A Different Psychiatry Is Needed for Discontinuing Antidepressants


A primary care physician looked for my advice. He had self-prescribed paroxetine 20 mg/day at a time when he was going through a painful divorce. He reported his case as follows:

“I had seen many patients of mine getting a lot of benefit from this medication and I thought that I could be one of those. It actually helped: I felt some relief and I experienced some sound sleep after several weeks. But my problems with my former wife were not over, and trying to save our children from our fight was not easy. So I thought I better kept on taking paroxetine, as a sort of protection.

“After a couple of years things were looking up a bit and I decided it was time to quit. I knew I had to do it gradually, so I split the 20 mg tablet. A nightmare: a flare up of somatic symptoms with total loss of concentration (I could not even work as a doctor). I went back to the original dose and things got better. I remembered that this happened also to some patients of mine; I had looked for advice to a couple of psychiatrists I was familiar with for a few patients who had problems similar to mine, and they just suggested me that those patients had simply to go back to the medications they took before.

“So I thought that may-be I was not ready and waited a few months. But the same happened again. I checked again with one of the two psychiatrists and she said “You are simply experiencing a relapse. Keep on taking your tablet.” I knew it was not true: relapse of what? I had never experienced the type of depression I had seen in my patients. I realized I was in a no man’s land, that I had a disease, but there was no place to go. As a primary care physician, I became quite good in referring my patients to proper specialist care. But I could not do anything for myself.”

Illustration of pills, a brain, and a person with scribbles indicating displeasure

This case, which I described in my recent book, exemplifies a major worldwide healthcare problem that is currently ignored. One person out of 6 in United States is taking psychotropic drugs. In 80% of cases, it is for long-term use and predominantly involves new generation antidepressants, such as SSRI (e.g., fluoxetine) and SNRI (e.g., venlafaxine). When patients want to take off these drugs and/or their physicians decide it is time to stop, substantial problems ensue. About one patient out of two experiences withdrawal symptoms, that do not necessarily subside after a few days or weeks and may be severe and threatening. Patients, like the primary care physician, do not know what to do.

You would hope that specialists or specialized centers would have better tools for assessment and treatment. But also, psychiatrists often do not know what to do, because of massive denial of the problem by scientific societies and journals (“antidepressant drugs do not cause dependence; it is just a matter of tapering them slowly; what patients experience are harmless discontinuation syndromes”). Major financial interests (pushing prescriptions to the highest doses and most prolonged administrations) are behind this denial.

What many psychiatrists have learnt is to perform a diagnosis according to DSM and to write one or more prescriptions in an automatic fashion. A problem is that the DSM applies to patients who no longer exist (drug-free subjects): most of the patients who come to clinical observation today are already taking psychotropic drugs and this occurrence is likely to affect the presentation and outcome of symptoms. Yet the iatrogenic perspective is more than just ignored: it is forbidden.

Helping patients to overcome their difficulties requires excellent skills in differential diagnosis; deep knowledge not only of the potential benefits of treatments (antidepressant drugs remain life-saving medications in severe depression), but also of their vulnerabilities; and awareness of the advances in psychotherapy that enable self-therapy. We also need psychiatrists who are able to understand that each individual case may be different (one size does not fit all) and to use clinical judgment for a better understanding of phenomena.

Withdrawal reactions are only part of the picture that may be triggered by use of antidepressant medications (the tip of the iceberg). Other problems might be associated: very serious medical side effects (e.g., gastric disturbances and hypertension), loss of effectiveness during maintenance that does not respond to dose increase, paradoxical effects (deep apathy), switching into a manic state in patients without a history of bipolar disorder, resistance (a medication that was helpful in the past is no longer effective after an interval), refractoriness to treatment. All these manifestations, which are expression of a state of behavioral toxicity that may occur with use of antidepressants, are subtle and would require a unifying outlook.

