to speak out about an underestimated risk of antidepressant use, the other side (mostly psychiatrists) tried to dispel these fears by contending that the withdrawal review was systematically flawed, its authors biased, and the occurrence of withdrawal massively overestimated. Sometimes, rather odd arguments were put forward in defence of antidepressants. For instance, one common reply to safety concerns repeatedly expressed on Twitter reads: “This is pill-shaming, the drugs have helped many patients.” The aim of other comments appears to be solely motivated by the desire to insult. For instance, on 25 January 2019, Hayes wrote on Twitter that the work by Davies and Read was a “wrong’un” and a “pig’s ear.”
And on 31 January, he asked on Twitter whether ignoring the placebo group in withdrawal research was due to “dishonesty or not understanding” on the part of Read (more on this crucial point of criticism below). Finally, in their journal article from 23 January, Jauhar and Hayes stated that “this review fails to adhere to widely accepted standards” and that “We urge readers to view the results and particularly the conclusions they present with great caution.”
What I wanted to illustrate is that the critique by Jauhar and Hayes expressed on social media and in the scientific literature was exceptionally fierce and reproachful. In my view, their critique was not only offending, but I also think that some of the most serious charges were unsubstantiated. Therefore, at this point, I felt that I have to enter this debate,8 because some (not all) allegations put forward by Jauhar and Hayes were evidently false. Davies and Read convincingly debunk most of them in their comprehensive response.9 For instance, contrary to what Jauhar and Hayes imply, the review set out with a comprehensive and systematic literature search. Inclusion and exclusion of studies was transparent and comprehensible. Moreover, the allegation that both the presentation of the results and the conclusions drawn from the data are severely flawed is unwarranted (or at least grossly exaggerated).
So does the Davies and Read review have no limitations at all? No, of course it has, as all research has. A major limitation is that the review is based on many studies that themselves have limitations. For example, most clinical trials were of very short duration, often merely a few weeks, and therefore possibly misleading, since most patients use antidepressants for at least one year (withdrawal reactions are unlikely when the drug was used for a very short time only). On the other hand, the generalizability of attitude surveys is limited due to selection bias (people with a specific interest in the topic are more likely to participate). However, this certainly is no failure on the part of Davies and Read and they also acknowledge these limitations in their review. Still, to be honest, I do not completely disagree with all issues raised by Jauhar and Hayes. For instance, I agree with them that the quality of the individual studies included in the review could have been assessed more systematically with a formal risk of bias measure. I also agree that the meta-analytic procedure applied by Davies and Read was rather crude (e.g. they did not address heterogeneity and they did not compute confidence intervals to quantify the precision of the point estimates). Nevertheless, and apart from these issues, the review was generally conducted in a systematic, transparent and objective way, so I would say that its methodology was mostly sound (and not severely flawed, as contended by Jauhar and Hayes). Most importantly, I don’t think that the limitations detailed above invalidate the main study findings and the conclusion drawn from the data, namely that withdrawal effects are much more common and persistent than indicated in official treatment guidelines and that a substantial portion of patients consider their withdrawal severe.
But that’s just half of the story. In my view, Jauhar and Hayes made several false and discrediting allegations. For instance, as comprehensively discussed by Davies and Read, Jauhar and Hayes contend that the review negligently missed 5 randomised trials, but upon closer inspection, Davies and Read noted that none of these industry-sponsored trials actually reported the incidence of withdrawal effects and that Jauhar and Hayes obviously did not check these publications. Instead, they apparently relied on a review co-written by the study sponsor (the pharmaceutical company Lundbeck), quoting figures that are not reported in these industry trials. In addition, Jauhar and Hayes write in their critique that “[Davies and Read] seem also to misunderstand simple principles that underpin why blinded RCTs are necessary. Thus, in the trial by Montgomery et al. (2005), DESS score was higher during placebo treatment than active treatment. … The findings from the Montgomery study illustrate precisely what a nocebo effect is.” This statement is absolutely false and misleading. The trial by Montgomery and colleagues was a so-called ‘discontinuation trial’. In this type of study, participants are treated with an antidepressant for a few weeks until their symptoms improve (in this case, 12 weeks), and then, in a randomly selected group of participants, the drug is unknowingly discontinued and replaced by a placebo pill, whereas the other participants, also unknowingly, remain on the drug. As a result, participants in the placebo group may experience withdrawal effects (as assessed with a questionnaire called DESS), whereas those who stayed on the drug, of course, cannot experience withdrawal. This explains why the DESS score is higher in the placebo group than in the drug group. Thus, this trial provides compelling evidence of a withdrawal reaction following discontinuation of an antidepressant. This is certainly not a nocebo effect. To be clear, this is not some kind of an academic quibble where some researchers disagree on an equivocal issue, but unambiguously a false allegation and serious misinterpretation of the data on the part of Jauhar and Hayes. It’s very unfortunate that such a fundamental error found its way into a scientific publication that will probably be read and disseminated widely.
