Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs. In this blog, he discusses the myth of the chemical imbalance and introduces the psychiatric drugs. Each Monday, a new section of the book is published, and all chapters are archived here.
“Psychiatry’s Starter Kit”: Depression pills
Patients and their relatives commonly refer to depression pills as “Psychiatry’s Starter Kit.” This is because many people start their psychiatric “careers” by consulting their family doctor with some problem many of us have from time to time and leave the doctor’s office with a prescription for a depression pill, which brings them into trouble.
As already noted, depression pills are often prescribed for non-approved indications, so-called off-label use. When the problems accumulate, the family doctor may refer the patient to psychiatric treatment. Most of these problems are iatrogenic (Greek for “something caused by a doctor”).
If you read package inserts for depression pills, which are easy to find in a Google search (e.g. “duloxetine fda”), you will see that these drugs make some people hypomanic, manic, or psychotic in other ways. When this happens, your doctor will likely conclude that you have become bipolar or suffer from psychotic depression and will give you additional drugs, e.g. a neuroleptic, lithium, an antiepileptic drug, or all three, in addition to the depression pill.
There is considerable overlap between the harms of psychiatric drugs and the symptoms psychiatrists use when making diagnoses, so it may not take long before you have several diagnoses and are on several drugs.2,4
In 2015, I was invited to lecture at a major hospital in Denmark by the psychiatric organisation in that region. Rasmus Licht, professor of psychiatry, lectured after me and there was a general discussion. Rasmus is a specialist in bipolar disorder, and I was one of the examiners when he defended his PhD about mania 17 years earlier.
I asked him how he could know, when he made the diagnosis bipolar in a patient who received a drug for ADHD, that it was not just the drug harms he saw, since they are very similar to the symptoms doctors use when diagnosing bipolar. I was flabbergasted when he said that a psychiatrist was able to distinguish between these two possibilities. I decided not to go any further into the discussion.
Rasmus said a lot of other things that weren’t correct, which illustrated what psychiatry does to its own people. When I first met him, he was a bright young man who impressed me. I hadn’t seen him in all those years, and it was shocking to watch how he had assimilated all psychiatry’s wrong ideas. We corresponded a little afterwards in a very friendly manner, but my attempts at convincing him he was wrong failed.
One of the things Rasmus wrote was that, “no matter what you write, it has not been clearly shown that antidepressants can change [sic] bipolar disorder. This has been believed, which is why it is mentioned in ICD 10 and DSM IV that if the mania only occurs when the patient has received an antidepressant at the same time, it speaks against bipolar disorder, as it is understood it could be drug induced mania. However, in contrast, the DSM 5 has taken the consequences of recent epidemiological studies and written that, even though a mania occurs during treatment with an antidepressant, this should be perceived as a true, i.e. primary, bipolar disorder. So, in this case, you speak against better knowledge.”
I wondered how it was possible for Rasmus to believe in such nonsense. It is total baloney to postulate that a mania that occurs during treatment with a depression pill is a new disorder when it might as well be an iatrogenic harm. It is nothing else than a smart trick the psychiatrists use to distance themselves from the harms they cause and from their accountability. It is always the patient who is to blame, never us or our drugs, is the message they send.
Rasmus should have criticised the psychiatrists who made up the DSM-5. Think also of Stine Toft whose history I described in the first chapter. She has never been manic, apart from the time when she received a depression pill.
I have had many such experiences, which is why I see absolutely no hope for psychiatry. People with mental health issues should consult professionals who will not treat them with psychiatric drugs but will listen to them and help them in other ways.25
I have described elsewhere how devastating the psychiatrists’ self-inflicted blindness towards reality is for their patients.4 The most prominent American child psychiatrist, Joseph Biederman, is also one of the most harmful ones. He invented the diagnosis of juvenile bipolar disorder, and he and his co-workers made a diagnosis of bipolar in 23% of 128 children with ADHD.26 This condition was virtually unknown before Biederman stepped into the scene, but in just eight years, from 1994-95 to 2002-03, the number of medical visits in the United States for children diagnosed with bipolar disorder increased 40-fold (an increase of 3900%).27
Do patients fall ill because of a chemical imbalance in the brain?
