Our guest today is Beverley Thomson. Beverley is a writer, researcher and speaker with a focus on psychiatric medication including antidepressants, benzodiazepines and ADHD drugs. She is interested in their history, how the drugs work, adverse effects, dependence, withdrawal and development of patient support services.
For the past 10 years, she has worked with organizations such as the British Medical Association, the Scottish Government and recently the UK All Party Parliamentary Group (APPPG) for prescribed drug dependence. She is currently part of a Scottish Government Short Life Working Group addressing the issue of prescribed drug harm and dependence in Scotland.
We talk about Beverley’s latest book, entitled Antidepressed: A Breakthrough Examination of Epidemic Antidepressant Harm and Dependence published by Hatherleigh Press in 2022. Featuring compelling accounts from people whose lives have been irrevocably harmed by prescribed antidepressants, Beverley’s work provides proof that there is no such thing as a magic pill and that pretending otherwise risks the lives and well-being of those who need help the most.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
James Moore: Beverley, welcome, thank you so much for taking the time to join me for the Mad in America podcast. We are shortly going to be talking about your new book, Antidepressed: A Breakthrough Examination of Epidemic Antidepressant Harm and Dependence, recently published by Hatherleigh Press.
But before we get there, I’d like to ask about you and your background and what was it that led you to want to write Antidepressed?
Beverley Thomson: Thank you so much for inviting me to talk with you, James. My initial interest began around 12 years ago when I was working in a counselling role in primary and secondary schools. I noticed the language being used by both teachers and parents was changing and rather than asking what was happening with or to a child we were starting to ask what was wrong with a child.
We were starting to hear “I think there is something wrong with him or her” or “I think he or she has ADHD” when talking about children who were obviously having difficulty coping with school or family life or what were often complex social issues. I suppose the first question I had was; why are we starting to blame children for their understandable difficulties coping with what are often very challenging circumstances?
This then led me to begin to read about the issues and attend conferences. I spoke with individuals about the labelling and medicating of both adults and children for so-called “mental health issues.” I soon realised this was becoming a huge issue and I developed an interest in all aspects of psychiatric drugs, particularly antidepressants, and how they were negatively affecting people.
The more patient experiences I read and listened to, the more I knew that patient voices needed to be heard. In the last few years, I realised there was a need for a book about antidepressants written in an accessible style which contains all the important work done to date by researchers, academics and advocates. My aim was to write a book to enable us to become “informed consumers” of antidepressants. I wanted to create a comprehensive book which was not written in medical or academic language. I want Antidepressed to empower us and educate us to see ourselves as “consumers” of these drugs rather than patients with little or no autonomy.
Someone once said to me that when you realise something is wrong you have a responsibility to tell others. I realised very early when I started my research that there are many things very wrong when it comes to antidepressants and other psychiatric drugs.
Moore: The book starts with a powerful letter from Anthony Schofield, who tragically ended his life at 52 years old. It is clear from his letter where he placed the blame for his agony and that was from taking and coming off prescribed antidepressants. I imagine that this tragedy is not an isolated event, so this is a very important book isn’t it?
Thomson: Like so many people, Anthony’s life was ruined by both overprescribing and the lack of support when he found himself suffering the adverse effects of and dependence on antidepressants. His issues began at a time when there was very little information available about the negative effects of antidepressants and there were no online support groups to help. He believed his situation was down to a lack of professional awareness and their failure to acknowledge these drugs could cause such life-changing psychological and physical harm. It was only towards the end of his life Anthony realised the antidepressants were to blame, but unfortunately it was too late.
For two years after Anthony’s death, I spoke with his mum, Bridget, two or three times a week and we became good friends. She had been seriously ill for over a year but was desperate to see my book published and she did, just before she passed away in February this year. I lost a best friend.
One of the last things Anthony asked his mum to do was to “tell the world about antidepressants” and I hope Antidepressed will be their voice. Antidepressed is not a book about politics or big pharma-bashing but it is about enabling us to be the informed patient Anthony had the right to be and his mum became even in her eighties. For Anthony and Bridget, I hope Antidepressed will prevent more tragedies and wasted lives.
Moore: Can we turn firstly to rates of prescribing? As you note in the book, we are seeing unprecedented increases in the prescribing of antidepressants in many parts of the world. Is this simply down to more people experiencing mental health problems or is there more to it than that?