Finally, how did the broader psychiatric research community react to the Davies and Read review? In my view, rather defensive, reiterating its preferred position on withdrawal reactions (for which it prefers the euphemism “discontinuation symptoms”). For instance, the prestigious American Journal of Psychiatry felt compelled to re-address the issue of antidepressant withdrawal and to publish a (corrective) review conducted by very prominent US psychiatrists, including Prof. A. John Rush and Prof. Madhukar Trivedi.10 According to the declaration at the end of their paper, these renowned researchers like to collaborate very closely with the pharmaceutical industry in exchange for money. According to ProPublica, Rush received $67,141 from the industry between 2013 and 2016, whereas Trivedi received $114,222 from the industry over the same time. Want to see an excerpt from such a conflict of interest statement? Well, here is a list of the companies that paid Trivedi in his role as consultant and/or advisor:
“Dr. Trivedi has served as a consultant or on advisory boards for Alkermes, Akili Interactive, Allergan Pharmaceuticals, Acadia Pharmaceuticals, Avanir Pharmaceuticals, Brintellix Global, Bristol-Myers Squibb, Caudex, Cerecor, Forest Pharmaceuticals, Global Medical Education, Health Research Associates, Insys, Johnson & Johnson Pharmaceutical Research and Development, Lilly Research Laboratories, Lundbeck Research USA, Medscape, Merck, Mitsubishi Pharma, MSI Methylation Sciences–Pamlab, Navitor, One Carbon Therapeutics, Otsuka America Pharmaceutical, Pfizer, and Takeda Global Research”
Understandably, such key opinion leaders (i.e. prominent speakers for the pharmaceutical industry) will certainly not write something that may offend the pharmaceutical industry. After all, you don’t bite the hand that feeds you (this bias is scientifically well established11). Instead, they state in their review, just like Burn and Baldwin did in their letter to The Times, that antidepressant withdrawal typically resolves spontaneously over 2–3 weeks. However, they just offer three references in support of this spurious claim. Two of these three references were case reports, both published in 1995, including 1 and 3 patients for a total of 4 patients (withdrawal lasted 3 weeks in one report and between 3 and 23 weeks in the other). The third reference, the only cohort study cited in support of their 2-3 weeks claim, was a small study by Fava and colleagues from 2007.12 In this study of 20 patients, a withdrawal reaction was observed in 9 patients (45% of all patients examined) and the syndrome subsided within 4 weeks in 6 patients (67% of all patients with withdrawal), whereas in 3 patients (33% of all patients with withdrawal) serious withdrawal symptoms persisted for several months after discontinuation.
Two things are noteworthy about this review published in the American Journal of Psychiatry: Not only did the authors arbitrarily select only three studies reporting on the duration of withdrawal based on a total of just 24 patients (which is by no means representative of the broader patient population), the evidence they cite does not even support their spurious claim. Two references were merely case reports, which have very little external validity, and the small cohort study they quoted found that in two-thirds of patients withdrawal lasted up to 4 weeks and in one-third, it lasted several months. So, once again, a prominent claim that withdrawal effects resolve within 2-3 weeks in the vast majority of patients misrepresents the scientific evidence and, therefore, is empirically unsubstantiated. Ironically, when researchers present selected case reports of patients who experienced severe and persistent withdrawal lasting for several months, then academic psychiatry swiftly points out that this is merely anecdotal evidence of poor external validity and therefore inconclusive and misleading. However, eminent US psychiatrists come through with just that in a leading psychiatric journal as long as the message that these anecdotal reports carry are welcome. This is alarming and unscientific.
Thus, given that Jauhar and Hayes pretended to be concerned about scientific integrity, one would expect that they immediately wrote a fierce critique rightly challenging Rush and Trivedi for misrepresenting the scientific literature and for drawing misleading conclusions about the duration of withdrawal effects. But obviously they did not and they probably never will. The “withdrawal typically resolves within 2 weeks” claim, although scientifically never firmly established (one might even say, it was disconfirmed), is rigidly defended by academic psychiatry and its strong ally, the pharmaceutical industry. To admit that antidepressants may cause physical dependence and thus severe withdrawal reactions in a significant portion of especially long-term users would challenge the current practice to prescribe these drugs to evermore people for increasingly longer duration for even mild forms of depression and anxiety. The victims of this excessive prescribing, also referred to as overmedicalization, are the millions of patients worldwide who suffer from withdrawal reactions and who discover that they cannot come off their antidepressants.13
Davies and Read put the claim that withdrawal symptoms affect only a small minority and typically resolve within 2 weeks to the test. They provide evidence that withdrawal effects occur in about half of all antidepressant users and that withdrawal is experienced as severe in about half of those concerned. These findings clearly contradict the preferred narrative in mainstream psychiatry. The media widely disseminated these inconvenient findings and soon the review by Davies and Read was fiercely attacked by academic psychiatry in the person of Jauhar and Hayes, who contend that the review was flawed and systematically biased. However, most allegations did not stand up to scrutiny and turned out to be greatly exaggerated or even false. In the interest of the patients who are currently experiencing withdrawal reactions and the many more who will suffer withdrawal effects in the future, we need to end this “war.” Academic psychiatry must address these problems and conduct thorough research on withdrawal reactions. Instead of declaring war, psychiatry should offer solutions on how it wants to combat severe and persistent antidepressant withdrawal. And it is important that psychiatry and clinical psychology reconcile, because, ultimately, we are on the same mission. Our purpose is to help people with mental health problems. Let’s not forget this, even amidst fierce scientific debates.
