Psychiatric Drugs Do Not Improve Disease or Reduce Mortality

Nassir Ghaemi: “Most psychiatric medications are purely symptomatic, with no known or proven effect on the underlying disease. They are like 50 variations of aspirin, used for fever or headache, rather than drugs that treat the causes of fever or headache.”

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According to psychiatrist Nassir Ghaemi, most psychiatric drugs are only effective at treating symptoms in the short term—like taking aspirin for pain—and don’t improve the long-term course of an illness or prevent hospitalization or mortality.

“Most psychiatric drugs have not been proven, in properly designed randomized trials, to improve the course of any illnesses they are purported to treat,” Ghaemi writes. “Specifically, they have not been shown to prevent hospitalization or extend life, as many clinicians believe.”

Ghaemi is a renowned psychiatrist based at Tufts University and Harvard Medical School. In addition to his medical degree, he also has graduate degrees in philosophy and public health. He specializes in depression and bipolar disorder research and has authored textbooks in various aspects of the field. His notable textbooks include A Clinician’s Guide to Statistics and Epidemiology in Mental Health, a textbook on Clinical Psychopharmacology, and Mood Disorders: A Practical Guide.

In his new article in Acta Scandinavica Psychiatrica, Ghaemi writes that disease-modifying treatments, as found in the rest of medicine, are concerned with improving the course of illness and preventing death. But psychiatry’s drugs are ineffective for this purpose—or even harmful.

His examples are psychiatry’s two mainstays of treatment, antidepressants and antipsychotics. For instance, he notes that antidepressant treatment increases suicide attempts, at least in some populations—and doesn’t decrease them in any:

 “It is well-known that standard antidepressants do not reduce overall suicide rates in so-called major depressive disorder (MDD), and in fact increase suicidal ideation and attempts in younger adults and children, based on randomized data,” he writes.

 Likewise, he notes that antipsychotics don’t improve the course of illness and instead have neurotoxic effects that reduce brain volume:

“In most studies of antipsychotics […] the course of illness remains chronic and deteriorating. It is not reversed with long-term antipsychotic treatment. Pathophysiologically, antipsychotics, both older and newer, have a neurotoxic effect in reduction of brain volume with long-term treatment.”

Ghaemi writes that the main difference between psychiatry and the rest of medicine is that psychiatry’s drugs are symptomatic—treating only the symptoms in the short term—while the rest of medicine involves disease-modifying drugs, which improve the course of the illness and reduce outcomes like hospitalization and death.

“Most psychiatric medications are purely symptomatic, with no known or proven effect on the underlying disease. They are like 50 variations of aspirin, used for fever or headache, rather than drugs that treat the causes of fever or headache,” Ghaemi writes.

For comparison, he notes that research in psychiatry focuses on symptom reduction. In contrast, in other fields of medicine, symptom reduction is not the concern—instead, hospitalization and death are more important. He compares drug development in heart disease with psychiatry:

“For new drugs in cardiovascular disease, researchers do not bother to measure chest pain or dyspnea. They simply measure time to myocardial infarction, or mortality […] In psychiatry, we measure symptoms of depression and anxiety and psychosis as primary outcomes […] studies usually do not even measure time to hospitalization, and mortality is not even on the radar.”

He adds that some drugs for heart disease, such as antihypertensives, don’t improve any symptoms in the short term, but they do successfully improve the overall course of the disease, helping people to live longer and suffer fewer heart attacks.

This, he writes, is because these drugs act on the actual biological pathways that cause the disease. But psychiatry’s drugs don’t do that:

“Biologically, antipsychotics are mainly dopamine blockers and standard antidepressants are mainly monoamine agonists. After their introduction in the 1960s, corresponding theories arose regarding the dopamine hypothesis of schizophrenia and the monoamine [serotonin] hypothesis for depression. Half a century of research has disproven these hypotheses: dopamine overactivity and monoamine depletion are not parts of the pathogenesis of schizophrenia and depression, respectively.”
He adds, “Hence, from a biological perspective, antipsychotics and antidepressants are not disease-modifying drugs.”

This would be acceptable if they had a clinical effect—even if the biological pathway was unknown, if the drugs successfully saved lives or prevented worsening illness, they would be successful. But, he writes:

“A consensus of schizophrenia experts has reviewed the current literature and concluded that antipsychotics do not worsen the course of schizophrenia, but they were not able to show that these agents improve that course either.”
And, for antidepressants, he adds, “the FDA meta-analysis found no benefit with antidepressants versus placebo after 6 months of treatment.”

Ghaemi goes on to take issue with the poor validity of psychiatric diagnoses, mainly as they are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM; now in its revised fifth edition).