Thomson: Despite the unprecedented increases in prescribing, there has never been any evidence of the “epidemic of depression” talked about. We do however have a mental health pseudo-epidemic in the Western World. The increase in antidepressant prescribing is a cultural as well as a medical trend and reflects the “medicalization” of everyday life.
The constant mental health messages we hear nowadays seem to be a media and political obsession. These messages have ultimately led to the increase in antidepressant prescribing as we are told to get help but for the majority of those who do, help will be medication. Governments and industry have capitalized on the fact that we believe and accept that antidepressants are a safe and effective answer to our problems.
We are told our mental health deserves parity with our physical health, but are these messages being strategically used by those in power to avoid responsibility?
The pharmaceutical industry, psychiatry and doctors are supported by governments and mental health organisations and charities to promote “mental health,” meaning it has become a massive industry. I guess the question is, are we enabling or allowing governments to fail to acknowledge and address the social determinants affecting our lives which are making us unhappy or anxious? Are we allowing them to make us believe it is all our fault and not theirs, and it is down to us to solve our problems by taking a pill?
We are told our mental health deserves parity with our physical health but we live with poverty, homelessness, unemployment, loneliness and many other societal factors causing our distress. Despite this, we are told it is about our “mental health” and “we” need to fix it. Our social problems have become medical ones and antidepressants make life easier for those in charge but unfortunately, as prescribing rates soar and markets are expanded, we are seeing more and more suffering caused by the adverse, often life-changing effects of these powerful psychoactive antidepressants.
I suppose there’s another side too, our growing power as consumers doesn’t seem relevant when it comes to the ever-increasing prescribing of psychiatric drugs. Whilst we have the means to ask questions through the use of the internet and social media, most of us still accept that the drugs we are prescribed are beneficial and will do us no harm.
We live in the age of the consumer and it’s a time when we have access to so much information about products and we can be empowered about the decisions we make. In most commercial areas, the balance of influence and power has shifted from the manufacturer to the consumer. In fact, in many areas of healthcare, the rise of healthcare consumerism and increased access to healthcare information have improved the choice for patients.
I started to ask myself why this hasn’t happened with antidepressants and other mental health drugs. Why do people accept that “the doctor still knows best” when it comes to our mental health treatment? Why have we not felt the need to inform ourselves about what are powerful and often life-changing drugs?
I suppose the answer is that pharmaceutical manufacturers’ marketing departments have not had to adjust their messaging and marketing strategies to meet the needs of a more informed consumer when it comes to antidepressants. The messages are very similar to the early 1990s; we have a chemical imbalance that needs to be corrected.
Normally, the modern consumer has often researched products they intend to buy beforehand, this means that the deliverer of services should have to be more informed about the product and more knowledgeable in their dealings with customers to ensure customer satisfaction. This hasn’t happened with psychiatric drugs; prescribers have not had to become more knowledgeable about the most up-to-date research.
Prescribing rates are increasing because we have allowed the mental health medical model of treatment to dominate without much questioning. I am hoping that the recent umbrella review by University College London researchers will mean that more people will begin to question the “chemical imbalance” and people will become more knowledgeable, meaning that prescribers also need to become more knowledgeable.
Moore: You have a section in the book which dispels myths and you ask “Who is looking after patient interests?” What did you find when you asked this question?
Thomson: Since 1988 and the birth of Prozac, we have been brainwashed by the powerful marketing messages of the pharmaceutical industry. In the 1990s, national campaigns informed doctors and the public of the dangers of depression and that antidepressants are the easy “quick fix” answer. We were convinced by the pharmaceutical industry and doctors that depression was a biological disease. That chemical imbalances needed balancing and all our life problems could be cured by a drug. This hasn’t had to change because not enough people question it.
But if we see our inability to cope with life as an illness or condition, the drug regulators and pharmaceutical industry see us as customers. What most people don’t realise is the FDA (Food and Drug Administration) in the US and MHRA (Medicines and Healthcare products Regulatory Agency) in the UK receive significant funding from the pharmaceutical industry and they employ ex-industry professionals in key leadership positions. The FDA is accused of not putting the American people first with their huge financial ties with pharma. The MHRA has been accused of corruption and they admit the costs they incur for regulating medicines are entirely met by fees from pharma.
These conflicts of interest are said to lead to lenient regulations placing the interests of pharma above patient protection. Most people are surprised to learn the FDA and MHRA require only two positive trials to approve a psychiatric drug for public use and they simply ignore all the negative trials. They have a history of manipulating research to highlight positive outcomes. The majority of psychiatric drug trials are of course conducted and commissioned by the pharmaceutical industry.
