Garbage in, Garbage out: The Newest Cochrane Meta-Analysis of Depression Pills in Children

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In May 2021, Cochrane published a network meta-analysis of depression pills for children and adolescents with depression. As the first author is Sarah Hetrick, co-ordinating editor in the Cochrane Mental Disorders group that published the review, one would expect the review to be better than average for Cochrane reviews in depression.

The abstract was seriously misleading

By reading the abstract, I realised that it would be a waste of time to read all the 225 pages in the review. The abstract illustrates a remarkable lack of common sense and overreliance on what the drug companies have chosen to publish, even though we know that such information is unreliable.

Image by Jernej Furman on Flickr.

“Major depressive disorders have a significant impact on children and adolescents, including on educational and vocational outcomes, interpersonal relationships, and physical and mental health and well-being. There is an association between major depressive disorder and suicidal ideation, suicide attempts, and suicide. Antidepressant medication is used in moderate to severe depression; there is now a range of newer generations of these medications.”

This is the whole background section in the abstract. The focus is on the disorder and the need to treat it with pills, warning that there is an association between depression and suicidality. It would have been more appropriate to mention that there is an “association” (actually more than this, as it is a causal relationship) between the use of depression pills and suicidal ideation, suicide attempts, and suicide.

“Newer generation”, “second generation”, and “third generation” of drugs is industry jargon which aims at giving readers the impression that they are better than older drugs. Such marketing terms that have no biochemical relevance should not be used in Cochrane reviews.

“…Proportions of suicide-related outcomes were low for most included studies and 95% confidence intervals were wide for all comparisons. The evidence is very uncertain about the effects of mirtazapine (OR 0.50, 95% CI 0.03, 8.04), duloxetine (OR 1.15, 95% CI 0.72, 1.82), vilazodone (OR 1.01, 95% CI 0.68, 1.48), desvenlafaxine (OR 0.94, 95% CI 0.59, 1.52), citalopram (OR 1.72, 95% CI 0.76, 3.87) or vortioxetine (OR 1.58, 95% CI 0.29, 8.60) on suicide-related outcomes compared with placebo.”

This information is highly misleading. The evidence is not “very uncertain.” We have known for almost 20 years that these drugs, as a class, increase the suicide risk in children and adolescents, which is why drug regulators warn about using them. The Cochrane authors miss the forest by looking at one tree at a time, and it gets worse:

“There is low certainty evidence that escitalopram may “at least slightly” reduce odds of suicide-related outcomes compared with placebo (OR 0.89, 95% CI 0.43, 1.84).”

Firstly, a drug cannot be better than itself. The active ingredient in escitalopram is the same as in citalopram, which is a stereoisomer. Stereoisomers consist of two halves, which are mirror images of each other, but only one of them is active. When the patent runs out, the company may patent the active half, a trick called evergreening, or “me-again.” Our patent laws are really weird since they allow this, which merely benefits the company for no societal gain. Second, none of the drugs reduce odds of suicide-related outcomes compared with placebo; they increase the odds. Third, the confidence interval goes from 0.43 to 1.84. This is not “low certainty evidence”, it is no evidence at all! (A confidence interval for an odds ratio that includes 1 is, by definition, not statistically significant.) At this point, I would like to know if any of the authors are on Lundbeck payroll, since that company sells both drugs.

“There is low certainty evidence that fluoxetine (OR 1.27, 95% CI 0.87, 1.86), paroxetine (OR 1.81, 95% CI 0.85, 3.86), sertraline (OR 3.03, 95% CI 0.60, 15.22), and venlafaxine (OR 13.84, 95% CI 1.79, 106.90) may “at least slightly” increase odds of suicide-related outcomes compared with placebo.”

This nonsense is outright dangerous. There is high certainty evidence that depression pills increase the risk of suicide, and “at least slightly” downgrades this harm to the extreme. The pills kill children and adolescents by driving them into suicide. And as they do not have clinically relevant effects, they should not be used at all.