In the seventies, when I was a medical student in Italy, I had the opportunity of spending a summer elective in Rochester, NY, seeing patients with George Engel and John Romano. They trained generations of psychiatrists who would have been able to deal with the major healthcare problems linked to use of antidepressants. But where have all these psychiatrists gone? We need to renew the psychosomatic approach of Engel and Romano.

The progress of neuroscience in the past two decades has often led us to believe that clinical problems in psychiatry were likely to be ultimately solved by this approach. Such hopes are understandable in terms of massive propaganda operated by Big Pharma. An increasing number of psychiatrists are wondering, however, why the cures and clinical insights that neuroscience has promised have not taken place.

It is clear that the problems related to the use of antidepressants cannot be solved by an oversimplified psychiatry brainwashed by the pharmaceutical industry. A different psychiatry is needed to address the problems and difficulties related to antidepressant drugs. This is the psychiatry that I have tried to outline in a manifesto in the last chapter of my book and which has been made available by Oxford University Press using this link: https://oxfordmedicine.com/view/10.1093/med/9780192896643.001.0001/med-9780192896643-chapter-13.

The healthcare problems associated with the use of antidepressants need to become a priority for research and funding. We know so little about a number of issues. We lack neurobiological investigations that may shed some light on why, with the same treatment for the same duration of time, certain patients develop withdrawal syndromes and other do not. We lack long-term investigations exploring the occurrence, clinical features and neurobiological correlates of persistent post-withdrawal disorders and large studies that may clarify the relationships between withdrawal syndromes and other manifestations of behavioral toxicity (e.g., refractoriness, loss of effects).

The hypothesis that very gradual tapering may yield a lower likelihood of withdrawal phenomena has very few data available to support it and runs counter the disadvantage of prolonging toxic exposure to antidepressants. There is the pressing need of randomized controlled trials comparing different methods of managing withdrawal syndromes, including psychotherapeutic strategies.

As taxpayers, we can no longer tolerate that public money gets wasted into roads to nowhere and projects that will never have an impact on clinical practice and suffering. It is time that we tell policymakers and key opinion leaders, “Your time is up. We have serious problems and we need a different psychiatry.”


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.


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  1. “Helping patients to overcome their difficulties requires excellent skills in differential diagnosis; deep knowledge not only of the potential benefits of treatments (ANTIDEPRESSANT DRUGS REMAIN LIFE-SAVING MEDICATIONS IN SEVERE DEPRESSION [emphasis added]), but also of their vulnerabilities; and awareness of the advances in psychotherapy that enable self-therapy.”

    In this blog Dr. Giovanni Fava wonders why we don’t have the science and commitment by today’s Medical Model to help people get OFF of antidepressant drugs. Well, he needs to look no further than his OWN failure of rigorous scientific consistency when it comes to Big Pharma and psychiatry’s myth about the so-called “benefits” of these drugs.

    Where is the scientific evidence, after more than 3 decades of prolific prescribing of hundreds of millions of prescriptions for SSRI drugs, that they are in truth, “LIFE-SAVING MEDICATIONS?”

    The collusion between Big Pharma and psychiatry (with their world’s largest and most expensive PR campaign in human history on the “benefits” of psychiatric drugs) is nothing but pure speculation and wishful thinking. MIA has published dozens and dozens of scientific analyses of drug studies over the past several years refuting the MYTH of the so-called “benefits” of these drugs.

    Dr. Fava ends his blog by saying, “We have serious problems and we need a different psychiatry.”

    Yes, I agree we do have serious problems in a capitalist world that turns literally everything and everyone into a commodity (to be bought and sold) for the almighty bottom line of profit. BUT I SAY, we DON’T need “a different psychiatry,” – we need NO PSYCHIATRY and a new economic and political system.


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    • In fact, the data suggest that antidepressants, far from saving lives, actually INCREASE the odds of someone committing suicide. And the fact that the suicide rate for folks leaving a psych hospitalization is so amazingly high does not speak well of the “treatment” they are receiving.