In March 2019, the FDA gave very quick approval and quite a bit of flexibility for the antidepressant esketamine, marketed as Spravato. This is based on ketamine which can have psychedelic and cognitive adverse effects. It is worrying that the FDA lowered the bar and approved such antidepressants, which it is said have “incredibly questionable safety and efficacy.” We have to ask ourselves “is the FDA putting patients at risk and not putting the American people first”?
Moore: Antidepressants are known to have a range of adverse effects. Amongst the more serious effects can be the risk of suicidal thought or action, sometimes precipitated by unbearable experiences like akathisia. What do we know about the relationship between antidepressant treatment and the risk of suicide?
Thomson: Unfortunately we choose to take antidepressants because the benefits have been widely promoted and the risks downplayed. There are common experiences, but everyone has a unique response to antidepressants and no one can predict how a person will react to them physically and psychologically.
Doctors rarely warn us about adverse effects when we are first prescribed antidepressants. A doctor should always give us comprehensive information when prescribing antidepressants enabling us to give fully informed consent. Informed consent means we understand why the treatment is being offered and are aware of the benefits and risks. It is our medical right, this happens in all other areas of medicine. The “chemical imbalance” theory has been an excellent way for prescribers to manufacture consent. By that I mean believing in the “chemical imbalance” theory means we think we know enough about these drugs and what they supposedly do to agree to take them and think we need them.
A Patient Information Leaflet (PIL) for an SSRI drug contains around 200 side effects; 50 they say are common and 140 uncommon. These are not “side” effects, they are adverse effects. The problem is that patient experiences of adverse effects paint a very different picture to the ones portrayed by the pharmaceutical industry and medical profession. It is alarming that dependence is listed as a “rare” side effect.
From anecdotal evidence we know the more serious risks can include varied and unpredictable physical and mental states, feeling emotionally numb, feeling detached, having distorted dreams, becoming agitated and becoming suicidal. People can have serious central nervous system problems and there are complex neurological effects including chronic brain impairment.
I call akathisia the “A word” of antidepressant adverse effects. It is a medication-induced state which can happen when patients start, stop, change dose or switch generics of some prescription medications including antidepressants. We also know that between 5 and 10% of people have difficulty metabolizing antidepressants and this can cause akathisia when starting the medication.
People call akathisia the epitome of losing their mind. It can cause an inner turmoil, uncontrollable physical restlessness, agitation and paranoia. I have a lot of information in my book about akathisia, provided by the Akathisia Alliance for Education and Research and the Medication-induced Suicide Prevention and Education Foundation in Memory of Stewart Dolin (MISSD).
It can cause suicide either because, like Anthony, we become unable to cope with the intolerable physical and psychological effects of akathisia, or our mind becomes so unbalanced and detached from reality, we literally have no option but to give in and act on our thoughts of suicide. Akathisia can be confused with psychosis and we need more research to understand how often akathisia is reported as first-episode psychosis.
The question we have to ask is, “If antidepressants are safe, why do they have a US FDA black box warning regarding safety and efficacy and the risk of suicidality in young adults?” There appears to be an alarming link between rising suicide rates and antidepressant prescribing. The use of antidepressants by people under 25 with depression is associated with double the risk of suicidal thoughts and behaviours. All suicide prevention strategies need to include awareness of prescription drug-induced suicide but unfortunately, this isn’t happening.
Moore: Can we talk a little about medically unexplained symptoms (MUS) and how they might relate to withdrawal effects from antidepressant drugs?
Thomson: Doctors often fail to recognise or believe physical or psychological symptoms are the adverse effects of antidepressants and they look for alternative explanations. This can result in examinations, tests and investigations which will result in negative results. Doctors will then label a patient’s adverse effects as medically unexplained, somatic or functional symptoms meaning that they are of unknown etiology or the cause is unknown.
These can then lead to diagnoses such as Chronic Fatigue Syndrome, fibromyalgia, ME or IBS. This is becoming a fast-growing area of research as professionals and drug companies capitalize on the opportunities the adverse effects of antidepressants present. I call it opportunistic medicine.
It is estimated that 1 in 4 people who visit a General Practitioner in the UK have “MUS” and 1 in 3 who see a neurologist. Doctors become very frustrated with patients who see them with functional or somatic symptoms. These are becoming a growing burden on health resources and the patient is often being blamed and further medicated. Ultimately, it leads to more labelling, more drugging and more illness.