“There is moderate certainty evidence that venlafaxine probably results in an “at least slightly” increased odds of suicide-related outcomes compared with desvenlafaxine (OR 0.07, 95% CI 0.01, 0.56).”

The problem with this nonsense is the same as with escitalopram and citalopram, as desvenlafaxine is also a “me again” product. Think about it. What is the likelihood that a drug can be better than itself, with a very small odds ratio and a confidence interval that goes from 0.01 to 0.56, far below unity? Extremely close to zero, but Cochrane did not bother but preferred to provide support to the industry’s cheating with the evidence.

Cipriani’s seriously misleading network meta-analysis in Lancet

This Cochrane review is just as disgraceful as Cipriani’s network meta-analysis of depression pills in adults, which was published in Lancet on 7 April 2018. The Cochrane authors should have learned from the devastating criticisms that were raised against this review, but they didn’t. In 2018, I published the article “Rewarding the companies that cheated the most in antidepressant trials,” in which I noted that Cipriani’s meta-analytic exercise was academic, with no clinical value, and that they drowned the many biases in the trials in statistics that were so complicated that it was impossible to know what all this led to.

In Cipriani’s case as well, the abstract was revealing. The authors claimed that in head-to-head trials, agomelatine, escitalopram, and vortioxetine were more effective than other antidepressants and that the same three drugs were also more tolerable than other antidepressants. This is highly unlikely to be true, and I therefore took a closer look at these three drugs and easily found out that it wasn’t true.

In 2019, Munkholm et al. reanalysed some of the data in Cipriani’s meta-analysis. They found that several methodological limitations were either unrecognised or underestimated; that the effect size was significantly higher in trials with a placebo run-in period and in published trials; and that the outcome data differed from the clinical study reports in 12 (63%) of the 19 trials they examined. When Munkholm et al.’s paper had been accepted for publication in BMJ Open, the editor wrote to Cipriani to ask him to respond. It is unbelievable that Cipriani did not find it necessary to defend his research.

The Cipriani network meta-analysis got colossal media attention, despite the fact that its estimate of the effect of depression pills was virtually the same as in previous meta-analyses—the pills were barely better than placebo. There were also highly critical letters in Lancet on 22 September 2018, which are listed below the PubMed record for Cipriani’s paper. Being a co-ordinating editor in the Cochrane Mental Disorders group, Hetrick has no excuse for not paying attention to the flaws in Cipriani’s review and for publishing another totally unreliable network meta-analysis of depression pills. This is really depressing, but I won’t take a pill for it.

Which data did the Cochrane authors include?

Despite the report’s 225 pages, it is not clear what Hetrick et al. did in their Cochrane review. I have access to clinical study reports from European drug regulators and I therefore know that Graham Emslie omitted two suicide attempts among 48 children on fluoxetine (there were none on placebo) from the publication of his trial in children and adolescents in 1997.

I tried to check if the two suicide attempts had been included in the Cochrane meta-analysis, but it proved impossible, as there are no data for suicide-related outcomes for individual drugs or studies (see page 59 in the review). The two suicide attempts are included in Lilly’s unpublished clinical study report X065, and I therefore searched on X065 in the Cochrane review but found the information confusing. On page 70, references to Emslie’s study are listed and the heading is this one:

“Emslie 1997 {published data only}

On the next page, there is this text:

“Medicines and Healthcare products Regulatory Agency (MHRA).
Fluoxetine Study 1 ID# X065. medicines.mhra.gov.uk (accessed
20 June 2004).”

If Hetrick et al. only used published data, it would make little sense to mention Lilly’s internal report. On page 103 there are “Notes” for this study, which say:

“Additional data were sought and supplied by the authors. Data in the MA for child, adolescent and total
populations taken from paper publication and these additional data
Child and adolescent data from author. MHRA # X065
MHRA contacted for additional data some of which was provided”

This is gobbledegook. Some text seems to be missing, and I can make no sense out of it. I have a simple question: Are the two suicide attempts included, yes or no? But I get no answer.

