Mental Health Survival Kit, Chapter 2: Is Psychiatry Evidence Based? (Part 8)

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 psychiatry’s resistance to admitting to withdrawal effects, as well as the way doctors and scientists are treated when they critique the establishment. Each Monday, a new section of the book is published, and all chapters are archived here.

False information on withdrawal from UK psychiatrists

In 2020, I co-authored a paper written by psychology professor John Read, “Why did official accounts of antidepressant withdrawal symptoms differ so much from research findings and patients’ experiences?”¹⁸⁰ We noted that the 2018 guidelines from NICE stated that depression pill withdrawal symptoms “are usually mild and self-limiting over about 1 week, but can be severe, particularly if the drug is stopped abruptly,” and that guidelines from the American Psychiatric Association asserted that symptoms “typically resolve without specific treatment over 1-2 weeks.”

However, a systematic review by James Davies and John Read showed that half of the patients experience withdrawal symptoms; half of those with symptoms experience the most extreme severity rating on offer; and some people experience withdrawal for months or even years.⁵⁷ A survey of 580 people reported that in 16% of the patients, the withdrawal symptoms lasted for over 3 years.⁵⁷

In February 2018, Wendy Burn, president of the Royal College of Psychiatrists (RCPsych) and David Baldwin, chair of the its Psychopharmacology Committee, wrote in The Times that, “We know that in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.”

Nine clinicians and academics wrote to Burn and Baldwin that their statement was incorrect and had misled the public on an important matter of public safety. We also noted that the RCPsych’s own survey of over 800 antidepressant users (Coming Off Antidepressants) found that withdrawal symptoms were experienced by 63% and lasted for up to 6 weeks, and that a quarter reported anxiety lasting more than 12 weeks. We furthermore noted that within 48 hours of publishing their misleading statement in The Times, RCPsych removed the Coming Off Antidepressants document from the website.

We asked them to retract their statement or provide supporting research. Baldwin sent two company funded papers with himself as first author. None of them provided data about how long withdrawal symptoms last.

Next, we sent a formal complaint to the RCPsych, signed by 30 people, including 10 who had experienced withdrawal effects for 1 to 10 years, 10 psychiatrists and 8 professors. We noted:

“People may be misled by the false statement into thinking that it is easy to withdraw and may therefore try to do so too quickly or without support from the prescriber, other professionals or loved ones. Other people, when weighing up the pros and cons of starting antidepressants may make their decision based partly on this wrong information. Of secondary concern is the fact that such irresponsible statements bring the College, the profession of psychiatry (to which some of us belong), and — vicariously — all mental health professionals, into disrepute.”

We provided numerous studies and reviews showing the Baldwin-Burn statement to be untrue and asked them to publicly retract, explain and apologise for their misleading statement; provide guidance or training for all RCPsych spokespersons, including the current president, on the importance of ensuring that public statements are evidence-based and on the limitations of relying on colleagues who are in receipt of payments from the pharmaceutical industry (e.g. Baldwin); and to reinstate, on the RCPsych website, the document Coming Off Antidepressants.

The RCPsych registrar, Adrian James, replied that there was “no evidence that the statement in The Times was misleading.” They dismissed the complaint and James gave four reasons, three of which were either irrelevant or disingenuous. He repeated an earlier claim by Burn that the removal of the survey from their website happened because it was out of date. Even when we pointed out that the removal was done within hours after we had shown it includes data contradicting the Baldwin-Burn statement, and that over 50 other items on their website were out of date, but not removed, James adhered to his explanation.

The only relevant comment was that the Baldwin-Burn statement was consistent with NICE recommendations that stated that doctors should advise patients that discontinuation symptoms are “usually mild and self-limiting over about 1 week.”

However, James misrepresented the NICE statement by leaving out the next sentence: “but can be severe, particularly if the drug is stopped abruptly.”

Four months after The Times letter, the CEO of the RCPsych, Paul Rees, sent a lengthy reply that merely echoed James. We responded that Rees’ emphatic statement that “it is no part of the College’s function to ‘police’ such debate” implied that even his most senior officials can say anything they like, however false or damaging, and the College would stand by them — as, indeed, it had in this case.