Moore: I’d like to ask you about generic drugs. Listeners might know that many antidepressants are no longer under patent by the original manufacturer, so they can be made more cheaply under licence elsewhere. Many might think that easier access to these drugs is a positive thing but there is a hidden side to the manufacture of generics, could you tell us about that?
Thomson: Once a brand-name drug’s patent expires, a generic drug can be produced. Manufacturers submit an ANDA (Abbreviated New Drug Application) to the FDA or MHRA for approval to market a generic version of the drug. For example, generic sertraline could be made in June 2006 when the patent for the brand name Zoloft expired. Generic drugs cost between 20% and 90% less than the branded version.
The problem is that we are told these drugs are the same but they are only approved on similarity, there are no clinical trials and they are not identical. Generic manufacturers do not actually see the brand drug registration file. That is the exact recipe of how the branded drug was made, so generic manufacturers develop their own formulation. The quality of manufacturing is raising serious concern. Each time we might be receiving a different make of generic with a different level of quality or bioequivalence.
The other major issue is the production of active ingredients in China which are being used by manufacturers without declaring the origin. So all drugs have an API (Active Pharmaceutical Ingredient) and the quality of the antidepressant is based on the quality of the API.
We often hear they don’t work as well but it can be more serious than that when it comes to psychotropic medication. If we are receiving generics with a different bioequivalence (for example 80% or 110%) this might cause adverse effects and it might even lead to involuntary withdrawal. I have even had reports of akathisia and suicide due to taking a different generic. We might be taking higher or lower doses each time we switch manufacturers. It might also cause real problems during tapering when maintaining accurate dosage is crucial.
If we are given a drug from a different manufacturer and we develop adverse symptoms, we need to assume it’s the drug’s fault. We need to make a note of the manufacturer and inform our prescriber.
Moore: The latter part of the book features testimonies from people affected by dependence and withdrawal and it is heart-wrenching to read of the suffering. I understand that many of these testimonies supported a plea to the Scottish Government to do more to tackle these issues. What was their response?
I was part of a short-life working group which was set up to address the issue but it has been ineffective. Now, four years on, Marion Brown, who launched the petition asking the Scottish Government to recognise and support those harmed by or dependent on prescribed medication, has just received the final report. In total, 967,220 people were prescribed antidepressants in Scotland in the period 2019-2020.
I was on Scotland Tonight last week, a news and culture programme on Scottish Television, and I was talking about the alarming rates of antidepressant prescribing in Scotland, particularly amongst the young. These alarming rates of prescribing to young people in 2019-2020 probably tell you the lack of response from the Scottish Government.
A total of 20,825 young people up to the age of 19 were prescribed antidepressants in Scotland in 2019-2020. This was an increase of almost 80% in 10 years. Current guidelines state young people should only be offered antidepressants in combination with talking therapies and, on this TV programme, a leading psychiatrist said “these guidelines are followed, young people are not prescribed antidepressants as the first option of treatment and are given frequent monitoring and review.”
We know from anecdotal evidence this is far from what is happening and we need to question the alarming link between antidepressants and suicide and self-harm amongst young people.
Moore: It is difficult to read the book without concluding that the best thing would be to treat as few people as possible with the lowest dosage of any particular antidepressant for the shortest possible time, taking care to taper at the end of a short treatment period. Yet this isn’t the approach we take. It seems that there is an increasing number of people taking the drugs long-term, why might long-term use be a problem?
Thomson: Many people say antidepressants saved their lives and they could not survive without them and, for many, this has become a self-fulfilling prophecy. Missing one dose might be the first sign of our dependence when we might experience dizziness, brain zaps and sickness. No one knows how long it takes to become dependent on antidepressants but anecdotal evidence tells us for some it is not very long. This is one of the main reasons we should take antidepressants for the shortest time possible.
It is perhaps dependence that makes it difficult to withdraw from antidepressants. Our level of dependence might dictate the severity of our withdrawal symptoms. If we try to stop and we experience withdrawal symptoms, many people remain blissfully ignorant dependents because they think or are told they have a relapse and that they need the drugs. Millions of people are unaware of the problems dependence might cause them.
Taking antidepressants long-term and the resulting dependence makes us vulnerable in so many ways. Imagine that you are dependent on antidepressants and you can’t get them, can’t access them or communicate your need for them. Your new antidepressant-maintained balanced state will probably become unbalanced and you will probably go into involuntary withdrawal. Having access to the drugs we need can literally in some cases be the difference between life and death. We are vulnerable if we are not properly informed about our drugs and if we receive bad advice from doctors.