- Jauhar S, & Hayes J (2019). The war on antidepressants: What we can, and can’t conclude, from the systematic review of antidepressant withdrawal effects by Davies and Read. Addictive Behaviors, Doi: 10.1016/j.addbeh.2019.01.0251 ↩
- Council for Evidence-Based Psychiatry (2018). Patients, academics and psychiatrists formally complain that the president of Royal College of Psychiatrists has misled the public over antidepressant safety. Retrieved from: http://cepuk.org/2018/03/09/patients-academics-psychiatrists-formally-complain-president-royal-college-psychiatrists-misled-public-antidepressant-safety (accessed: 27.01.2019) ↩
- Mad in America (2018). UK Royal College Dismisses Complaint. Retrieved from: https://www.madinamerica.com/2018/05/royal-college-dismisses-complaint (accessed: 27.01.2019) ↩
- Davies J, & Read J (2018). A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addictive Behaviors, Doi: 10.1016/j.addbeh.2018.08.027 ↩
- Boseley S (2018). Antidepressant withdrawal symptoms severe, says new report. Retrieved from: https://www.theguardian.com/society/2018/oct/02/antidepressant-withdrawal-symptoms-severe-says-new-report (accessed: 27.01.2019) ↩
- Hayes J, & Jauhar S (2018). Antidepressant withdrawal: Reviewing the paper behind the headlines. Retrieved from: https://www.nationalelfservice.net/treatment/antidepressants/antidepressant-withdrawal-reviewing-the-paper-behind-the-headlines (accessed: 27.01.2019) ↩
- Davies J, & Read J (2018). Antidepressant withdrawal review: authors respond in detail to Mental Elf critique. Retrieved from: http://cepuk.org/2018/11/05/antidepressant-withdrawal-review-authors-respond-mental-elf-critique (accessed: 27.01.2019) ↩
- Hengartner MP (2019). Commentary on Jauhar and Hayes. Addictive Behaviors, in press. ↩
- Davies J, & Read J (2019). Authors’ response to a critique by Jauhar and Hayes of ‘A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guideline evidence-based?’ Addictive Behaviors, Doi: 10.1016/j.addbeh.2019.01.026 ↩
- Jha MK, Rush AJ, & Trivedi MH (2018). When discontinuing SSRI antidepressants is a challenge: Management tips. American Journal of Psychiatry, 175:1176-1184. ↩
- Wang AT, McCoy CP, Murad MH, & Montori VM (2010). Association between industry affiliation and position on cardiovascular risk with rosiglitazone: Cross sectional systematic review. British Medical Journal, 340:c1344. ↩
- Fava GA, Bernardi M, Tomba E, & Rafanelli C (2007). Effects of gradual discontinuation of selective serotonin reuptake inhibitors in panic disorder with agoraphobia. International Journal of Neuropsychopharmacology, 10:835-838. ↩
- Hengartner MP, & Plöderl M (2018). False beliefs in academic psychiatry: The case of antidepressant drugs. Ethical Human Psychology and Psychiatry, 20:6-16. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Typically, withdrawal estimates of this sort are more likely to be under estimates than they are to be over estimates. This is true for any negative effects associated with drugs in which such blind faith has been invested. Psychiatric drugs are the mainstay of contemporary psychiatric treatment programs. I’m not saying that the use of these drugs is scientifically justified thereby, but I am saying that doctors are not looking for any problems regarding the use of their panacea. Either way, you don’t have war, you have an advertising spiel. In the public “mental health” system, drugs are going to win, but perhaps there is hope for doing things differently in private practice. Should healthy practices win out in private practice, then I think you’d probably have more material with which to bring such a debate into the public sphere. As I imagine that the most important consideration in the public realm is custom, I would think it is probably in private practice that any major, and scientifically valid, contributions to this argument might advance.
I’m not sure ‘a war on antidepressants’ would be such a bad thing. I think, in fact, that it could mean that some people would be a lot healthier off drugs than they are currently on antidepressants.
This blog contains some very important exposure of the many crimes committed by psychiatry regarding the myth of the “chemical imbalance” theory, the proliferation of antidepressant prescriptions, and the overall denial of major withdrawal syndromes.
However, I must take major issue with the themes in your last concluding paragraph. You said:
” Instead of declaring war, psychiatry should offer solutions on how it wants to combat severe and persistent antidepressant withdrawal. And it is important that psychiatry and clinical psychology reconcile, because, ultimately, we are on the same mission. Our purpose is to help people with mental health problems. Let’s not forget this, even amidst fierce scientific debates.”