Cochrane is beholden to industry

The above shows that Cochrane is beholden to industry and is too uncritical. On 23 April 2021, Professor Ken Stein, Director of the Evidence Synthesis Programme at the UK National Institute for Health Research, spoke at a webinar for about half an hour about the work in the UK Cochrane groups and their future funding. His criticism of Cochrane was much the same as mine when I was a Cochrane Governing Board member, and he emphasized that Cochrane authors should be iconoclastic, which we were when we founded the Cochrane Collaboration in 1993. Stein also spoke about the importance of scientific integrity and said that this was a point raised by people in the Collaboration to ensure that “garbage does not go into the reviews; otherwise, your reviews will be garbage.”

It is highly unusual for a top funder to say that the recipient of the funding must ensure that garbage does not go into the research. This suggests that Stein is aware of the statement by Cochrane editor and author Tom Jefferson in the article, “Cochrane – a sinking ship”: “If your review is made up of studies which are biased and in some cases are ghost written or the studies are cherry picked and you don’t take that into account in your review, then it’s garbage in and garbage out … with a nice little Cochrane logo on it.” Stein was present at the Cochrane colloquium in Edinburgh in September 2018 where I was expelled after a show trial because of my criticism of psychiatric drugs and he knew very well what had happened. Just after my expulsion, BMJ’s editor-in-chief, Fiona Godlee, wrote that Cochrane should be committed to holding industry and academia to account, and that my expulsion from Cochrane reflects “a deep seated difference of opinion about how close to industry is too close.”

Cochrane’s CEO Mark Wilson, who ensured I was expelled, had seen the “writing on the wall,” which Stein said had been present for 8 years, which is exactly the period when Wilson, a journalist, ruled the organisation and destroyed it. I have been unable to find a resignation letter or anything else that could elucidate the circumstances around Wilson’s sudden departure from Cochrane in the middle of a month, five days before Stein’s webinar.

Stein indicated that there would be a major cut in funding in 2022. I find it likely that this is the beginning of the end for Cochrane as we know it, as 21 Cochrane review groups out of 52 worldwide are based in the UK. This move is deserved. Cochrane has degenerated into a highly ineffective behemoth, a cook-book exercise with plenty of nonsense, gobbledegook, and a lack of common sense, filling hundreds of pages for a single review and yet lacking essential information. Not even a co-ordinating editor is able to lift herself up over this mess, but propagates it.

Wilson did not have much sense for science and was preoccupied with branding. He introduced the motto “Trusted evidence” for Cochrane reviews. When it comes to psychiatric drugs, the Cochrane motto should be “Distrust the so-called evidence.”

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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.

30 COMMENTS

    • Depression is a fraud?! Then what do you label the symptoms? I am an LPC and I myself have mild clinical depression and an anxiety disorder. Taking meds was life changing for me. As well as for many of my clients. No one wants to take meds if they don’t need them. It depends on how the client is able to function day to day. I don’t push meds unless it is strongly indicated and then I will strongly recommend trying a med to see if their mood improves. How can you say that the illness is a fraud? What do you base you opinion on? What do you propose to do to help people who are suffering? Is there a better way to help people? I am always open to hear new theories. I also believe that taking meds does mess with your brain chemistry and I bet they are a bitch to stop. I have no intention of coming off of my meds. I don’t know of any other way to help people who clearly need more than therapy. My clients’ health means a lot to me. if there is a better way to help them then let’s hear it.

      Peter wrote all of these papers and yet he doesn’t say how on earth to help people who need help desperately. Is there a better way to help people? People should not be prescribed meds right away unless it is strongly indicated but for true clinical depression how does he propose that we help people function on a daily basis?