There are no specific chemical changes in the brain that causes psychiatric disorders. The studies that have claimed that a common mental disorder like depression and psychosis starts with a chemical imbalance in the brain are all unreliable.4
A difference in dopamine levels between patients with a schizophrenia diagnosis and healthy people cannot tell us anything about what started the psychosis. If a house burns down and we find ashes, it doesn’t mean that it was the ashes that set the house on fire. Similarly, if a lion attacks us, we get terribly frightened and produce stress hormones, but this doesn’t prove that it was the stress hormones that made us scared.
People with psychoses have often suffered traumatic experiences in the past, so we should see these trauma as contributing causal factors and not reduce suffering to some biochemical imbalance that, if it exists at all, is more likely to be the result of the psychosis rather than its cause.28
A paper that analysed the 41 most rigorous studies found that people who had suffered childhood adversity were 2.8 times more likely to develop psychosis than those who had not (p < 0.001, which means that the probability of getting such a result, or an even larger number than 2.8, if in reality there is no relationship, is less than one in a thousand).29 Nine of the ten studies that tested for a dose-response relationship found it.29
Another study found that people who had experienced three types of trauma (e.g. sexual abuse, physical abuse, and bullying) were 18 times more likely to be psychotic than non-abused people, and if they had had experienced five types of trauma, they were 193 times more likely to be psychotic (95% confidence interval 51 to 736 times, which means that the true risk is 95% likely to be within the interval 51 to 736 times the risk of a person who has not been exposed to trauma).30
Such data are very convincing, unless you are a psychiatrist. A survey of 2813 UK psychiatrists showed that for every psychiatrist who thinks schizophrenia is caused primarily by social factors, there are 115 who think it is caused primarily by biological factors.31
The myth about a chemical imbalance in the brain being the cause of psychiatric disorders is one of the biggest lies in psychiatry and also one of the most harmful ones. As noted in the previous blog, it has existed for at least 65 years, since Himwich claimed that neuroleptics work like insulin for diabetes.9 It seems impossible to make the myth go away, as it is so useful for the psychiatric guild to keep it. It gives them an alibi for treating their patients with harmful drugs and makes them look like real doctors in the public eye.
In 2019, Maryanne Demasi and I collected information about depression from 39 popular websites in 10 countries: Australia, Canada, Denmark, Ireland, New Zealand, Norway, South Africa, Sweden, UK, and USA. We found that 29 websites (74%) attributed depression to a chemical imbalance or claimed that depression pills could fix or correct such an imbalance.32
I have good reasons for calling my 2015 psychiatry book “Deadly Psychiatry and Organised Denial.”4 The denial, not only of reality but even of psychiatry’s own stance when challenged, is so immense that I shall illustrate it in some detail, using my own country as an example. It is the same everywhere, so it doesn’t matter if you have never heard of the people I mention.
In 2005, psychiatry professor Lars Kessing and colleagues published a survey of 493 patients with depressive or bipolar disorder that showed that 80% of the patients agreed with the statement: “Antidepressants correct the changes that occurred in my brain due to stress or problems.”33 I shall say more about Kessing in Chapter 5, where I shall also describe what happens when critical TV programmes try to tell the truth about psychiatry.34-36
In 2013, Thomas Middelboe, the chairman of the Danish Psychiatric Association, described the term “chemical imbalance” as a metaphor psychiatry has grasped at in an attempt to explain diseases whose causes are unknown:37 “It is a bit goofy to say that people lack a substance in the brain, but chemical imbalance – I might use that term. We are dealing with neurobiological processes that are disturbed.”