First off, psychiatry declared “war” on human beings many decades ago with all their inhumane forms of so-called” treatment.” Many decades ago it was lobotomies, ECT, and snake pit asylums etc. and then its steroid driven collusion with Big Pharma led to their evolution into Biological Psychiatry and its pseudo-scientific DSM diagnoses and labels, more ECT, worldwide psych drugging in the hundreds of millions, more forced “treatment”, and “genetic theories of original sin” etc.
Then, asking psychiatry to “offer solutions” to the very problems which justify their existence and make them large sums of money and prestige, is like asking Dracula to “suck water” instead of blood – ain’t going to happen! This does not mean there are not some (a tiny minority) of psychiatrists who legitimately help people, but we need to look at the institution (and its oppressive social role in society) as a whole here when making these types of proposals.
AND, do you REALLY want to “reconcile” with psychiatry, and are you “on the same mission” with them??? Maybe your purpose is to “help people”, but the institutional role of psychiatry is definitely the exact opposite. It is NOT a legitimate part of medicine (totally based on pseudo-science) and needs to be abolished from the planet. Let the more honest tiny minority of psychiatrists either become neurologists and/or become humane (rejecting the entire Disease/Drug Based Medical Model) therapists.
And finally, please let go of the term “mental Health.” Ideas, thoughts, feeling, and out of the “norm” behaviors, are not “sick.” They are normal responses to abnormal conditions in a very much trauma filled and unjust world.
The entire Medical Model of Biological Psychiatry exists as a way to take people’s attention (or their bodies and minds if they are incarcerated in psych hospitals) away from both understanding and then becoming creative agents of change to transform this “sick” world we live in, to a more humane place to call home.
Very well stated Richard. Yes lots of detailed, good information in this article and I agree with your critique of the last paragraph and that trying to survive in a world that is “sick”, and morally and spiritually bankrupt, is the biggest reason for distress these days.
I know two people who have been taking AD’s for a few years now. One of them accidentally forgot a pill one day and by the next day became extremely ill and at first didn’t realize what was causing her to be so sick. That was her first indication she was hooked. Both have tried to get off the pills but they can’t tolerate the horrific withdrawal so are still stuck taking them.
Bravo, Richard! Great post!
The entire Medical Model of Biological Psychiatry exists as a way to take people’s attention (or their bodies and minds if they are incarcerated in psych hospitals) away from both understanding and then becoming creative agents of change to transform this “sick” world we live in, to a more humane place to call home.
Once again, you cling to this notion of “Biological Psychiatry,” which seems to have no purpose other than to send a message that there is such a thing as “non-biological psychiatry,” which is better than the “biological” kind. I don’t see any purpose to this other than as a way to get professionals to buy into a “partial” solution that still would allow them to claim legitimacy while practicing “non-biological psychiatry.” I don’t think you’ve ever really explained this; I see very few others making such a confusing “distinction.”
Perhaps they want to return to the “non-biological psychiatry” of the 19th century: to lock people up because they are “immoral”, not because they are “sick”. Big difference.
I wish they would since that would go over like a lead balloon nowadays.
At least the 19th century folks were honest. “I don’t like this behavior so I’m going to punish those who do it even if it is legal.”
Everything in “mental health” is punishment for weird but legal thoughts/behaviors. If laws were broken there are already courts for criminals to be tried.
It’s not about sex so much now but little nit picky stuff. Sadness. Anxiety. Squirming in class. Liking anything authorities don’t. Liking art “too much.” Being too sensitive. Or independent. (That’s “toxic” now. Independent folks don’t consume enough.)
Sometimes psychiatry is used to help prosecute actual crimes, especially in terms of sentence reduction in exchange for “treatment,” etc. Not to mention the insanity defense.
Yeah. Thorazine is VERY biological, try taking it sometime. But for some reason its use in the 50’s-60’s didn’t count as “biological psychiatry.” For that matter, they used to keep people drunk on the “ships of fools,” also very biological.
“Perhaps they want to return to the ‘non-biological psychiatry’ of the 19th century: to lock people up because they are ‘immoral,’ not because they are ‘sick.’ Big difference.”
Translation of “immoral”: Disagreement with the religions or government.
Despite the reality that today our government and 501c3 government controlled religions are the bastions of immorality.
Or wearing an ugly paisley blouse/tie that embarrasses your family members. Pretty crazy huh? Personality Disorder no doubt. 😛
Well, they do have to draw a line somewhere. 🙂
Rachel where did that imogee come from?
Use the colon and capital P. Emoji face with the tongue sticking out. Like so. 😛
Do you have a list somewhere I can link to?