“The process of defining DSM-5 definitions has been influenced heavily by non-scientific factors, and has not proven successful in biological and pharmacological research,” he writes. “However, the APA is fully committed to the DSM-5 ideology, and unwilling to allow more scientific approaches to diagnosis. The National Institute of Mental Health (NIMH) has acknowledged this problem, and no longer uses DSM criteria for biological research.”

According to Ghaemi, one exception to the rule of psychiatry’s ineffective drugs is lithium.

“Only lithium has been proven to improve the course of any psychiatric illness. Further only lithium has been proven to prevent completed suicide in randomized clinical trials in psychiatry […] It is the only drug in psychiatry which is proven to be disease-modifying.”

Thus, Ghaemi argues, “Current psychiatric drug development has failed and will not succeed for structural reasons.” However, he writes that lithium has better evidence of improving the actual course of illness and preventing suicide, and thus “should be used more frequently and consistently than is current practice.”

 

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Ghaemi, S. N. (2022). Symptomatic versus disease-modifying effects of psychiatric drugs. Acta Psychiatric Scandinavica. Published online June 2, 2022. https://doi.org/10.1111/acps.13459 (Link)

52 COMMENTS

  1. It is good to discuss the poison in the well. But if individuals must have their pills to survive then who are we to say they must not?

    I believe a skirmish occured about Dawkins.

    When I first became loyal to my angels I used to launch tirades against Dawkins the Atheist. So I was stunned one afternoon when my angels told me that Dawkins is an angel.

    How so?

    My angels said they do not want anyone to believe in them.

    How so?

    They said that they want people to be guided by their “freedom of choice” since this is the most holy of guides. They said that beliefs get in the way of that. I then felt crestfallen and seem to remember I may have begun to weep.

    But then my angels said that if my free choice is to believe in angels then the angels love my free choice. And even more than my choice enjoying, the angels love me. I am appalled that they do. This is because I have only known human love and that is not really the love of angels. Human love is comodifying and like a manipulative currency. Cold coins that scold the palm of who needs love. Angels love is more like the love your deep deep soul has for you. If you understand every choice you make then so do the angels. Understanding is healing. When we die and go to the life beyond we feel healed, not because we are loved in a human way, but because we are healed of even any need for love by a vast and blissful understanding of ourselves and everyone.

    The only thing angels do not like is abuse, bullying and cruelty.

    They abhor the abuse of children. They try to put a stop to it as fast as they can, often by giving peripheral family jitters and psychic questions about telltale signs. But for more ordinary things in life they cannot often intervene, because to do so would be an imposition of not allowing living creatures freedom of choice. To live means to be free. To be free means to feel well.

    But angels can give people pause for doubt before they do a bullying outward act. A pause of greater awareness. However, in a world overly keen on certainty no moment of doubt gets a look in.

    I often call my angels “my” angels because not everyone likes to believe in them. But I feel that they are not only “my” angels. They are everyone else’s angels too. Even they are the angels of my opponents. They never barge in to someone’s space without a clear invite. They never indoctrinate. They never impose what is best for you or for your own good. Not unless you derive comfort from being mothered or fathered in that spiritual way. You can send then packing. You can call on them in tough times. You can disbelieve they exist and they won’t feel snubbed. They support the “free choice” of anyone and everyone. Your choice is equal to my choice.

    They are eager for your life to be all about your choices not theirs.

    Believe only what uplifts you to believe.

    I am schizophrenic so I get muddled…this comment may be from my ill bit of my brain.

  2. very helpful. thank you.

    so..at best, psychiatry is offering dozens of palliatives? and…the only substance psychiatry offers that has data proving a genuine benefit on the afflicted (possibly the affliction, too?) is lithium? -lithium- ?

    oh man. that’s…well, its sort of what I’d gleaned from my own misadventures and reading, but…wow. that’s billions upon billions of dollars, from tax payers and “patients” and families and insurance companies…

    for what, really? not to mention the untold agony of lives destroyed by the labels and the “treatments” and the confinements and…

    what is the point, again?

    on the plus side…the relative success (compared to everything else, it seems) of lithium makes me wonder if there is more substance to Orthomolecular treatment of various ailments than I had originally thought. Time to restock the C and B3 and read some more Hoffer and Pauling. 🙂

    thanks again.

  3. What kindness would do, now costs huge amounts of money to fail at doing. Simple kindness, to show some interest in thoughts and feelings, give others a place in your world, help them feel worthy, significant, wanted, of value, known, cared about, and belong.