In 2014, I debated with psychiatry professor Poul Videbech at a public meeting arranged by medical students. After I had carefully explained and documented why far too many people are in treatment with depression pills and had suggested that we tapered off the drugs, Videbech said, in front of 600 people including patients and their relatives: “Who would take insulin from a diabetic?”
In 2015, Psychiatry in the Capital Region and the Joint Council of Psychiatric Societies held a meeting with the title, “Truths or falsehoods about psychiatric drugs.” The occasion was that I had started a prolonged debate about psychiatric drugs a year earlier when I published ten myths in psychiatry that are harmful for the patients in a newspaper.4 The article also exists in English.38 Officially, the aim of the meeting was to provide “a neutral and sober assessment of the drugs,” but its true purpose was to protect the status quo.
There was a long introduction where my name wasn’t mentioned even though I was the direct reason for having the meeting, and I wasn’t invited to speak. Psychologist Olga Runciman pointed out that the story about mental disorders being caused by a chemical imbalance was dead abroad and asked if it was also dead in Denmark. None of the psychiatry professors wanted to answer, and the chair didn’t hold them to account, not even after I had said twice that they hadn’t replied.
Eight months later, the day before my psychiatry book came out,4 there was a long interview with me in the newspaper where I had described the ten myths.39 I emphasized that one of the biggest myths, which over half of patients had been told,33 is that they suffer from a chemical imbalance in the brain. I also said that many patients ended up taking drugs for the rest of their lives because they had been fooled this way or had been told that they would become brain damaged if they didn’t take the drugs.
Videbech was also interviewed and said: “Against better knowledge, he assigns to his opponent all sorts of unfair motives. For example, we have known for the last 20 years that the theory of the chemical imbalance in the brain for depression is far too simple. I have written about this in my textbooks for many years. It is therefore totally off limits when I and others are assigned such views.”
Well, not really. The myth about the chemical imbalance is only a thing of the past when challenged. Psychiatry professor Birte Glenthøj was also interviewed and confirmed that the myth was still alive and well: “We know from research that patients suffering from schizophrenia have on average increased formation and release of dopamine, and that this is linked to the development of the psychotic symptoms. Increased dopamine activity is also seen before patients are first given antipsychotic medication, so it has nothing to do with the medication.”
Two weeks after I published my psychiatry book, psychiatrist Marianne Geoffroy wrote in an industry supported throw-away magazine that I used public funds to publish private, non-scientific books, which she compared to Scientology books. She claimed that I scared citizens suffering from psychiatric disorders away from getting relevant treatment.40 In an electronic comment, psychiatrist Lars Søndergård (see more about him in Chapter 5) said that he didn’t know of any psychiatrist who attributed mental illness to a “chemical imbalance in the brain.”
Another psychiatrist, Julius Nissen, responded: “I have spent my many years in psychiatry talking to a lot of people who have received exactly this explanation and the comparison with insulin, that it is a substance they need. This conviction makes it very hard to motivate them to withdraw from the drug. It is precisely because they, during the withdrawal, de facto experience a ‘chemical imbalance,’ now that the brain is accustomed to the substance. They therefore feel confirmed that the hypothesis is true because they are ill, even though it is side effects that must be overcome.”
In early 2017, Videbech postulated again that when people are depressed, there is an imbalance in the brain.41 I complained to the editor of the publicly available Handbook for Patients, which has official status in Denmark, that Kessing and Videbech had written in their two contributions that depression is caused by a chemical imbalance.42,43
I got nowhere, of course, but felt it was my duty towards the patients to at least try. Kessing and Videbech changed a few minor things and introduced new claims that made their articles worse. I complained again, and again to no avail, and the lie about the chemical imbalance continued.
In his update, Kessing added that, “it is known that antidepressant drugs stimulate the brain to make new nerve cells in certain areas.” Videbech wrote the same, but there were no references. If this can happen, it only means that depression pills are harmful to brain cells, as the brain forms new cells in response to a brain injury. This is well documented, for example in electroshock therapy and neuroleptics.7 Leading psychiatrists consider their patients ignorant, but I must say that the level of ignorance among themselves about their own specialty is astounding.