If the object was to lock up immoral people, even in the 19th century, the wrong people were getting the shaft. The thing about the “mental health” system that is so alarming is its circumvention of ‘rule of law’. What they were saying in the 19th century is that some people’s morality was “sick”. Today they are saying it’s their brains. Either way, it’s a loophole in “rule of law” that allows the “mental health” system to operate at all. People have talked about ‘othering’ here. The whole process could be referred to as a process of ‘othering’. Other peoples “morality” or “thought processes” are “sick” because “ours” are well, says this particular brand of an ‘us versus them’ dichotomy. It’s no wonder that “mental patients” served as the guinea pigs for Hitler’s final solution to the Jewish problem. People could conveniently avert their gaze. “Mental patients” have always fulfilled the role of the scapegoat’s scapegoat.
And plenty of “immoral” people got away with whatever they wanted, because they had money, status and power.
That’s what Samuel Butler was mocking in his novel Erewhon.
Excellent post. Thank you. I would only add that there is no such thing as mental illness. There are, however, coping mechanisms people learn that allow them to function after a fashion in the face of overwhelming emotional trauma/abuse. These coping mechanisms tend to make others uncomfortable and so they label these people as mentally ill and do all they can to eliminate this source of discomfort for thenselves.
If psychiatry ever acknowledges/addresses this, it will predictably use it as an excuse to introduce yet more “medication assisted treatment” – in other words, to put yet more addictive drugs into the system, as doctors are doing now when prescribing the opioid Suboxone to “treat” opioid addiction. Besides, academic psychiatry can never be viewed as a potential source of valid research – everything it’s come out with has and will always be pure lies. Let’s not ask anything of such a field.
Gee Lawrence, everyone seems to be ignoring you — how’ve you been?
Any thoughts on the above comments re: “biological” psychiatry as a new species, rather than a variant of the same old?
In The Jungle Books the monkeys tell Mowgli repeatedly “We are more intelligent and resourceful than any other animals in the jungle.”
When he looks incredulous they protest, “It’s true. It’s true. We all say it is and we should know.” 😀
Thus Pharma-psychiatry defends itself.
The so-called antidepressants should be outlawed as any other drug which harms or kills people is outlawed. Instead they keep prescribing the damned things as helpful treatment for depression. If something doesn’t work any better than placebo and if something harms people to the point of making them suicidal or homicidal then they are not “medicine” and should be taken off the market. We shouldn’t even have to be having this discussion at all. They should be removed from the market, period. They should be taken away from GP’s and psychiatrists since they masquerade as “good treatment”.
Instead the drug companies are allowed to continue producing them and psychiatrists and real doctors are allowed to keep prescribing them to unsuspecting or gullible people. This is a crime of epic proportions and yet nothing is done about it.
In this article, the economic determinants of this dispute are not discussed.
Psychiatrists make money with antidepressants, psychologists, no.
A patient may turn to a psychiatrist to cure his “depression”, or to a psychologist. But he can also turn to both, especially if the psychiatrist redirects his patient to a psychologist after prescribing antidepressants, or if a psychologist redirects his patient to a psychiatrist in psychotherapy. Which is common, and even usual.
Thus, although rivals, psychiatrists and psychologists have an economic interest to collaborate, since they have the same clientele.
However there are also territorial wars. The excessive promotion of antidepressants by psychiatrists can lead to a loss of clientele for psychologists. This is why psychologists occasionally remember that antidepressants are bad for your health, which puts psychiatrists in a rage.
However, the collaboration between psychiatrists and psychologists is far too fruitful: one profession deals with drugs, the other with psychotherapy. That is why some psychologists are not favorable to the war, they think that antidepressants can be criticized “a little but not too much”, since psychologists and psychiatrists have fundamentally the same interests.
This is what really explains this little controversy, and the eagerness of some psychologists to sign peace with the psychiatrists, with whom they share their clientele.
I just picked one and typed in Zoloft and Google auto suggested “Zoloft withdrawal symptoms.” That is great cause many people Google a new medication and are informed about the withdrawal part unlike in most doctors offices.
As long as Google doesn’t play “algorithm” games with search results and suggestions like they do with current events an politics I think we can the war on anti depressants.
In my opinion it was people getting sick and posting online that led to this “war” otherwise they would still be denying withdrawal symptoms happen like back in 2007 when I was sick from psychiatric drug withdrawal and they told me that cant be true cause the poison they gave me was “non addictive.”
So far we have 30 topics https://www.madinamerica.com/forums/forum/psychiatric-drug-withdrawal/
These forum testimonials online are the research. Before these what ever the drug rep said was all you could get.
As JRR Tolkien wisely said, “It takes but one enemy to make a war.” And we know who created THIS war. It’s not the fault of the downtrodden who rise up against the oppressors that the oppressors fight to maintain their power. They could simply acknowledge that these drugs have little positive effect and a lot of potential harms, and redo their “algorithms” accordingly. No war would be necessary if those in charge would simply admit the facts and work from them.
In defense of the oppressors, Steve, they would be in a lot of hot water if the American Psychiatric Association ever made a PSA saying, “Heh heh. We goofed. Seems these things never fixed any brain problems, muddled people’s thoughts, destroyed inhibitions against suicide and violent crimes, and were addictive as street drugs too.”