  4. We were just discussing this in the comments of an article last week. While I agree with all of Nassir’s points with respect to psychiatric drugs, he seems to have a very optimistic view, comparatively, of the rest of medicine. The notion that disease-modifying treatments are the norm in western medicine, as implied in this article, is one that I don’t think is supportable. Some major categories of chronic disease and how they’re treated:

    Autoimmune conditions: Treatments are entirely symptomatic as far as I can tell – various types of immune-suppressants all geared towards slowing down (but far from eliminating) a given disease’s progression.

    Chronic Respiratory Disease: Same as above.

    Cardiovascular markers (BP/Cholesterol): Treatments are all focused on reducing the symptom (marker). They then claim to increase life expectancy due to the improved marker – which sure sounds like a disease-modifying effect on the surface – but when you dig deeper you’re ultimately disappointed. Statins for example lower LDL cholesterol and reduce cardiac deaths, but they have only a very tiny effect (if any at all) on overall life expectancy, because deaths increase from other causes (i.e. side effects). So while this is arguably a disease-modifying effect, it’s not much of a life-modifying one.

    Cancer: This one is ‘disease-modifying’ in the sense that cancer cells can be killed directly, but the collateral damage is massive, and there’s little to no effort put into understanding why the disease occurs in the first place, and how to prevent it. As such, merely destroying the cancer cells is essentially a symptomatic approach.

    So while psychiatric meds are a disaster for all the reasons stated by the author, glorifying the rest of medicine seems unwarranted. It’s all of western medicine in my view – both physical and mental health – that suffers from this fundamental issue of treating symptoms rather than causes.

          • Unconscionable enablers.

            So long as the ad revenue is pouring in, they don’t give a monkeys.

            Paedophile grooming, misogyny, far right extremism.. These platforms are repeatedly at the forefront of social ills, over and over, the only pushback coming from people of conscience.

            There needs to be a pushback against the social platforms that are now the enablers of off-label psychiatric drug use, at the very least.

            By their own definition, off label is non-medical, non-evidenced, AKA drug abuse.

            And these platforms are enabling the current frenzy of psychiatric drug abuse, the normalisation of it by self-appointed amateur experts although, of course, the irony is that some random on a social network site, with a modicum of intelligence, can quite straightforwardly mimic the drug expertise of a psychiatrist.

            It’s not exactly rocket science to drug someone up.

    • Terry.baranski you are spot on about ALL of western medicine simply treating symptoms. After given a cancer diagnosis in 2009 and told I had a very poor chance to survive I had an eye opening experience/nightmare as to the arrogance and corruption of western medicine and that they will push toxic cancer treatments on people when it turns out there was no cancer to treat. If you question or resist the treatments they can quickly slap psych labels on you to try take away your autonomy. Like psychiatry, it is another money making industry. That is why after so very many years western medicine has no real interest in, or money put towards prevention of cancer and no cure either. Too many $$$ to be made.

    • ” there’s little to no effort put into understanding why the disease occurs in the first place, and how to prevent it” – that’s not quite true. Tons of papers are written on the topic, it is much discussed in some very respected textbooks (e.g. Albert’s “Molecular biology of the cell”).

      • There is a LOT of effort to try and prove that it’s all biological, despite decades of failure. But as to actually trying to UNDERSTAND why these things happen, there is almost no research at all. And research that assumes a conclusion before it begins is not really scientific research at all.

  5. Number One: What the author of this study says about Lithium is very interesting. The only thing he didn’t mention is that for some people at least, lithium, can be built up to a level of dangerous toxicity. At first, this is avoided through blood tests where the lithium level is monitored. But, eventually, the body seems to decide it has enough lithium and rebels against it. The other thing he didn’t mention is how scrupulous when on lithium to avoid salt-restriced diets, keep hydrated, avoid heat, and make sure you alwys have something like Gatorade available.
    Number Two: I have a purely unscientific theory about one of the reasons that these antipsychotics and antidepressants do no good and can be dangerous. I think that it might be because they use “synthetic ingredients” to copy the natural chemicals in the brain. Perhaps, instead of drugging people like they want to do, maybe the psychiatrists and their ilk need to discover what might bring on what Maslow used to call “peak experiences” or basically what makes a person happy for each individual person. That would change the brain chemistry naturally, rather than poison it synthectically. But then the psychiatrist might not holdany longer the illusion of being a Medical Doctor, because he or she is no longer writing prescriptions for these drugs. Thank you.

    • good points, rebel.

      I’m doing a DIY Orthomolecular protocol, so the lithium reference sort of…affirms what Hoffer and other OM “experts” have written, for decades and decades. Except…OM tends to be remarkably non-toxic, so..there’s that. I think some “alternative” practitioners recommend very, very, very low doses of some forms of lithium for distressed people, now and then. Never had much interest because of my lithium=destruction of kidney function association, based on what I’ve observed in others.