      There is no drug on the market today that can legitimately claim to reduce the suicide rate. Even the drug companies don’t claim that in their advertisements. They count on psychiatrists to do that bit of marketing for them.

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      • I would argue there are rare exceptions– really unusual situations when this class of medications might be useful. And even for these, if we lived in a less toxic culture, the need for antidepressants could be avoided.

        I am aware of one case where a young adult with TBI from a disenfranchised population had episodes where he/she had no impulse control, and put him/herself and his family at serious risk. Everyone advocated for this person, who was an affable, highly intelligent individual, and tried to manage symptoms without ‘medication,’ but the neuro evals came back inconclusive, and the insurance company pretty much threw up their hands– stopped paying the therapist, who continued treating the patient anyway.

        SSRIs were the last possible intervention before incarceration, and in this situation, against all expectations, they worked. Only time I’ve ever witnessed efficacy for this class of medication.

        The risk of long-term side effects was outweighed by the need to keep the patient out of long-term incarceration or hospitalization. We should have better options, but at the time– and currently– we did not and do not.

        My own feeling is that SSRIs should be reserved for situations like this. Prescribing them should be about as rare– and considered nearly as reckless– as using mandrake root as a recreational drug.

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        • Catalyzt says, “Prescribing (SSRIs) should be reserved for situations like this. Prescribing them should be about as rare – and considered nearly as reckles- as using mandrake root as a recreational drug” –
          I agree – psych drugs should only be used as a last resort and only after people are well informed about the reality of side effects AND the possible difficulties of withdrawal which at the present time isn’t done nearly enough as most psychiatrists have little to no concept of the risks involved in pumping people full of drugs –

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          • I’m disgusted with anyone who buys into the half-cocked notion of psychiatry and it’s “medications” – and I don’t care if it’s “new”, “critical”, “mainstream”, or any other damn fool word someone decides to plop in front of it. All this does is remind me of the stupid phrase, “War On Terror”. NEWS FLASH – war IS terror, and from this I extrapolate that psychiatry, its practitioners, and ANY words used to distinguish it ARE the “illness”, and NOT the other way around. But it looks as though some people are content living life bass-ackwards –

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          • And isn’t it interesting how most psychiatrists shy away from using the word ‘withdrawal’ when commenting on ‘patients’ stopping their psych drugs? So they’ve latched onto the word “discontinuation”, because their saying ‘withdrawal’ would be indirectly admitting that mainstream psychiatry facilities drug addiction –

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          • You are quite right. There was a quite open discussion of this back in the 90s. They chose the term ‘medication’ instead of ‘drug,’ and substituted ‘discontinuation syndrome’ for ‘withdrawal,’ to differentiate as much as possible their psychiatric “medications” from their close cousins, street drugs (and sometimes they actually USED street drugs and called them “medications” instead.) There is no doubt what you say is absolutely and intentionally true.

            “Severe and persistent withdrawal syndromes from antidepressants have long been neglected or minimised. Obscuring a potentially serious risk, the pharmaceutical industry coined the term “discontinuation syndrome” to avoid association of antidepressants with psychotropic dependence. This term is unnecessary and misleading, suggesting antidepressants cannot cause dependence and withdrawal.11,16 Thus, patients and prescribers may misattribute withdrawal symptoms as relapse or emergence of new mental disorders.11,16,21”


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          • Psychiatric drugs are NOT “medications”. They are NUMBING agents. And some people find them helpful. But they carry a lot of risk, and psychiatry’s holding them up as magic bullets is what I object to. But the world’s saturation with psych drugs won’t last forever, as sooner or later people get wise to the bullshit they’re sold.

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    • “I agree we do have serious problems in a capitalist world that turns literally everything and everyone into a commodity (to be bought and sold) for the almighty bottom line of profit. BUT I SAY, we DON’T need ‘a different psychiatry,’ – we need NO PSYCHIATRY and a new economic and political system.”