A lot of people would be angry. A lot of us already are, but multiply that number by 20.
I don’t think the shame is as much a deterrent as the loss of funding!
As one of the, likely millions of, people who had the common adverse effects and symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar,” I can say with 100% certainty that antidepressant withdrawal effects can last for decades.
I first got brain zaps from an antidepressant, fraudulently prescribed as a “safe smoking cessation med,” in 2001. All the psych drugs harmed me, so I’ve been off them completely since 2009. But I still have the damn antidepressant withdrawal induced brain zaps in 2018.
As to the psychologists and psychiatrists having the same mission, you are incorrect that that mission is helping people. But you are correct you do share a mission, according to both industries’ medical literature. And that mission is profiteering off of covering up child abuse.
The DSM was even intentionally set up to prevent all “mental health professionals” from ever helping any child abuse survivors ever, unless they first misdiagnose them with the “invalid” DSM disorders, since child abuse is NOT an insurance billable disorder.
Oh, and if you’re interested in psychiatric epidemiology, you might find it interesting to learn that the schizophrenia treatments, the neuroleptics (aka as antipsychotics), can create both the negative and positive symptoms of schizophrenia. The negative symptoms can be created via neuroleptic induced deficit syndrome, and the positive symptoms can be created via antipsychotic and/or antidepressant induced anticholinergic toxidrome.
We need a war on the sort of mentality that would oppose a war on anti-depressants and the systemic violence they represent. We also need a war on the prevalent Mengelian mentality which advocates more “research,” as any “research” on “mental illness” is terminally flawed from the outset by the premise that such a thing exists, when it clearly cannot. Additionally any “research” using humans or animals should be banned as dangerous and cruel. And those who advocate for such such should be held to any existing international standards governing human rights violations.
Good answer, oldhead.
No “mental” illnesses perhaps, but a number of physical illnesses that present with “mental” symptoms that won’t be relieved with psychiatric drugs (and that shrinks don’t know about because their real medical training is ignored) do exist.
Exactly, the Geneva Convention ruled that human beings cannot be experimented on without consent. But psychiatry does it all the time and gets away with it with no consequences at all.
I can’t believe they make money off people going through hard times or living with trauma that the authorities missed and “didn’t do their job in the first place”. We are talking about a pill that was “crap” in 1997 and they had a team at Ely Lily to try and market this to the masses. The original group just wanted to scrap it and call it a day but they named it Prozac and sold it. They sold us the “chemical imbalance theory” and billions of dollars were made. Viraprim wrote this in his book. And even joked that he bribed Sweden to sell this “crap”. And here we are debating whether Davies and Read are correct or not in their study when the numbers clearly say they is “right” in their analysis. How do you show perfect science to prove an abomination of the scientific method when proving antidepressants are effective to begin with? How about using common sense?
Academic psychiatry has essentially co-opted the phrase “The war on women”, in a disingenuous politically motivated, fear-mongering attempt to attack the authors and content of this scientific review, and stay relevant while playing the victim, which is absolutely disgusting. If anything, Psychiatry is the war on the human mind. It is preposterous and horrendous that academic psychiatry, a supposedly legitimate field, would allege the authors, or anyone for that matter is somehow “starting a war” for conducting objective scientific research and publishing the findings. (In this case on antidepressant withdrawal.) It is even more baffling that the other strategy employed in this “scientific critique” boils down to mischaracterizing the findings and methods of the study itself.
How are the responses of “You are pill shaming!” and “Many patients are helped by these pills!” appropriate or effective rebuttals to objective scientific reviews by anyone, ESPECIALLY in the fields of academia? Even if there are some flaws within the study, they are clearly irrelevant and do not invalidate the reality of antidepressant withdrawal, or the study as a whole, as you’ve already stated. I mean frankly, this is common sense. Of course antidepressant withdrawal would last more than two weeks. This is a potent psychotropic pharmaceutical drug. How is this even up for debate? I am stunned.
If I were to conduct a scientific review on the existence of climate change, and BP’s chosen “scientific critique” was titled “The War on Warm Weather”, which was simply a misconstruing and twisting of climate change science, and the finishing touch was to claim that objective science “shames people who drive cars”, wouldn’t you question the validity of that critique? Also much like climate change, the field of Psychiatry is contributing to a public health crisis of pandemic proportion and it is beyond irresponsible to deny these objective truths to say the least.
Furthermore these same people will dismiss or demonize those suffering after years on these drugs–shaming them to exonerate the pills (and their morally bankrupt profession)–and ignore how many health problems we have including early onset dementia and premature death. Skew the surveys and use anecdotal evidence–but only the anecdotes that they want the public to hear.
Thank you Rachel! Your comments are always so insightful and I couldn’t have said it better myself. You have contributed to society more than most people do in their lifetime with the sharing of your important thoughts. What you are describing is such an egregious form of gas lighting, victim blaming, oppression and violence. I do not have the words to express how barbaric and evil that is.