      • I am not sure if anyone is aware that back in the 1970s, at least, lithium, was kept under “lock and key, in a cage” nonetheless, almost like they keep the “opiates” now. That means, that although they thought then that lithium was helpful, it was also considered dangerous. Thank you.

  6. I think Dr. Ghaemi’s paper is just his way of getting ahead of the increasingly loud narrative he sees coming down the pike. And what’s coming down the pike? More and more people disputing psychiatry’s bullshit narrative. In other words, he practicing “the real psychiatry”, which just happens to be CYA (cover your ass) medicine – and NO psychiatrist wants to be caught with his/her psychiatric pants down –

    But it’s deeper than that, as most psychiatrists will remain forever wedded to the delusion that psychiatric “illness” is “biologically rooted” in some way, because if they did, they’d lose their day job. Because guess what? Most, if not all psychiatric distress is the result of some sort of emotional trauma, whether conscious, or not –

  7. My husband suffered a TBI and a stroke due to an injuryat the age of 60 in 2019. The man was very intelligent. Business owner for 30 years. Auto transmission business. Genius technician, cabinet maker, electrician, master chess player, etc. I could go on and on.He was given anti psychotic meds for behavior shortly after he started coming around from being in NICU for a month. Shipped directly to nursing home and rehab facility. His left side was severly compromised due to the stroke and he got very frustrated. He kept trying to get up to go to the bathroom and could not get any help. I believe his brain was not allowed to heal properly due to these meds. Haldol, olazapine, seraquel, (sp)?, vraylar, trazodone, Xanax, etc., none of these helped his symptoms. Now he can does not even know when he has to go potty. He was a master chess player and could still play chess after the injury. After these meds he is no longer able to. I was told he was developing brain atrophy due to no physical therapy? I believe these meds caused a severe barrier to his brain healing properly. Of course Dr’s. Told me I didn’t know what I was talking about and maybe I don’t. However I kept asking myself, are these meds causing harm while his brain was trying to heal? The injury occurred Aug. 2019, meds started as soon as he started getting frustrated at lack of physical, speech, & occupational therapy, hence behavioral issues. Nursing facility physciatrists just put him on meds much to my objections and suspicion to adverse effects for brain recuperation. Any insight on this? If anything I don’t believe these meds are good for TBI patients, especially very shortly after the injury. I believe they are actually harmful to the brain healing. I kept questioning this to no avail. My comment is mainly to gain insight and to hopefully prevent this for other TBI patients. I don’t believe these meds are in any way good or helpful to these patients. I believe they caused detrimental harm!!

    • I am sorry about what happened to your husband. Maybe I am saying the wrong thing but I appreciate your story. What I appreciate about is that is a real story with probable evidence of the effects of these drugs on an innocent person, your husband.
      Sadly, many times, some commenters just reiterate the same thing over and over about the illegitimacy of psychiatry (which could be true as much of their practices are definitely questionable) and even worse disparaging those who do believe in the legitimacy of at least portions of psychiatry. Each person does have a right to make his or her own decisions as to how to live their life and what to accept or disregard in that life. But unfortunately with your husband, due to his illness, he was unable to make the appropriate decisions and even more tragic was that the doctors, etc. refused to listen to you, his closest advocate as per the concept of marriage, and even refuse to discuss your questions. This is clear but tragic evidence of the misuse and tragic effects of these drugs. This is what is really needed, not constant reiteration of this and that than can hurt people or even bring up past hurtful memories to someone. Thank you for your story. I do hope things do begin to improve with your husband. In my case, after some of the drugs you noted prescribed for me, I did improve. Of course to improve, I needed to discontinue taking these drugs forever. I hope that that can happen with your husband. I know that you must miss your husband terribly, even though he is still here. I can only say that my heart goes out to you and that, despite circumstances, I wish both you and your husband well and complete recovery. Thank you.

  8. I don’t know about this doctor or the validity of his research, but antidepressants were a lifesaver for me. I went from barely being able to get out of bed, hospitalized, and suicidal to a functioning person. Maybe they only do treat the symptoms, but thank God they do.