      I found this website interesting, and enlightening. It largely explains how, why, when, and by and for whom, we were all turned into a “commodity (to be bought and sold) for the almighty bottom line of profit.” It’s rather convoluted, and a complex subject to wrap one’s head around – the fraud, lies, and criminality are quite staggering – thus I’d start with his “foundational knowledge.”


      I think this guy describes the complex situation in an understandable manner, and with love and hope for our future.

      And I agree with Richard, we not only need to get rid of psychiatry, we need to get rid of the US service corporation’s (called the “US government’s”) entire business model. Particularly, since their business model is un-Constitutional, and intended to harm and steal everything from the men, women, and children of the United States.

      Thank you, Giovanni, for being a doctor who is speaking out about the reality of psychiatry’s iatrogenic illness creation problems. As one of the millions of people who had the common symptoms of antidepressant withdrawal, misdiagnosed as “bipolar,” by doctors who were apparently too stupid to read their own DSM-IV-TR “bible.”

      I will add that the antipsychotics can create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.” And they can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome – meaning that both “bipolar” and “schizophrenia” are iatrogenic illnesses, created with the psychiatric drugs.

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    • Richard says, “…we DON’T need “a different psychiatry” – we need NO PSYCHIATRY” –
      Thank you Richard. I think you’re unequivocally right.

      Although it’s sad reading about Dr. Fava’s difficulties in getting off psych drugs, his honesty and insights are heartening. However, imo, the end of his story is discouraging because like most psychiatrists, he’s hooked on the belief that – with more “research” – psychiatry can find unambiguous answers for why the brain reacts the way it does to its myriad of “medications”. This amount of confidence is hubris. The brain is far too complicated. Psychiatrists should leave it alone. They’ve made enough mess already. And it’s too bad that after all he’s been through, Dr. Fava STILL CAN’T SEE mainstream psychiatry for what it is. And what is it? State-sanctioned drug pushing, IMO –

      I’m grateful that Dr. Fava made public his adverse experiences, as this might help other psychiatrists take their patients’ complaints more seriously. But waiting for mainstream psychiatrists to change their thinking is like waiting for thieves to return items they’ve already stolen –

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      • I think as much as Dr. Fava’s experience has taught him, he misses the point. Doesn’t he see that studying the minutiae of psychiatric drug withdrawal does nothing to stop the problem from happening in the first place? Nor did I hear him questioning the value and safety of prescribing psych drugs in the first place, especially for extended periods of time. Granted – he does see that psychiatric drug withdrawal is fraught with difficulties, and he does see that scientific societies are in denial, and he does see the overwhelming influence Big Pharma’s propaganda. But studying the minutiae of psych drug withdrawal is pointless. What needs to happen is for doctors to stop prescribing psych drugs willy nilly in the first place. Indeed, doctors have become impulsive; they themselves have developed a seriously bad habit. But Maybe Dr. Fava addresses these things in his book. If so, more power to him.

        If you come away from a service feeling worse, then what’s the point of that service? The best thing for people to realize is that psychiatric drugs are potentially dangerous substances that can not only cause serious and even disastrous side effects, but could very likely be difficult if not impossible for them to get off safely – and THAT is something doctors are unlikely to tell them, because, after all, what on earth would mainstream psychiatry do without its iatrogenic illnesses???

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        • Dr. Fava says, “The healthcare problems associated with the use of antidepressants need to become a priority for research and funding.”

          Wow. Whoop dee do. Where have I heard this line before….oh yes….psychiatry! And where has all this “research and funding” led to? Oh yes, MORE research and funding AND MORE PROBLEMS CREATED BY THEIR RESEARCH AND FUNDING!!!

          The only thing mainstream psychiatry does well is create its own addicts. It’s a bottomless pit. But for some reason, most psychiatrists still believe in building roads to nowhere.