We explained that we were now certain that the Royal College of Psychiatrists prioritises the interests of the College and the profession it represents over the wellbeing of patients; does not value empirical research studies as the appropriate basis for making public statements and for resolving disputes, and has thereby positioned itself outside the domain of evidence-based medicine; has a complaints process which results in substantive, carefully documented, complaints on serious matters of public safety not being investigated, but rather dismissed out of hand by one individual; has no interest in engaging in meaningful discussion with professional and patient groups who question the College’s position on an issue; is prepared to use blatantly disingenuous tactics to try to discredit reasonable complaints, and has thereby positioned itself outside the domain of ethical, professional bodies; is unaware of, or unconcerned about, the distorting influence of the pharmaceutical industry, and the need to maintain a strong, ethical boundary between itself and profit-based organisations.

Even though the RCPsych is not accountable to Parliament, or it seems to anyone, we wrote to the Secretary of Health and Social Care and informed the government that,

“The Royal College of Psychiatrists is currently operating outside the ethical, professional and scientific standards expected of a body representing medical professionals … We believe the RCPsych responses show a trail of obfuscation, dishonesty and inability or unwillingness to engage with a concerned group of professionals, scientists and patients.

“If a group of scientists and psychiatrists together cannot challenge the RCPsych in a way that leads to an appropriate, considered response and to productive engagement with the complainants, what hope is there for individual patients to have a complaint taken seriously?”

Burn and Baldwin never retracted their false statement, provided research to support it, or apologised for misleading the public. Neither did James nor Rees ever address our concerns about the complaint procedure.

We made our complaint public, and the BBC’s Radio 4 programme, Today, covered it on 3 October 2018. The RCPsych refused to provide a spokesperson to debate with John Read. Instead, Clare Gerada, ex-chair of the Royal College of General Practitioners, represented their perspective. She denigrated the complaint as an “anti-antidepressant story” and vehemently defended the RCPsych officials’ position saying that, “the vast majority of patients that come off antidepressants have no problems whatsoever.”

Later, the Royal Society of Medicine (RSM) launched a podcast series, “RSM Health Matters.” The opening topic was about depression pills and withdrawal. One of the two interviewees was Sir Simon Wessely, president of the RSM (and recent president of RCPsych). The other one was Gerada. None of them disclosed they are married, and both stressed that depression pills enable people to “lead normal lives.”

Wessely rejected any link between depression pills and suicide, despite it having been sufficiently well demonstrated for the drugs to carry Black Box Warnings. He also stated, categorically, that depression pills are “not addictive.” Gerada complained that, “Once a year when the prescribing figures come out, we have this soul-searching — why are we prescribing too much of this medication.”

She said that she personally even prescribes them for people she knows “are going to get depressed” in the future and encouraged “psychiatrists to move away from the fear, which has been propagated I think by the media and certain people, to actually say, is there a space for antidepressants in preventing depression?”

Regarding withdrawal, Gerada stated: “As a GP of 26 years … probably 50% of the tens of thousands of patients I have seen have been there with a mental health issue and I can count on one hand the number who have gone on to have long-term problems withdrawing from antidepressants or problems coming off antidepressants.”

If we interpret “tens of thousands” to mean 30,000, Gerada was talking about roughly 15,000 people with mental health issues. Given her enthusiasm for depression pills, which she uses even “prophylactically,” we assumed she prescribed them to 25% of these patients, about 3,750 people. Even if only half of them have ever tried to come off the drugs, then she is claiming an incidence of withdrawal effects of 5 out of 1,875 or 0.3%. The recent research-based estimate of the actual rate, 56%,⁵⁷ is 210 times larger than Gerada’s clinical experience.

On November 27, 2018 the BBC Radio programme All in the Mind invited John Read and psychiatrist Sameer Jauhar to discuss the Davies and Read review. Jauhar explained that, “My hope is that people don’t get scared about antidepressants … by thinking that the numbers that have been given out apply to them.” When the interviewer asked if patients were warned about withdrawal effects in advance when they started antidepressants, Jauhar replied: “Yes. Like with any other medicine in general medicine you warn patients about any side effects.”