  9. Once upon a time, mainstream psychiatrists were bought by the pharmaceutical industry. They delightedly ate up the notion that psychiatric distress/“diagnoses” have “biological” origin. They were (and still are) bedazzled by the pharmaceutical industry’s seductive “scientific” narrative, and the money and prestige were (and still are) the icing on their cake. So it’s hard for them to recognize that most, if not all, psychiatric distress/“diagnoses” are actually the manifestation of some kind of stress, be it a singular traumatic event, or the result of living amid a series constant, and very often hard to detect, negative stressors for long periods of time. And most psychiatrists have grown accustomed to being the drug industry’s lapdog. But that’s the story of ego, temptation, and greed – a story as old as time –

    • I’m not sure they were ever “bedazzled.” If you listen to the discussions around the time of the creation of the DSM III, they were quite blatant about their political goal of establishing psychiatry as a “real science” by pushing claims of biological causation and treatment. Of course, Big Pharma was happy to help out for a price, and they developed a symbiotic economic relationship that continues today. Many lower-level “mental health professionals” are, in fact, bedazzled, but the leadership premeditatedly planned to sell this concept to the public, whether or not it was true, and they have succeeded.

  10. “Hence, from a biological perspective, antipsychotics and antidepressants are not disease-modifying drugs.”

    Well, this is not true. Since it’s pretty well documented that the antidepressants can create mania, which then gets misdiagnosed as bipolar – thus the antidepressants are a “disease modifying drug.” All DSMs – prior to the DSM5 – pointed out this type of misdiagnosis was inappropriate.

    Plus the antidepressants and antipsychotics can create psychosis, via anticholinergic toxidrome. And the antipsychotics / neuroleptics can create the negative symptoms of schizophrenia, via neuroleptic induced deficit syndrome – thus the antipsychotics are also “disease modifying [creating] drugs.”

    As to the “invalidity” of all DSMs, “The National Institute of Mental Health (NIMH) has acknowledged this problem, and no longer uses DSM criteria for biological research.”

    Is this true? I hope so. But I’ve noticed the NIMH has been taking all confessions of the “invalidity” of the DSM off the internet.

    Thank you, as always, Peter, for speaking the truth.

  11. I’m intrigued by the fact that this seemingly strong critic of most psych “meds” is Nassir Ghaemi, the same guy who, if memory serves, was instrumental in promoting the novel diagnosis of “Bipolar 2” some years ago. With every expanded definition of mental illness lies a new opportunity for drug prescription and sales…this has a very Allan Frances-y feel to it: Do the damage and then become the crusading critic to CYA.

    Will be glad to be proved wrong.

    • Looks like NG’s trying to cover his tracks because he sees where things are going. And like most psychiatrists, he’s got a hat for every occasion and is good at talking out of both sides of his mouth. It’s just the same old psychiatry shtick. He oughta come up with a diagnosis for THAT –

      • I think you’re right about the higher ups. But maybe they’re all corrupt. But I just don’t think the average doctor/medical professor is smart enough to know the difference. And I certainly don’t look to the medical students – they’re too green. And you have to be wary about anything that’s become so profit-driven. Kinda makes me wonder if they’re all a bunch of psychopaths –

          • Someone Else,
            I’m so sorry you went through that.
            It’s horrible how the people we’re supposed to turn to are trained in denial and “blame the victim” strategies. But thankfully, there’s good people too, of which you seem to be one.

      • NG’s at a point and place in his career where he can afford to “speak out”, so he won’t be left holding the bag. But the rest have to keep their mouths shut, or else they risk losing their shirts. But you’re right, they pretty much all know they’re up to no good –

      • Steve says, “…they DO know what’s going on”, and, “…its straight up corruption, at least at the higher levels…” –

        NG’s paper smells like a load of damage control. It could be the start of a world wide “psychiatric” apology tour. He and other bigwigs probably got together over an online conference call to finagle some sort of public relations CYA strategy. And if they did, good luck. They’re gonna need it, because it’s not 1980, it’s 2022 –

    • Miranda Spencer says, “With every expanded definition of mental illness lies a new opportunity for drug prescription and sales…”

      But I would add some slight variations –
      With every expanded definition of mental illness lies a new opportunity for drug dependence and fortunes to be made (by psychiatrists and drug companies).

      But what else are they supposed to do when that’s all they’ve got?

  12. Hey, did you happen to read Dr. G’s latest paper?
    You mean the one where he says psychiatric drugs aren’t the miracle drugs they said they were?
    Yeah, that’s the one –
    Yup, sure did…
    Oh good, so….wait! Where are you going!?
    To get my violin –
    Your violin? Why?
    Because it sounds the guy’s singing a CYA swan song –

  13. As a nurse practitioner actively practicing in the trenches w people who suffer from addictions and as a former mentee of Nassir Ghaemi I have been able to use what I have learned in the real world. I am extremely conservative in my prescribing practices and thanks to his tutelage I and many of my patients are grateful for being exposed to his philosophy.

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