          But I just had a brilliant idea – why not stop prescribing these “medications” so randomly in the first place??? Then maybe there’d be no more withdrawal problems – imagine that!

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          • Most medical specialties can lay claim to finding more cures and therapies, whereas mainstream psychiatry specializes in creating and naming its very own set of iatrogenic illnesses, i.e. MORE diagnoses, MORE drugs FOR THEIR iatrogenic illnesses –

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          • Thank you Steve for the ncbi link. It’s good to see that withdrawal from psych drugs is being taken more seriously. But I can’t help thinking that a lot of people’s problems could have been easily avoided had they not been prescribed to in the first place. And as reassuring as formal studies can be, they’re cold comfort to those who have suffered, are suffering, or will suffer, and unnecessarily so.
            I see the creation, marketing, and prescribing of psychiatric “medications” as the most appalling and glaring example of institutional corruption out there. But I like holding the thought that before too long, psychiatric “medications” could go the way of the cigarette industry; it’s still here, but is no longer looked at as it once was not too long ago, as public sentiment has changed drastically in recent years. And I’ve never underestimated the power of people’s own good sense eventually coming to the fore –

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        • Dr. Fava’s blog gives a good example of where mainstream psychiatrists mind end up going – which isn’t much different from where they are now. In other words, they may eventually see value in researching the various permutations of people’s reactions to psych drugs. But he, like most psychiatrists, apparently can’t see the immanent complexities, probable inconclusiveness, and therefore questionable value in engaging in such an expensive and time consuming endeavor. But mainstream psychiatrists think they can do the impossible, as they’ve been led to believe that science has no limits. Like spoiled children, they’ve never been told when enough is enough. And why can’t they see when enough is enough? Because their collective narcissism prevents them from seeing how their endless “research and funding” is just their way of acting out their own unresolved childhood dynamics: mother and daddy’s Golden Child, teacher’s pet, high test scores and awards for this, that, and the other thing. And while they’ve yet to see themselves as causing the problems, they remain obsessed with winning The Prize –

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          • And while mainstream psychiatrists get busy dreaming of yet MORE “research and funding” – for the problems THEY’VE CREATED – what are their plans for those they’ve already harmed? Which is a silly question to ask, because, as far too many people have come to realize, most psychiatrists are nothing if not predictable, meaning they’re dismissive and consider patients’ lives expendable, because after all, they’re scientists – meaning they’re more than happy complacently waiting for even MORE intricately tragic permutations to surface, providing them even MORE clinically detached scientific amusement –

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          • Dr. Fava’s blog gives a good example of where mainstream psychiatry MIGHT eventually end up going –
            Down yet another rabbit hole of most likely harmful and ultimately futile “research and funding” –

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          • I think most doctors have become impulsive; indeed, many seem to have developed the seriously bad habit of prescribing psych drugs willy nilly – and I’ve yet to hear them adequately question the value, safety, or necessity of prescribing psych drugs in the first place, or question their unfounded insistence on keeping people on psych drugs for unreasonably long and indefinite periods of time. No wisdom there –

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          • Psychiatric pill pushing is a convenient and lucrative way for many practitioners to act out and find solace in their long forgotten childhood family dynamics, (i.e. The Golden Child, The Scapegoat). But no matter which end of the narcissistic spectrum a practitioner happens to fall into, the dynamics of the so-called “therapeutic relationship” remain the same: an attention seeking power addict fixated on maintaining control of every aspect of their “patient’s” lives, and unconsciously their OWN lives, as becoming a professional “hero/healer” is their way of achieving emotional “regulation”, because these types of unbalanced relationships serve to maintain a practitioner’s tightly held illusions of being the embodiment and bearer of knowledge and truth, and to therefore act – or more accurately ACT OUT – their obsessive need to be seen as “the authority” –

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      • A “different” psychiatry???
        Just how “different” can it be if they’re still prescribing their pharmaceutical garbage? And even if psychiatrists stopped prescribing their “medications”, people would still have to contend with their pathologizing labels.