I know I really zoomed in there on the nuances of this situation with academic psychiatry’s politically and economically motivated attempt to attack objective science, but I want to make sure that I am 100% clear that I am not letting the field of Psychology off the hook for the pseudoscience and harm it has perpetuated as well. Thanks again!
And it is important that psychiatry and clinical psychology reconcile, because, ultimately, we are on the same mission. Our purpose is to help people with mental health problems.
That is so incredibly false. Whether or not you realize it, if you are collaborating with psychiatry your social function is to keep people in line and mystify their suffering.
Part of the disconnect between psychologists (or MFTs for that matter) and psychiatrists is that psychologists often see their patients with greater frequency over a longer period of time.
I know older psychiatrists who actually practice psychotherapy, though they also have patients they see for medication. Generally, they are less aware of adverse effects of medication because many of those effects may manifest well after discharge. As an MFT, I see many patients who have been on SSRIs for many years, and so I see adverse outcomes such as suicidality and withdrawal far more commonly in my practice than my psychiatrist does in his or hers.
Before I got my license, I think my psychiatrist found my views on SSRIs to be a little hysterical. Now? Not so much. I don’t know a damn thing about his caseload, obviously, but he knows what I have seen and he trusts me, it’s impossible to imagine that his prescribing habits have not changed, though of course he could not tell me if I asked him. Many psychiatrists are actually dedicated healers with a wealth of clinical experience who have been fed the same propaganda their patients have.
Couldn’t agree more to your last statement.
Most front line psychiatrists really want to help. But they only follow guidelines and visit industry sponsored conferences. They have a very biased view on the evidence. And if I inform them about balanced scientific views, most of them simply ignore it. And then I can feel the power-issues.
What you describe doesn’t sound like an attitude of someone who “really wants to help,” but more a deliberate wearing of blinders. Are we to conclude that these “front-line” shrinks are ignorant sheep?
Ah, the power issues! It’s easy to claim you’re trying to help when your social power protects you completely from the consequences of your help being so terribly harmful.
They have completed premedical training however. How can they not know the history of the science behind their profession? Are they really that ignorant of what their prescriptions do? How they maim and kill people?
However kindly their intentions their ignorance and the damage they inflict (even if unwittingly) terrifies me. It should terrify us all. Damaging a patient through avoidable ignorance or neglect can still lead to a legitimate doctor being sued.
Point taken. I’m talking about psychiatrists who were licensed long before the SSRIs came on the scene. The methodological flaws in the research are not always so easy to see, and if only a small percentage of your caseload used SSRIs– say your caseload is only 15% SSRI, 15% MAOI or tricyclic, 10% mood stabilizer, 10% antipsychotic, and 50% unmedicated who do only talk therapy– it is harder to see the harms of SSRIs. Even if most of your SSRI patients had adverse effects, it could be well-hidden in your drop-outs and transfers. I can easily imagine that it would take a quarter century or so to start connecting the dots, particularly if you’re being bombarded with well-crafted propaganda from companies that you trusted, at least somewhat, in 1980.
In my Master’s program, I was trained to hunt for logical fallacies and junk science. A few generations ago, I think clinicians were much more naive in this respect.
Yes. A lot of ordinary GPs would fall into this category as well.
And most psychiatrists are not as remorseless or deceitful as members of the American Psychiatric Association and similar Inner Circle groups.
Exactly. If the tide is turning– and regrettably, it’s way too early to tell– it’s because individual patients are reporting back to their doctors and psychiatrists who are outside that circle, and slowly but surely, they’re writing fewer scrips.
No no no, that’s not what will turn the tide. Only organized resistance has a chance to do so, and an understanding that ALL psychiatric drugging is based on junk science.
It is bizarre that a spotlight on a serious adverse effect of a class of drugs is cast as a war on the drugs themselves.
The assumption that antidepressant withdrawal symptoms generally are mild, transitory, and last only a few weeks was promulgated in a pair of supplements to the Journal of Clinical Psychiatry in 1997 and 2006 arising from “expert” symposia sponsored by pharmaceutical manufacturers Lilly and Wyeth, respectively, and led by the notorious Dr. Alan Schatzberg.
The conclusions of the “consensus panel” were based only on the opinions of the participants. There was no data or real evidence involved. No citations were given for the statements about the severity of withdrawal syndrome.
These papers are buried in the citations of nearly all other medical literature about antidepressant withdrawal syndrome, with the erroneous assumptions circulated over and over until they calcified throughout psychiatry into “evidence.”
To his credit, one of the experts from Schatzberg’s “consensus panel,” the UK’s Dr. Peter Haddad, repeatedly has made an effort to remedy this misinformation, authoring many papers about withdrawal syndrome and warning about its misdiagnosis. He has pointed out repeatedly that withdrawal symptoms may be relatively mild only in most cases — there are exceptions, the extent of which is unknown.