      • Diane Smith says: “People should not be prescribed meds right away unless it is strongly indicated but for true clinical depression how does he propose that we help people function on a daily basis?”

        What is “true clinical depression?” This is just a made up term by psychiatry and Big Pharma. It has no provable scientific basis. And it fits well with those people doing therapy who do not have the patience and understanding to work with people struggling to survive in a difficult world.

        And what does “strongly indicated” really mean? Sometimes both the “client” AND the therapist are looking for the quick fix.

        Richard

        • “True clinical depression” is completely subjective and indistinguishable from “mere sadness.” Not even the DSM has “criteria” for “clinical depression.” It sounds like a technical term, but it is literally meaningless in terms of any kind of research or statistical purposes, even within the sketchy confines of psychiatry’s own subjective “model” for understanding “mental illness.”

          I also don’t find it convincing that we ought to prescribe drugs “until something better comes along.” There are lots of people (including me) who find their own pathway out of feeling severely depressed. It is an error to assume that all “depressed” people have something wrong with them, or that all who DO have something wrong have the SAME thing wrong and need the same kind of help. “Depression” is a catch-all category that says absolutely nothing about what the person is depressed about or what can or should be done about it. When someone says “depression is a fake illness,” they don’t mean that depression doesn’t happen, they mean that “depression” is not a real entity that is valid for study and conclusions. It is not helpful to group all “depressed” or “clinically depressed” people into the same category when any two “depressed” people may have little to nothing in common with each other beyond how they happen to be feeling.

      • “Trying” a drug is not so simple. If you try it for 3 days, and have a horrible experience, you can walk away, but if you “try” it for 3 weeks or more, then you are faced with having your neurotransmitters altered, homeostatis getting involved – and the long difficult haul of trying to get off of the drug.

        You don’t “try” something that requires tapering unless you are sure. Or desperate. Or uninformed. Or misinformed.

      • I agree with you that a severe low mood, anxiety etc. which cripple a person are very real. And when a person is in the throes of extreme suffering, he’d be desperate for help. Denying the reality of suffering is not good. But helping people the way the mental health profession does is horrible.

        In a period of acute suffering, a person would be so desperate to end the pain, that the only thing on his mind would be to do just that, i.e. to end it. Many of these people are also teenagers with not much power in their hands. They can’t plan 10 years ahead or what the impact of whatever mental health treatment they get would be years down the line, socially, legally, medically or in any other way. Among many other things, being told by mental health workers that it is okay to be labelled with stigmatising and derogatory labels, and there are millions of such people, so it’s fine, is just wrong. I have never yet met a shrink who admits the dangers of his profession, except some renegade ones here.

        See my post below for more details.

      • Truth and integrity in science: hmm I wonder why this author needs to crowdfund. Science is the pursuit of truth. This guy is just trying to monetise his fringe ideas. As someone who has read extensively across the medical literature to inform an accurate understanding of how antidepressants work and given my 30 years taking them for OCD and MDD, I know they are effective regardless of some minor unwanted side effects. They work on the brain circuits implicated in each disorder. You need to study molecular biology and molecular neuropharmacology to understand how they work. It’s very complex and NOT just a chemical imbalance. Gp’s tend to be clueless so read widely and deeply. Ask questions of experts in the field as I have – reaching out to many across the world for a clearer picture of their mechanisms of action. An MD is no where near enough to understand this stuff. Seek experts with both PHD and MDs for clear information. For now, I am incredibly grateful for modern psychiatry and those scientists who dedicate their lives to helping those of use with serious diseases.

        And yes I have tried alternative routes and going off meds with supporting psychotherapy a number of occasions swayed at the time by the anti psychiatry movement with only relapse and severe anguish the result. Years later I know better and only visit this site today to hopefully allay any fears and normalise the need for antidepressants if you are suffering.