Read said: “The two largest surveys that we’ve done, of 1800 and 1400 people, when asked were they ever told anything about withdrawal effects, less than 2% in both surveys said that.”¹⁸⁰

In April 2019, the Journal of Psychopharmacology published a critique of the Davies and Read review, which was dismissed as “a partisan narrative.” The lead author was Jauhar, accompanied, amongst others, by Baldwin and psychiatrist David Nutt, the journal editor. Three of the six authors, Nutt, Baldwin, and Oxford University psychiatrist Guy Goodwin, disclosed payments from 26 different drug companies, but Jauhar failed to disclose his research funding from Alkermes or his paid lectures for Lundbeck.

The Journal of Psychopharmacology is owned by the British Association of Psychopharmacology, which accepts money from the industry in the form of sponsored satellite symposia that are not controlled by the Association. Both the current president, Allan Young, and past presidents, including Nutt, have received money from the drug industry.

John Read’s tenacity paid out. On 30 May 2019, the RCPsych published a statement where they noted that, “Discontinuation of antidepressants should involve the dosage being tapered or slowly decreased to reduce the risk of distressing symptoms, which may occur over several months … The use of antidepressants should always be underpinned by a discussion about the potential level of benefits and harms, including withdrawal.”

Within hours, however, Allan Young, tried to undermine this U-turn by the RCPsych. He repeated his drug company line: “So called withdrawal reactions are usually mild to moderate and respond well to simple management. Anxiety about this should not obscure the real benefits of this type of treatment.”

In September 2019, Public Health England published a historic 152-page evidence review making important recommendations, including for services to assist people coming off depression pills and other psychiatric drugs, and about better research and more accurate national guidelines.¹⁸¹ The following month, NICE updated its guidelines in line with the Davies and Read review.

What this illustrates is: We already knew that drug companies don’t care about patient safety if it could harm sales.^4,51 We now know that psychiatric leaders also don’t care about patient safety if it could threaten their own reputation, the guild they represent, or the flow of money they receive from drug companies. This corruption of a whole medical specialty also permeates our authorities, which rely heavily on specialists when issuing guidelines.

I exposed some of the same people in my 2015 book under the headline: “Silverbacks in the UK exhibit psychiatry’s organised denial.”⁴ It started with my keynote lecture at the opening meeting of the Council for Evidence-based Psychiatry on 30 April 2014 in the House of Lords, chaired by the Earl of Sandwich, “Why the use of psychiatric drugs may be doing more harm than good.” The other speakers, psychiatrist Joanna Moncrieff and anthropologist James Davies, gave similar talks.

Two months later, Nutt, Goodwin and three male colleagues bullied me in the first issue of a new journal, Lancet Psychiatry.¹⁸² Their style and arguments revealed the arrogance and blindness at the top of the psychiatric guild everywhere in the world. The title of their paper was: “Attacks on antidepressants: signs of deep-seated stigma?” I was accused, directly or indirectly, of being “anti-psychiatry,” “anti-capitalist,” having “extreme or alternative political views,” launching a “new nadir in irrational polemic,” which had suspended my “training in evidence analysis for popular polemic” and made me “prefer anecdote to evidence,” which was “insulting to the discipline of psychiatry.”

Empty rhetoric this was. What was insulting to psychiatry and to the patients was their article. They claimed that depression pills are among the most effective drugs in the whole of medicine, with an impressive effect on acute depression and on preventing recurrence.

They noted that fewer patients on a depression pill than on placebo drop out of the trials because of treatment inefficacy, which they believed showed that the pills are effective. This is wrong. Many more patients drop out of trials due to adverse events on drug than on placebo.¹¹⁴ This tends to happen early, and then there are fewer patients who can drop out because of lack of effect in the drug group than in the placebo group. It is therefore a fatal flaw to look at drop-outs due to lack of efficacy. We included all dropouts and found that placebo is better than a depression pill.¹¹⁴

They mentioned that many people who are not taking depression pills commit suicide, claiming that a “blanket condemnation of antidepressants by lobby groups and colleagues risks increasing that proportion.” This is an incredible argument considering that depression pills cause suicide!