The elderly can become vulnerable if they have no support and are unable to make decisions or communicate properly their need for medication. A young person can be vulnerable when they move away from the security of home and family particularly if they are not educated about the dangers of suddenly stopping their antidepressants and of their potential dependence.
We are vulnerable If we are not able to afford our long-term medication. It’s estimated that between 2.5 and 5 million in the US are struggling to afford the psychiatric medications they rely on. We are vulnerable when there are drug shortages and when changes in cheap generic drugs cause adverse effects.
I think we need to start with education for patients and the medical profession. We need greater transparency and access to unbiased research. Everyone has a right to take antidepressants but they also have a right to know the potential harms and risks. The problem is that with millions around the world dependent on these drugs, it is impossible and impracticable to have a world without them in the near future.
We are told by governments and health care organisations that we should take charge of our health by being informed consumers and I hope in the future people will have a better understanding of antidepressants and they will ask their prescriber more specific questions about their treatment. Ultimately, better-informed consumers mean we will need to have better-informed professionals.
Many people are becoming better informed and asking if these drugs are safe, effective and worth having but most people still believe we live in an age of “the doctor knows best” when the reality is, much of the time “the doctor simply does as he or she is told.”
In lots of areas of mental health, we talk about the need for a change of narrative. The most popular being asking “What happened to you?” rather than “What is wrong with you?” but maybe we should also think in ways of changing how we see ourselves. Yes, we are doctors and patients who prescribe and take drugs but we must always remember it is about selling and consuming.
I have a quote from my book which explains how I see the future in relation to the use of antidepressants.
Whilst Governments around the world debate, medics remain wilfully blind and charities secure their funding, the change has to start with us, as individuals, as advocates and as informed patients. The fact that we know a doctor’s appointment is often the start of a lifelong journey as a psychiatric patient with a stigmatising lifelong condition and dependence on psychiatric medication means the shift starts with us questioning the overuse of antidepressants and looking at alternative ways to support and care for each other. It starts by becoming more knowledgeable, reclaiming some control and power over our own healthcare and by taking responsibility to educate ourselves to the best of our ability. It starts by understanding antidepressants are not the easy and quick fix their makers and doctors say they are.
Moore: Do we need to critically examine and change the place of psychotropic drugs in our response to mental health difficulties do you think?
Thomson: There are some things we desperately need if we are to avoid overprescribing, harm and death caused by antidepressants. We need to be in a position where we can give informed consent about these drugs. Not the manufactured consent that I described earlier. If we agree to take antidepressants, we need to be fully informed about the benefits and the risks.
We need updated prescribing guidelines based on evidence and that means we need more research which is independent and not industry-funded. If we choose to take antidepressants, we need to take them for the shortest time possible to try to avoid dependence.
If we develop symptoms after starting, reducing or stopping antidepressants we must always assume it’s the drug’s fault until proven otherwise. We desperately need more unbiased research, particularly regarding long-term effects and the best ways to withdraw from antidepressants.
We need to look at pharma producing drugs in smaller doses and making use of tapering strips which you have supported through a petition, James. We need education for the public and professionals, particularly about withdrawal, akathisia and antidepressant-induced suicide.
We urgently need support services for those harmed or dependent, and we must develop withdrawal and deprescribing programmes. It was really unfortunate that the UK Government recently decided not to fund a helpline that would have helped so many people when it comes to coming off antidepressants.
We need to question the often unnecessary and dangerous prescribing to children, young people, the elderly and the armed forces and veterans. We must also question the potential harmful effects of using cheap generic antidepressants because this is a huge issue.
I do not say that people shouldn’t take antidepressant drugs, I say that we need to know about the benefits and the risks. So many people have said to me “I should have known these things” when they realise they are dependent on antidepressants. I know so many people who wished they had been fully aware, before they swallowed their first pill, of the realities of a life taking antidepressants. I urge people to challenge our preconceived societal ideas and beliefs about antidepressants. We should educate ourselves to the best of our ability and learn from the experiences of others.
Moore: Beverley, thank you for joining me today. Antidepressed is a vital read for anyone taking the drugs, anyone considering taking them, for family members and for carers and particularly important for anyone that has anything to do with prescribing the drugs.
I can’t help thinking that if they read Antidepressed from cover to cover, we would be prescribing these drugs in a radically different way and we would be taking much more care to ensure that people weren’t left on the drugs long-term without information or support.
Thomson: Thank you, James.