        • I think it’s a little presumptuous to state that they are “effective regardless of some minor unwanted side effects.” First off, they may be effective for you, but that doesn’t mean they are effective for everyone else, and it feels like it invalidates others’ experience to say otherwise. You wouldn’t want others to tell you they don’t work at all, so I think it’s fair not to tell others that they “work” as if your experience is true for everyone.

          Second, let’s not pretend that the side effects are always “minor!” There are many people on this site who have had awful “side effects,” including loss of sexual functioning, loss of feelings of pleasure, psychotic symptoms, suicidal and/or homicidal feelings, loss of appetite, and many more. Again, you are assuming that other people have experiences similar to yours, and I can assure you that this is by no means always or even most often the case.

          With all due respect, we work to be accepting of everyone’s experiences here. It would be appreciated if you would do the same.

          Additionally, I am not aware of ANY research ANYWHERE that identifies a particular “pathway” or “circuits” (or that even is able to objectively identify a physical “pathway” or “circuit” in any manner) that is associated with ANY DSM disorder. The psychiatric profession has finally disclaimed the “chemical imbalance” theory, only after decades of pressure from many quarters, including researchers themselves. The idea of “circuits” being involved is just another theoretical explanation that lacks supporting evidence. When I see research where a “pathway” in the brain is objectively defined and where some objective measurement of “flow” through the “pathway” is obtainable, I’ll start listening to talk about “pathways.” The psychiatric profession has spent decades manufacturing and falsifying and exaggerating or minimizing research to suit its own agenda. I don’t really care what “the experts” have to say, I want to see the research myself before I believe it.

          Finally, I will submit that, however well antidepressants or any other drug in question work for a particular person or group of people, the very idea that “mental illnesses” are purely physiological phenomena that will admit to a purely physiological cause in all or even most cases is, again, pure speculation, and indeed ignores obvious evidence to the contrary. If it’s all biology, why is it that immigrants and urban populations and people sexually abused as kids have much higher rates of schizophrenia diagnoses than the general population? Why is adult depression and anxiety associated at a 90% or better rate with childhood abuse and neglect? How do people get better without drugs or medical interventions at all? How did I overcome serious depression and anxiety with therapy, reading, and facing life’s challenges with support from friends and family and community? Do you wish to invalidate my experience by claiming that I “didn’t have depression, really” or that “it wasn’t that bad,” or is it that my brain chemistry somehow changed through my own thoughts and relationships and interactions with life? And if my brain chemistry can change (and there’s plenty of evidence that it can) through social experiences and alterations of thought and behavior patterns, why would you insist that drugs are the answer for everyone?

          How do you explain the actual PHYSICAL changes in the brain that happen with meditation or other processes that don’t involve any kind of physical intervention at all if it’s all biological?

          I am glad the drugs have worked for you. You are certainly not alone in saying that. But please, don’t try to talk down to people who have had different experiences. My belief is that “depression” isn’t even a legitimate category of “disorder” – people are depressed for a myriad of reasons, some physical, some psychological, some spiritual, some social. What works for one person doesn’t work for every other person. We all need to find our own paths. You have found yours – let other people find their own and explain to YOU how it is for them, instead of assuming you are in a position to tell the rest of us “what is true.”

        • I will answer you in the form of questions.

          Do the drugs in question only reside in the brain?

          Do you know what it does to your digestive system? (hint: 85-90% of body’s serotonin resides in gut)

          Do you know what it does to your liver? Kidneys? Adrenals?

          Do you know about the cardiac effects of these drugs?

          Do you know about the endocrine effects of these drugs?

          Do you know about the drugs’ effects on the nervous/muscular system? (dystonias & dyskinesias?)

          Have you ever tried to come off of the drugs, and experienced withdrawals?