Like Kessing, Videbech argued that treatment with depression pills can be lifelong, e.g. if the depression appears after 50 years of age. I have never heard of any reliable scientific evidence in support of this.
In 2018, a patient wrote in a newspaper:44 “When a psychiatrist changed my medication … it ‘worked’ by putting on about 20 kilos. When I wanted to come off the drug, he told me the usual lie: That I had a chemical imbalance and needed the pills. So, I continued … My mother always said, ‘don’t go to the bakery for meat.’ And going to a medically trained doctor in the hope of getting answers to mental problems is exactly that.” Subsequently, my PhD student Anders Sørensen helped him come off his drugs.
Why is it that we need to listen to the patients and not to the psychiatrists if we want to know the truth about psychiatric drugs and electroshock?4,23 One patient couldn’t remember even the commonest things, like the name of the Danish capital, after she was electroshocked.23 She was permanently and seriously brain damaged by electroshocks she should never have received but she was told it was her “disease” even though she didn’t have any psychiatric disorder; she was sexually abused as a child. Her book is a frightening account of virtually everything that is wrong with psychiatry,23 just as the book about a young woman the psychiatrists killed with neuroleptics (see Chapter 4).4,45
Before turning to the question whether psychiatric drugs have specific, worthwhile effects, in line with the doctrine of biological psychiatry, I shall expose the idea about a chemical imbalance to a little logic.
If a deficit in serotonin is the cause of depression and a drug that increases serotonin works for depression, then we would not expect a drug that lowers serotonin to work for depression. Nonetheless, this is the case, e.g. for tianeptin.2,3 More generally, it seems that almost everything that causes side effects, which all drugs do, “works” for depression,8 including several drugs that do not increase serotonin, e.g. mirtazapine.
This, and other evidence I shall discuss below, suggests that depression pills don’t work for depression. The patients think they are helpful because they can feel something is happening in their body, and the psychiatrists delude themselves.
If a deficit in serotonin is the cause of depression, mice genetically depleted of brain serotonin should be seriously depressed—but they behave just like other mice.46
If a deficit in serotonin is the cause of depression, depression pills should work pretty quickly because monoamine levels in the brain increase in one to two days after the start of treatment.47 They don’t. The improvement comes gradually, with very little difference between drug and placebo, and whether they get drug or placebo, it usually takes weeks before the patients can feel their depression has lifted.4,48
If depression pills work by increasing the level of serotonin, we would not expect them to work in diseases that have never been claimed to have anything to do with a lack of serotonin, e.g. social phobia.47 When my research group reviewed the type of diagnoses that had been investigated in placebo-controlled trials of depression pills, we counted 214 unique diagnoses, in addition to depression and anxiety.49
The trials were driven by commercial interests, focusing on prevalent diseases and everyday problems to such an extent that no one can live a full life without experiencing several of the problems for which these drugs were tested. We concluded that depression pills are the modern version of Aldous Huxley’s soma pill intended to keep everyone happy in Brave New World.
In 1996, Steven Hyman, former director of the US National Institute of Mental Health, pointed out that depression pills do not correct a chemical imbalance in the brain but, on the contrary, create a chemical imbalance.50 This is why so many people struggle to come off psychiatric drugs (see Chapter 4).
The myth about the chemical imbalance is very harmful for other reasons. It makes people believe there is something seriously wrong with them, and sometimes they are even told it is hereditary. The result is that patients fear what would happen if they stopped, even if they taper off slowly. Similarly, the myth convinces doctors they are right when they persuade their patients to take drugs they don’t like or are afraid of.
The drug industry and its paid allies in the psychiatric profession have betrayed the whole world, and the recipe is simple. You take a drug and find out that it increases X, e.g. serotonin, or lowers Y, e.g. dopamine. You then invent the hypothesis that the people you treat are deficient in X or produce too much Y.