As Dr. Haddad stated in 2001: “Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion.” (Haddad, P.M. Drug-Safety (2001) 24: 183. https://doi.org/10.2165/00002018-200124030-00003)
I also had personal correspondence in 2006 with another member of the expert panel, Dr. Richard Shelton, who admitted to me that some individuals can suffer severe and prolonged withdrawal syndrome. (Like Dr. Schatzberg, Dr. Shelton went on to a lucrative career as a pharmaceutical company consultant.)
The “experts” who presented their opinions as evidence informing medicine’s assumptions about psychiatric drug withdrawal are well aware they have not disclosed all the risks. Consequently, physicians everywhere have a false sense of safety about these drugs and are blind to the adverse effects.
However, given the extremely high rate of psychiatric prescription, the expedient gloss over the potential of injury has caused damage to millions of people.
In correspondence years ago with Dr. Haddad, he hinted that gathering case histories would be instructive in this debate. On my Web site, SurvivingAntidepressants.org, I have gathered almost 6,000 case histories of difficult psychiatric drug withdrawal, none of them mild, transient, and lasting a few weeks. You can see them here http://survivingantidepressants.org/index.php?/forum/3-introductions-and-updates/
These case histories also demonstrate the many, many ways people are being misdiagnosed and misprescribed. Taken together, they’re a landscape of the pitfalls in medical knowledge regarding psychiatric drugs and their adverse effects.
Another critic of the Read and Davies paper, Dr. Ronald Pies, recently contended in Psychiatric Times that psychiatrists know how to taper people slowly off drugs and therefore serious withdrawal syndrome as reported by Read and Davies is nearly non-existent.
Dr. Pies’s claims are based solely on his own 2012 paper, in its prolix entirety at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/, in which he states:
“In my own practice, I would typically “wean” a patient off a chronically administered antidepressant over a period of 3 to 6 months and sometimes longer. To my knowledge, this period of tapering has rarely, if ever, been used in existing studies of antidepressants or in routine clinical practice.”
Dr. Pies knows very well that “proper psychiatric care” for tapering “managed appropriately” is virtually impossible for patients to find. This tends to confirm Read and Davies are on the right track. We need better ways to taper people off psychiatric drugs.
If there’s NOT a “war on the drugs themselves” there should be.
Dr. “I-don’t-know-any-real-psychiatrist-who-promotes-the-chemical-imbalance-metaphor” Pies.
You know. That old rascal. 😀 Needs a better organized filing system to keep his lies organized.
Fooling all of the people all of the time is a tough act to pull. Lincoln said it was impossible. But what would Honest Abe know about successful mass deceptions?
Alto– good to see you again. I remember you well from Boring Old Man, I miss Mickey, Bernard, and the rest of the crew badly, and remember y’all fondly. I like to think things have changed a little bit over the last three or four years, but so sloooowwwwllly. (BTW, I still enjoy visiting your site, though I don’t get over there as often as I should.)
Recently, I had an appointment with my own neurologist for headaches– Ivy-league educated, very fast and thorough exam, classic 21st century doctor’s appointment. I came prepared with a list of symptoms and history, and she delivered as good an assessment as you could ask for given the time constraints.
At one point, she asked me if I had tried SSRIs or serotonin agonists. I quickly used my toolkit of coping skills to keep my blood pressure from skyrocketing, and simply asked her, “Why on earth would you use a serotonergic agent? Yeah, the headaches are bad, but serotonin is the most common neurotransmitter, it can show up almost anywhere in the brain, you never know what the hell it will do.”
I guess I was expecting some kind of an argument. Instead, she just nodded curtly and said something like, “Yeah, I get where you’re coming from. Let’s keep doing what you’re doing for now.”
Six or seven years ago, I might have gotten some glib neurobabble or a power-point presentation with a graphic of little parachutes making the brave journey through the synaptic gap and huddling together at the receptors. Of course it’s impossible to extrapolate from one person’s experience, but I feel like it’s possible… possible… that at least some junk psych meds are finally becoming a little less popular. And in my own practice, I’ve recently had referrals for clients of all ages, but particularly young people, who were “depressed” (per DSM V) but hadn’t been started on SSRIs– a welcome change since the days of my internship. The patients who haven’t started on SSRIs do seem easier to work with, both in brief and long term modalities of talk therapy. Some of ’em turn on a dime, particularly the kids with no history of major trauma– work through some attachment issues, identify some resources, out the door and back on the road in 12-26 weeks.
One reason I wish I’d started this career sooner (though it would have been impossible, I was too much of a hothead when I was younger) is that I’d love to see how some of these folks do as they get older. I expect some of them to come back now and then over the next quarter century or so, if I live that long and can keep practicing, but I just have a hunch that the unmedicated ones will only be coming in for a 5-to-26 week tune-up after a major life transition or crisis.
To be fair, I do see good outcomes for some medicated clients, and a few very favorable long-term prognoses within that group as well… but not nearly as many, and all of them were doing regular weekly therapy well over a year, sometimes over two years.
Hello, Catalyzt. I miss Mickey terribly, though the others…..
I do think things have changed a little, physicians in general have gotten a little more objective about the new generation of drugs and are not as quick to believe they’re wonder drugs.