          Have you had any sexual side effects? (these can be crippling)

          Have you been on the drugs longer than 5-10 years? Have you had any mysterious “other” ailments crop up after 5 years on the drugs? (commonly, fibromyalgia, IBS, impotence, arrhythmias, muscle pain & spasms, insomnia, restless legs, tremors, chronic fatigue, autoimmune problems, but these are only the common ones – there are many, many more)

          These drugs are not meant for the long term, but the way the drugs work make it extremely hard to come off of them. Extremely hard for a “short course,” because once you’ve been on them for 3 weeks, your body has adjusted to them.

  1. Dr. Gøtzsche presents some good criticisms of the Cochrane review of antidepressants in children. And I think the review should have been far more critical than it was. Specifically, given the lack of credible evidence, they shouldn’t have suggested that antidepressants might sometimes be considered because their findings “reflect the average effects of the antidepressants, and given depression is a heterogeneous condition, some individuals may experience a greater response.”

    But I want to point out that the Cochrane abstract was hardly a resounding endorsement of the pills. It said:

    “Findings suggest that most newer antidepressants may reduce depression symptoms in a small and unimportant way compared with placebo. Furthermore, there are likely to be small and unimportant differences in the reduction of depression symptoms between the majority of antidepressants.”

    • Hi Marie,

      I was prescribed antidepressants in the 1980s. The reason I was probably prescribed them was because of my paradoxical drug reactions.

      The antidepressants made no difference to my mood:- On going on them, on being on them, or on coming off them.

      But my overal mood in independance has improved a lot over the years.

    • I have no doubt that taking meds may not be the best way to treat people who are depressed but until someone comes up with a better way what do you propose?
      I am not saying that the Cochrane review was not a bunch of bologna, which it definitely sounds like it was. And I know that pharmaceutical companies spin their findings in the most flattering way but I am at a loss as to help people who desperately need more than talk therapy. I have seen people have amazing results with depression meds.

      • Diane Smith says: “And I know that pharmaceutical companies spin their findings in the most flattering way but I am at a loss as to help people who desperately need more than talk therapy. I have seen people have amazing results with depression meds.”

        Talk therapy may not immediately help people (and bad therapy may actually harm people) because we live in a very traumatic and difficult world.

        And “mind altering drugs” do sometimes provide short term benefits for people suffering deep emotional pain, but this DOES NOT mean it will benefit people in the long term. The evidence shows just the opposite; long term use of psych drugs causes FAR MORE HARM THAN GOOD!

        Richard

      • Hi Diane,

        This is the type of approach I use for Anxiety..

        https://www.psychologytoday.com/gb/blog/understanding-the-anxious-mind/202108/anxiety-and-the-art-doing-nothing

        ..it can be painful but it works.

        Leonard Cohen used Buddhist Meditation…
        https://www.psychiatrictimes.com/view/what-leonard-cohen-can-teach-us-about-depression
        …I do Buddhist Meditation as well.

        But I didn’t learn either of these from Doctors or Psychologists!

      • There are millions of things you can do for depression.

        The hard part is that it’s challeinging to “do something” when depressed.

        My depressions (and I’ve heard from others with similar experience) are about my body trying to shut me down because I’ve made choices in my life that go against my true being (psyche). When I shut down in depression, everything falls away, and the only things I pick up are the things I can.

        Depression is about winnowing away the unnecessary “do” and “stuff” and “relationships” in life. It’s a warning to be heeded.

        So – while waiting, you may nap a lot. Maybe you will indulge in some binge watching, or play video games. Maybe you will walk in the sun, go swimming, ride your bike, change your diet (do not underestimate the ability of gluten, processed foods, etc., to damage your mood), maybe take up yoga or exercise of some sort. Maybe you will, as Richard suggests – talk to someone. Maybe it will be a professional, or a religious person, or just a beloved friend or family member. Maybe you will be understood, maybe you won’t. Maybe you will write about it instead, or make art, or music or dance to express it.

        There are as many ways out of depression as there are ways in. To say that a pill is the ONLY answer is extremely limiting.