There is nothing wrong with inventing hypotheses. That’s how science works. But when your hypothesis gets rejected, again and again, no matter what you do and how ingenious you are and how much you manipulate your design and the data, it is time to bury the hypothesis for good.
This won’t happen. The chemical imbalance myth is not a question about science, it is about money, prestige and guild interests.
Can you imagine a cardiologist saying, “You have a chemical imbalance in your heart, so you need to take this drug for the rest of your life,” when she doesn’t have a clue what she is talking about?
Are psychoactive drugs specific and worthwhile?
The psychiatrists constantly say that they use drugs with specific effects that are similarly effective as many other drugs, e.g. used for rheumatic pain and asthma.
For many psychiatric drugs, we can tell which main receptor in the brain they target, resulting in blocking or enhancing the effect of a particular neurotransmitter, e.g. serotonin, dopamine, or gamma-aminobutyric acid (GABA).
This looks like a specific effect, like insulin for diabetes, but it isn’t. If your blood sugar is very high, you may end up in hyperglycaemic coma, which can lead to permanent brain damage and death. However, if you are treated with insulin, intravenous fluids and electrolytes, you will usually recover fully. The effect is dramatic and quick.
Antibiotics are also highly specific treatments. You may become fatally ill if you are infected with streptococci, but may recover within an hour or two if you receive penicillin.
Psychiatric drugs interact with several receptors including receptors elsewhere in the body, outside the brain. More than a hundred neurotransmitters have been described, and the brain is a highly complicated system, which makes it impossible to know what will happen when you perturb this system with a drug.
It is revealing to see what happens when people are exposed to psychiatric drugs and other brain-active substances. There are remarkable similarities, no matter which drug or substance we use, whether it be prescription drugs, narcotics bought in the street, alcohol, or opium. Common effects are numbing of feelings, emotional blunting, drowsiness, lack of control over your thoughts, caring less about yourself and others, and reduced or absent capacity for having sex and falling in love.
Psychoactive substances change your brain, and if you abruptly stop taking a drug, the withdrawal symptoms are also remarkably similar, no matter what drug it is. There are also differences, but it is clear that psychiatric drugs do not have specific actions. If you give them to healthy volunteers or animals, they will experience the same unspecific effects as patients do. This is not so for specific drugs. If you give penicillin to a healthy person, that person will not become any better and will likely not feel anything.
We have many specific drugs that can increase survival. Antibiotics, antihypertensives, streptokinase for heart attacks, aspirin for preventing new heart attacks, coagulation factors for people with hereditary clotting defects, vitamins for people with serious vitamin deficiencies, thyroid hormones for myxoedema, and a lot else.
Psychiatric drugs cannot cure people, only dampen their symptoms, which come with a lot of harmful effects. And they don’t save people’s lives; they kill people. I have estimated, based on the best science I could find, that psychiatric drugs are the third leading cause of death, after heart disease and cancer.4 Perhaps they are not quite that harmful, but there is no doubt that they kill hundreds of thousands of people every year. I have estimated that just one neuroleptic drug, olanzapine (Zyprexa), had killed 200,000 patients up to 2007.51 What is particularly saddening is that by far most of these patients should never have been treated with Zyprexa.
Do the psychiatrists want to hear about this? No. In October 2017, I gave two invited talks at the World Psychiatric Association’s 17th World Congress of Psychiatry in Berlin. When I spoke about “Withdrawal from psychotropics,” there were around 150 psychiatrists in the audience. Fifteen minutes later, I spoke about “Why are psychiatric drugs the third leading cause of death after heart disease and cancer?” Three psychiatrists out of the over 10,000 at the congress attended and they refused to give interviews and carefully avoided being filmed by the documentary film team that followed me, as if they were on their way to see a porn movie.