        Problems withdrawing from psych drugs wouldn’t happen if the world weren’t crawling with licensed drug pushers. But it seems most psychiatrists love their masquerade –

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        • It’s a shame most psychiatrists, (and for that matter most people), can’t see psych drugs for what they are.
          And what are they?
          Powerful psychoactive substances not unlike the illegal stuff on the street.
          Why can’t most psychiatrists see this?
          Because most psychiatrists are emotionally illiterate –
          Emotionally illiterate?
          Meaning most psychiatrists are unable to see what they’re doing in its true light –
          In its true light? What is it’s “true light”?
          It’s true light is that essentially what most psychiatrists are doing is a socially acceptable form of drug dealing, publicly financed by profit driven pharmaceutical companies that pay scant attention to the very real possibility that their “medications” can and do wreak havoc on people’s brains and bodies. And most psychiatrists are completely unaware of how much associating with Big Pharma boosts their already grandiose egos, which helps them forget that a drug is a drug is a drug – but THIS is something your brain and body NEVER forgets –

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          • It’s a sad day when people’s emotions and bodies are commodified, drugged, and used as fuel for mainstream psychiatry’s “research and funding”. Indeed, it seems most psychiatrists are blind to the fact that people’s lives and minds are more than an afterthought for psychiatrists to ponder in their almost nonexistent but well funded “thoughtful” moments.

            And mainstream psychiatry wants everyone believing that it’s “medications” have little to no risk, or are worth the risk. But this is not true, as anyone with a modicum of insight could tell them –

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          • Change will come when people start realizing that taking psych drugs is more for the practitioner’s benefit than their own, as most practitioners are unconsciously self serving and having people on psych drugs eases their rigidly trained minds –

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          • What does prescribing psych drugs do for people?
            It can do a lot of things, many of which aren’t very good, but mainly it indicates many a practitioner’s emotional illiteracy –
            And what is “many a practitioner’s emotional illiteracy”?
            Their inability to understand, catalog and manage their own emotions and feelings, which their psych drugs conveniently extinguish –

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        • Many practitioners (unbeknownst to themselves), find solace in acting out their own long forgotten family dynamics, and this is accomplished through the act of prescribing “medications”. Indeed, being captive of long forgotten unmet childhood needs can haunt “professionals” as much as anyone else. But awareness of these dynamics eludes them, so they hastily and unwaveringly resort to “medicating” people faster than blinking an eye. So perhaps they’d do well to read one of Dr. Jung’s many quotes, i.e. “Everything that irritates us about others can lead us to an understanding of ourselves” –

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          • And what does indiscriminate, incessant prescribing of psych drugs (as well as the avalanche of pharmaceutical advertising) reveal about mainstream psychiatry?
            An utter lack of concern for patient health and safety, complete disregard for medical integrity, and TOTAL vulgarity –

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      • Maybe people would think twice about gulping down pharmaceutical psych poisons if they realized what they’re actually swallowing –
        And what are they actually swallowing?
        Chemical bullets to silence their voice and kill their spirit –

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        • Change may happen when people start seeing that taking psych drugs is for the practitioner’s benefit more than their own. Just think of the term “emotional regulation”.

          And if that’s not enough, getting acquainted with what drug companies are really up to might do the trick. And what are drug companies really up to? Getting and keeping people dependent on their drugs. And a good way to get acquainted with this rarely discussed information is to read “The Deadly Corruption of Clinical Trials” by Carl Elliot.

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        • Maybe people would think twice about psych drugs if they realized they’re seen as herd animals by mainstream psychiatrists and the pharmaceutical industry – and that there’s more to life than becoming one of mainstream psychiatry’s “statistics” –

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  2. To clarify my above comment, I do not mean to be dismissive of all of Dr Fava’s research and critical writings on psychiatric drugs. I have praised some of his past writings and believe he is one of the few psychiatrists today that is raising serious criticisms of the psychiatric profession.