    • Not everyone reacts the same to each med. Some people do get terrible side effects that are usually listed in the paperwork that you get with the med. But some people get tremendous results with meds. So it’s a question of do you want to try meds to see if you feel better from a certain med. If that med doesn’t work you try another.

      If it’s a question of having a life or spending your life depressed, lethargic, on disability because you can’t hold a job… then to me I will try the meds and see what results I get.

      • What people do not consider is the long term effects of being drugged.

        I don’t “feel” anything is being damaged, and yet, my kidneys and liver don’t work as well as they used to.

        These drugs affect the entire body – digestion, cardiovascular, endocrine, muscular, more. The whole body – not just the brain.

        Over time (in my experience, about 3-5 years) you start to develop mysterious illnesses. Maybe it looks like an autoimmune disorder; maybe it looks like IBS; maybe it’s restless legs, or sexual dysfunction; maybe it shows up as chronic fatigue or fibromyalgia.

        These drugs affect far more than mood (or brain).

      • I’m okay with meds as long as I don’t have to get labelled with labels to get them or have observation after observation about all sorts of aspects of my life written in files I have no access to, which can be read left, right and centre by healthcare providers and in which a person who is a psychiatrist can write rubbish about me with basically impunity; the choice is my own, and I have appropriate information about what I’m taking. Long shot, I know.

        But it doesn’t work that way in practice. The power imbalance is massive. Every label you get labelled with has life-changing negative social and legal repercussions. Coercion is a thing. Now, I don’t think coercion is bad in and of itself in the sense that you might be pestered by your employer to come to work on time. But it’s much scarier and more dangerous in psychiatry. Very easy for others including family members to get their way through people who are psychiatrists. Gaslighting is also a thing.

        And it isn’t just the psychiatrists. Even many of the people in roles of patients are so indoctrinated with the whole thing, so deep into the system, that they’re basically like people drowning in a lake, and they don’t take your hand because they want to get out of the whole debacle, but basically they reach out only to drown you in the pond along with them. They see mental health professionals as beyond what they really are, almost like quasi-gods.

        I’ve also seen that it’s become a trend for former patients to become some part of the system themselves, either as peer workers, psychologists or whatever else. How many people become infectious diseases doctors because they had a bad case of dengue? Not many. In a small number of cases they die, but usually they get better and go home. Years down the line, they may not even remember the names or faces of the doctors who treated them. There’s a beginning and an end, unlike in psychiatry where revolving door patients are common.

        • They are also doing other nasty things in psychiatry like labelling people with disorders for drug induced effects of psychiatric drugs. It is common for people with attention problems to be prescribed stimulants and for people with anxiety, depression, intrusive thoughts etc. to be prescribed SSRIs. It’s bad enough that they have those problems. But when these drugs make some of these people manic and psychotic and do ridiculous things which they would not do otherwise, they are swiftly labelled “bipolar”. It amounts to a neat way to remove responsibility from the drug or prescriber and ascribe it as a problem of the patient even when nothing like that ever happened prior to psychiatric drug use.

          Tuberculosis drugs can cause psychosis in some people. Do they label people as “schizophrenics” due to that?

          Next, things like “personality disorders” which enter into the moral territory of people’s behaviour with others around them, they often amount to state sanctioned defamation. I’ve had severe family problems and I’ve been confrontational with both them and shrinks because they were a danger to my well-being and reputation. I could have been labelled with one of those things if I weren’t careful enough and if you saw only that side of me, and there’s nothing to say I might not be in the future. Also, the way I behave with those groups of people is very different to how I behave with my friends or with strangers. I might be personable in the latter case.