The first thing people notice when they start taking a psychiatric drug is its harms. Few people will not experience any harms. The obvious reaction to this would be to tell your doctor that you don’t want the drug. But—according to psychiatry’s script—your doctor will persuade you to continue and you will be told that it takes some time before the effect kicks in and that the harms—which doctors call side effects because it sounds nicer—will be less noticeable with time.
So, you carry on. Even when you have become well, which would have happened in most cases, also without drugs, your doctor will insist—according to guidelines based on highly flawed studies that have often been written by doctors on industry payroll4—that you need to continue for another number of months, sometimes years, or for the rest of your life.
In their article, “Do antidepressants cure or create abnormal brain states?”, Joanna Moncrieff and David Cohen explain why the disease-centered model of drug action that assumes that drugs rectify biological abnormalities is incorrect.52 A drug-centered model is far more plausible. In this model, which is not a model but just plain reality, psychotropic drugs create abnormal states that may coincidentally relieve symptoms. Alcohol’s disinhibiting effects may relieve symptoms of social phobia, but that doesn’t imply that alcohol corrects a chemical imbalance underlying social phobia.
The authors argue that a disease-based model—like insulin for diabetes—could be considered established if:
- The pathology of psychiatric conditions or symptoms had been delineated independently from the characterisation of drug action, and drug action could be extrapolated from that pathology;
- Rating scales used to evaluate drug treatment in clinical trials reliably detected changes in the manifestations of an underlying disease process rather than detecting drug-induced effects;
- Animal models of psychiatric conditions selected specific drugs;
- Drugs thought to have a specific action in certain conditions were shown to be superior to drugs thought to have nonspecific effects;
- Healthy volunteers showed different or absent patterns of effects, compared with diagnosed patients, since drugs would be expected to exert their therapeutic effects only in an abnormal nervous system;
- And the widespread use of supposedly disease-specific drugs led to demonstrable improvements in short or long-term outcome of psychiatric disorders.
None of this is true for psychiatric drugs. In a circular chain of logic, the monoamine theory of depression was formulated primarily in response to observations that the first marketed depression pills increased brain monoamine levels. Monoamines include serotonin, dopamine, and norepinephrine, but there is no evidence that there is a monoamine abnormality in depression.
The depression rating scales, e.g. the Hamilton scale,53 contain items that are not specific to depression, including sleeping difficulties, anxiety, agitation, and somatic complaints. These symptoms are likely to respond to the nonspecific sedative effects that occur with many depression pills and other substances, e.g. alcohol, opium, and neuroleptics, which could then also be considered depression pills, but we do not prescribe alcohol or morphine for people with depression or call them depression pills.
Using the Hamilton scale, even stimulants like cocaine, ecstasy, amphetamine, and ADHD drugs could be considered depression pills. Almost everything could. Indeed, many drugs that are not considered to be depression pills show comparable effects to them, e.g. benzodiazepines, opiates, buspirone, stimulants, reserpine, and other neuroleptics.52
Recent sharp increases in depression pill use have been accompanied by increased prevalence and duration of depressive episodes and rising levels of sickness absence.52 In all countries where this relationship has been examined, the increased use of psychiatric drugs has been accompanied by an increase in disability pensions for mental health reasons.3 This shows that psychiatric drugs are harmful.
- We should all contribute to changing psychiatry’s seriously misleading narrative.
- Depression pill is the correct term for an “antidepressant,” as it makes no promises.
- Major tranquilliser is the correct term for an “antipsychotic,” as this is what the drug does, to patients, healthy volunteers and animals. It may also be called a neuroleptic, which makes no promises.
- Sedative is the correct term for an “anti-anxiety” drug, as this is what the drug does, to patients, healthy volunteers and animals.
- Speed on prescription is the correct term for ADHD drugs, as they work like amphetamine, and as some of them are amphetamine.
- “Mood stabilizer” is like the unicorn. Since such a drug doesn’t exist, the term should not be used.
To read the footnotes for this chapter and others, click here.
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.