    However, my above comment is meant to show how even the “critical psychiatry” adherents sometimes lapse into the same speculative pseudoscience that they often criticize.

    I am sure there is plenty of cognitive dissonance and defensiveness for today’s “critical psychiatrists” when it comes contemplating the elimination of psychiatry as a genuine and legitimate medical specialty.

    Until psychiatry finally disappears (through enormous political struggle), “critical psychiatrists” can seize the moral high ground by raising holy hell within their profession and helping the millions of psychiatric victims get off their harmful drugs and/or dramatically reduce their reliance on these substances.


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    • Richard D. Lewis writes, “…even the “critical psychiatry” adherents sometimes lapse into the same speculative pseudoscience that they often criticize”, and, “I’m sure there is plenty of cognitive dissonance and defensiveness for today’s “critical psychiatrists” when it comes to contemplating the elimination of psychiatry as a genuine and legitimate medical specialty”.

      I agree. Most psychiatrists are totally defensive, especially the ones who claim not to be. They’re like dealing with an adolescent who’s latched onto a false identity that tells them they they know everything and everyone else is stupid. Very cult like.

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    • Thank you Richard D. Lewis for calling psychiatry speculative pseudoscience.

      I don’t think psychiatry of any sort merits more “research and funding”. That ship has sailed and it sank. Just look at Dr. Insel’s efforts: a billion dollar vanity project undertaken so mainstream psychiatry can say it’s on the “cutting edge” of the “neuro-bio-genomic” craze. But the dynamics are easy to read: most psychiatrists have egos so big they’re frantic to keep alive their illusions of relevance. And what does this require? More “research and funding”. It’s psychiatry’s milk and honey. But it leads to nowhere and worse.

      And egos are powerful things, and most psychiatrists are driven by their egos more than anything else. And constantly “playing doctor” feeds their egos. And most psychiatrists, including the “critical” ones, have become quite adept at rationalizing their collective cognitive dissonance. After all, it keeps them safe and warm and fattens their wallets.

      The public would be far better served by thoroughly knowing and understanding the very real risks involved in both taking AND discontinuing psych drugs. But most of the time they receive little more than lip service from the “practitioners” entrusted to help them.

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      • Maybe “critical” psychiatrists should look at themselves more critically. Mainstream psychiatrists certainly should.

        And just WHAT do these “practitioners” do anyway??? They take understandably upset people and call them “sick”, “ill”, “diseased” or “disordered”. Then they prescribe “medications” that actually MAKE people sick, ill, diseased and disordered.

        So if you want to be called “sick”, “ill”, “diseased” or “disordered”, AND BECOME ADDICTED to psychiatry’s “medications”, be sure to see a mainstream or maybe even a “critical” psychiatrist. Seems the odds for both are about the same –

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  3. Good article Dr Fava. As someone who has lived with a “persistent post withdrawal disorder” for over 10 years now I hope there is a lot more research into it. I think it’s too late for me but I believe SSRIs would be used much less if patients (and doctors) really knew all of the potential harms. Once we have good research into the lasting harmful effects it will become very difficult to deny it. Then hopefully in the future people like me won’t be given an SSRI after a 5 minute conversation with a doctor.

    You wrote “antidepressants are life-saving medications”, what is this belief based on? Obviously as someone who has been permanently harmed by these drugs I’m very sympathetic towards the criticisms of them (as I’m sure many members of this site are). As far as I know these drugs only show a very small average difference from placebo and no difference in mortality. Is there any good evidence that they are life-saving even for a small number of people?

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    • Depending on the person, they can be ‘life-saving’ (though I don’t know what they’re eventually saving the life for), or ‘life-ruining’. Pretty much like anything else. Some people say they’ve been saved by ECT. Others say their life has been totally ruined by it.