          Can a person sue a psychiatrist under any legal grounds for such labels? I’m not sure. I don’t care much about politics (and this could apply to any politician or human being), but, as an example, why were so many people so eager to label ex-US President Trump with a personality disorder because they didn’t like his policies or behaviour? Criticise the man, his behaviour and his policies all you want, but why medicalise it and wrap it around in the garb of some circular reasoning based disorder? Go to YouTube comment sections under videos of personality disorders, and you’ll find people label their moms, dads, children, spouses, ex-partners and every Tom, Dick and Harry they don’t like with such labels. Why not state a man’s behaviour for what it is and hate that behaviour and that individual person rather than do that? There’s a difference between ordinary labels and words which we use in colloquial language (which we all do) and the medicalised ones which appear as “diagnoses” in health files, and soon dwindle into the narrative of bad genes and bad brains.

      • The above might seem off topic, but it’s related. You brought up the point of meds, but individuals can get so frustrated or screwed over by the psych system for a plethora of reasons, they end up hating everything associated with it, prescription drugs included. Now, if you could walk into a store and purchase pills like you purchase detergent (and I know the pitfalls of that {drug abuse, lack of knowledge etc.}), no shrinks or psych system involved, it would be a lot different. People would try them out like they try booze or smokes. Take whatever they want and not take what they don’t. Just saying.

        • I’m all for stopping the “gatekeeping” of drugs, especially as people are able to research and be better informed than even 10 or 20 years ago.

          However, to put antidepressants (and anxiolytics and neuroleptics) on the shelf for people to try or not try is like placing bombs for sale at your local hardware store.

          Some people have horrible reactions after just one pill. Katinka Blackford Newman, “THe Pill That Steals” is just one example, but I’ve seen several on SA, who said, “I just took 3 days worth, and now I’m screwed.”

          These drugs are unsafe, should be banned, and let people smoke cannabis or microdose or some other, safer option.

          That said, I do agree with you about the harms of labels. I am fortunate, and able to use that to my benefit: “I’m bipolar, you can’t give me that drug, it will set me off.” I’ve used this to refuse Lyrica, amitryptaline – all those helpful “pain” drugs.

          But there are many many people who cannot get health care – their health scares are “all in their head” because of that diag-nonsense label. It can affect work, medical, privacy issues – even confrontations with law enforcement can be sullied by that effing label.

  2. The Cipriani meta-analysis (Apr 2018) did indeed get “colossal media attention” – that’s because it was a marketing exercise to promote depression pills as “safe and effective”, and it worked a treat. I illustrated how the conspirators pulled this off in my cartoon “Anatomy of a Confidence Trick.” https://www.madinamerica.com/2018/08/anatomy-confidence-trick/

    The quality of the research didn’t matter a jot, all that mattered was that the public picked up the “safe and effective” message from trusted sources. Same trick being pulled now, on a global scale – works every time.

    • Anyone who has something to sell is going to spin their results in a flattering way to make more money. Remember tobacco sales, commercials… they knew all along how deadly smoking was for people. They didn’t care at all. Money is the bottom line.

      Until profit is removed from certain industries this will continue to happen. Or until people become honest and put people’s lives before profit. Which I doubt will ever happen. So we have to hope and depend that there are honest people doing peer review work and have no
      ties to any pharmaceutical companies so that they can be bought.
      Also, it would be very helpful if the government put the people first. And protected the people they are being paid to serve. But most of them don’t. And they accept campaign money from the biggest Satanic snakes on the planet. And it’s not just our government. Do you really think that the Chinese enjoy not being able to go outside on certain days because their air is exceptionally filthy? How come Canada has to run “their” oil sludge pipelines through the US and we don’t get a dime from them. We only get poisoned water. Now the Clinton Foundation got billions from the Canadian oil barons in the form of donations. All of this is a sickness in our society. I feel sorry for the average person who is busting his and her butts everyday.

    • Thank you Auntie Psychiatry.

      Surely this was ‘Marketing Masquerading as Medicine’? An exemplar of Evidence-Debased Medicine?

      “There is no need for propaganda to be rich in intellectual content”. Joseph Goebbels.

      Your cartoons are inspirational.

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