They claimed that most of those who commit suicide are depressed, but the underlying data don’t allow this conclusion.¹⁸³ Only about a quarter of people who kill themselves have a diagnosis of depression. Many more get a post-mortem diagnosis based on a so-called psychological autopsy. Establishing a diagnosis of a psychiatric disorder in a dead person is a highly bias-prone process. Social acceptability bias threatens the validity of such retrospective diagnosis-making. Relatives often seek socially acceptable explanations and may be unaware of or unwilling to disclose certain problems, particularly those that generate shame or put some of the blame on themselves.

“Some of the safest drugs ever made,” they wrote. This is difficult to reconcile with the results of a carefully conducted cohort study that showed that SSRIs kill one of 28 people above 65 years of age treated for one year,⁹⁶ and with the fact that the pills double suicides.^97-100

“The anti-psychiatry movement has revived itself with the recent conspiracy theory that the pharmaceutical industry, in league with psychiatrists, actively plots to create diseases and manufacture drugs no better than placebo.” They did not see the irony. It is not a conspiracy theory but a simple fact that psychiatrists have created so many “diseases” that there is at least one for every citizen, and it is also correct that the drugs are not worth using.

The height of professional denial and arrogance came when they suggested that we should ignore “severe experiences to drugs,” which they dismissed as anecdotes and claimed might be distorted by the “incentive of litigation.” It is deeply insulting to those parents who have lost a child and those spouses who have lost a partner because depression pills drove some people to commit suicide or homicide, or both. In their finishing remarks, the psychiatrists said that my “extreme assertions … express and reinforce stigma against mental illnesses and the people who have them.” It has been documented that it is the psychiatrists that stigmatise the patients, not those who criticise psychiatry.⁴

Sami Timimi is a fellow of the RCPsych, and he wrote to Burn, the RCPsych president, in a letter co-signed by 30 people, requesting that the RCPsych replace Baldwin as its representative on the Expert Reference Group of Public Health England’s Review of Prescribed Medicines, with an RCPsych member who is not compromised by conflicts of interest with the pharmaceutical industry.

Burn replied that Baldwin’s industry involvement did not in any way compromise his work and warned Timimi that he needed to uphold, “the values which the College expects of its members.” Like Nutt, Goodwin and other silverbacks, Burn didn’t see the irony of her remark. The values seem to allow corruption.

When Scottish psychiatrist Peter Gordon by the end of 2019 expressed his views about psychiatric overmedication and its potential for harm, the chair of the Scottish Division of the Royal College of Psychiatrists made a telephone call to the Associate Medical Director of the NHS Board where Gordon worked and expressed concerns about his mental health.¹⁸⁰ Several of us have experienced being “diagnosed” by our psychiatric opponents, on my part both in a newspaper, during a court case where I was an expert witness,⁵⁴ and in a conversation between two psychiatrists at a private party one of my friends overheard.

Another example of fake diagnosis-making comes from Emory University in USA, where psychiatric professor Charles Nemeroff worked.⁴ Millions of drug industry dollars changed hands secretly for more than a decade, and one reason why the scam could continue for so long was that at least 15 whistleblowers were ordered to undergo psychiatric evaluations by Emory’s psychiatrists, who reportedly wrote up such exams without even examining the targeted doctors or gathering factual evidence, after which several of them were fired.

Some of these “evaluations” were done by Nemeroff himself. In the Soviet Union, dissidents were given fake psychiatric diagnoses and locked up or disappeared forever.

Such gross ethical transgressions are unique for psychiatry; they are not even possible in other specialties. If a cardiologist loses an academic discussion, or his colleague has exposed his fraud, it won’t help him to suddenly claim that his opponent got a heart attack.

 

To read the footnotes for this chapter and others, click here.