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  4. This is the best sentence in the excerpt from your book. “Clinical decision-making, for all patients, should address the attainment of individual goals and the identification and treatment of all modifiable and non- biological factors, rather than focus solely on the diagnosis and treatment of individual diseases” It priorizes what the person wants for their goals, and identifies all their areas in their life that they may be able to change.

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    • Yes but we dont need doctors for that.
      So no “clinical decision-making”.

      Biological factors are unproven, thus non existent until proven otherwise, so medical attention is not legitimate until proven otherwise.

      All I see is doctors flexing their muscles trying to find the next ‘protocol’ in order to improve something that is in their view legitimate and fitting.
      It is not. It is sheer delusion.

      Medical intervention is illegitimate since science never prove that it was necessary. If anything, figures show that it is downright catastrophic.

      The only thing to do is to humbly recognize the mismatch and the void of capacity, to apologize for having participated in an enterprise of enormous criminal proportion, and to leave the room.

      But very few doctors seem to be able to do that, because their status/profit/ego precludes that.

      They are as delusional as the “schizophrenics” they are unable to help. They just have the power to defend their delusion.

      Meanwhile, the massacre goes on. The real question is when will doctors have the decency to try and stop it.

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    • Eric

      Yes, this sentence is pointing to the importance of environmental and solution focused factors in overcoming depression and sadness.

      BUT, we must also point out that in today’s trauma ridden and exploitative world, sadness and depression are normal reactions to difficult circumstances. And how a person eventually responds to these circumstances (without being drugged!) can potentially teach that person valuable lessons for how to survive in the future.

      HOWEVER, that sentence in which you chose to praise is also riddled with some of the worst and most oppressive language in the Medical Model’s arsenal – “diagnosis and treatment of individual diseases.”

      There is NO scientific evidence that these problems are actual “diseases.” And there is tons of evidence in the backlog of MIA articles over the years detailing just how harmful a psychiatric “diagnosis” can be to the self identity formation of a human being.


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  5. We dont need an other psychiatry.

    The problem is not that psychiatry has made errors and needs amendments.

    The problem is that it is fundamentally misplaced.
    Antidepressants do not exist.
    Depression do not exist either.
    Just because a doctor speaks words does not make them truth.

    It’s all a massive castle of illusions that need to disappear, along with the spurious medicalization of human suffering.

    Doctors dont need to save their place.
    They need to apologize, to relinquish the place and to go and practice real medicine.

    Everything else is just the windmills of power.

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  6. I can’t see any reason to use these drugs other than to reduce and undermine.

    A stressed person might take ‘antidepressants’ for relief, but if anything goes wrong they can easily end up a “long term psychiatric patient”.

    Even if someone were “Severely Depressed” they would probably still be better off without ‘antidepressants’ – and experimenting with alternative means:-

    (copy and google).

    …If this doesn’t work – theres plenty of other stuff that does.

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  7. Why not start with confronting the idea that dsm/icd do in fact describe medical conditions and consider the possibility that the issues clients present with have a meaning beyond a simple- minded listing of what they do and look at the meaning behind so-called “symptoms”, what people are stressed. At the moment dsm/icd amounts to, “I feel depressed” and, “I feel depressed because I have depression”, and around and round it goes for any dsm/icd category. if a person wants to look at – why – they have the feelings they do and act as they do, given the quality of their life with many psychiatrists, psychologists, clinical this or that, what they are likely to receive is a ready made, off the rack response, a dsm/icd label usually accompanied with a cocktail of dangerous drugs. And, if the person is brave enough to want to follow the why and/or to look at strategies to deal with their suffering, improve their lives without being drugged, they will probably be further labeled as “resistant”, meaning they have the temerity to question the psychiatrist/GP, psychologist, “clinical social worker’s”.. interpretation of the person’s life. This might be of interest as an alternative to trying to fix an outdated and dangerous bio-medical model (but I doubt if it will ever be put into practice – no obvious money for drug companies, psychiatrists…): https://www.bps.org.uk/power-threat-meaning-framework

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